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mpharm year 3 sem 2 > week 7 > Flashcards

week 7 Flashcards

1
Q

what does COPD stand for ?

A

Chronic Obstructive Pulmonary Disease

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2
Q

COPD is characterised by reduced what?

A

FEV1 and FEV1/VC ratio

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3
Q

consequence of glandular hypertrophy, reduced number of cilia ?(1)

A

increased cough with or without sputum

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4
Q

consequences of cell metaplasia (increases sputum), smooth muscle hypertrophy, fibrosis (2)

A

increased mucous production
increased expiratory flow resistance

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5
Q

consequences of loss of alveolar fine structure (2)

A

loss of lung recoil
reduced gas exchange

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6
Q

name 4 clinical symptoms of COPD

A

cough
sputum
wheeze
dyspnoea (shortness of breath)

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7
Q

BODE index- what does it stand for?

A

BMI
degree of airflow Obstruction (assessed by FEV1)
Dyspnoea scale (modified medical research council)
Exercise capacity assessed by 6min walking distance test

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8
Q

why is early diagnosis for COPD so important?

A

implementation of treatment before irreversible pathological change occurs

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9
Q
  • Overweight and cyanotic (blue)
  • Elevated haemoglobin
  • Peripheral oedema
  • Rhonchi and wheezing

are characteristic of which clinical phenotype of COPD?

A

chronic bronchitis

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10
Q
  • older and thin
  • severe dyspnoea
  • quiet chest
  • x-ray hyperinflation with flattened diaphragms

are characteristic of which clinical phenotype of COPD?

A

emphysema

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11
Q

what gene contributes to genetic susceptibility to COPD?

A

Alpha one anti trypsin (α1-AT)

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12
Q

what does α1-AT do?

A

protease inhibitor
balances activity of elastase and other destructive enzyme proteases
these destroy elastin leading to loss of lung recoil and reduced gas exchange in the lung
common in emphysema

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13
Q

how does pollution affect inflammatory cells action?

A

when neutrophils, macrophages, lymphocytes etc are full of pollution/ smoking particles they cannot deal with pathogens so infections are more likely

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14
Q

why are COPD patients more likely to have infections ?

A

when neutrophils, macrophages, lymphocytes etc are full of pollution/ smoking particles they cannot deal with pathogens so infections are more likely

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15
Q

how does scar tissue affect patient’s breathing ?

A

scar tissue is not very elastic and so causes constriction and narrowing of airways

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16
Q

name 5 treatment goals in COPD

A

improving healthy status
reducing symptoms
preserving lung function decline (slowing rate of decline)
preventing exacerbations
reducing mortality

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17
Q

all COPD stage treatment

A

avoidance of risk factors (smoking, pollution)
flu vaccination

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18
Q

what is stage 0 of COPD? what are some characteristics (4)

A

at risk
chronic cough and sputum
exposure to risk factors
normal spirometry

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19
Q

what is stage 1 of COPD? what are some characteristics?

A

mild COPD
FEV1/FVC<70%
FEV<80% predicted
with or without symptoms

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20
Q

what is stage 2 of COPD? what are 2 characteristics?

A

moderate COPD
FEV1 40-59%

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21
Q

what is stage 3 of COPD? what are 2 characteristics?

A

severe COPD
FEV<40%

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22
Q

mild COPD treatment

A

short acting bronchodilator- only when required

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23
Q

moderate COPD treatment

A

regular treatment with one or more bronchodilators
rehabilitation (lifestyle changes)
inhaled steroids (only carry on if significant improvement) -stop if no response

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24
Q

severe COPD treatment

A

regular treatment with one or more bronchodilators
rehabilitation (lifestyle changes)
inhaled steroids (only carry on if significant improvement) -stop if no response
treatment of complications
long term oxygen therapy
surgical treatments

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25
Q

name 8 different therapy options for COPD

A

bronchodilators
beta 2 antagonists (long, short acting)
muscarinic antagonists (long, short acting)
inhaled steroids
methylxanthines (theophylline)
oxygen therapy
proteases inhibitors
biologics

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26
Q

why are protease inhibitors helpful in COPD treatment?

A

helpful in emphysema patients caused by alpha 1 anti trypsin deficiency

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27
Q

define fine particle fraction (FPF)

A

fraction of particles (<5 microns) that can achieve deposition in the lower respiratory tract

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28
Q

define mass median aerodynamic diameter (MMAD)

A

diameter at which 50% of the particles of an aerosol by mass are larger and 50% are smaller than the median diameter

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29
Q

define labelled dose (inhaler)

A

dose that is metered and stated on device packaging

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30
Q

define emitted dose (inhaler)

A

the mass of drug emitted per actuation that is actually available for inhalation at the mouth

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31
Q

define aerosol

A

colloidal systems consisting of very finely subdivided liquid or solid particles dispersed in and surrounded by a gas

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32
Q

name 5 advantages for local treatment of a respiratory disease

A
  • non invasive
  • painless
  • delivers high drug concentrations directly to the disease site/sites
  • rapid clinical responses
  • bypasses barriers to therapeutic efficacy (like first pass metabolism, GI absorption)
  • achieve similar or superior clinical effects with much less systemic dose (less side effects)
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33
Q

name 3 disadvantages for local treatment of a respiratory disease

A
  • administration techniques differ between and within device categories
  • less than optimal technique of device can therefore compromise therapeutic effect
  • more patient training and time is required for effective drug administration
34
Q

name the 5 components for a pressurised meter dosed inhaler

A

container
propellants
actuator
metering valve
formulation

35
Q

what is the container of a pMDI commonly made of - why is this?

A

aluminium
inexpensive and strong enough to withstand pressure of contents inside
also good for photo stability

36
Q

what part of the inhaler is where the canister is held?

A

the actuator

37
Q

what is the typical volume a metering valve will deliver?

A

25-100 ul

38
Q

name 3 issues related to using ethanol within inhaler preparations

A

ethanol can change
- the formulation density, thus the total mass of formulation atomised during device actuation
- atomisation of the formulation and the size of atomised droplets
- the evaporation rate of the droplets towards their residual particle sizes

39
Q

why are drug salt forms used in inhalers?

A

the drug must be practically insoluble in the formulation vehicle- this is why many insoluble salt forms of drugs are used

40
Q

what kind of mill is used to reduce particle size and ensure a narrow particle size distribution for inhaler suspension ?

A

spiral jet mill- reduces particle size due to high velocity drug particle- particle collisions and particle-wall collisions

41
Q

name 4 particle interactions which can change particle size distribution

A

mechanical interlocking due to surface asperities
capillary forces from the presence of water
electrostatic interactions
van der Waals forces

42
Q

what can be used to minimise particle interactions?

A

use of suspending agent stabilisers like PEG

43
Q

name 3 advantages of using a dry powder inhaler

A
  • simpler to use (breath activated, less co-cordination required)
  • propellant free and environmentally friendly
  • stability and processing is preferred as they are formulated as one phase, solid particle blends
44
Q

how do dry powder inhalers create an aerosol?

A

upon inhalation by the patient using device mouthpiece, turbulent flow is created within the reservoir- this causes de-agglomeration of the micronised API from the lactose carrier, creating an aerosol dispersion of the API for inhalation

45
Q

name 4 important considerations of drug properties for dry powder inhalers

A

powder flow
particle size
particle shape and surface properties
drug-carrier interactions

46
Q

name the 2 common types of nebuliser design

A

air-jet
vibration mesh

47
Q

how does an air jet nebuliser work?

A

uses compressed air to generate a fine mist

48
Q

name one advantage and one disadvantage of an air jet nebuliser

A
  • offers a range of particle sizes, no medication restrictions
  • can be loud- patient setting (hopsital- disturbing others)
49
Q

how does a vibrating mesh nebuliser work?

A

uses ultrasonic vibrations passed through water to generate a fine mist

50
Q

name one advantage and one disadvantage of an vibrating mesh nebuliser

A
  • offers consistant particle size, almost silent
  • medication restrictions (heat is transferred to medication- if denatured etc cannot be used)
51
Q

patient choice for inspiratory flow of >30 L/min and good actuation

A
  • pMDI
  • BA-pMDI (breath activated)
  • DPI
  • nebuliser
52
Q

patient choice for inspiratory flow of >30 L/min and poor actuation

A
  • pMDI+ spacer
  • BA- pMDI (breath activated)
  • DPI
  • nebuliser
53
Q

patient choice for inspiratory flow of <30 L/min and good actuation

A
  • pMDI
  • nebuliser
54
Q

patient choice for inspiratory flow of <30 L/min and poor actuation

A
  • pMDI+ spacer
  • nebuliser
55
Q

name 2 formulation and device characteristics impacting PK/PD following inhalation

A

lung deposition (amount of distribution) mainly related to FPF

pulmonary residence time of drug particle

56
Q

name 2 drug characteristics impacting PK/PD following inhalation

A

receptor binding efficacy
log P, solubility, pKa
PK profile (metabolic features, protein binding, vd, Cl

57
Q

name 6 limitations of chronic ICS use

A

systemic effects
- HPA (hypothalamic-pituitary-adrenal) axis effects
- growth suppression
- corticosteroid induced osteoporosis (decrease osteocalcin)
- skin thinning and bruising

local effects
- oral candidiasis
- pharyngitis/ laringitis (husky, hoarse voice)

58
Q

name 8 PK considerations for ICS

A
  • formulation
  • bioavailiabilty
  • receptor binding affinity
  • on-site activation
  • lung residence time - lipophilicity, lipid conjugation
  • half life
  • protein binding
  • clearance
59
Q

how long should we leave a COPD patient on ICS before review?

A

6-8 weeks
if no improvement/ response then discontinue treatment

60
Q

why should we be cautious with ICS in COPD pateints?

A

increased risk of pneumonia infections due to immunosuppressant effects of steroid

61
Q

what can eospinohil counts tell us about a patient with COPD?

A

if these are increased can show possible responsiveness to steroid treatment

62
Q

give 6 reasons why we use respiratory physiotherapy

A
  • improves efficiency of ventilation
  • mobilises and aids secretion clearance
  • reduces breathlessness and work of breathing
  • support weaning from mechanical ventilation
  • maintain or improve exercise capacity
  • improve functional activities
63
Q

name 4 methods of breathing control

A
  • belly breathing
  • pursed lip breathing
  • square breathing
  • blow as you go
64
Q

How does a plasma esterase perform acid and base-catalysed hydrolysis of an ester simultaneously?

A

doesn’t let the acid and base touch as they would neutralise each other
aspartate acts as base
histidine acts as acid

65
Q

what do curly arrows show? full? half?

A

show the movement of electrons
full arrow head shows movement of pairs of electrons while a half arrow head shows movement of just one electron

66
Q

is chronic productive cough more commonly associated with asthma or COPD?

A

COPD

67
Q

is night time wakening with breathlessness/ wheeze more commonly associated with asthma or COPD?

A

asthma

68
Q

is more variable symptoms day to day (dinural variation) more commonly associated with asthma or COPD?

A

asthma

69
Q

which grade of COPD is not troubled except on strenuous exercise ?

A

grade one

70
Q

which grade of COPD is short of breath when hurrying on the flat or walking up a slight hill?

A

grade two

71
Q

which grade of COPD is walks slower than most on the flat, stops after about a mile or stops after walking 15 mins at own pace?

A

grade three

72
Q

which grade of COPD is stops for breath after walking 100 yards pr a few minutes on the level?

A

grade four

73
Q

which grade of COPD is too breathless to leave the house?

A

grade five

74
Q

name name 8 aims of COPD management

A
  • reduce symptoms
  • improve exercise tolerance
  • improve health related quality of life
  • prevent exacerbations
  • provide a package of care that meets the patients needs
  • provide treatment that minimises the risk of adverse effects
  • reduce mortality
  • prevent disease progression
75
Q

name 4 non pharmacological treatments for COPD

A
  • smoking cessation
  • pulmonary rehabilitation
  • vaccinations (covid, flu, pneumonia)
  • physiotherapy
76
Q

treatment for breathlessness/ exercise limitations in COPD

A

short acting bronchodilator
SAMA- Ipratropium
OR
SABA- salbutamol

77
Q

treatment for exacerbations or persistent breathlessness in COPD with an FEV1 >50%

A

LABA - salmeterol, formoterol
LAMA- tiotropium

78
Q

treatment for exacerbations or persistent breathlessness in COPD with an FEV1 <50%

A

LABA- salmterol, formoterol
AND
ICS - budesonide
or LAMA- tiotropium

79
Q

treatment for persistent exacerbations or persistent breathlessness in COPD

A

LAMA- tiotropium
AND
LABA- salmeterol, formoterol
AND
ICS- budesonide

80
Q

when are LABAs used in COPD treatment?

A

only in combination with ICS or LAMA

mpharm year 3 sem 2 (11 decks)

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