respiratory pharmacology Flashcards
1
Q
name different types of bronchodilators? 4
A
- adrenergic agonists- beta 2 agonists (salbutamol, salmeterol, formoterol)
- muscarinic antagonists/ anticholinergics (tiotropium= long acting anti-muscarinic (LAMA))
- ipratropium (short acting anti muscarinic (SAMA))
- methylxanthines (aminophylline)
2
Q
name 2 types of anti -inflammatory drugs?
A
- steroids (prednisolone=oral, beclomethasone= inhaled corticosteroid (ICS)
- leukotriene receptor antagonist (montelukast)
3
Q
describe pressurised metered dose inhaled (pMDIs)? 3
A
- Deep exhale/ inhale and puff/ hold breath for slow ten count/ exhale slowly/ wait on minute before second
- Use spacer/aerochamber
- HCFC- carbon footprint
4
Q
how do you take dry powder inhalers?
A
- Usually one inhalation, not a puff
5
Q
salbutamol:
- duration
- routes (2)
- mechanism of action (3)
- use (2)
A
-short acting (begin immediately, 3-5 hour duration)
- inhaled or nebuliser (higher dose)
- intravenous-very rarely used
- binding to beta (2)- receptors in the lungs results in relaxation of bronchial smooth muscles
- it is believed salbutamol increases cAMO production by activating adenylate cycles and the actions of salbutamol are mediated by cAMP
- SAMA
- asthma and COPD
- another SABA= terbutaline
6
Q
salmeterol:
- duration
- routes
- mechanism
- use (3)
A
- long acting (begin 2-30 min, 10-12 hour duration)
- inhaled
- LAMA
- asthma= in patient requiring long term regular bronchodilator therapy on ICS
- not PRN and always used with ICS in asthma
- COPD: persistent symptoms despite SABA
7
Q
formoterol:
- duration
- routes
- mechanism of action
- use (2)
A
- long acting (with short onset similar to salbutamol but with prolonged duration 10-12 hours)
- inhaled
- long acting beta adrenoceptor agonist
- asthma and COPD
- combined with ICS (always) for asthma
8
Q
tiotropium:
- duration
- routes
- mechanism of action (3)
- indication (2)
A
- long acting (24 hour) once daily
- inhaled
- tiotropium is a LAMA
- similar affinity to the subtypes of muscarinic receptors, M1-M5
- in the airways, it exhibits pharmacological effects through inhibition of M3-receptors at the smooth muscle leading to bronchodilation
- stable COPD: symptoms despite SABA
- asthma: in not improving despite ICS/LABA
9
Q
what is ipratropium? 3
A
- short acting antimuscarinic agent
- onset 30 mins, lasts 6 hour
- nebulised for acute presentations of COPD and sometimes asthma
10
Q
theophylline:
- duration
- routes (2)
- mechanism of action (2)
- indication (2)
A
- half life around 5 hours healthy adults
- oral
- IV
- phosphodiesterase inhibitor
- requires monitoring of level (blood test)
- oral: COPD and asthma- persistant symptoms
- IV: COPD and asthma- medical emergancies
11
Q
describe systemic glucocorticoids? 5
A
- prednisolone
- IV or oral
- stronger effects as higher doses
- action unaffected by inspiratory effort/ inhaler technique
- more side effects, especially with long term therapy
12
Q
describe inhaled glucocorticoids? 4
A
- beclomethasone, fluticasone, budesonide
- localised action
- fewer side effects: some absorption occurs
- disease may prevent penetration fo drug to effected areas
13
Q
what are the airway effects of glucocorticoids? 5
A
- Decrease release of inflammatory mediator
- Decrease infiltration and action of white blood cells
- Decrease airway oedema
- Decrease airway mucus production
- Increase number and sensitivity of beta-2 receptors
14
Q
what are the adverse effects of glucocorticoids?
- general 10
- inhaled 2
A
- 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
- Oral candidiasis- white plaques in mouth
- Dysphonia
15
Q
name 3 combination inhalers?
A
- ICS/LABA
- LAMA/LABA
- ICA/LABA/LAMA
