DRUGS

Question 1

Oxygen: Description and MoA

Answer 1

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

Question 2

Oxygen: Indications

Answer 2

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

Question 3

Oxygen: Adverse Effects and interactions

Answer 3

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

Question 4

Oxygen: COPD patients

Answer 4

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.

Question 5

Oxygen: Route

Answer 5

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

Question 6

Oxygen: Prescribing and Dose

Answer 6

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%)

Question 7

Corticosteroids (systemic): Examples

Answer 7

Prednisolone, Hydrocortisone, Dexamethasone

Question 8

Corticosteroids (systemic): Indications

Answer 8

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

Question 9

Corticosteroids (systemic): MoA

Answer 9

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

Question 10

Corticosteroids (systemic): Adverse effects

Answer 10

• Immunosuppression

- Muscle weakness, skin thinning and easy bruising

Question 11

Corticosteroids (systemic): Dose

Answer 11

Prednisolone 5mg = Hydrocortisone 20mg

Prednisolone max dose 40-60mg

Question 12

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

Answer 12

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

Question 13

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

Answer 13

• 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)

Question 14

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

Answer 14

• 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

Question 15

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

Answer 15

• 100-200mg inhaled PRN no more than 4 times a day

- 2.5mg can also be nebulised

Question 16

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

Answer 16

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

Question 17

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

Answer 17

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

Question 18

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

Answer 18

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

Question 19

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

Answer 19

Inhaled

Question 20

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

Answer 20

Combined inhaler with corticosteroids

Either as metered dose inhaler or dry powder inhaler

Question 21

Anti-Cholinergics: MoA

Answer 21

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

Question 22

Anti-Cholinergics: Anti-muscarinics

Answer 22

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

Question 23

Anti-Cholinergics: Examples

Answer 23

Ipratropium, Tiotropium

Question 24

Anti-Cholinergics: Indications

Answer 24

1. COPD - help to relieve symptoms of exacerbations

2. Asthma. Can be added onto beta agonist or corticosteroid therapies

Question 25

Anti-Cholinergics: Adverse effects and interactions

Answer 25

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

Question 26

Anti-Cholinergics: Route, Prescribing and Dose

Answer 26

Inhalation | PRN or QDS standard dose is 40mg

Question 27

Mucolytics: Examples

Answer 27

Carbocysteine

Question 28

Mucolytics: MoA

Answer 28

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

Question 29

Mucolytics: Indications

Answer 29

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

Question 30

Mucolytics: Adverse effects and interactions

Answer 30

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

Question 31

Mucolytics: Route, Prescribing and Dose

Answer 31

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

Question 32

Theophylline: MoA

Answer 32

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

Question 33

Theophylline: Indications

Answer 33

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

Question 34

Theophylline: Adverse Effects and interactions

Answer 34

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

Question 35

Theophylline: Route, Prescribing and Dose

Answer 35

For asthma: 250-500mg BD PO