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Clinical Pharmacology > Respiratory Pharmacology > Flashcards

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
Q

What are some of the side effects of long acting muscarinic antagonists?

A

Typical anticholinergic effects:

  • dry mouth
  • urinary retention
  • dry eyes
26
Q

Name a LAMA (long acting muscarinic antagonist)

A

Tiotropium

(inhaled)

27
Q

How does theophylline work?

A

Adenosine receceptor antagonist - a methylxanthine

Use in acute asthmatics only

28
Q

When are oral steroids given to manage asthma?

A

For severe, uncontrolled asthma (specialist direction only)

given post acute exacerbation for atleast 5 days

post acute COPD for 5-7 days

29
Q

What is the name of the oral steroid given in special circumstances for asthma maintainance?

A

Prednisolone

30
Q

What signs and symptoms indicate acute severe asthma?

A
  • Unable to complete full sentances
  • Peak flow > 33-50%
  • Respiratory rate >25/min
  • Heart rate >110/min
31
Q

When is asthma considered life threatening?

A

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
Q

How do you treat acute severe and life threatening asthma?

A

Oxygen

Salbutamol

Hydrocortisone

Ipratropium - short acting

Theophylline - long acting

Magnesium

Escalate to ICU

33
Q

What is ipratropium?

A
  • Nebulised ipratropium bromide
  • short acting muscarinic antagonist (SAMA) alongside B2 agonist
  • Selective for M3 receptors
34
Q

What are the 5 tasks of COPD management?

A
  1. Confirm COPD diagnosis
  2. Stop smoking
  3. Record MRC dyspnoea score
  4. Offer vaccination
  5. Consider medication
35
Q

What drugs can be given in an acute exacerbation of COPD?

A
  • Nebulised salbutamol and or/ ipratropium
  • Nebuliser driven by air not oxygen
  • Oral steroids
  • Narrow spectrium antibiotics
36
Q

How are pressurised metered dose inhalers used?

A
  • inhalation of drug
  • slow breath in and hold
  • can be used with a spacer to improve delivery
37
Q

How do breath actuated inhalers pMDI work?

A

Automatic actuation- dose delivered upon inspiration

38
Q

How do dry powder inhalers work?

A
  • micro ionised drug plus carrier powder
  • fast and deep inhalation
39
Q

What is the ideal particle size for inhalers getting to airways?

A

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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