Respiratory Pharmacology Flashcards by Chris Gillman-Wells

why do we cough

protective reflex: prevents lungs from aspiration

common symptom of respiratory disease

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what are the two types of cough

useless and useful

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what is a useless cough, eg, should it be suppressed

persistent and unproductive: dry cough
eg asthma, oesophageal reflux
yes it should be suppressed using antivusses - must treat underlying cause tho

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what is a useful cough, eg and should it be suppressed

expels secretions such as sputum in chest infection

it should not be suppressed unless it is exhausting the patient or painful

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what is the mechanism of a cough

cough receptors or lung irritant receptors
cough centre in the medulla
vagal stimulation leading to cough

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what can you use to suppress dry cough

afferent side: reduce stimuli

efferent side: medullary centre - using opioids, non opioids sedatives

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how do you reduce stimuli on the afferent side

Above larynx: Linctuses (demulscents)
Below larynx: Steam inhalation, Nebulised local anaesthetics
Treat cause: stop smoking

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how do you reduce stimuli on the efferent side

Opiods (codeine, methadone, pholcodeine)
Non opiods (dextromethorphan, noscapine)
Sedatives: diphenhydramine, chlorpheniramine

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what is the difference between mucolytics and expectorants

mucolytics make it easier to remove sticky substances such as DNA build up in CF - decrease the viscosity
expectorants increase the volume of secretion but with not added value

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what are the most common causes of chronic cough

Upper airways cough syndrome (post nasal drip)  Bronchial Asthma
Chronic Obstructive Pulmonary Disease
Gastroesophageal ref lux disease

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what are the 4 types of bronchial asthma

asthma associated with allergic reactions
asthma not associated with specific allergen
exercise induced asthma
asthma associated with chronic obstructive disease

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describe the process of allergy mediated asthma

1 - antigen detected by APC which presents it to Th2 which targets B cell to produce IgE which activates mast cell to produce chemical mediators of inflammation
2 - antigen directly stimulates mast cell

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what are the different treatments for asthma

Non specific reduction of bronchial hyperactivity: Nonpharmacological: Stopsmoking,weightreduction  Pharmacological: Corticosteroids

 Dilatation of narrowed bronchi:
 Mimicking dilator neurotransmitter: Sympathomimetics  Direct acting bronchodilators: Methylxanthines
 Blockade of constrictor transmitter: Anticholinergics

Preventionofreleaseof transmitter  Mast cell stabilisers

Antagonism of released transmitter:  Leukotriene receptor antagonists

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what are the non-specific reductions of bronchial hyperactivity

corticosteroids
anti-inflammatory - decrease oedema
reduced bronchial activity - reduce exacerbations (do not relax bronchiole smooth muscle)

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what are the inhaled vs tablet corticosteroids

brown inhaler
beclomethasone
fluticasone
oral corticosteroids - prednisone (for severe asthma)

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what are the adverse effects of corticosteroids

iatrogenic cushing syndrome
inhibition of hypothalamic pituitary axis
oropharyngeal candidadiasis
hoareness

what are mast cell stabilisers

Cromolyn sodium , Nedocromil sodium
 Inhibit release of mast cell mediators
 Administered by inhalation and very poorly absorbed
 No effect on bronchial smooth muscle  No use in acute bronchospasm
 Only valuable if taken prophylactically
 Main uses: Allergic rhinitis, allergic conjunctivitis
Sideeffects: Throatirritation,cough,dermatitis, myositis, gastroenteritis

what are leyukotrine pathway inhibitors

check home screen

what are inhibitors of leukotriene synthesis

Inhibit 5-lipoxygenase

 Zileuton (discontinued) – liver toxicity

what are inhibitors of leukotriene receptors

inhibit binding of leukotriene to receptor

montelukast

what are leukotriene receptors antagonists and give example

Uses
 Allergen induced asthma, Exercise induced asthma  Reduce frequency of exacerbations
 Given orally: Good for children
 Not effective in acute asthma
 Minor adverse effects :
 Headache, Gastritis, Flu-like symptoms, CS syndrome
 Montelukast : Commonly used  Cost - cheap

what substances affect bronchial tone

beta agonists and theophylline cause bronchodilation

what is the blue inhaler

act via B2 agonists
Short acting (3-6 hours) SABA
 Albuterol~Salbutamol, terbutaline, fenoterol, metaproterenol
 Long acting (12 -24 hours) LABA  Salmetrol, formetrol
 Non selective  Adrenaline

what is the most commonly used blue inhaler

salbutamol

when is adrenaline used

in emergency situations as subcutaneous injection

what are some side effects of B2 receptors agonists

Heart- Palpitation, tachycardia, cardiac arrhythmias  Muscle- Tremor  Others - Restlessness, nervousness, hypokalemia

what are methylxanthines and what are some adverse effects

Administered oral or i.v..  Adjuvant therapy in asthma  Adverse effects: Palpitations, cardiac arrhythmia,hypotension  Gastrointestinal irritation ( increased acid production)  Diuresis, hypokalemia  Anxiety, headache, seizures  Therapeutic window (55 -110 mmol/l)

what are two examples of methylxanthines

``` Theophylline  Oral : rapid and complete absorption  90 % metabolised, saturable metabolism  Adjuvant therapy in Asthma  SR Theophylline  Aminophylline  Intravenous  Used in severe asthma  Loading dose infusion ```

how do anticholinergic agents help asthma

act via inhibiting muscarinic receptors - M3

give examples of muscarinic antagonists and what it does

tiotropoium - long acting | inhibit effects of vagus nerve stimulation

what are some adverse effects of muscarinic antagonists

Airway irritation  Anticholinergic effects  GI upset, urinary retention

what other drugs affect asthma airways

anti IgE monoclonal antibodies ketoifen magnesium ketamine

how do monoclonal antibodies affect asthma

``` Omalizumab  Inhibits binding of IgE to mast cells  Repeated administration  Lessens asthma severity  Reduces magnitude of response  Reduced requirement of steroids  Very expensive ```

how does ketotifen affect asthma

Histamine receptor antagonist (H1)  Some anti-asthma effect  Side effects: drowsiness etc  No proven benefit

how does Mg affect asthma

Patients who fail to respond to inhaled bronchodilators  By intravenous infusion

how does ketamine affect asthma

Anaesthetic agents  Bronchodilator properties  No role in routine management  Used in life-threatening or near fatal asthma

what are the similarities and differences between asthma and COPD

Asthma – Reversible airway obstruction  COPD – Incompletely reversible airway obstruction Both characterised by airflow limitation  COPD occurs in older patients  COPD progressive worsening over age