Respiratory Drugs Flashcards
What is an example of a Beta-Adrenergic Bronchodilator?
Salbutamol,
Salmeterol
What is the mechanism of action for salbutamol
Short-acting Beta-2 adrenoceptor agonists (SABA)
Relaxes bronchial smooth muscle, inducing bronchodilation.
Inhibit pro-inflammatory cytokine release from mast cells and TNF-α release from monocytes, reducing airway inflammation.
Increase mucus clearance from the airways by stimulating cilia action.
What are the main indications of salbutamol and salmeterol
asthma
COPD
List some side effects of salbutamol and salmeterol
Tremor
Tachycardia / cardiac dysrhythmia
Headache
Sleep disturbances
What is important clinically regarding Pharmacokinetics/dynamics for salbutamol
Only a small % of inhaled drug reaches target in the airways – a spacer may improve drug delivery
What information should you tell the patient before starting salbutamol
Check inhaler technique, review the need for spacer / nebuliser.
In exercise-induced-asthma, a dose immediately before exercise can reduce incidence of symptoms.
If required more than once daily, treatment needs reviewed.
What is the mechanism of action for salmeterol
Long-acting Beta-2 adrenoceptor agonist (LABA)
Relaxes bronchial smooth muscle, inducing bronchodilation.
Inhibit pro-inflammatory cytokine release from mast cells and TNF-α release from monocytes, reducing airway inflammation.
Increase mucus clearance from the airways by stimulating cilia action.
What is important clinically regarding Pharmacokinetics/dynamics for salmeterol
Not to be commenced in patients with rapidly deteriorating asthma – slower onset of action than SABA’s.
What information should you tell the patient before starting salmeterol
Report any deterioration in symptoms following initiation of LABA.
Do not exceed stated dose.
Seek medical advice when stated dose fails to control symptoms.
what are 2 examples of Anti-Muscarinic Bronchodilators?
Tiotropium
Ipratropium Bromide
What is the MoA for anti-muscarinic bronchodilators?
Muscarinic receptor (M3) antagonists producing bronchodilatory effects. Reduces mucus secretion and may increase bronchial mucus clearance by stimulating cilia.
What are the main indications for Tiotropium and Ipratropium Bromide
Asthma
COPD
Rhinitis
List some side effects of Tiotropium and Ipratropium Bromide
dry mouth
cough
constipation
What is important clinically regarding Pharmacokinetics/dynamics for anti-muscarinic bronchodilators
Inhaled and poorly absorbed into the circulation – unable to affect systemic muscarinic/cholinergic receptors
Nebulised Ipratropium Bromide should always be administered via a mouth piece to minimize the risk of acute angle closure glaucoma.
What information should you tell the patient before starting an anti-muscarinic bronchodilator
Good inhaler technique improves efficacy.
Cough may arise
what is an example of inhaled corticosteroids?
Beclomethasone
what is the MoA for beclomethasone?
Anti-inflammatory effect on the airways.
Decrease formation of pro-inflammatory cytokines.
Up-regulates beta-2-adrenoreceptors in airways.
what are the indications for inhaled corticosteroids?
treatment of COPD and asthma
List some side effects of beclomethasone:
oral candidiasis
adrenal suppression
osteoporosis
what is important clinically regarding Pharmacokinetics/dynamics for inhaled corticosteroids
Takes several weeks to months for full effects of therapy.
Spacer devices can reduce risk of thrush and improve drug delivery.
What information should you tell the patient before starting beclomethasone
If on higher dose, carry a steroid card.
Increase dose during periods of illness.
what are some examples of anti-histamines? (H1 receptor antagonists)
Chlorpheniramine
Desloratidine
Fexofenadine
Hydroxyzine
what is the MoA of anti-histamines (H1 receptor antagonists)?
Antihistamine; H1 receptor antagonist.
Inhibits histamine-mediated contraction and vasodilation of the bronchial smooth muscle.
what are the indications for anti-histamines? (H1 receptor antagonists)
anaphylaxis
hay fever
urticaria
sedation
list some side effects of anti-histamines (H1 receptor antagonists)
drowsiness
tinnitus
what is important clinically regarding Pharmacokinetics/dynamics for anti histamines (H1 receptor antagonists)?
Renally excreted
Sedation arises from central nervous system H1 antagonism (second generation H1 antagonists do not cross the blood brain barrier in therapeutic doses).
What information should you tell the patient before starting anti histamines (H1 receptor antagonists)?
Do not operate heavy machinery.
Do not drive.
