Pharmacology of airways disease

Question 1

How do Beta 2 agonists work?

Answer 1

prevent bronchoconstriction
increase cAMP
smooth muscle relaxation
SABA/LABA

Question 2

Side effects of Beta 2 agonists?

Answer 2

fine tremor
tachycardia/palpitations
hypokalemia

Question 3

How do anticholinergics work?

Answer 3

activating M3 (muscarinic) receptors causes bronchoconstriction, therefore an antagonist prevents this and prevents bronchoconstriction

Question 4

Indications for SAMAs/LAMAs

Answer 4

COPD
severe asthma

Question 5

What does SAMA and LAMA stand for?

Answer 5

short-acting muscarinic antagonist
long-acting muscarinic antagonist

Question 6

SAMA and LAMA examples

Answer 6

SAMA = ipratropium bromide
LAMA = tiotropium, glycopyrronium, aclidinium

Question 7

What are the beneficial effects of corticosteroids in airways disease?

Answer 7

reduce inflammatory mediators
increase anti-inflammatory mediators
reduce eosinophils, macrophages, lymphocytes

Question 8

Adverse effects of corticosteroids

Answer 8

personality changes
hyperglycaemia
CNS irritability
moon face
increased susceptibility to infection
fluid retention
thin skin
GI distress (increased acid)
hirsutism
striae
osteoporosis
bruises + petechiae

Question 9

What should be done in secondary care for uncontrolled asthma?

Answer 9

check it’s asthma
check inhaler technique
consider biologic therapy

Question 10

What is an LTRA?
List some examples

Answer 10

leukotriene receptor antagonist

montelukast
zafirlukast
pranlukast

taken as a tablet - asthma only

Question 11

How does Omalizumab work?

Answer 11

monoclonal antibody
binds circulating IgE

Question 12

How is Omalizumab given?

Answer 12

SC injection every 2-4 weeks

Question 13

How does Mepolizumab work?

Answer 13

monoclonal antibody - blocks IL-5

Question 14

Omalizumab indication

Answer 14

severe/uncontrolled allergic asthma

Question 15

Mepolizumab indication

Answer 15

uncontrolled eosinophilic asthma

Question 16

How do xanthines work?
List some examples

Answer 16

inhibit phosphodiesterase
theophylline, aminophylline
bronchodilatory + anti-inflammatory effects

Question 17

Indication for mucolytics

Answer 17

chronic bronchitis

Question 18

List 3 mucolytic drugs

Answer 18

carbocisteine
erdosteine
mecysteine

Question 19

Benefits of inhaled drug over oral

Answer 19

inhaled drug is delivered where it is required
reduces systemic exposure
reduces systemic adverse effects

Question 20

Name 3 types of inhaler

Answer 20

MDI (metered dose inhaler)
nebuliser
dry powder inhaler

Question 21

Advantages of using a spacer with an inhaler

Answer 21

coordination: delay in inspiration, exhaling through device (valved spacer)

less oropharyngeal deposition
improved lung delivery
comparable efficacy to nebulisers

Question 22

Disadvantages of using a spacer with an inhaler

Answer 22

size
cost
assembling (older people/OA/RA)
electrostatic (newly rinsed = less delivery than used)

Question 23

What should the goal SpO2 be in patients at risk of CO2 retention?

Answer 23

88-92%

Question 24

What is the normal SpO2 goal for patients (not at risk of CO2 retention)?

Answer 24

94-98%