Respiratory Pharmacology

Question 1

Gives types of bronchodilators

Answer 1

Adrenergic Agonists

• Adrenergic Agonists: Beta-2 agonists,
• Salbutamol, salmeterol, formoterol
• Antimuscarinic /cholinergic
• Tiotropium, (Long-Acting Muscarinic Anti)
• Ipratropium ( Short-Acting Muscarinic Anti)
• Methylxanthines (Aminophylline)

Question 2

Give types of Anti-inflammatory drugs

Answer 2

Steroids

- Prednisolone: oral

- Beclomethasone: Inhaled CorticoSteroid

Leukotriene receptor antagonist

• Montelukast

Mucolytic agents

• Carbocysteine

Question 3

What type of Inhaled drug devices are there?

Answer 3

• Pressurised Metered Dose Inhalers
• deep inhale, hold for 10, exhale slowly, 1 minute before 2nd puff
• can use areochamber or spacer, has a high carbon footprint HCFCs
• Dry-powder Inhalers
• one inhalation, not a puff

Question 4

What is the duration of Salbutamol?

Answer 4

• short-acting
• begins immediately
• last 3-5 hours

Question 5

What are the routes of intake for Salbutamol?

Answer 5

• Inhaled or nebuliser: at higher doses
• IV: rarely used prescribed in acute severe asthma unresponsive to nebulised bronchodilators and life-threatening asthma

Question 6

Describe the mechanism of action of salbutamol

Answer 6

• Beta-2 receptors in the lungs
• activates adenylate cyclase
• this increases cAMP production
• causes relaxation of bronchial smooth muscle

Question 7

What are the uses of Salbutamol

Answer 7

• Asthma
• COPD
• terbutaline is another SABA alternative

Question 8

What is the duration of Salmeterol?

Answer 8

• Long-acting
• begins with 2-30 mins
• lasts 10-12 hours

Question 9

What is the rate of intake and mechanism of action of Salmeterol?

Answer 9

• Inhaled
• Long-acting beta-adrenoceptor agonist
• acts on Beta-2 receptor increases cAMP in the cell through adenylate cyclase.

Question 10

ICS = inhaled corticosteroid, FEV1: air forced out of lungs in 1 sec

What is the use of Salmeterol?

Answer 10

Asthma

• those requiring long-term regular bronchodilator therapy on ICS
• always used with ICS in asthma

COPD

• when there are persistent symptoms despite SABA
• wither LABA /LAMA combination or ICS?LABA combination FEV1 <50%)

Question 11

What is the duration of Formoterol?

Answer 11

• Long-acting
• short onset like salbutamol
• prolonged duration 10-12 hours

Question 12

What is the route and mechanism of action of Formoterol?

Answer 12

• inhaled
• Long-acting beta-adrenoreceptor agonist

Question 13

What is the use of Formoterol?

Answer 13

• Asthma: always combined with ICS
• COPD

Question 14

What is the duration and rout of intake of Tiotropium?

Answer 14

• Long-acting (24 hours): once daily
• inhaled as: dry powder (handihaler), Mist (respimat)

Question 15

What is the mechanism of action of Tiotropium?

Answer 15

• Long-acting antimuscarinic agent (LAMA)
• similar affinity to subtypes of muscarinic receptors M1-M5
• inhibits M3-receptors at the smooth muscle –> bronchodilation

Question 16

What is the use of Tiotropium?

Answer 16

In stable COPD: symptoms despite SABA

Asthma: if no improvement with ICS/LABA specialist advice from hospital

Question 17

Give the duration, intake ad use of Ipratropium

Answer 17

• Short-acting Antimuscuarainic agent
• Onset of 30 mins
• last 6 hours
• through nebuliser
• nebulised for acute presentation of COPD and sometimes Asthma
• used in an emergency in situations

Question 18

Give the duration, intake of Theophylline

Answer 18

• Half-life of 5 hours in healthy in adults
• Oral or Intravenous

Question 19

What is the mechanism of action of Theophylline?

Answer 19

• Phosphodiesterase inhibitor
• inhibits the action of Phosphodiesterase enzyme (PDEs)
• therefore the action cAMP and cGMP is not decreased in target cells
• therefore increased smooth muscle relaxation
• requires monitoring through blood tests

Question 20

What is the use of Theophylline?

Answer 20

Orally

• COPD and asthma for persistent symptoms

Intravenous

• COPD and asthma-medical emergencies

Question 21

What are some adverse effects of Bronchodilators?

Answer 21

• Tachycardia
• nervousness, irritability, tremor
• inhaled preparations have less adverse effects
• oral and IV preparations are less commonly used but have more side effects: Tachyarrhythmias/angina
• usually dose related

Question 22

What are the methods of delivery for oxygen and their indications?

Answer 22

Controlled: hypercapnic respiratory failure

• venturi

Uncontrolled: pneumonia

• Nasal
• Hudson mask
• Reservoir

Question 23

Give an example of systemic and inhaled Glucocorticoids and their method of administration?

Answer 23

Systemic: Prednisolone

• IV or Oral administration

Inhaled: Beclometastone, fluticasone, budesonide

Question 24

What is the effects on the airways from Glucocorticoids?

Answer 24

• Decrease release of inflammatory mediator
• Decrease infiltration and action of white blood cells
• Decrease airway oedema
• Decrease airway mucus production
• INcrease number of the sensitivity of beta-2 receptors

Question 25

What are the 4 main types of Allergic Rhinitis medications? Give examples.

Answer 25

Antihistamines

• Cetirizine, Chlorpheniramine
• H1 antagonist

Intranasal Glucocorticoids

• Beclometasone (Beconase)
• Montelukast: inhibits leukotriene receptors

Sympathomimetics

• pseudoephedrine: alpha-agonist

Question 26

What are the indications and route of intake for Amoxicillin?

Answer 26

• moderate spectrum, bacteriolytic, B lactam antibiotic
• active against gram-negative and gram-positive bacteria
• taken via IV or Orally
• use in CAP typical/ COPD exacerbations/ bronchitis

Question 27

What are the indications and route of intake for a Co-amoxiclav?

Answer 27

• amoxicillin is susceptible to degradation by B lactamase producing bacteria so can be combined with clavulanic acid
• this is a Beta-lactamase inhibitor

Tazobactum:

• used in hospital-acquired infections and gram-negative bacteria
• extended-spectrum b lactam antibiotic