Chapter 3- Respiratory System

Question 1

Two advantages of giving drugs via the respiratory tract

Answer 1

Dose required is smaller

Side effects are reduced

Question 2

True or false - budesonide ans beclometasone are approximately equivalent in clinical practice

Answer 2

True but there may be variations with different drug delivery devices

Question 3

Fluticasone and mometasone provide equal activity to beclometasone and budesonide at what dose

Answer 3

Half of the dose

Question 4

In children, high doses of inhaled corticosteroids can be associated with what systemic side effects

Answer 4

Growth failure
Reduced bone mineral density
Adrenal suppression

Question 5

Four symptoms of asthma

Answer 5

Cough
Wheezing
Chest tightness
SoB

Question 6

What 3 things define moderate acute asthma

Answer 6

Increasing symptoms
Peak flow > 50-75% best or predicted
No signs of severe acute asthma

Question 7

What 4 things define severe acute asthma

Answer 7

Peak flow 33-50% best or predicted
RR >25/min
HR >110/min
Inability to complete sentences

Question 8

Name two inhaled short acting b2 agonists

Answer 8

Salbutamol

Terbutaline

Question 9

Name a less selective b2agonist less appropriate for use as a bronchodilator due to risk of causing arrhythmias

Answer 9

Ephedrine/adrenaline

Question 10

Name two long acting b2 agonists used in asthma

Answer 10

Formeterol

Salmeterol

Question 11

Which has a quicker onset of action: salmeterol or formeterol

Answer 11

Formeterol - similar to the speed of salbutamol

Question 12

Name 2 long acting b2agonists indicated in COPD

Answer 12

Indacaterol

Olodaterol

Question 13

Which act quicker - SABA or SAMA

Answer 13

SABAAAA

Question 14

Ipratroprium inhalation reaches peak effect when and lass how long

Answer 14

30-60mins after use

Lads 3-6 hours

Question 15

Combination of b2 agonists + theophylline increase risks of what

Answer 15

HYPOkalaemia

Question 16

List 7 indications where a lower concentration of oxygen therapy may be required

Answer 16

COPD
Advanced cystic fibrosis
Severe non CF bronchiectasis
Severe kyphoscoliosis or severe ankylosing spondylitis
Severe lung scarring from TB
Musculoskeletal disorders with respiratory weakness
Overdose of opioids, BZ or others causing resp depression

Question 17

Name 4 types of oxygen therapy

Answer 17

Emergency oxygen
Short burst (intermittent)
Long term
Ambulatory

Question 18

What’s the caution on ipratropium

Answer 18

Acute angle-closure glaucoma : ensure to keep nebuliser solution away from eyes

Question 19

Bambuterol is a prodrug of what

Answer 19

Terbutaline

Question 20

High doses of salbutamol can cause what type of acidosis

Answer 20

Lactic acidosis

Question 21

True or false: QVAR has extra fine particles and is more potent than other beclometasone containing inhalers- it is three times as potent as clenil

Answer 21

True apart from it’s TWICE as potent as clenil

Question 22

Name three monoclonal antibodies used in severe asthma

Answer 22

Mepolizumab
Omalizumab
Reslizumab

Question 23

Name two leukotriene receptor antagonists used in asthma

Answer 23

Montelukast

Zafirlukast

Question 24

How does montelukast and zafirlukast work

Answer 24

They are leukotriene receptor antagonists so they block the effects of cysteinyl leukotrienes in the airways

Question 25

What is roflumilast

Answer 25

Phosphodiesterase type 4 inhibitor used as an adjunct in COPD

Question 26

What do you need to do when dosing aminophylline in extremes of body weight

Answer 26

Use ideal weight for height

Question 27

The plasma theophylline concentration is increased in what 3 conditions

Answer 27

Heart failure Hepatic impairment Viral infections

Question 28

True or false: the plasma theophylline level is increased in smokers

Answer 28

False it's decreased in smokers

Question 29

True or false: the plasma theophylline level is decreased by alcohol consumption

Answer 29

True

Question 30

Signs of overdose of theophylline

Answer 30

``` Vomiting Agitation Restlessness Dilated pupils Sinus tachycardia Hyperglycaemia Haematemesis Convulsions Supraventricular and ventricular arrhythmias Hypokalaemia ```

Question 31

Name 8 non-sedating antihistamines

Answer 31

``` Acrivastine Bilastine Cetirazine Desloratadine Fexofenadine Levocetirizine Loratadine Mizolastine ```

Question 32

What's the caution with high doses of the sedating antihistamine: alimemazine

Answer 32

Photosensitivity - avoid exposure to sunlight

Question 33

MHRA warning about chlorphenamine

Answer 33

Children under 6 should not be given OTC cough and cold medicines containing chlorphenamine

Question 34

True or false: many antihistamines should be avoided in acute porphyrias

Answer 34

True! - some are thought to be safe though

Question 35

MHRA warning with hydroxyzine

Answer 35

Risk of QT prolongation and torsade de pointes

Question 36

Risk factors for QT prolongation

Answer 36

``` Electrolyte imbalances Bradycardia CVD Family history of cardiac death Concomitant drugs that prolong QT ```

Question 37

MHRA warning advice with promethazine

Answer 37

Children under 6 years should not be given OTC cough and cold medicines containing promethazine

Question 38

Contraindication of mucolytics

Answer 38

Active peptic ulceration

Question 39

What is dornase alpha

Answer 39

Mucolytic used in cyatic fibrosis

Question 40

What drug is indicated for the treatment of cystic fibrosis in patients who have a G551D mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene

Answer 40

Ivacaftor