Respiratory Flashcards
Beclometasone, budesonide
Indication: asthma
- regular preventer when reliver alone not sufficient
Class: inhaled corticosteroid
Action:
- steroid - act at nucelus to modify transcription
- block phospholipids to arachidonate (prostaglandins)
- reduce mucosal inflamation, widen airways, reduce mucus
- reduce symtoms, exacerbations, prevents death
Adverse effects:
- local immunosupressive action - candidiasis, hoarse voice - can wash out mouth
- penumonia risk possible im COPD at high doses
Other:
- high FPM - poor oral bioavailability
- liophilic side chain, slow dissolution in bronchial fluid, high affinity for gluccorticoid receptor
Salbutamol, terbutaline
Indication: asthma
- symptom releif as required
Class: Beta 2 agonist - SABA
Action:
- beta 2, alpha s, cAMP, PKA
- bronchodilation of airway smooth muscle
- increase mucus clearance by cilia
- prevent bronchoconstrction prior to exercise
Adverse effects:
- adrenergic - tachycardia, palpitations, tremor, anxiety, increase glycogenolysis, increase renin
- SVT - increase SAN, HR, decrease refractory period at AVN
- when used regularly can reduce asthma control
- tolerance - down regulation of receptors
Interactions: beta blockers reduce effects
Formoterol, salmeterol
Indication: asthma
- add on therpy to ICS
Class: Beta 2 agonist - LABA
Action:
- beta 2, alpha s, cAMP, PKA
- bronchodilation of airway smooth muscle
- increase mucus clearance by cilia
- prevent bronchoconstrction prior to exercise
Adverse effects:
- adrenergic - tachycardia, palpitations, tremor, anxiety, increase glycogenolysis, increase renin
- SVT - increase SAN, HR, decrease refractory period at AVN
- only prescribed alongside ICS - alone can mask airway inflamation and fatal attacks
Interactions: beta blockers reduce effects
Other:
- formoterol = fast long acting
- salmeterol = slow long acting
Montelukast
Indication: asthma
- alternative to LABA in 2nd step
Class: leukotriene receptor antagonist
Actions:
- block cysLT1 at cysLTR1(gpcr)
- Blocks leukrotiene release from mast cells/eosinophils
- decreases bronchoconstrction, mucus, oedema
Adverse effects:
- headache
- GI distrubance
- dry mouth
- hyperactivity
Other: useful in 15% of asthmatics - most move onto a LABA
Tiotropium
Indication: severe asthma and COPD
Class: long acting muscarinic antagonist - LAMA
Action: blocks vagally mediated contraction of airway smooth muscle (Ach)
Adverse effects:
- Antcholingeric - dry mouth, urinary retention, dry eyes
Theophylline
Indication: poorly controlled asthma
Class: adenosine receptor antagonist
Action: decrease bronchoconstrcition
Route: ORAL
Warnings:
- narrow therapeutic window
- arrythmias
Interactions: CYP450 inhibtors - increase conc of theophylline
Prednisolone
Indication: life threatening asthma
Class: steroid
Action:
- steroid - act at nucelus to modify transcription
- block phospholipids to arachidonate (prostaglandins)
- reduce mucosal inflamation, widen airways, reduce mucus
- reduce symtoms, exacerbations, prevents death
Other:
- oral
- minimum 5 days
- Continue ics alongside
Ipratropium
Indicaton: life threatening asthma
Class: short acting muscarnic antagonist (SAMA)
Action: blocks vagally mediated contraction of airway smooth muscle (Ach)
Other: alongside beta 2 agonist if poor response alone
Aminophylline
Indication: life threatening asthma
Class: adenosine receptor antagonist
Action: decrease bronchoconstrcition
Route: IV
Other:
- near fatal and no sucess with prednislone/ipratropium
- caution if taking p.o theophylline
Asthma management steps
- Low dose ICS + SABA prn
- Low dose ICS/LABA + SABA prn OR
Low dose ICS + LTRA + SABA prn - Medium dose ICS/LABA +SABA prn OR
Maintenance and reliever therapy (stop SABA) - High dose ICS/LABA + SABA + additional therapies
Life threatening asthma management
- Oxygen - 94-98%
- High dose nebulised beta 2 agonist - oxygen driven
- Oral steroids - prednisolone
- Nebulised ipratropium bromide
- IV aminophylline if no success with above
COPD management
Confirm diagnosis, smoking cessation, breathlessness score/ offer pulmonary rehabilitation, vaccination, medication
Medication:
- in acute exacerbations = nebulised salbutamol and/or ipratropium
- oral steroids (less effective than in asthma, eosinophils vs neutrophils)
- antibiotics
