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Respiratory Pharmacology Flashcards

1
Q

What is asthma?

A

A chronic inflammatory airway disease of intermittent airway obstruction and hyper-reactivity of the small airways

Reversible both spontaneously and with drugs

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2
Q

What should you always check before stepping up or down asthma medications?

A
  • Check adherence
  • Check inhaler technique
  • Eliminate trigger factors
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3
Q

Describe the stepwise approach to asthma management

A
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4
Q

How are steroids used in the management of asthma?

A

Inhaled corticosteroids are a regular preventer when relievers alone are not sufficient

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5
Q

Name 3 inhaled corticosteroids

A
  1. Beclometasone
  2. Budesonide
  3. Fluticasone
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6
Q

How do inhaled corticosteroids work do manage asthma?

A
  • Pass through plasma membrane to activate cytoplasmic receptors and modify transcription in the nucleus
  • Increase B2 receptors and decrease inflammatory mediators
  • reduces mucosal inflammation, widens airways, reduces mucus
  • reduces symptoms, exacerbations and prevent death
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7
Q

What are some of the side effects of using inhaled corticosteroids?

A
  • Can cause local immunosuppresion → candidiasis, hoarse voice
  • Pneumonia risk in COPD
  • Very few ADRs if taken correctly
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8
Q

What is the bioavailability of inhaled corticosteroids? How is this modfied to improve this?

A
  • Poor oral bioavailability
  • Lipophilic side chain added which causes:
    • slow dissolution in aqueous bronchial fluid
    • high affinity for glucocorticoid receptor
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9
Q

What are the 2 types of B2 agonist? When is each used respectively?

A

SABA (short acting) - for symptoms relief through reversal of bronchocontriction

LABA (long acting)- add on therapy to ICS and SABA

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10
Q

Name 2 fast acting, SABAs

A
  • Salbutamol
  • Terbutaline
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11
Q

Give an example of a fast acting LABA

A

Formoterol

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12
Q

Give an example of a slow acting LABA

A

Salmeterol (12 hr)

Vilanterol (24 hr)

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13
Q

How do B2 agonists work?

A
  • Bind to GPCR Gs in airways smooth muscle
  • alpha s stimulates adenylate cyclase
  • increase in cAMP → increases PKA
  • Causes airways smooth muscle relaxation and increases mucus clearance by action of cilia
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14
Q

What happens if B2 agonists are used too frequently?

A

Can build a tolerance - reduces effectiveness of asthma control

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15
Q

What are some of the side effects of B2 agonists?

A
  • Adrenergic effects - tachycardia, palpitations, anxiety and tremor
  • Suptraventricular Tachycardia (risk in COPD patients)
    • increases HR
    • decreases refractory period at AVN
  • increases glycogenolysis (liver)
  • increases renin (kidney)
  • Muscle cramps
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16
Q

What heart medications should you be careful about prescribing when prescribing beta 2 agonists?

A

Beta blockers!

counter the effects

17
Q

What important prescribing condition must you consider when prescribing LABA?

A

Must only be Rx’d alongside ICS

Otherwise: increases risk of death when Rx’d alone as can mask airway inflammation

18
Q

How does formoterol compare to salmeterol?

A

Formoterol is more potent and more efficacious than salmeterol

19
Q

What are some of the benefits of a combined inhaler?

A
  • Ease of use
  • increased adherance
  • less prescriptions- less cost, easier admin
  • improved safety
20
Q

What alternative to LABA do NICE guidelines reccommend?

A

LTRA- leukotriene receptor antagonist

21
Q

Give an example of a LTRA?

A

Montelukast

22
Q

How do Leukotriene receptor antagonists work?

A

Leukotriences (LTC4) are released by mast cells/eosinophils causing bronchoconstriction, mucus and oedema through the GPCR CysLT1

LTRA block CysLT1

23
Q

What are some of the side effects of montelukast (LTRA)?

A
  • Heache
  • GI disturbance
  • Dry mouth
  • Hyperactivity
24
Q

How do long acting muscarinic antagonists (LAMA) work?

A
  • Selective for M3 receptors in smooth muscle
  • Exert anticholinergic effects by inhibiting receptors
25
What are some of the side effects of long acting muscarinic antagonists?
Typical anticholinergic effects: * dry mouth * urinary retention * dry eyes
26
Name a LAMA (long acting muscarinic antagonist)
Tiotropium | (inhaled)
27
How does theophylline work?
Adenosine receceptor antagonist - a methylxanthine Use in acute asthmatics only
28
When are oral steroids given to manage asthma?
For **severe, uncontrolled asthma** (specialist direction only) given post acute exacerbation for atleast 5 days post acute COPD for 5-7 days
29
What is the name of the oral steroid given in special circumstances for asthma maintainance?
Prednisolone
30
What signs and symptoms indicate acute severe asthma?
* Unable to complete full sentances * Peak flow \> 33-50% * Respiratory rate \>25/min * Heart rate \>110/min
31
When is asthma considered life threatening?
Acute severe asthma signs **+** * peak flow \<33% * SpO2 \<92% * PaO2 \<8kPa * PaCO2 4.6-6.0 kPa * Silent chest * Cyanosed * Poor respiratory effort * Arrhythmia * Exhaustion * Altered conciousness * Hypotension
32
How do you treat acute severe and life threatening asthma?
**O**xygen **S**albutamol **H**ydrocortisone **I**pratropium - short acting **T**heophylline - long acting **M**agnesium **E**scalate to ICU
33
What is ipratropium?
* Nebulised ipratropium bromide * short acting muscarinic antagonist (SAMA) alongside B2 agonist * Selective for M3 receptors
34
What are the 5 tasks of COPD management?
1. Confirm COPD diagnosis 2. Stop smoking 3. Record MRC dyspnoea score 4. Offer vaccination 5. Consider medication
35
What drugs can be given in an acute exacerbation of COPD?
* Nebulised salbutamol and or/ ipratropium * Nebuliser driven by **air** _not oxygen_ * Oral steroids * Narrow spectrium antibiotics
36
How are pressurised metered dose inhalers used?
* inhalation of drug * slow breath in and hold * can be used with a spacer to improve delivery
37
How do breath actuated inhalers pMDI work?
Automatic actuation- dose delivered upon inspiration
38
How do dry powder inhalers work?
* micro ionised drug plus carrier powder * fast and deep inhalation
39
What is the ideal particle size for inhalers getting to airways?
1-5 microns **too small**: inhaled to alveoli and exhaled without being deposited **too large:** deposited in mouth and oropharynx

Clinical Pharmacology (25 decks)

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