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Respiratory physiology > Lecture 12 - Respiratory Pharmacology > Flashcards

Lecture 12 - Respiratory Pharmacology Flashcards

(62 cards)

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1
Q

What is a cough

A

symotom of a respiratory disease

Protective reflect: prevents lungs from aspiration

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2
Q

What is a useless cough

A

persistent and unproductive: dry

eg. ashtma, oesophageal reflux, sinusitis and psychogenic

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3
Q

Should a useless cough be suprressed?

A

yes it should
cough supressants are called - antitussives
always treat underlying cause as cough is a symptom

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4
Q

What is a useful cough?

A

expels secretions i.e sputum - productive

eg. chest infection

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5
Q

Should a useful cough be suppressed?

A

No

yes if it is exhausting and dangerous

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6
Q

Mechanism of a cough

A

Cough receptors in nose or upper airways (lung irritant receptors detected. goes to the
cough centre in the medulla which leads to stimulation leading to cough

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7
Q

How do dry cough - cough suprressants act? and what drugs act to reduce that afferent side

A

On the afferent side: reduce stimuli
- above larynx - linctuses
Below larynx - steam inhalation, nebulised local anaesthetics
Treat cause: stop smoking

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8
Q

What happens on the efferent side: in dry cough suppressants?

A

Medullary cough centre - antitussives

  • opiods (codeine, methadone, pholcodeine)
  • non opiods (dextromethorphan, noscapine)
  • sedatives: diphenhydramine, chlorpheniramine
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9
Q

Efferemt side antitussives

A 
Opiods (codeine, methadone, pholcodeine) 
Non opiods (dextromethorphan, noscapine)
Sedatives: diphenhydramine, chlorpheniramine
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10
Q

Productive cough

A

Expectorants which increase volume of secretion and mucolytics which decrease the viscosity

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11
Q

Examples of expectorants

A

Guaiphenesin, ipecacuanha

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12
Q

Examples of mucolytics

A

Acetyl cysteine, recombinaant humane DNase

used for cystic fibrosis

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13
Q

What is the best treatment for a productive cough that shouldn’t be suppressed?

A

antibiotics

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14
Q

3 common causes of a chronic caugh

A

upper airways cough syndrome - post nasal drip
bronchial asthma/COPD
Gastrooesophageal reflux disease

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15
Q

Treatment for upper airways cough syndrome - post nasal drip?

A

anti- allergics, and nasal decongestants

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16
Q

Gastroesophageal reflux disease

A

anti-reflux therapy with PPi’s

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17
Q

What are the causes of chronic obstructive lung diseases

A

inflammation, bronchoconstriction and secretions (mucus plugs)

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18
Q

What are the types of bronchial asthma

A

associated with allergic reactions - Type 1 hypersensitivity
not associated with specific allergen
exercise induced asthma
asthma associated with COPD

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19
Q

Describe the pathology of allergen mediated asthma

A

Antigen is presented through TH 2 cell to a B cell which induces IgE production and Mast cell activation. This mediates the release of mediators (histamine) and causes the pharmacological effects - bronchoconstriction

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20
Q

Treatment of asthma

A

non-specific reduction of bronchial hypersensitity -
non - pharmacological : stop smoking, weight reduction
pharmacological: corticosteroids
Dilation of narrowed bronchi
mimicking dilators: sympathomimetics
direct acting bronchodilators: methylaxines
Blockade of constrictor transmitter: Anti-cholinergics
Prevention of release of transmitter
- mast cell stabilisers
Antagonism of released transmitter
- leukotriene receptor antagonists

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21
Q

How to prevent an antigen:antibody reaction

A

avoidance of allergen

  • difficult to find
  • insufficient evidence
  • avoidance of tobacco and weight reduction
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22
Q

What do corticosteroids do

A

anti-inflammatory - inhibit influx of inflamm cells, reduce microvascular leakage - decreased oedema
reduce bronchial reactivity - reduce asthma exacerbations and do not relax bronchial smooth muscle

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23
Q

What are the different types of corticosteroids?

A

inhaled and oral

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24
Q

Inhaled corticosteroids - first line for asthma

A

beclomethasone, budesonide
fluticasone, flunisolide, triamcinolone
first line regular therapy - mild to mod asthma

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25
oral corticosteroids - for sever asthma
Prednisolone, methylprednisolone Betamethasone and triamcinolone for severe asthma
26
What are the adverse effects of corticosteroids
Iatrogenic Cushings syndrome - diabetes, hypertension, peptic ulcer, psychosis, delayed puberty Inhibition of hypothalamic pituitary axis Other side effects -oropharyngeal candidiasis -hoarseness: direct effect vocal cords
27
Which corticosteroid produces less side effects
cyclesonide - prodrug
28
How do mast cell stabilisers work and examples?
cromolyn sodium, nedocromil sodium | - inhibit release of mediators - histamine
29
How are mast cell stabilisers administered
by inhalation and very poorly absorbed no effect on bronchial smooth muscle no use in acute bronchospasms
30
When are mast cell stabilisers useful
when taken prophylactically (as a preventative defensive measure) main uses: allergy rhinitis, allergic conjunctivitis side effects: throat irritation, cough, dermatitis, myositis and gastroenteritis
31
What do Leukotriene pathway inhibitors do?
prevents bronchospasms. arachidonic acid produces leukotrienes and prostaglandins. 5 They inhibit Lipoxygenase which cause leukotriene synthesis and leukotriene receptor antagonists block receptors from causing bronchospasms.
32
Inhibition of leukotriene synthesis occurs by
inhibition of 5-lipoxygenase | zileuton - discontinued liver toxicity
33
Inhibition of leukotriene receptors done by
inhibit binding of leukotriene to receptor
34
leukotriene receptor inhibitors
montelukast, zafirlukast
35
When are leukotriene receptor antagonists used?
allergen induced asthma, exercise induced asthma reduce frequency of exacerbations given orally: good for children.
36
Are leukotriene receptor anatagonists useful in acute asthma
nope
37
side effects of leukotriene receptor anatagonists
headache, gastritis, flu-like symptoms
38
commonly used leukotriene receptor anatagonists
montelukast - receptor blocker
39
How is bronchial tone controlled
``` Theophylline and muscarinic antagonists cause bronchodilation. bronchial dilator drugs sympathomimetics parasymptholytic agents - anticholinergic drugs Methylxanthines ```
40
Sympathomimetic
- Act via B2 adrenoceptors selective B2 agonist agents -short acting albuterol, salbutamol - most common terbutaline, fenoterol, metaproterenol Long acting - salmetrol, formetrol Non-selective - adrenaline - use in emergency as subcutaneous injection
41
Selective B2 agonists
``` dose inhalers or nebulisation onset - immediate peak 15-30 mins duration 3-4 hours first line therapy albuterol-salbutamol ```
42
Side effects of selective B 2 agonists
due to b2 receptors in heart muscle and other tissues | - palpitations, tachycardia, cardiac arrhythmias tremor, restlessness, nervousness, hypokalaemia
43
What role do Phosphodiesterase inhibitors play in bronchodilation
decrease in breakdown of cAMP and hence cause dilation
44
Methylxanthines
oral or IV | adjuvant therapy in asthma
45
Adverse effects of methylxanthines
``` palpitations, cardiac arrhythmia, hypotension GI irritation diuresis, hypokalaemia anxiety, headache, seizures therapeutic window - 55-110 mmol/l ```
46
Theophylline
methylxanthine oral: rapid and complete absorption 90% metabolised adjuvant therapy
47
Aminophylline is used for? | and how is it administered?
intravenous | sever asthma
48
What do anti-cholinergic agents do
act via inhibiting musarinic receptors selective type: ipratropium, tiotropium, oxitropium inhibits effects of vagus nerve stimulation
49
How are anti-cholinergics administered and what are the adverse effects?
``` inhalation adjuvant therapy in acute sever asthma, COPD Adverse effects: - airway irritation -anticholinergic effects -GI upset, urinary retention ```
50
long acting anti-cholinergics
tiotropium
51
anti cholinergic - colour
green inhalers
52
corticosteroids - colour
brown inhalers
53
Selective short acting B2 agonists colour
blue inhalers
54
Anti IgE monoclonal antibody
``` Omalizumab inhibits binding of IgE to mast cells Repeat administration - lessens asthma severity -reduces magnitude of response -reduced requirement of steroids -very expensive ```
55
Anti IgE monoclonal antibody example
Omalizumab
56
Ketotifen
Histamine receptor antagonist some anti-asthma effect side effects: drowsiness no proven benefit
57
Magnesium
patients who fail to respond to inhaled bronchodilators | IV infusion
58
Ketamine/ volatile anaesthetic agents
anaesthetic agents bronchodilator properties no role in routine management used in life threatening or near fatal asthma
59
is asthma reversible?
yes it is
60
COPD reversibility
incompletely reversible airway obstruction
61
COPD characteristics
occurs in older patients | progressive worsening over age
62
COPD treatment
approach same as for asthma Anti-muscarinics - more effective than b2 agonists in COPD Smoking cessation - major role in COPD

Respiratory physiology (12 decks)

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