Resp Flashcards
1
Q
What are bronchodilators
A
Medications which relieve bronchoconstriction caused by conditions that affect air passageways and alveoli.
2
Q
Alpha and beta adrenoceptors and muscarinic acetylcholine receptors (mAChRs) are…
A
G-protein coupled receptors
3
Q
Alpha1 affect
A
Blood vessels, gut, liver, bladder, sweat glands, iris
4
Q
Alpha2 affect
A
Presynaptically on all adrenergic nerve terminals, post-pancreas
5
Q
Beta1 affect
A
Heart muscle, gut, juxtaglomerular apparatus
6
Q
Beta2 affect
A
Bronchioles, skeletal muscle, pancreas, mast cells, liver, uterus
7
Q
Beta3 affect
A
Adipose tissue, heart
8
Q
Alpha1 receptors activate:
A
Phospholipase C (PLC) producing inositol trisphosphate (IP3) and diacylglycerol (DAG)
9
Q
Alpha2 receptors inhibit
A
Adenylate cyclase thus decreasing cyclic adenosine monophosphate (cAMP)
10
Q
All subtypes of beta receptors stimulate…
A
Adenylate cyclase thus increasing cAMP
11
Q
Alpha1 receptor activation results in
A
Vasoconstriction, pupil dilation, decreasing peristalsis and decreasing voiding, sweating, hepatic glycogenolysis
12
Q
Alpha2 receptor activation results in
A
Autoinhibition of transmitter release (NA and acetylcholine receptor release from autonomic nerves)
13
Q
Beta1 receptor activation results in
A
Increased cardiac rate and force, relaxation of GI smooth muscle (decreasing peristalsis), renin release and lipolysis
14
Q
Beta2 receptor activation results in
A
Bronchodilation, vasodilation, relaxation of uterine smooth muscle, hepatic glycogenolysis, increased insulin secretion, fine muscle tremor
15
Q
Beta3 receptor activation results in
A
Lipolysis
16
Q
Selective alpha1 agonists
A
Phenylephrine and oxymetazoline
17
Q
Selective alpha2 agonists
A
Clonidine
18
Q
Selective beta1 agonists
A
Dobutamine
19
Q
Selective beta2 agonists
A
Salbutamol, formoterol, terbutaline and salmeterol used mainly in asthma
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
21
Q
What do beta2 adrenoceptor agonists inhibit
A
Inhibit mediator release from mast cells and decrease mucus production
22
Q
What are the main short-acting drugs in the beta2 adrenoceptor agonist class?
A
Salbutamol and terbutaline
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
24
Q
Characteristics of salbutamol and terbutaline:
A
Rapid onset of action, within a few minutes; effect lasts for 3-5 hours
25
Common AEs of salbutamol and terbutaline:
Fine muscle tremor, headache, palpitations, hypotension due to peripheral vasodilation, hypokalaemia, increase in BGL
26
How long do longer acting beta2 agonists (LABA) produce effects for
Up to 12 hours
27
E.g. of LABA
Salmeterol, formoterol/eformeterol
28
What are LABA used for
To improve resp function in patients with COPD
29
What drugs are not recommended for use in asthma and why?
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)
30
Beta antagonists (e.g. propranolol) can cause...
Wheezing in asthmatics (no effect on airway function in normal individuals) and can precipitate an acute asthma attack
31
How many muscarinic receptor subtypes have been identified?
Five
32
What does M1 act on
Act in the brain on higher cerebral function and peripherally on the parietal cells of the gastric mucosa to increase acid secretion
33
What does M2 act on
Act in the myocardium and decrease HR and the force of contraction
34
What does M3 act on
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)
35
The physiological roles for which muscarinic receptors are unknown?
M4 and M5
36
M1, M3 and M5 receptors activate...
Phospholipase C, hence formation of two secondary messengers (IP3 and DAG) eventually leading to an intracellular increase of calcium and excitation
37
M2 and M4 receptors inhibit
Adenylate cyclase, thereby decreasing the production of the second messenger cAMP leading to inhibition
38
What are muscarinic receptor antagonists referred to as and why?
Generally referred to as parasympatholytic because they selectively reduce or abolish the effects of the peripheral nervous system (PNS)
39
What are the parasympatholytic effects muscarinic receptor antagonists have?
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.
40
Muscarinic antagonists used specifically as an anti-asthmatic are:
Ipratropium (non-selective) and tiotropium (M3 receptor selective) by inhalation
41
Ipratropium and tiotropium side effects:
Dry mouth, urinary retention, facial flushing, constipation, pupil dilation
42
Ipratropium and tiotropium properties:
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
43
What do ipratropium and tiotropium do?
These stop the activity of acetylcholine in the smooth muscle preventing contraction and producing relaxation
44
E.g. of anticholinergics:
Short-acting muscarinic antagonist (SAMA) and long-acting muscarinic antagonist (LAMA)
45
E.g. of SAMA
Inhaled ipratropium
46
What does SAMA do
Blocks the action of acetylcholine thereby inhibiting nerve impulses responsible for involuntary muscle movements and various bodily functions
47
What do LAMA do
Blocks the action of acetylcholine thereby inhibiting nerve impulses responsible for involuntary muscle movements and various bodily functions
48
E.g. of LAMA
Aclidinium, glycopyrronium (inhaled), tiotropium, umeclidinium
49
SAMA and LAMA mode of action
Blocks the action of acetylcholine in bronchial smooth muscle
50
SAMA and LAMA side effects
Dry mouth, throat irritation
51
E.g. of beta2 agonists
Short-acting beta agonists (SABA) and long-acting beta agonists (LABA)
52
For what and when are SABA used
To provide quick relief (rescue inhalant) of asthma symptoms, during periods of acute symptoms and exacerbations
53
E.g. of SABA
Salbutamol and terbutaline
54
For what and when are LABA used
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
55
E.g. of LABA
Formoterol, indacaterol, salmeterol, vilanterol
56
SABA and LABA mode of action
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
57
AEs of SABA and LABA
Dry mouth, throat irritation, tremor, palpitations and headache
58
What are the three pharmacologically active naturally occurring methylxanthines?
Theophylline (tea, coffee), theobromine (cocoa) and caffeine (coffee, tea)
59
What are the methylxanthines used in clinical medicine?
Theophylline and aminophylline
60
What does theophylline do
Produces bronchodilation through enzyme inhibition
61
Side effects of theophylline
Nausea, vomiting, diarrhoea, gastro-oesophageal reflux, headache, insomnia, irritability, anxiety, tremor, palpitations
62
What do mucolytics do
Generally lower (alter) the viscosity of mucus and enhance its transport by activating ciliated epithelium (mucociliary clearance)
63
E.g. of mucolytics
"Bromhexine duro-tuss chest cough liquid", "acetylcysteine mucomyst" and "dornase alfa pulmozyme"
64
What is "Bromhexine duro-tuss chest cough liquid" used for
Used to reduce excess mucus associated with colds, flu, other resp tract infections
65
How is "Bromhexine duro-tuss chest cough liquid" administered
An oral mucolytic agent administered as a liquid or tablet
66
What does "Bromhexine duro-tuss chest cough liquid" act on
Acts on mucus secreting cells to alter the structure of viscous mucus
67
AEs of "Bromhexine duro-tuss chest cough liquid"
Nausea, vomiting, diarrhoea, allergy, severe skin reactions
68
What is "acetylcysteine mucomyst" used for
Used in bronchopulmonary disease (cystic fibrosis), anaesthesia, antidote for paracetamol overdose
69
What does "acetylcysteine mucomyst" do
Reduces viscosity by interfering directly with the chemical composition of mucus
70
AEs of "acetylcysteine mucomyst"
Stomatitis, nausea, bronchospasm
71
What is "dornase alfa pulmozyme" used for
Used to manage resp complications of CF
72
How does "dornase alfa pulmozyme" work
Works by an enzyme that breaks down the DNA of the decaying neutrophils
73
Side effects of "dornase alfa pulmozyme"
Voice alteration, pharyngitis, laryngitis and rash
74
Glucocorticoids are synthesised and released by
The adrenal cortex
75
Glucocorticoids are regulated by
Hypothalamic corticotropin-releasing factor and pituitary adrenocorticotropic hormone (ACTH)
76
What are the main actions of corticosteroids
Enteral effects on metabolism, water and electrolyte balance, negative feedback effects (adenohypophysis and hypothalamus) as well as anti-inflammatory and immunosuppressive effects
77
What can corticosteroids cause when administered early?
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
What can corticosteroids cause when administered later?
Can decrease number and activity of mononuclear cells and fibroblasts, decrease angiogenesis and chronic inflammation but also decrease healing
79
How can corticosteroids be administered
Orally, topically or parentally
80
How are corticosteroids used therapeutically
Therapeutically useful for anti-inflammatory therapy and immunosuppression but can have unwanted metabolic actions
81
What can prolonged use of corticosteroids cause
Prolonged use can cause suppression of response to infection and endogenous glucocorticoid synthesis as well as osteoporosis and iatrogenic Cushing’s syndrome
82
Corticosteroids aren't useful in asthma because
They aren't bronchodilators and are not useful in acute asthma. Clinical effects take days to develop.
83
How is corticosteroid useful in asthma
They have an important role in reducing airway inflammation (oedema, mucus production, bronchoconstriction) in prophylaxis if taken continuously
84
How can corticosteroids be administered in asthma
Inhaled, given orally, IV
85
E.g. of corticosteroids that can be inhaled
Beclomethasone, budesonide, ciclesonide, fluticasone furoate, fluticasone propionate
86
E.g. of corticosteroids that can be taken orally
Prednisolone, dexamethasone
87
E.g. of corticosteroids that can be given via IV
Dexamethasone, hydrocortisone
88
What do corticosteroids do in asthma
Inhibit activation of macrophages and mediator release from eosinophils, reduce the formation of various inflammatory mediators
89
AEs of corticosteroids in asthma
```
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
What is the aim in pharmacological treatment of asthma
Eliminating the causative agent and based on the severity of the asthma
91
Acute asthma treatment goals
Reverse bronchoconstriction and relieve inflammation (if required, oral corticosteroids can also be administered early as part of treatment)
92
Best treatment of chronic asthma
Prevent and avoid known allergens/triggers
93
Chronic asthma meds are
Usually inhaled anti-inflammatory agents like corticosteroids
94
E.g. of chronic asthma meds
LABA and ipratropium used to control persistent bronchospasm and leukotriene receptor antagonists (montelukast and zafirlukast)
95
What are the leukotrienes inflammatory mediators (LTC4, LTD4, LTE3) associated with?
Asthma causing mucus secretion, airway wall oedema and bronchospasm
96
Meds for mild asthma
Use beta2-agonist (salbutamol) as a reusable inhalant.
| A short course of inhaled corticosteroids may be appropriate
97
Meds for moderate asthma
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
Meds for severe asthma
- 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
Meds for chronic bronchitis
Consists of bronchodilators and mucolytics, long acting inhaled beta2-agonists ipratropium, oral theophylline and corticosteroids in the later stages
100
Meds for acute exacerbations of emphysema
Bronchodilators (inhaled) and oral corticosteroids, oxygen therapy
101
Meds for emphysema management
Inhaled anti-cholinergic medications and beta2-agonists
102
When should a pneumonia pt's IV antibiotic therapy be switched to oral therapy?
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
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 doxycycline or macrolide class of antibiotic should be prescribed
104
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)
Resp and antimicrobial meds or fluoroquinolone (restricted PBS scheme) OR penicillin plus doxycycline or a macrolide
105
What med for an outpatient who has regions with over 25% macrolide-resistant S.pneumoniae
Doxycycline or a macrolide
106
What med for an inpatient in the medical unit
Doxycycline or a macrolide
107
What med for an inpatient in ICU
Doxycycline or a macrolide
108
What med for a pt with a Pseudomonas infection
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
What med for a pt with a Pseudomonas infection but pt has a penicillin allergy
Substitute aztreonam for the beta lactam
110
What med for a pt with a community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA)
Add vancomycin or linezolid
111
E.g. of antipneumoccoal, antipseudomonal beta lactams
Imipenem/cilastatin, meropenem (PBS restricted use), cefepime, piperacillin/tazobactam
112
What are the antibiotics used in typical pneumonia
(Broad spectrum)- beta lactams (penicillins and cephalosporins), macrolides (erythromycin), fluoroquinolones
113
How quickly would a pneumonia pt respond to the antibiotics
In 48-72 hours in uncomplicated cases
114
What are the vaccines used to prevent typical pneumonia
Hib vaccine, flu vaccine, pneumococcal vaccine
115
Who is Hib vaccine usually used by
Mainly kids for Haemophilus influenzae type B
116
Who is flu vaccine usually used by
Older people, smokers and people with chronic illness and weakened immune system
117
Who is flu vaccine usually used by
Chronic illness, asplenic (no normal spleen function) patients, transplant recipient
118
What is the treatment for atypical pneumonia
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
What kind of antibiotics for community acquired pneumonia?
Broad spectrum antibiotics
120
How long should the total treatment time for community acquired pneumonia be?
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
Meds for opportunistic pneumonia
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
Meds for CMV, a herpesvirus, that can cause viral pneumonia?
Antiviral medications and high-dose immunoglobulins are used for treatment.
123
Pulmonary oedema treatment depends on
The cause
124
Cardiogenic pulmonary oedema meds are and for:
Pharmacological agents (e.g. diuretics, vasodilators, drugs that improve heart contractions (reverse cause of decreased contractility and increase systolic function))
125
E.g. of cardiogenic pulmonary oedema meds
Dopamine, dobutamine, adrenaline
126
Cardiogenic pulmonary oedema management:
Supportive measures like mechanical ventilation, hemodynamic and CV monitoring with pharmacological agents may be required
127
E.g. of meds for pulmonary oedema
Spironolactone, frusemide, vasodilators and sympathomimetics, dopamine and dobutamine (sympathomimetics)
128
What is spironolactone
Aldosterone antagonist and potassium sparing diuretic
129
What does spironolactone do
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
AEs of spironolactone
Hyperkalaemia
131
What is frusemide and what does it do
The most common diuretic, short acting and rapidly reduces fluid volume. Causes diuresis by reabsorption of sodium and chloride in the ascending limb
132
AEs of frusemide (dose related)
Electrolyte disturbances (hyponatraemia, hypokalaemia, syncope, dehydration, orthostatic hypotension)
133
E.g. of vasodilators
Glyceryl nitrate
134
How can vasodilators and sympathomimetics be administered
Sublingual or IV
135
What do vasodilators and sympathomimetics do?
Dilates vessels addressing the workload on the heart
136
AEs of vasodilators and sympathomimetics
Tachycardia, hypotension, flushing, headache
137
What do dopamine and dobutamine do
Increase CO
138
Dopamine and dobutamine are both
Vasodilators but dopamine is a vasoconstrictor at higher doses and can cause tachycardia and ventricular ectopic beats
139
How is respiratory distress syndrome treated and why
With corticosteroids to accelerate formation of surfactant or a post-natal surfactant (e.g. beractant) into the trachea
140
What can't be used to treat viral croup?
Antibiotics, mucolytics or bronchodilators
141
What could help in some cases of viral croup?
Corticosteroids
142
How is viral croup treated?
Primarily with supportive measures including oxygen, antipyretics and increased fluid intake with careful monitoring
