9.2 Respiratory pharmacology

Question 1

what should be considered in asthma before stepping treatment up or down?

Answer 1

check adherence
check inhaler technique
eliminate/reduce triggers

Question 2

ADRs for inhaled corticosteroids
how to avoid?

Answer 2

candidiasis, hoarse voice

advise patient to swill mouth after use, to remove residue of drug

Question 3

how to inhaled corticosteroids work?

Answer 3

pass through plasma membrane to activate cytoplasmic receptors which passes into nucleus to modify transcription

this reduces mucosal inflammation, widens airways via SM relaxation, reduces mucus, reduces interleukins chemokine and cytokines

Question 4

why do ICS have few ADRs

Answer 4

poor oral bioavailability, high affinity for glucocorticoid receptor

Question 5

how to presume a LABA, and why?

Answer 5

with ICS, could mask airway inflammation and near fatal/fatal attacks alone

Question 6

how does tiotropium work?

Answer 6

block vagal stimulation via muscarinic ACh block

Question 7

why must we measure plasma conc of theophylline?

Answer 7

narrow therapeutic index so could potentially cause life threatening complications

Question 8

drug for apnoea of prematurity

Answer 8

caffeine citrate (works like theophylline)

Question 9

drugs for acute severe asthma

Answer 9

-oxygen
-high dose nebuliser beta 2 agonist
-oral steroids prednisolone
-nebulised iprotropium bromide

-maybe aminophylline if no success with above

Question 10

drugs for acute COPD exacerbation

Answer 10

-nebulised salbutamol and or ipratropium
-oral steroids
-snitbiotics