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MLA - Pharmacology Revision > Respiratory Drugs > Flashcards

Respiratory Drugs Flashcards

1
Q

What types of bronchodilator drugs are there?

A

Β-2 agonists - short and long acting = SABA and LABA

Muscarinic antagonists - short and long acting = SAMA and LAMA

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2
Q

Give examples of
- SABA
- LABA
- SAMA
- LAMA

A

SABA = Salbutamol (Ventolin), Terbutaline (Bricanyl)
LABA = Formoterol and Salmeterol

SAMA = Ipratropium bromide,
LAMA = Tiotropium, aclidinium bromide

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3
Q

Give an example of a phosphodiesterase inhibitor

A

Theophylline, aminophylline

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4
Q

Given an example of a leukotriene inhibitor

A

Montelukast

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5
Q

Which penicillin is used in respiratory problems?

A

Amoxicillin
Flucloxacillin

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6
Q

Which B-lactam AB is used for respiratory problems?

A

Co-Amox

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7
Q

Which glycopeptide AB is used for respiratory problems?

A

Vancomycin

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8
Q

Which cephalosporins are used for respiratory problems?

A

Cephalexin, Ceftriaxone, Ceftazidime

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9
Q

Which tetracycline is used for respiratory problems?

A

Doxycycline

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10
Q

Which macrolide is used for respiratory problems?

A

Clarithyromycin, Erythromycin

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11
Q

Which aminoglycoside AB is used for respiratory problems?

A

Gentamicin

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12
Q

Which quinolone is used for respiratory problems?

A

Ciprofloxacin

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13
Q

Which nitromidazole AB is used for respiratory problems?

A

Metronidazole

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14
Q

Which antifungals are used in respiratory illness?

A

Amphotericin B
Fluconazole

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15
Q

Which Anti-TB drugs are used?

A

Isoniazid
Rifampicin
Ethambutol
Pyrazinamide

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16
Q

What is the difference between β 2 adrenoreceptors in the airways and muscarinic cholinergic receptors?

A

Β-2 cause bronchodilator when activated - therefore want to use β 2 agonists - part of the SS (NOR)

Muscarinics cause bronchoconstriction when activated - therefore want to use muscarinic antagonist drugs - part of the PSS (ACh) system

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17
Q

How can you differentiate asthma and COPD?

A

Asthma - has variable obstruction - and can be treated as obstruction is reversible. Patients should be well in between exacerbations.

COPD = progressive airflow obstruction that is not fully reversible and does not change much. Ps are symptomatic most of the time.

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18
Q

What is the advantages and disadvantages of the following methods of drug administration:
- Inhaled
- Oral
- IV

A

Inhaled = direct deposition into lungs (adv) but very technique dependent

Oral = not technique dependent (adv) but dependant on absorption in gut

IV = systemic effects, not technique dependant (adv) but more side effects.

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19
Q

How efficient are inhalers?

A

Not very - only between 8-15% of the drug actually reaches the lung, no matter how good the inhaler technique is

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20
Q

What factors determine particle deposition in the lungs?

A

Size of particle (smaller goes further - although too small and they get expired)

Inspiratory flow rate

Distance needed for the particle to travel (determined by method of inhalation)

21
Q

What is salbutamol given for?

How can it be given?

A

Relief of symptoms of asthma, BET and COPD - breathlessness, chest tightness and wheeze

Via inhaler or nebuliser

22
Q

What is salbutamol given with for exacerbations in hospital?

A

6L of O2 (asthma) and 6L air (COPD)

23
Q

What is the onset of salbutamol? How long does it last for?

A

Within 10 mins
Lasts for 3-5 hours

24
Q

What are the side effects of salbutamol?

A

Tachycardia
Tremor
Agitation
Due to activation of β receptors in heart and skeletal muscle

If given IV (rare) - get tachyarrythmias, angina - need cardiac monitoring

25
Q

What is the onset of action and duration of Salmeterol?

What is it used in combination with?

What is it used for?

A

Onset = 30 mins

Duration = 10-12 hours

Used in combo with ICS or LAMA

Used for treatment of asthma and COPD

26
Q

What is the onset of action of formoterol?

How long does it last?

What is it used in combination with?

What is it used for?

A

Rapid onset - like salbutamol

Duration = 10-12 hrs

Always used in combo with ICS or LAMA

Used for treatment of asthma and COPD

27
Q

How does Ipratropium bromide work?

A

Blocks M3 receptors in smooth muscle of airways

28
Q

What is the onset of action of Ipratropium bromide? How long does it last?

When is it used?

What does it do?

A

Onset = 30 minutes
Lasts - 6 hours - QDS
Used in inhaler for COPD and nebuliser for asthma or COPD exacerbations

Reduced mucus production and has weaker bronchodilator effect than SABA

29
Q

What is the duration of action of tiotropium and aclidinium?

What do they do?
How are given and what for?

A

12-24 hours

Cause bronchodilation, reduce bronchospasm and decrease mucus production.

Given in inhaler - used for COPD and chronic asthma

30
Q

What are the side effects of SAMA and LAMAs?

A

Ancholinergic side effects

Dry mouth
Blurred vision
Closed-angle glaucoma
Urinary retention
Cardiac arrythmias
Taste disturbance
Dizziness
Epistaxis

31
Q

Which steroids are given for respiratory exacerbations via the following routes:

Oral

Inhaled (ICS)

IV

A

Oral = prednisolone, dexamethasone

ICS = beclomethasone, fluticasone, budesonide

IV = methylprednisolone, hydrocortisone

32
Q

What are some common side effects of inhaled steroids?

How can you reduce these?

A

Oral candidiasis
Dysphonia

Gargle after use
Use spacer (reduces deposition in throat)

33
Q

Name three types of inhaler devices

A

Pressurised metered dose inhalers (pMDI)
Dry powder inhalers
Soft mist inhalers

34
Q

What is important to remember about methylxanthine medications?

A

Need monitoring of serum levels - as they have a narrow therapeutic range

35
Q

How does montelukast work?

A

Blocks leukotrienes from working - thereby reducing inflammation and causes bronchodilation

36
Q

When is montelukast prescribed?

A

On step 3 of the asthma ladder - not optimally controlled by ICS + LABA..

Use for asthma induced by exercise, allergens (high IgE), cold air and aspirin

37
Q

When are biologics used for asthma?

A

When P has severe or eosinophilic asthma - in Step 4 or 5 of the asthma ladder.

38
Q

Name some mucolytic agents that are used for COPD, BET and CF

A

Carbocisteine
N-acetyl cysteine (NAC)

39
Q

What are the side effects of mucolytic agents?

A

Gastric ulcers, abdo discomfort and diarrhoea

40
Q

How is asthma managed?

A

Avoid allergens and smoking
Use inhaled therapy
Complete personalised asthma self-management plan
Regulare reviews
Stepwise approach up and down the asthma ladder

41
Q

How should you treat an acute asthma exacerbation in hospital?

A

ABC approach
Maintain SpO2 >92% (give O2 6L/min - Hudson mask)
ABGs - and monitor. Rising CO2 = indicates deterioration - escalate
CXR - exclude pneumothorax, consolidation etc
Peak flow - can help decide if admission / discharge needed

Can give nebulised salbutamol and ipratropium bromide (work synergistically) - produces greater bronchodilation than one drug alone.

Give systemic steroids (IV hydrocortisone or oral prednisolone) - reduces mortality.

If v severe - can give IV mag sulphate and IV aminophylline

ABs if chest infection

IV fluids and K+ if hypokalaemia

42
Q

How does magnesium sulphate work for asthma?

A

It is a bronchodilator - it stabilises T-cells and reduces inflammatory markers

43
Q

What pharmacological management can be given for COPD?

A

Inhaled therapy
LTOT
Non-invasive ventilation

44
Q

What surgical management can be given for COPD?

A

Lung volume reduction surgery (removes parts that are not ventilating - thereby improving the ventilation of the rest of the lung)
Lung transplant

45
Q

Which drug class is being debated about its use in COPD?

A

Inhaled corticosteroids

46
Q

What is the scale for measuring severity of COPD?

A

mMRC Dyspnoea Scale

47
Q

What management are patients given in hospital for COPD exacerbations?

A

CXR - exclude other causes
Nebuliser - SABA and LAMA (salbutamol and ipratropium bromide)
Oral or IV steroids (prednisolone or hydrocortisone)
Controlled O2 - check ABGs and get baseline O2 level
IV aminophylline if needed
ABs and mucolytics
NIV for T2RF
LMWH as DVT prophylaxis
Nutrition and early physio

48
Q
A

MLA - Pharmacology Revision (12 decks)

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