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103 theme 4 > respiratory pharmacology > Flashcards

respiratory pharmacology Flashcards

1
Q

how can drugs be grouped to treat respiratory system issues

A 
Upper airways
Allergy
Lower airways
Asthma
COPD
Respiratory infection (bronchitis, pneumonia, atypical)
Interstitial lung disease 
Ventilatory failure
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2
Q

what are types of airway drugs

A

bronchodilators and anti-inflammatory

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3
Q

what are bronchodilators

A

Adrenergic agonists (beta 2 agonists like salbutamol, salmeterol, formoterol)
Muscarinic antagonists/anticholinergics (tioropium – long acting anti muscarinic LAMA)
Other LAMA’s include aclidinium, glycopyrronium, umeclidinium
Ipratropium short acting anti muscarinic SAMA
Methylxanthines(aminophyllines)

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4
Q

what are anti-inflammatory drugs

A

Steroids (prednisolone – oral, beclomethasone – ICS)

Leukotriene receptor antagonists (montelukast)

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5
Q

how are pMDIs used

A

deep exhale/inhale and puff/hold breath for slow ten count/exhale slowly/wait a min for second puff
use spacer/aerochamber

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6
Q

how are DPIs used

A

usually one inhalation, not puff

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7
Q

what is salbutamol

A

short acting (immediate, 3-5 hour)
inhaled/nebuliser (high dose), intravenous (rarely used)
binds to beta 2 receptors in lungs, relaxation of bronchial smooth muscles. Increase cAMP production by activating adenylate cyclase (mediate salbutamol’s actions)
SABA
Asthma and COPD
Another SABA- terbutaline

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8
Q

what is salmeterol

A

long acting (begin 2-30 min, lasts 10-12 hours)
inhaled
LABA
asthma (patients requiring long term regular bronchodilator therapy on ICS)
Always used with ICS in asthma
COPD – persistent symptoms despite SABA (LABA/LAMA combo or ICS/LABA combo FEV1 <50%)

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9
Q

what is formoterol

A

LABA but onset similar to salbutamol with prolonged duration 10-12 hours)
Inhaled LABA used for Asthma and COPD, combined with ICS for asthma

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10
Q

what is tiotropium

A 
long acting 24 hours, once daily
inhaled (dry powder or mist Respimat)
LAMA, similar affinity for muscarinic receptor subtypes M1-5. In airways it inhibits M3 receptors at smooth muscle – bronchodilation
stable COPD (symptoms despite SABA, any severity and with LABA) or asthma (not improving despite ICS/LABA – specialist advice from hospital)
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11
Q

what ipratropium

A

Short acting antimuscarinic agent
Onset 30 mins, lasts 6 hours
Nebulised
Nebulised for any acute presentations of COPD and sometimes asthma

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12
Q

what is theophylline

A

half life around 5 hours healthy adults
oral/IV
phosphodiesterase inhibitor, requires monitoring of level (blood test)
Oral – COPD and asthma – persistent symptoms
IV – COPD and asthma MEs

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13
Q

what adverse events arise due to brochodilators

A 
Tachycardia
Nervous, irritability, tremor
Inhaled preparations – less common 
Oral preparations (hardly used) and IV – more SE common (tachyarrhythmias and angina)
Usually dose regulated
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14
Q

what are the systemic effects of glucocorticoids

A

Systemic (eg Prednisolone)
IV or oral
Stronger effects as higher doses
Action unaffected by insp effort/inhaler technique
More SEs, esp long term therapy
Inhaled (eg beclomethasone, fluticasone, budesonide)

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15
Q

what are the localised effects of glucocorticoids

A

Fewer SE, some absorption occurs

Disease may prevent penetration of drug to affected areas

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16
Q

what are the airway effects of glucocorticoids

A

Decrease release of inflammatory mediator
Decrease filtration and action of WBCs
Decrease airway oedema
Decrease airway mucus production
Increase number and sensitivity of B2 receptors

17
Q

what adverse events result from glucocorticoids when inhaled

A 
Inhaled – gargle and use spacer
Oral candidiasis (white plaques) and dysphonia
18
Q

what adverse events result from glucocorticoids

A 
General 
Adrenal suppression 
Bone loss – exercise, vit D, calcium 
Slow growth in children but not ultimate height 
Increase risk of cataracts and glaucoma
Increased risk of infection
Gastric ulceration 
Hypertension 
Diabetes
Mood disturbance
19
Q

what are combination inhalers

A

ICS/LABA (formoterol/budesonide, formoterol/beclomethasone, salmeterol/fluticasone)
LAMA/LABA (eg tiotropium/olodaterol)
ICS/LABA/LAMA (beclomethasone/formoterol/glycopyrronium)

20
Q

what is the asthma treatment ladder

A 
Steps, move up ladder depending on symptoms and success of current drugs 
Side effects (important to move down as well as up, patients often left on too much steroid)
21
Q

how can allergic rhinitis be treated

A 
Antihistamines 
Cetirizine, chlorpheniramine
H1 antagonists
Intranasal glucocorticoids 
Montelukast (Singulair) 
Sympathomimetics (decongestants) – alpha agonists, issues with abuse and MAOI
22
Q

what are side effects of antihistamines

A

Side effects – drowsiness, dry mouth, dry eyes, confusion

23
Q

what does montelukast do

A

inhibit leukotriene receptors, decrease inflammation, bronchoconstriction, oedema, mucus, recruitment of eosinophils

24
Q

how is oxygen delivered

A

Controlled (venturi) or uncontrolled (nasal, Hudson, reservoir)

25
Q

what are types of respiratory infection

A

Bronchitis (COPD and asthma)
Community acquired pneumonia (CAP) – severity scoring
Hospital acquired pneumonia HAP (early and late)
Ventilator acquired pneumonia (VAP)
Aspiration
Bronchitis doesn’t equal pneumonia – treated differently

26
Q

what antibiotics are used for respiratory infection

A

Penicillins eg amoxicillin
Moderate-spectrum, bacteriolytic, B lactam
Routes IV/oral
Use – CAP (typical/COPD exacerbations/bronchitis)
Active against gram negative and gram positive bacteria

27
Q

what is co-amoxiclav

A

Amoxicillin susceptible to degradation by B lactamase-producing bacteria so can be combined with clavulanic acid – a beta lactamase inhibitor

28
Q

what are other antibiotics used for respiratory infections (t)

A

Tetracyclines (doxycycline)
Inhibits protein synthesis
Broad spectrum action gram positive and negative
Useful for atypical infections eg mycoplasma
Oral route only

29
Q

side effects of tetracyclines

A

GI upset/staining teeth/allergy/photosensitivity

30
Q

what are other antibiotics used for respiratory infections (q)

A

(eg ciprofloxacin, levofloxacin, moxifloxacin)
Acts via dna fragmentation, gram neg and pos coverage (and pseudomonas)
Route – IV/oral/inhaled (CF)

31
Q

side effects of quinolines

A

GI upset/C difficile/tendonitis/liver upset/prolonged QTc and arrhythmia

32
Q

what are other antibiotics used for respiratory infections (m)

A

(eg erythromycin, clarithromycin)
Commonly used in resp infection (inc atypical pneumonia_
Acts via protein synthesis inhibitors
IV/PO
Gram positive/limited gram negative cover

33
Q

side effects of macrolides

A

GI/allergy/liver abnormality/prolonged QTc and interactions

34
Q

what results from ILDs and how are they treated

A

Some idiopathic interstitial pneumonias eg hypersensitivity pneumonia (prednisolone, azathioprine/MMF)
Idiopathic pulmonary fibrosis (pirfenidone)
Anti inflammatory/anti fibrotic
Reduces fibroblast proliferation, reduces collagen production

103 theme 4 (20 decks)

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