Respiratory Pharmacology Flashcards
Gives types of bronchodilators
Adrenergic Agonists
- Adrenergic Agonists: Beta-2 agonists,
- Salbutamol, salmeterol, formoterol
- Antimuscarinic /cholinergic
- Tiotropium, (Long-Acting Muscarinic Anti)
- Ipratropium ( Short-Acting Muscarinic Anti)
- Methylxanthines (Aminophylline)
Give types of Anti-inflammatory drugs
Steroids
- Prednisolone: oral
- Beclomethasone: Inhaled CorticoSteroid
Leukotriene receptor antagonist
- Montelukast
Mucolytic agents
- Carbocysteine
What type of Inhaled drug devices are there?
- 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
What is the duration of Salbutamol?
- short-acting
- begins immediately
- last 3-5 hours
What are the routes of intake for Salbutamol?
- Inhaled or nebuliser: at higher doses
- IV: rarely used prescribed in acute severe asthma unresponsive to nebulised bronchodilators and life-threatening asthma
Describe the mechanism of action of salbutamol
- Beta-2 receptors in the lungs
- activates adenylate cyclase
- this increases cAMP production
- causes relaxation of bronchial smooth muscle
What are the uses of Salbutamol
- Asthma
- COPD
- terbutaline is another SABA alternative
What is the duration of Salmeterol?
- Long-acting
- begins with 2-30 mins
- lasts 10-12 hours
What is the rate of intake and mechanism of action of Salmeterol?
- Inhaled
- Long-acting beta-adrenoceptor agonist
- acts on Beta-2 receptor increases cAMP in the cell through adenylate cyclase.
ICS = inhaled corticosteroid, FEV1: air forced out of lungs in 1 sec
What is the use of Salmeterol?
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%)
What is the duration of Formoterol?
- Long-acting
- short onset like salbutamol
- prolonged duration 10-12 hours
What is the route and mechanism of action of Formoterol?
- inhaled
- Long-acting beta-adrenoreceptor agonist
What is the use of Formoterol?
- Asthma: always combined with ICS
- COPD
What is the duration and rout of intake of Tiotropium?
- Long-acting (24 hours): once daily
- inhaled as: dry powder (handihaler), Mist (respimat)
What is the mechanism of action of Tiotropium?
- Long-acting antimuscarinic agent (LAMA)
- similar affinity to subtypes of muscarinic receptors M1-M5
- inhibits M3-receptors at the smooth muscle –> bronchodilation
What is the use of Tiotropium?
In stable COPD: symptoms despite SABA
Asthma: if no improvement with ICS/LABA specialist advice from hospital
Give the duration, intake ad use of Ipratropium
- 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
Give the duration, intake of Theophylline
- Half-life of 5 hours in healthy in adults
- Oral or Intravenous
What is the mechanism of action of Theophylline?
- 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
What is the use of Theophylline?
Orally
- COPD and asthma for persistent symptoms
Intravenous
- COPD and asthma-medical emergencies
What are some adverse effects of Bronchodilators?
- 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
What are the methods of delivery for oxygen and their indications?
Controlled: hypercapnic respiratory failure
- venturi
Uncontrolled: pneumonia
- Nasal
- Hudson mask
- Reservoir
Give an example of systemic and inhaled Glucocorticoids and their method of administration?
Systemic: Prednisolone
- IV or Oral administration
Inhaled: Beclometastone, fluticasone, budesonide
What is the effects on the airways from Glucocorticoids?
- 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
What are the 4 main types of Allergic Rhinitis medications? Give examples.
Antihistamines
- Cetirizine, Chlorpheniramine
- H1 antagonist
Intranasal Glucocorticoids
- Beclometasone (Beconase)
- Montelukast: inhibits leukotriene receptors
Sympathomimetics
- pseudoephedrine: alpha-agonist
What are the indications and route of intake for Amoxicillin?
- 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
What are the indications and route of intake for a Co-amoxiclav?
- 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
