Lecture 17 - Respiratory Drugs

Question 1

What is asthma?

Answer 1

Chronic inflammatory airway disease with intermittent airway obstruction and hyper-reactivity small airways
Its is reversible broth spontaneously and with drugs

Question 2

What is considered controlled asthma?

Answer 2

Minimal symptoms during day and night
Minimal need for reliever
No limitation of physical activity
Normal lung function

Question 3

What is uncontrolled asthma?

Answer 3

The asthma has an impact on a perosns lifestyle restricting their normal activities

Question 4

Before stepping up treatment for asthma, what must be done?

Answer 4

Ensures correct inhaler technique
Ensure adhering to treatment
Remove triggers

Question 5

What is the initial add on therapy if a person has uncontrolled asthma?
According to BTS guidelines

Answer 5

Give Long Acting Beta Agonist (with their inhaled corticosteroids)

Question 6

What is the initial add on therapy for a person with uncontrolled asthma according to NICE guidelines?

Answer 6

Add Leukotriene Receptor Antagoinst instead of LABA (with their Inhaled corticosteroids)

Question 7

What are some examples of inhaled corticosteroids?

Answer 7

Beclometasone
Budesonide
Fluticasone

Question 8

What is the general way that inhaled corticosteroids work?

Answer 8

Pass through plasma membrane, activate cytoplasmic receptors, activated receptor then passes into neucleus to modify transcription

Question 9

What do inhaled corticosteroids do?

Answer 9

Reduces mucosal inflammation
Widens airways
Reduces mucus
Reduces symptoms, exacerbations preventing death

Question 10

What are the adverse drug reactions of inhaled corticosteroids?

Answer 10

Local immunosuppressive action (candidiasis and hoarse voice)

Question 11

What are the contraindications for inhaled corticosteroids?

Answer 11

Pneumonia risk possible in COPD at high doses

Question 12

What are the ADRs for inhaled corticosteroids?

Answer 12

Very few if taken correctly q

Question 13

What is the mechanism of action of steroids?

Answer 13

Go into the nucleus increasing nuclear transcription increasing B2 receptors and anti-inflammatories

Question 14

Why is a poor oral biboavialibaltu for inhaled corticosteroids an advantage?

Answer 14

Means unlikely to have systemic side effects

Question 15

What type of eof receptor do inhaled corticosteroids have a high affinity for?

Answer 15

Glucocorticoid receptor

Question 16

What is a fast short acting B2 agonist?

Answer 16

Salbutamol

Question 17

What is an example of a slow long acting B2 agonist?

Answer 17

Salmeterol

Question 18

What do short acting B2 agonists do?

Answer 18

Reverse bronchoconstriction relieving symptoms (only to be used p.r.n)

Question 19

What do Long Actting B2 agonists do (LABA)?

Answer 19

Add on therapy to inhaled corticosteroids and p.r.n SABA

Prevents bronchoconstriction before exercise and increases mucus clearance by cilia

Question 20

What are the adverse effects of B2 agonists?

Answer 20

Adrenergic fight or flight effects
Tachycardia (palpitations), anxiety and tremor
Inc glycogenolysis and inc renin in kidney

Supraventricular tachycardia

Question 21

What are the contraindications for B2 agonists?

Answer 21

LABA (Salmeterol) should only be taken alongside inhaled corticosteroids
LABA alone can mask airway inflammation and near fatal; and fatal attacks

The tachycardaia may provoke angina

Question 22

Why are combined fixed dose inhalers with Inhaled Corticosteroids and LABA benefical?

Answer 22

Improves adherence

Question 23

What drug must LABA (Salmeterol) always be prescribed alongside with?

Answer 23

Inhaled corticosteroids

Question 24

What are the drug drug interactions of B2 agonists?

Answer 24

B blockers may reduce effects

Question 25

What type of drug is montelukast?

Answer 25

Leukotriene receptor antagonist (LTRA)

Question 26

When is montelukast (Leukotriene receptor antagonist) used?

Answer 26

As an alternative to LABA in the 2nd step in the NICE guidelines for asthmatics

Question 27

What is the mechanism of action for montelukast (Leukotriene receptor antagonist) in asthma?

Answer 27

Leukotrienes are released by mast cells and eosinophils and cause: -bronchoconstriction -inc mucus -oedema By binding to CysLT1 (GPCR) So drug blocks CysLT1 receptor at CYSLTR1

Question 28

What are the adverse drug reactions for montelukast (LTRA)?

Answer 28

Headache, GI disturbance, dry mouth and hyperactivity

Question 29

What are the contraindications and drug-drug interactions for montelukast (LTRA)?

Answer 29

Contra = neuropsychiatric Drug = no major drug reactions

Question 30

What are long acting muscarinic antagonists used for?

Answer 30

Severe asthma COPD

Question 31

What is an example of Long Acting Muscarinic Antagonist?

Answer 31

Tiotropium

Question 32

What is the mechanism of action of Tiotropium (Long Acting Muscarinic Antagonist LAMA)?

Answer 32

Blocks vagally mediated contraction of airway smooth muscle

Question 33

What are the adverse drug reactions for Tiotropium (LAMA)?

Answer 33

Infrequent anticholinergic effects (dry mouth, urinary retention dry eyes)

Question 34

What is the drug Theophylline used for?

Answer 34

Chronic poorly controlled asthma

Question 35

What is the mechanism of action of theophylline?

Answer 35

Antagonises adenosine receptor and inhibts phosphodiesterase (cAMP and cGMP levels rise) so more PKA so more MLCK phosphorylated so less MLC phosphylated so causes LESS BRONCHOCONSTRICTION

Question 36

What are the contraindications for theophylline?

Answer 36

It has a narrow therapeutic index so can cause potentially life threatening complications like arrhythmias

Question 37

What are the drug drug interaction for theophylline?

Answer 37

CYP450 inhibtors so increase concentrations of theophylline

Question 38

When should asthmatic patients self management plans be reviewed?

Answer 38

Following treatment for an exacerbation following a hospital discharge

Question 39

What may be the cause of asthma in elite athletes?

Answer 39

May be exercise induced bronchospasm May be due to cold air or pollutants

Question 40

What is considered acute severe?

Answer 40

Unable to complete sentences Resp rate >25min HR > 110bp/min

Question 41

What is considered life-threatening asthma?

Answer 41

All acute severe asthma symptoms +: Peak flow < 33% Arterial oxygen sats < 92% Silent chest, cyanosis, poor Resp effort, arrhythmia, exhaustion

Question 42

What oxygen saturation is considered acute severe and life threatening asthma?

Answer 42

94% - 98%

Question 43

What are some steroids used for acute severe and life-threatening asthma?

Answer 43

Prednisolone Hydrocortisone

Question 44

What is the method of administration for prednisolone?

Answer 44

Oral

Question 45

What is the method of administration for prednisolone?

Answer 45

Oral

Question 46

What is the method of administration for hydrocortisone (glucocorticoid) ?

Answer 46

IV

Question 47

What is an example of a short acting Muscarinic antagonist (SAMA) for acute severe and life-threatening asthma?

Answer 47

Ipratropium (nebulised)

Question 48

When is IV magnesium sulphate used?

Answer 48

Life threatening asthma

Question 49

What is a short acting Muscarinic antagonist (SAMA)? What is a long acting Muscarinic antagonist (LAMA)?

Answer 49

SAMA = ipratropium LAMA = Tiotropium I comes before T in the alphabet so SAMA = ipratropium

Question 50

What are the 5 steps to managing COPD?

Answer 50

Confirm diagnosis Smoking cessation Breathlessness score Vaccinations Medication

Question 51

What drugs are given in acute exacerbations of COPD?

Answer 51

Nebulised salbutamol And/or Ipratropium

Question 52

If a patient with COPD acute exacerbation is hypercapnic or acidotic, what should drive the nebuliser, air or oxygen?

Answer 52

Nebuliser with salbutamol and ipratropium should be driven by air

Question 53

Why can oral steroids be less effective than in eosinophilic asthma?

Answer 53

Reduced action on neutrophils in many with COPD

Question 54

What are pressurised metered dose inhalers?

Answer 54

Have to inhale and push button (can use spacer to help)

Question 55

What are dry powered inhalers?

Answer 55

Microionisd drug plus carrier powder

Question 56

Why is technique extremely important when taking inhalers?

Answer 56

Drug may not end up in the lungs