Pharmacology - Respiratory Flashcards

1
Q

Bronchodilators

Beta-agonists

Short acting 2-4hrs – Salbutamol, terbutaline

Long acting 12-18hrs – Salmeterol, formoterol

A

Indications: Asthma and other reversible airway obstruction + premature labour

MOA: Bronchodilators –> Selective B2 agonists act on bronchi to cause SM relaxation and decrease mucus production

S/E’s: Fine tremor, headache, muscle cramps, tachhycardia, palpitations, hypokalaemia (high doses)

CI’s: Caution in hyperthyroidism, CVS disease, arrhythmias, HTN, DM (risk of DKA when given IV)

Interactions: Hypokalaemia in high doses and with corticosteroids, diuretics, theophylline.

Other: Salbutamol = ventolin (reliever, short acting, fast onset, can be given IV in acute asthma) Terbutaline = bricanyl (ditto)

Salmeterol = serevent (preventer, long acting 12-18hrs)

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2
Q

Bronchodilators

Muscarinic Antagonists

Short acting 3-6hrs – Ipatropium

Long acting – Tiotropium

A

Indications: Reversible airways obstruction esp COPD

MOA: Bronchodilators - Anti-muscarinic –> block muscarinic ACh receptors in the SM of bronchi causing bronchodilation and decreased mucus secretion

S/E’s: Dry mouth, constipation, blurry vision, urinary retention

CI’s: Prostatic hypertrophy, bladder outflow obstruction, closed angle glaucoma

Interactions: -

Other: Ipatropium = atrovent (reliever, short acting)

Tiotropium = spiriva (preventer, long acting)

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3
Q

Beclometasone (Becotide)

Budesonide (Pulmicort)

Fluticasone (Flixotide)

Symbicort (Budesonide + Formoterol)

Seretide (Fluticasone + Salmeterol)

Inhaled corticosteroids

A

Indications: Reversible and irreversible airways disease e.g asthma/COPD

MOA: Corticosteroids –> act over weeks to decrease inflammation by decreasing cytokine production, prostaglandin/leukotriene synthesis, IgE secretion + leukocyte recruitment. Prevent long term decreases in lung function.

S/E’s: Inhaled = oral candidiasis, Long term use = OP, high dose can have system s/e’s, Oral use = systemic s/e’s

CI’s: Can cause paradoxical bronchospasm so use B2 agonist first

Interactions:-

Other: Take 12/52 to reach maximum effect. Decreased risk of complications if use a spacer device and rinse mouth after use. Fluticasone 2x as potent therefore use lower doses!

Symbicort = budesonide + formeterol (preventer and reliever in one as formoterol has fast onset)

Seretide = fluticasone + salmeterol

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4
Q

Theophylline MR

Aminophylline IV only

A

Indications: Reversible airways obstruction, severe asthma

MOA: Methylxanthines –> are phosphodiesterase inhibitors therefore increase cAMP, activates PKA, inhibits TNFalpha + leukotriene synthesis–> decreases inflammation and causes SM bronchodilation

S/E’s: Nausea, vomiting, arrhythmias, seizures, hypokalaemia

CI’s: Caution if arrhythmias/heart disease, HTN, hyperthyroid, PUD, lower dose in hepatic impairment

Interactions: Decreased levels in smoking, ETOH, Cyp inducers, adenosine. Increased levels with CCB’s, Cyp inhibitors.

Other: Aminophylline given only IV (give slowly, if too fast –> VT). Monitor ECG + bloods (K etc) + plasma level

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5
Q

Montelukast

Zafirlukast

A

Indications: Prophylaxis of asthma (esp exercise and NSAID induced)

MOA: Leukotriene receptor antagonist –> blocks the action of leukotriene on the cysteinyl leukotriene receptor –> decreases bronchoconstriction and inflammation

S/E’s: Abdo pain, thirst, headache, GI disturbance, ?Churg-Strauss syndrome

CI’s: Pregnancy

Interactions:

Other:

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6
Q

Roflumilast

A

Indications: Adjunct to bronchodilators for the maintenance of severe COPD assoc with chronic bronchitis and hx of frequent exacerbations

MOA: Phosphodiesterase type 4 inhibitor –> anti inflammation

S/E’s: D/V/N, abdo pain, weight loss

CI’s: Severe immunological disease, severe acute infectious disease, immunosuppresive drugs, pregnancy, depression/suicide hx

Interactions: Rifampicin –> inhibts effects

Other:

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7
Q

Omalizumab

A

Indications: Prophylaxis of allergic asthma (severe)

MOA: Humanised anti IgE Ab –> specifically binds to free IgE (IgE type 1 hypersensitivity reactions)

S/E’s: Abdo pain, headache, pyrexia

CI’s: Caution in autoimmune diseases, hepatic/renal impairment, pregnancy

Interactions:

Other: Sub cut injection every 2-4weeks

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8
Q

Carbocysteine

A

Indications: Reduction in sputum viscosity e.g. COPD, chronic productive cough, CF

MOA: Mucolytic

S/E’s: GI bleeding (rare)

CI’s: Active peptic ulceration, pregnancy

Interactions:

Other:

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9
Q

Dornase ALPFA (DNase)

A

Indications: Management of CF pts with a FVC of >40% predicted – improves pulmonary function

MOA: Mucolytic –> is a genetically engineered version of human DNase

S/E’s: Rarely dyspepsia, chest pain, dysphonia

CI’s:

Interactions:

Other:

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10
Q

Cetirizine

Loratidine/Clarityn

Fexofenadine

(Non sedating)

Chlorphenamine/Piriton (Sedating)

A

Indications: Symptomatic relief of allergies e.g. hayfever

MOA: Anti-histamines – selective H1R antagonists

S/E’s: Hypotension, arrhythmias (Increases QT/palpitations), anti AchM effects, drowsiness

CI’s: Severe liver disease, Caution in BPH/urinary retention, closed angle glaucoma, long QT syndrome

Interactions:

Other:

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11
Q

Treatment of Chronic Asthma

A

General - Inhaler technique, avoid allergens/triggers, stop smoking, monitor PEF (diary), pt education re compliance/attack management/specialist nurse etc

Medical

  1. SABA PRN (if used >1/d or nocte symptons then step
  2. Low dose inhaled steroid e.g. beclametasone 100-400 micrograms BD (usually start on 200)
  3. LABA e.g. salmeterol 50micrograms BD –> if a good response continue. If control still poor increase steroid to 400ug BD. If no benefit discontinue and increase steroid dose.
  4. If still poor control –> Trial of leukotriene receptor antagonist or theophylline (MR) or Bagonist PO or steroid dose 1000ug BD
  5. Oral steroids : Prednisolone 5-10mg OD (refer to specialist), use lowest dose possible to control symptoms
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12
Q

Treatment of chronic COPD

Assess Severity:

Mild = FEV1 >80%, FEV/FVC <0.7 + symptoms

Moderate = FEV1 50-79%

Severe = FEV1 30-49%

Very severe = FEV1 <30%

A

General - stop smoking/nicotine replacement/support progs, exercise, pulmonary rehab, lose weight, good nutrition, screen and tx other comorbidities, influenza/pneumococcal vaccines

Mucolytics - consider if chronic productive cough e.g carbocisteine

SOB +/- exercise limitation - SABA + SAMA (ipatropium) PRN

Exacerbations/SOB - LABA or LAMA + ICS

Persistent exacerbations - LABA + LAMA + ICS + roflumikast/theophylline, consider home nebs

LTOT - aim for PaO2 > 8 for 15hr/day (increases survival by 50%)

Surgery - Lung volume reduction sx

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