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Medications > Resp > Flashcards

Resp Flashcards

1
Q

What are bronchodilators

A

Medications which relieve bronchoconstriction caused by conditions that affect air passageways and alveoli.

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2
Q

Alpha and beta adrenoceptors and muscarinic acetylcholine receptors (mAChRs) are…

A

G-protein coupled receptors

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3
Q

Alpha1 affect

A

Blood vessels, gut, liver, bladder, sweat glands, iris

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4
Q

Alpha2 affect

A

Presynaptically on all adrenergic nerve terminals, post-pancreas

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5
Q

Beta1 affect

A

Heart muscle, gut, juxtaglomerular apparatus

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6
Q

Beta2 affect

A

Bronchioles, skeletal muscle, pancreas, mast cells, liver, uterus

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7
Q

Beta3 affect

A

Adipose tissue, heart

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8
Q

Alpha1 receptors activate:

A

Phospholipase C (PLC) producing inositol trisphosphate (IP3) and diacylglycerol (DAG)

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9
Q

Alpha2 receptors inhibit

A

Adenylate cyclase thus decreasing cyclic adenosine monophosphate (cAMP)

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10
Q

All subtypes of beta receptors stimulate…

A

Adenylate cyclase thus increasing cAMP

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11
Q

Alpha1 receptor activation results in

A

Vasoconstriction, pupil dilation, decreasing peristalsis and decreasing voiding, sweating, hepatic glycogenolysis

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12
Q

Alpha2 receptor activation results in

A

Autoinhibition of transmitter release (NA and acetylcholine receptor release from autonomic nerves)

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13
Q

Beta1 receptor activation results in

A

Increased cardiac rate and force, relaxation of GI smooth muscle (decreasing peristalsis), renin release and lipolysis

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14
Q

Beta2 receptor activation results in

A

Bronchodilation, vasodilation, relaxation of uterine smooth muscle, hepatic glycogenolysis, increased insulin secretion, fine muscle tremor

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15
Q

Beta3 receptor activation results in

A

Lipolysis

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16
Q

Selective alpha1 agonists

A

Phenylephrine and oxymetazoline

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17
Q

Selective alpha2 agonists

A

Clonidine

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18
Q

Selective beta1 agonists

A

Dobutamine

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19
Q

Selective beta2 agonists

A

Salbutamol, formoterol, terbutaline and salmeterol used mainly in asthma

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20
Q

The drug class of choice for an immediate phase asthmatic attack and what does it do?

A

Beta2 adrenoceptor agonist- dilate the bronchi by a direct action on the beta2 adrenoceptors in the bronchial smooth muscle causing relaxation

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21
Q

What do beta2 adrenoceptor agonists inhibit

A

Inhibit mediator release from mast cells and decrease mucus production

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22
Q

What are the main short-acting drugs in the beta2 adrenoceptor agonist class?

A

Salbutamol and terbutaline

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23
Q

How are salbutamol and terbutaline administered?

A

Typically administered by inhalation (aerosol, powder, nebuliser) but can be given by IV in severe attacks

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24
Q

Characteristics of salbutamol and terbutaline:

A

Rapid onset of action, within a few minutes; effect lasts for 3-5 hours

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25
Q

Common AEs of salbutamol and terbutaline:

A

Fine muscle tremor, headache, palpitations, hypotension due to peripheral vasodilation, hypokalaemia, increase in BGL

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26
Q

How long do longer acting beta2 agonists (LABA) produce effects for

A

Up to 12 hours

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27
Q

E.g. of LABA

A

Salmeterol, formoterol/eformeterol

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28
Q

What are LABA used for

A

To improve resp function in patients with COPD

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29
Q

What drugs are not recommended for use in asthma and why?

A

Drugs acting on both beta 1 and 2 (e.g. adrenaline and isoprenaline) are not recommended for use in asthma as they may lead to cardio-acceleration, anginal attack and myocardial infarction (MI)

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30
Q

Beta antagonists (e.g. propranolol) can cause…

A

Wheezing in asthmatics (no effect on airway function in normal individuals) and can precipitate an acute asthma attack

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31
Q

How many muscarinic receptor subtypes have been identified?

A

Five

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32
Q

What does M1 act on

A

Act in the brain on higher cerebral function and peripherally on the parietal cells of the gastric mucosa to increase acid secretion

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33
Q

What does M2 act on

A

Act in the myocardium and decrease HR and the force of contraction

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34
Q

What does M3 act on

A

Affect exocrine glands and visceral smooth muscle, pupil constriction, increase gut motility and secretion of digestive juices, promote voiding and defecation as well as secretion from exocrine glands (lacrimation, salivation, sweating)

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35
Q

The physiological roles for which muscarinic receptors are unknown?

A

M4 and M5

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36
Q

M1, M3 and M5 receptors activate…

A

Phospholipase C, hence formation of two secondary messengers (IP3 and DAG) eventually leading to an intracellular increase of calcium and excitation

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37
Q

M2 and M4 receptors inhibit

A

Adenylate cyclase, thereby decreasing the production of the second messenger cAMP leading to inhibition

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38
Q

What are muscarinic receptor antagonists referred to as and why?

A

Generally referred to as parasympatholytic because they selectively reduce or abolish the effects of the peripheral nervous system (PNS)

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39
Q

What are the parasympatholytic effects muscarinic receptor antagonists have?

A

Inhibition of secretions- salivary, lacrimal, bronchial and sweat glands.
HR- modest tachycardia.
Eye- pupil dilation, unresponsive to light (blurred vision).
GI tract- reduced GI motility (constipation).
Other smooth muscle- bronchial, biliary, urinary tract smooth muscle dilation (bronchodilation, smooth muscle relaxation, decreased voiding).
CNS- high doses cause agitation and disorientation.

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40
Q

Muscarinic antagonists used specifically as an anti-asthmatic are:

A

Ipratropium (non-selective) and tiotropium (M3 receptor selective) by inhalation

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41
Q

Ipratropium and tiotropium side effects:

A

Dry mouth, urinary retention, facial flushing, constipation, pupil dilation

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42
Q

Ipratropium and tiotropium properties:

A

o Maximum effect is after 30 minutes
o Lasts 3-5 hours
o Can be useful as an adjunct to another therapy (when a beta2 agonist alone is inadequate) to help with bronchodilation and reduce mucus secretion
o Not absorbed well into circulation so there is minimal action on muscarinic receptors in locations other than the bronchi

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43
Q

What do ipratropium and tiotropium do?

A

These stop the activity of acetylcholine in the smooth muscle preventing contraction and producing relaxation

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44
Q

E.g. of anticholinergics:

A

Short-acting muscarinic antagonist (SAMA) and long-acting muscarinic antagonist (LAMA)

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45
Q

E.g. of SAMA

A

Inhaled ipratropium

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46
Q

What does SAMA do

A

Blocks the action of acetylcholine thereby inhibiting nerve impulses responsible for involuntary muscle movements and various bodily functions

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47
Q

What do LAMA do

A

Blocks the action of acetylcholine thereby inhibiting nerve impulses responsible for involuntary muscle movements and various bodily functions

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48
Q

E.g. of LAMA

A

Aclidinium, glycopyrronium (inhaled), tiotropium, umeclidinium

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49
Q

SAMA and LAMA mode of action

A

Blocks the action of acetylcholine in bronchial smooth muscle

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50
Q

SAMA and LAMA side effects

A

Dry mouth, throat irritation

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51
Q

E.g. of beta2 agonists

A

Short-acting beta agonists (SABA) and long-acting beta agonists (LABA)

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52
Q

For what and when are SABA used

A

To provide quick relief (rescue inhalant) of asthma symptoms, during periods of acute symptoms and exacerbations

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53
Q

E.g. of SABA

A

Salbutamol and terbutaline

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54
Q

For what and when are LABA used

A

Taken daily (maintenance inhalant) to relax the muscles lining the airways that carry air to the lungs, used to achieve and maintain prophylactic control of persistent asthma

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55
Q

E.g. of LABA

A

Formoterol, indacaterol, salmeterol, vilanterol

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56
Q

SABA and LABA mode of action

A

Both stimulate beta2 adrenergic receptors in the smooth muscle of bronchi and bronchioles. These receptors in turn stimulate the enzyme adenyl cyclase to increase production of cAMP which produces bronchodilation

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57
Q

AEs of SABA and LABA

A

Dry mouth, throat irritation, tremor, palpitations and headache

58
Q

What are the three pharmacologically active naturally occurring methylxanthines?

A

Theophylline (tea, coffee), theobromine (cocoa) and caffeine (coffee, tea)

59
Q

What are the methylxanthines used in clinical medicine?

A

Theophylline and aminophylline

60
Q

What does theophylline do

A

Produces bronchodilation through enzyme inhibition

61
Q

Side effects of theophylline

A

Nausea, vomiting, diarrhoea, gastro-oesophageal reflux, headache, insomnia, irritability, anxiety, tremor, palpitations

62
Q

What do mucolytics do

A

Generally lower (alter) the viscosity of mucus and enhance its transport by activating ciliated epithelium (mucociliary clearance)

63
Q

E.g. of mucolytics

A

“Bromhexine duro-tuss chest cough liquid”, “acetylcysteine mucomyst” and “dornase alfa pulmozyme”

64
Q

What is “Bromhexine duro-tuss chest cough liquid” used for

A

Used to reduce excess mucus associated with colds, flu, other resp tract infections

65
Q

How is “Bromhexine duro-tuss chest cough liquid” administered

A

An oral mucolytic agent administered as a liquid or tablet

66
Q

What does “Bromhexine duro-tuss chest cough liquid” act on

A

Acts on mucus secreting cells to alter the structure of viscous mucus

67
Q

AEs of “Bromhexine duro-tuss chest cough liquid”

A

Nausea, vomiting, diarrhoea, allergy, severe skin reactions

68
Q

What is “acetylcysteine mucomyst” used for

A

Used in bronchopulmonary disease (cystic fibrosis), anaesthesia, antidote for paracetamol overdose

69
Q

What does “acetylcysteine mucomyst” do

A

Reduces viscosity by interfering directly with the chemical composition of mucus

70
Q

AEs of “acetylcysteine mucomyst”

A

Stomatitis, nausea, bronchospasm

71
Q

What is “dornase alfa pulmozyme” used for

A

Used to manage resp complications of CF

72
Q

How does “dornase alfa pulmozyme” work

A

Works by an enzyme that breaks down the DNA of the decaying neutrophils

73
Q

Side effects of “dornase alfa pulmozyme”

A

Voice alteration, pharyngitis, laryngitis and rash

74
Q

Glucocorticoids are synthesised and released by

A

The adrenal cortex

75
Q

Glucocorticoids are regulated by

A

Hypothalamic corticotropin-releasing factor and pituitary adrenocorticotropic hormone (ACTH)

76
Q

What are the main actions of corticosteroids

A

Enteral effects on metabolism, water and electrolyte balance, negative feedback effects (adenohypophysis and hypothalamus) as well as anti-inflammatory and immunosuppressive effects

77
Q

What can corticosteroids cause when administered early?

A

A reduction in the acute inflammatory response by inhibiting mast cell degranulation, decrease in inflammatory mediators, cause vasoconstriction, reduced exudation, decrease in number and activity of leucocytes and macrophages

78
Q

What can corticosteroids cause when administered later?

A

Can decrease number and activity of mononuclear cells and fibroblasts, decrease angiogenesis and chronic inflammation but also decrease healing

79
Q

How can corticosteroids be administered

A

Orally, topically or parentally

80
Q

How are corticosteroids used therapeutically

A

Therapeutically useful for anti-inflammatory therapy and immunosuppression but can have unwanted metabolic actions

81
Q

What can prolonged use of corticosteroids cause

A

Prolonged use can cause suppression of response to infection and endogenous glucocorticoid synthesis as well as osteoporosis and iatrogenic Cushing’s syndrome

82
Q

Corticosteroids aren’t useful in asthma because

A

They aren’t bronchodilators and are not useful in acute asthma. Clinical effects take days to develop.

83
Q

How is corticosteroid useful in asthma

A

They have an important role in reducing airway inflammation (oedema, mucus production, bronchoconstriction) in prophylaxis if taken continuously

84
Q

How can corticosteroids be administered in asthma

A

Inhaled, given orally, IV

85
Q

E.g. of corticosteroids that can be inhaled

A

Beclomethasone, budesonide, ciclesonide, fluticasone furoate, fluticasone propionate

86
Q

E.g. of corticosteroids that can be taken orally

A

Prednisolone, dexamethasone

87
Q

E.g. of corticosteroids that can be given via IV

A

Dexamethasone, hydrocortisone

88
Q

What do corticosteroids do in asthma

A

Inhibit activation of macrophages and mediator release from eosinophils, reduce the formation of various inflammatory mediators

89
Q

AEs of corticosteroids in asthma

A 
o	infection of candida albicans in the pharynx (thrush) due to immunosuppression of the pharyngeal mucosa
o	dysphonia
o	bruising
o	sodium and water retention
o	oedema
o	hypertension
o	hypokalaemia
o	hyperglycaemia
o	diabetes
o	dyslipidaemia
o	osteoporosis
o	psychiatric effects
90
Q

What is the aim in pharmacological treatment of asthma

A

Eliminating the causative agent and based on the severity of the asthma

91
Q

Acute asthma treatment goals

A

Reverse bronchoconstriction and relieve inflammation (if required, oral corticosteroids can also be administered early as part of treatment)

92
Q

Best treatment of chronic asthma

A

Prevent and avoid known allergens/triggers

93
Q

Chronic asthma meds are

A

Usually inhaled anti-inflammatory agents like corticosteroids

94
Q

E.g. of chronic asthma meds

A

LABA and ipratropium used to control persistent bronchospasm and leukotriene receptor antagonists (montelukast and zafirlukast)

95
Q

What are the leukotrienes inflammatory mediators (LTC4, LTD4, LTE3) associated with?

A

Asthma causing mucus secretion, airway wall oedema and bronchospasm

96
Q

Meds for mild asthma

A

Use beta2-agonist (salbutamol) as a reusable inhalant.

A short course of inhaled corticosteroids may be appropriate

97
Q

Meds for moderate asthma

A

Salbutamol (5-10mg; 8 puffs every 15 mins for 3 doses) used initially with corticosteroids (50mg oral prednisolone, 250mg hydrocortisone) and then reviewed an hour after last dose (O2 therapy may be required)

98
Q

Meds for severe asthma

A
  • Oxygen required to maintain SpO2 at >92%
  • Continuous beta2-agonists administered intravenously and corticosteroids/ipratropium
  • In cases of status asthmatics, where asthma attacks follow one another without pause, intubation is typically required
99
Q

Meds for chronic bronchitis

A

Consists of bronchodilators and mucolytics, long acting inhaled beta2-agonists ipratropium, oral theophylline and corticosteroids in the later stages

100
Q

Meds for acute exacerbations of emphysema

A

Bronchodilators (inhaled) and oral corticosteroids, oxygen therapy

101
Q

Meds for emphysema management

A

Inhaled anti-cholinergic medications and beta2-agonists

102
Q

When should a pneumonia pt’s IV antibiotic therapy be switched to oral therapy?

A

As soon as the pt is:
o hemodynamically stable
o improving clinically
o able to ingest oral medication and has a normally functioning gastrointestinal (GI) tract.

103
Q

What med for an outpatient who was previously healthy and had no recent antibiotic therapy in the past 3 months and no risk for medication-resistant staph pneumoniae (DRSP)

A

A doxycycline or macrolide class of antibiotic should be prescribed

104
Q

What med for an outpatient who has comorbidities (e.g. COPD; diabetes; chronic liver, heart, lung of renal disease; malignancy; use of antibiotics in past 3 months)

A

Resp and antimicrobial meds or fluoroquinolone (restricted PBS scheme) OR penicillin plus doxycycline or a macrolide

105
Q

What med for an outpatient who has regions with over 25% macrolide-resistant S.pneumoniae

A

Doxycycline or a macrolide

106
Q

What med for an inpatient in the medical unit

A

Doxycycline or a macrolide

107
Q

What med for an inpatient in ICU

A

Doxycycline or a macrolide

108
Q

What med for a pt with a Pseudomonas infection

A

Antipneumococcal, antipseudomonal beta lactam plus either ciprofllaxin or levofloxacin OR antipneumococcal, antipseudomonal beta lactam plus aminoglycoside and azithromycin OR antipneumococcal, antipseudomonal beta lactam plus an aminoglycoside and an antipneumococcal fluoroquinolone (restricted PBS scheme)

109
Q

What med for a pt with a Pseudomonas infection but pt has a penicillin allergy

A

Substitute aztreonam for the beta lactam

110
Q

What med for a pt with a community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA)

A

Add vancomycin or linezolid

111
Q

E.g. of antipneumoccoal, antipseudomonal beta lactams

A

Imipenem/cilastatin, meropenem (PBS restricted use), cefepime, piperacillin/tazobactam

112
Q

What are the antibiotics used in typical pneumonia

A

(Broad spectrum)- beta lactams (penicillins and cephalosporins), macrolides (erythromycin), fluoroquinolones

113
Q

How quickly would a pneumonia pt respond to the antibiotics

A

In 48-72 hours in uncomplicated cases

114
Q

What are the vaccines used to prevent typical pneumonia

A

Hib vaccine, flu vaccine, pneumococcal vaccine

115
Q

Who is Hib vaccine usually used by

A

Mainly kids for Haemophilus influenzae type B

116
Q

Who is flu vaccine usually used by

A

Older people, smokers and people with chronic illness and weakened immune system

117
Q

Who is flu vaccine usually used by

A

Chronic illness, asplenic (no normal spleen function) patients, transplant recipient

118
Q

What is the treatment for atypical pneumonia

A

Supportive therapy oxygen therapy, hydration (IV fluids), fever management (antipyretic therapy) and possibly macrolides
Antiviral agents may be prescribed in severe infections and immunocompromised patients (famciclovir)

119
Q

What kind of antibiotics for community acquired pneumonia?

A

Broad spectrum antibiotics

120
Q

How long should the total treatment time for community acquired pneumonia be?

A

Minimum 5 days, pt should be afebrile for 48-72 hours before stopping treatment, but treatment could be longer if there are complications or the initial therapy was not active against the identified pathogen

121
Q

Meds for opportunistic pneumonia

A

Treatment consists of a course of trimethoprim/sulfamethoxazole (Bactrim), either IV or orally depending on the severity of disease and the patient’s response

122
Q

Meds for CMV, a herpesvirus, that can cause viral pneumonia?

A

Antiviral medications and high-dose immunoglobulins are used for treatment.

123
Q

Pulmonary oedema treatment depends on

A

The cause

124
Q

Cardiogenic pulmonary oedema meds are and for:

A

Pharmacological agents (e.g. diuretics, vasodilators, drugs that improve heart contractions (reverse cause of decreased contractility and increase systolic function))

125
Q

E.g. of cardiogenic pulmonary oedema meds

A

Dopamine, dobutamine, adrenaline

126
Q

Cardiogenic pulmonary oedema management:

A

Supportive measures like mechanical ventilation, hemodynamic and CV monitoring with pharmacological agents may be required

127
Q

E.g. of meds for pulmonary oedema

A

Spironolactone, frusemide, vasodilators and sympathomimetics, dopamine and dobutamine (sympathomimetics)

128
Q

What is spironolactone

A

Aldosterone antagonist and potassium sparing diuretic

129
Q

What does spironolactone do

A

Decrease reticulation volume by diuresis by inhibiting sodium absorption in the distal tubule by blocking sodium channels and aldosterone. This causes an increase in sodium excretion and thus fluid.

130
Q

AEs of spironolactone

A

Hyperkalaemia

131
Q

What is frusemide and what does it do

A

The most common diuretic, short acting and rapidly reduces fluid volume. Causes diuresis by reabsorption of sodium and chloride in the ascending limb

132
Q

AEs of frusemide (dose related)

A

Electrolyte disturbances (hyponatraemia, hypokalaemia, syncope, dehydration, orthostatic hypotension)

133
Q

E.g. of vasodilators

A

Glyceryl nitrate

134
Q

How can vasodilators and sympathomimetics be administered

A

Sublingual or IV

135
Q

What do vasodilators and sympathomimetics do?

A

Dilates vessels addressing the workload on the heart

136
Q

AEs of vasodilators and sympathomimetics

A

Tachycardia, hypotension, flushing, headache

137
Q

What do dopamine and dobutamine do

A

Increase CO

138
Q

Dopamine and dobutamine are both

A

Vasodilators but dopamine is a vasoconstrictor at higher doses and can cause tachycardia and ventricular ectopic beats

139
Q

How is respiratory distress syndrome treated and why

A

With corticosteroids to accelerate formation of surfactant or a post-natal surfactant (e.g. beractant) into the trachea

140
Q

What can’t be used to treat viral croup?

A

Antibiotics, mucolytics or bronchodilators

141
Q

What could help in some cases of viral croup?

A

Corticosteroids

142
Q

How is viral croup treated?

A

Primarily with supportive measures including oxygen, antipyretics and increased fluid intake with careful monitoring

Medications (10 decks)

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