DRUGS Flashcards Preview

RESPIRATORY > DRUGS > Flashcards

Flashcards in DRUGS Deck (35):
1

Oxygen: Description and MoA

Used for patients in hypoxemic states or at risk. Increases O2 sats and tissue perfusion- prevent anaerobic metabolism.
Useful in anxiety and stress.

2

Oxygen: Indications

1. Hypoxia: patients that are SOB or in a state of hypoperfusion
2. Accelerates reabsorption of pleural gas in pneumothorax
3. Reduce half life of carboxyhemoglobin in CO poisoning

3

Oxygen: Adverse Effects and interactions

- Can cause dry throat and mouth
**Less likely to occur with patient using nasal cannula (always consider in long term).
V flammable (smokers)

4

Oxygen: COPD patients

Physiologically respiratory drive is hypercapnia. In COPD flips to hypoxic drive so giving oxygen can depress RR and worsen hypoxia.
If it is an emergency COPD will still need oxygen.

5

Oxygen: Route

High flow (15L/min) through non rebreathe mask.
Can be given with reservoir of salbutamol
Venturi valves useful for controlling how much oxygen someone is receiving (good for COPD patients) - they blend oxygen with room air in fixed ratio

6

Oxygen: Prescribing and Dose

Often prescribed retrospectively. In emergency aim for sats 94-98 or 88-92 in COPD
HIGH FLOW: 15L/min (60-80% O2)
NASAL CANNULAE 2-6L/min (25-50%)

7

Corticosteroids (systemic): Examples

Prednisolone, Hydrocortisone, Dexamethasone

8

Corticosteroids (systemic): Indications

- Allergies or inflammation
- Autoimmune suppression
- Part of chemotherapy
- Hormone replacement for those with adrenal insufficiency

9

Corticosteroids (systemic): MoA

Bind to glucocorticoid receptors which then translate to cell nucleus and regulate gene expression. Up-regulate anti-inflammatory genes.
Suppress action of monocytes and eosinophils

10

Corticosteroids (systemic): Adverse effects

- Immunosuppression
- Muscle weakness, skin thinning and easy bruising

11

Corticosteroids (systemic): Dose

Prednisolone 5mg = Hydrocortisone 20mg

Prednisolone max dose 40-60mg

12

Short-acting Beta-2 agonists (Salbutamol): Indications

- Asthma reliever, PRN inhaler
- SOB relief in COPD
- Alongside insulin,glucose and calcium gluconate as urgent treatment for hyperkalaemia

13

Short-acting Beta-2 agonists (Salbutamol): MoA

- Beta-2 receptors found in tubes of body (on SMCs). GPCR which when activated leads to smooth muscle relaxation: dilate bronchioles
- Stimulate Na+/K+ ATPase pumps on cell surfaces pumping K+ into cellular compartment (hence good in hyperkalaemia)

14

Short-acting Beta-2 agonists (Salbutamol): Adverse effects

- Tachycardia, palpitations, anxiety and fine tremor (due to effect on heart and blood vessels)
- Increase serum glucose concentration (difficult for diabetics)
- Can lead to a rise in lactate levels leading to muscle cramps

15

Short-acting Beta-2 agonists (Salbutamol): Dose

- 100-200mg inhaled PRN no more than 4 times a day
- 2.5mg can also be nebulised

16

Long-Acting Beta-2 agonists (Salmeterol): MoA

Acts on Beta-2 GPCRs on SMCs to dilate bronchioles and improve ventilation. Also act on Na+/K+ ATPase pumps and move potassium into intracellular compartment: good for treatment for hyperkalaemia

17

Long-Acting Beta-2 agonists (Salmeterol): Indications

1. Asthma (usually 3rd line) after, and in combination with salbutamol and inhaled corticosteroids (beclametasone)
2. COPD second line therapy after steroids
3. Hyperkalaemia

18

Long-Acting Beta-2 agonists (Salmeterol): Adverse effects and interactions

Tachycardia, Palpitations, Tremor, anxiety, muscle cramps
Increased blood glucose.
Always give at same time as inhaled corticosteroids

19

Long-Acting Beta-2 agonists (Salmeterol): Route

Inhaled

20

Long-Acting Beta-2 agonists (Salmeterol): Dose and Prescribing

Combined inhaler with corticosteroids
Either as metered dose inhaler or dry powder inhaler

21

Anti-Cholinergics: MoA

Block the NT ACh - responsible for PARASYMPATHETIC control in the body including smooth muscle in the lungs.

22

Anti-Cholinergics: Anti-muscarinics

type of anti-cholinergic. Reduce smooth muscle tone and reduce secretions in the resp tract helping to relieve symptoms

23

Anti-Cholinergics: Examples

Ipratropium, Tiotropium

24

Anti-Cholinergics: Indications

1. COPD - help to relieve symptoms of exacerbations
2. Asthma. Can be added onto beta agonist or corticosteroid therapies

25

Anti-Cholinergics: Adverse effects and interactions

Often don't get into systemic circulation (inhaled) and so don't have that many adverse effects.
Dry mouth

Use with caution in ANGULAR GLAUCOMA because they can increase IOP

26

Anti-Cholinergics: Route, Prescribing and Dose

Inhalation
PRN or QDS standard dose is 40mg

27

Mucolytics: Examples

Carbocysteine

28

Mucolytics: MoA

Work by reducing the viscosity of the mucus which allows the patient to bring up their sputum much more easily.
This is important because if mucus lingers then this is a risk factor for developing a infection in the chest

29

Mucolytics: Indications

Useful for those that have productive coughs and might otherwise be a bit less able to clear their chests
- The frail
- COPD

Also useful in patients with CF who have unusually thick and sticks mucus

30

Mucolytics: Adverse effects and interactions

Should not be given in patients who are on any medications to dry up their sputum or patients on ANTITUSSIVES

Also don't give to someone with a peptic ulcer because it can cause gastric bleeding

31

Mucolytics: Route, Prescribing and Dose

PO often chewable tablets. Can also be aerosolised
500mg PO chew

32

Theophylline: MoA

Useful for COPD management. Phosphodiesterase inhibitor which increases intra-cellular cAMP and inhibits leukotriene synthesis which reduced inflammation in bronchioles

Naturally occurring substance which is structurally similar to caffeine

33

Theophylline: Indications

1. COPD and asthmatics to help reduce inflammation in bronchioles (they also seem to increase steroid sensitivity)
2. Theophylline is a positive IONOTROPE (increases contractility of the heart)so can be useful in heart failure
3. Increases blood pressure and renal perfusion

34

Theophylline: Adverse Effects and interactions

Theophylline has narrow therapeutic window:
toxicity is increased by some antibiotics including erythromycin and flouroquinolones such as ciprofloxacin

- Nausea
- Diarrhoea
- Tachycardia

35

Theophylline: Route, Prescribing and Dose

For asthma: 250-500mg BD PO