RESPIRATORY DRUGS

Question 1

At what concentration is oxygen normally administered and why?

Answer 1

60%

if higher can increase risk of hypoventilation and CO2 retention

Question 2

when is high concentration oxygen administered?

Answer 2

critically ill patients

Question 3

give an example of a beta 2 agonist

Answer 3

Short acting: salbutamol, terbutaline

Long acting: salmeterol, formoterol,

Question 4

give a instances when administration of oxygen should be done with caution/not at all

Answer 4

Type 2 respiratory failure (severe COPD) due to the compensation mechanism

Question 5

how do beta 2 agonists work?

Answer 5

stimulate smooth muscle receptors in lungs and activate cAMP which relaxes smooth muscle - reduces airway resistance

Question 6

Give instances when short and long acting beta 2 agonists are used?

Answer 6

Asthma: short acting are used for relieve of breathlessness but long is used as step 3 treatment for chronic asthma
COPD: short is used for relieving breathlessness and long is used in step 2 of treatment
Hperkalaemia: nebulised salbutamol used in addition with insulin, glucose and calcium gluconate

Question 7

give 4 administration methods for beta 2 agonists

Answer 7

oral
inhaled
IV
nebulised

Question 8

give 3 contraindications for use of beta 2 agonists

Answer 8

Hypersensitivity
pre-existing cardiac tachy-arrythmia
pregnancy (cleft palette)

Question 9

give a cardiac side effect of beta 2 agonists

Answer 9

palpitations/tachycardia

Question 10

give an electrolyte side effect of salbutamol

Answer 10

hypokalaemia

Question 11

give 4 other side effects of beta 2 agonists

Answer 11

fine tremor
nervousness
anxiety
Muscle cramps ( caused by long acting)

Question 12

how do beta 2 agonists interact with beta blockers?

Answer 12

Reduce the effect of beta 2 agonists

Question 13

why should high doses of beta 2 agonists be used cautiously with either diuretics, theophylline or corticosteroids?

Answer 13

can potentiate hypokalemia

Question 14

why should infused beta 2 agonists not be used with methyldopa?

Answer 14

Can cause acute hypotension

Question 15

give an example of an anticholinergic (antimuscarinic)

Answer 15

long acting= tiotropium

Short acting= ipratropium

Question 16

how do antimuscarinic work?

Answer 16

It is competitive inhibitor of acetylcholine on the muscarinic receptor. Which blocks the parasympathetic effects (rest and digest) therefore:
Increase heart rate and conduction
Reduce smooth muscle tone in the respiratory tract
Reduced secretion of glands in the respiratory glands and GI tract
Inthe eye they cause relaxation of the pupillary constrictor and ciliary muscles, causing pupillary dilatation and preventing accommodation,
respectively

Question 17

when are antimuscarinic used?

Answer 17

COPD: short acting is used to relieve breathlessness caused by exercise and long acting is used for prophylaxis of exacerbation and breathlessness

Asthma: short acting is used with conjunction with short beta 2 agonist for acute exacerbation while long acting is used in step 4 treatment of chronic asthma with inhaled corticosteroids and long acting beta 2 agonist

Question 18

how are anticholinergics taken?

Answer 18

capsules inside inhalation device

Question 19

why are anticholinergics contraindicated in narrow angle glaucoma?

Answer 19

can worsen symptoms causing pain, blurred vision and corneal oedema by increase intraocular pressure

Question 20

give a renal side effect of anticholinergics

Answer 20

urinary retention

Question 21

how are anticholinergics metabolised?

Answer 21

barely metabolised, 75% in urine

Question 22

give an example of a corticosteroid

Answer 22

prednisolone, hydrocortisone and dexamethasone

Question 23

what are the effect of corticosteroids?

Answer 23

1) Promote of anti inflammatory genes and inhibitor of pro inflammatory genes
2) Metabolic effect causing glucogensis
3) Mineralocorticoid effects of water and sodium retention and potassium excretion via urine

Question 24

Give 4 examples of when corticosteroids are used

Answer 24

1) Treatment of inflammatory disorders and allergic reaction: anaphylaxis and asthma/COPD
2) suppression of autoimmune disease= IBD or inflammatory arthritis
3) Used in chemotherapy or reduce tumour induced inflammation
4) Hormonal replacement in adrenal insufficiency and hypopituitarism

Question 25

why are corticosteroids contraindicated in chickenpox and shingles?

Answer 25

can make diseases more severe

Question 26

give a contraindication of corticosteroids

Answer 26

systemic fungal infection and immunosuppression

Question 27

Give a GI side effect of corticosteroids

Answer 27

peptic ulcer

Question 28

What is the side effect caused by the mineralocorticoid effects of corticosteroids?

Answer 28

hypertension Oedema Hypokalaemia

Question 29

give an electrolyte side effects of corticosteroids

Answer 29

hypernatraemia and hypokalaemia

Question 30

Give a hormonal/endocrine side effects of corticosteroids

Answer 30

cushingoid state growth suppression in children Adrenal suppression

Question 31

GIve an oral side effect of corticosteroids

Answer 31

oral thrush

Question 32

give a facial side effect of corticosteroids

Answer 32

facial oedema + petichiae

Question 33

how are corticosteroids metabolised?

Answer 33

broken down by and induce cytochrome p450

Question 34

give an example of a mucolytic

Answer 34

carbocysteine and erdosteine

Question 35

how does carbocysteine work?

Answer 35

dissolve mucus and lower viscosity - helps with clearance

Question 36

when are mucolytics used?

Answer 36

COPD bronchiectasis paracetamol overdose

Question 37

give 2 contraindications for use of mucolytics

Answer 37

active peptic ulceration | pregnancy in the first trimester

Question 38

give 2 respiratory side effects for mucolytics

Answer 38

bronchoconstriction | respiratory tract irritation

Question 39

give a systemic side effect for mucolytics

Answer 39

pyrexia

Question 40

give an ENT side effect for mucolytics

Answer 40

rhinorrhoea

Question 41

why shouldn't mucolytics be used with antitussives?

Answer 41

cough suppressants + increased mucus production is a bad combo

Question 42

in what 4 ways does theophylline work?

Answer 42

phosphodiesterase inhibitor - reduces inflammation and innate immunity Adenosine receptor antagonist = reduce inflammation reverse steroid insensitivity reverse effects of oxidative stress

Question 43

give 2 indications for theophylline

Answer 43

COPD | asthma

Question 44

give 4 contraindications for theophylline

Answer 44

active peptic ulcer disease underlying seizure disorders Hepatic impairment Pregnancy --> neonatal irritability and apnoea has been reported

Question 45

give a cardiac side effect for theophyllines

Answer 45

arrhythmias/tachycardia

Question 46

give 2 other side effects of theophyllines

Answer 46

Nausea and vomiting headache dizziness insomnia

Question 47

how is theophylline metabolised?

Answer 47

cytochrome p450

Question 48

When is oxygen administrated?

Answer 48

To increase oxygen tissue delivery for any condition that causes hypoxemia To increase reabsorption of pleural gas in pneumothorax To reduce the half life of carboxyhemoglobin in Carbon monoxide poisoning

Question 49

When is it contradictory to give high flow oxygen?

Answer 49

When the patient has chronic type 2 respiratory failure as the patient has adapted to the hypoxia and hypercapenia

Question 50

What should the aim of oxygen levels be for a patient who has type 2 respiratory failure

Answer 50

88%-92%

Question 51

By giving high flow oxygen to a person with chronic type 2 respiratory failure what is the result?

Answer 51

Disruption to the adaptive state leading to rise in blood co2 levels. Causing respiratory acidosis, impaired consciousness and worsened tissue hypoxia

Question 52

What should long acting beta 2 agonist be administrated with when used for chronic asthma?

Answer 52

Be administrated with inhaled corticosteroids

Question 53

What are the most common side effect of anticholinergics?

Answer 53

Dry mouth and throat irritation

Question 54

What are the metabolic side effects of corticosteroids?

Answer 54

DM Osteoporosis Bone fracture

Question 55

Interaction with what drugs increase risk of peptic ulcers with corticosteroids?

Answer 55

NSAIDS and aspirin. Consider giving gastroprotection

Question 56

Interaction of corticosteroids with what drugs can cause hypokalaemia?

Answer 56

Beta 2 agonist, thiazides and loop diuretics and theophylline

Question 57

What affect does corticosteroids have on vaccines?

Answer 57

Reduce the effect on the immune system

Question 58

What drugs reduce the plasma levels of corticosteroids?

Answer 58

Drug that inhibit cytochrome p450 such as phenytoin and rifampicin

Question 59

What affect does corticosteroid treatment have on adrenal cortisol production?

Answer 59

It causes the supression of pituitary ACTH secretion switching of stimulus for normal adrenal cortisol production

Question 60

What is the effect of prolong corticosteroid treatment on the adrenal glands?

Answer 60

It causes adrenal atropy and prevents endogenous cortisol production

Question 61

What is the risk of sudden withdrawel of long term corticosteroid use?

Answer 61

Patient develops acute addisons crisis with potential cardiovascular collapse

Question 62

What is the treatment for step 1: mild, intermittent asthma?

Answer 62

Short acting Beta 2 agonist = salbutamol

Question 63

What is the step 2 treatment for asthma?

Answer 63

Corticosteroids inhaled such as beclometasone budesonide and fluticasone

Question 64

What is the step 3 treatment for asthma?

Answer 64

Inhaled long-acting beta2 agonists such as salmeterol and formoterol Has to be given with inhaled corticosteroids

Question 65

What improvements does step 3 have to asthma by the indication of long acting beta 2 agonist?

Answer 65

Improves lung function and symptoms and decreases asthma attacks in adults and children.

Question 66

What is step 4 treatment for asthma? | Poor control when you are on inhaled steroids and additional treatment

Answer 66

Long acting muscranics: tiotropium

Question 67

What is step 5 treatment for asthma?

Answer 67

Additional oral steroids such as prednisolone

Question 68

Give examples of 3 inhaled corticosteroids?

Answer 68

beclometasone, budesonide, fluticasone

Question 69

What is the use of inhaled corticosteroids for asthma?

Answer 69

Step 2 to treat airway inflammation and control symptoms

Question 70

When is inhaled corticosteroids used for COPD?

Answer 70

Used to to control symptoms and prevent exacerbations in patients who have severe airflow obstruction

Question 71

With what drugs is inhaled corticosteroids used in conjuction with for COPD?

Answer 71

long-acting | β2-agonist and/or a long-acting antimuscarinic bronchodilator.

Question 72

What is the function of the inhaled corticosteroids?

Answer 72

Reduces mucosal inflammation, widens the airways,and reduces mucus secretion. This improves symptoms and reduces exacerbations in asthma and COPD

Question 73

What are two common side effects of inhaled corticosteroids?

Answer 73

``` Oral candidasis (oral thrush) Hoarse voice ```

Question 74

What side effect can inhaled corticosteroids induce in patients with copd?

Answer 74

pneumonia

Question 75

What is the contradictions for high dose inhaled corticosteroids particularly fluticasone?

Answer 75

For COPD patients as can cause pneumonia | Children= cause growth suppresison

Question 76

how many puffs can a patient take of salbutamol at any one time?

Answer 76

Up to 10 puffs with a minute between each