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4 Clinical Pharmacology and Intro to Prescribing > 18 Respiratory Pharmacology > Flashcards

18 Respiratory Pharmacology Flashcards

1
Q

What is ‘uncontrolled asthma’ defined as?

A

asthma that has an impact on a person’s lifestyle or restricts their normal activities

Guidelines:

  1. 3+ days with symptoms eg coughing, wheezing, shortness of breath, chest tightness
  2. 3+ days needing to use SABA for symptomatic relief
  3. 1+ nights per week awakening due to asthma
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2
Q

What 3 factors should we consider before stepping up or stepping down asthma management?

A
  1. Adherence
  2. Inhaler technique
  3. Eliminate trigger factors
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3
Q

Name 3 inhaled corticosteroids.

A
  1. Beclometasone
  2. Budesonide
  3. Fluticasone
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4
Q

How do inhaled corticosteroids work to treat asthma?

When are they indicated?

What is their action?

What is their mechanism of action?

A

Indicated:

  • Regular preventer when reliever alone no sufficient
  • Reduce symptoms, exarcerbations and death

Action:

  • Reduce mucosal inflammation
  • Widen airways
  • Reduce mucous

Mechanism of action:

  • Activate cytoplasmic receptors
  • Activated receptor passes into nucleus to modify transcription
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5
Q

What are some of the side effects/complications of the immunosupressive actions of inhaled corticosteroids?

A
  • Candiasis
  • Hoarse voice
  • Pneumonia risk with COPD

(if taken correctly- few significant ADRs)

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6
Q

Why do corticosteroid need to be inhaled?

A

Almost complete first pass metabolism

Poor oral bioavailability

Direct to site of action

  • High affinity for glucocorticoid receptor
  • Slow dissolution in aqueous bronchial fluid
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7
Q

Beta agonists are used in the treatment of asthma. What are the indications for SABAs and LABAs?

A

SABAs= symptom relief through bronchodilation

LABAs= add on therapy to ICS and SABA

Both-
aim to prevent bronchoconstriction prior to exercise

increase mucus clearance by action of cilia

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8
Q

Why should SABAs be taken for asthma only when needed?

A

Can acquire tolerance to SABAs if taken inappropriately

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9
Q

Give some examples of SABAs and LABAs.

A
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10
Q

What are some of the side effects of Beta 2 agonists?

A

Adrenergic- fight or flight effects:

  • Palpitations
  • Tachycardia
  • Anxiety
  • Tremor
  • SVT

LABA- muscle cramps

REMEMBER- beta blocker- may reduce actions so just be aware of interaction

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11
Q

Why should a LABA not be used on its own and what should it be given with?

A

LABA- should be given with ICS

Increased risk of death when prescribed alone

Alone can mask airway inflammation and near fatal attacks

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12
Q

When is a LABA added to the management of asthma?

A
  • When asthma not controlled with ICS
  • To improve lung function
  • Reduce asthma exacerbations
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13
Q

How do the LABAs formoterol and salmeterol compare?

A

Formoterol= more potent and more efficacious than salmeterol

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14
Q

Give an example of a leukotriene receptor antagonist. (LTRA)

A

Montelukast

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15
Q

What are the indications for Montelukast (LTRA)?

A

= alternative to LABA in NICE guidlines

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16
Q

How do LTRAs eg Montelukast work to treat asthma?

(Leukotriene receptor antagonist)

A

Leukotrienes cause:

  • bronchoconstriction
  • increas mucus
  • increase oedema

through CysLT1- GPCR

LTRA block CysLT1

17
Q

Give some ADRs for LTRAs. (eg montelukast)

A
  1. Headache
  2. GI disturbance
  3. Dry mouth
  4. Hyperactivity
18
Q

What can be given to asthmatics as last step therapies? (3)

Give examples of each.

A

LAMA (long acting muscarinic antagonist) (M3)

Severe asthma and COPD

  • Tiotropium

Methylxanthine

  • Theophylline

Oral steroids

Severe uncontrolled asthma

Post acute exacerbation- at least 5 days

Post COPD acute exacerbation- 5-7 days

  • Prednisolone
19
Q

List the main ADRs for LAMAs eg tiotropium.

A
  • Dry mouth
  • Urinary retention
  • Dry eyes

(typical anticholinergic effects)

20
Q

Why does caution need to be taken when prescribing theophyline?

A

Narrow therapeutic index

Potentially life threatening complications including arrhythmia

Need to consider interactions with CYP450 inhibitors

21
Q

How do methylxanthines work?

A

Adenosine receptor antagonist

22
Q

How should we manage acute severe and life-threatening asthma?

A
  1. Oxygen
  2. Beta 2 agonist
    1. High dose
    2. Nebulised
    3. Oxygen driven
    • SAMA (if needed with Beta agonist)
      1. eg Ipratropium
    • consider i.v theophylline
  5. Oral steroids
    1. 7-14 days
    2. Continue ICS alongside
23
Q

What are the 5 tasks involved in COPD management?

A
  1. Confirm diagnosis
  2. Stop smoking
  3. MRC Dyspnoea scale + Offer pulmonary rehabilitation
  4. Vaccinations
    1. Flu
    2. Pneumococcal
  5. Consider medication
24
Q

What drugs might we need to give someone who has had an acute exacerbation of COPD requiring hospitalisation?

A
  1. Salbutamol (nebulised, driven by air not o2)
    1. +/- ipratropium (SAMA)
  2. Oral steroids (may be more effective in asthma)
  3. Antibiotics
25
Q

Give 3 inhaler types that you can get (in terms of use).

A
  1. Pressurised metered dose inhalers (pMDI)
    1. Inhalation and actuation of device (slow breath and hold) can be used with spacer
    2. Breath-actuated (automatic)
  2. Dry powder inhalers (DPI)
    1. Fast deep inhalation
26
Q

Why is inhaler technique so important?

A

Dictates particle size and depostion

Can use In-check DIAL device as guide for technique

27
Q

For future reference- Respiratory inhalers

A

4 Clinical Pharmacology and Intro to Prescribing (27 decks)

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