Respiratory Medicine

Question 1

What is the hierarchy of lung structure?

Answer 1

Trachea - bronchus - bronchioles - alveoli

Question 2

Which part of the lung is distal?

Answer 2

Bronchus through to capillaries

Question 3

How many British people have asthma? How much does it cost the NHS per annum?

Answer 3

5.4 million.

Costs £1 billion

Question 4

Pathophysiology of bronchoconstriction, mucous plugs, mucosal oedema, increased vascularity, increased smooth muscle mass and inflammatory cell activation describes what condition?

Answer 4

Asthma

Question 5

What is the difference between a brief vs longer asthma attack?

Answer 5

Brief = Last minutes, caused by tightening of muscles.
Longer = Increased mass decreasing lumen of bronchioles

Question 6

What is COPD?

Answer 6

Resp disease where airflow is limited - not fully reversible. Usually progressive and associated with abnormal inflammatory response due to noxious particles/gases.

Question 7

How many British people have COPD? How much does COPD cost NHS per annum?

Answer 7

1.2 million people.

£3 billion per year.

Question 8

What is the pathophysiology of COPD?

Answer 8

Narrowing of airways by:

• Collagen disposition
• Mucosal thickening
• Inflammatory exudate in airway lumen

Question 9

What happens in emphysema?

Answer 9

Alveolar membrane breakdown

Question 10

Signs and symptoms of COPD?

Answer 10

• SOB
• Chronic cough
• Phlegm
• Wheezing
• Chest tightness
• Resp infection

Question 11

What is main route of drug admin for resp diseases?

Answer 11

Inhalation

Question 12

What percent of inhaled medication is deposited in lung and swallowed?

Answer 12

Lung = 5%
Swallowed = 95%

Question 13

What kind of metabolism do inhaled drugs take?

Answer 13

First-pass metabolism

Question 14

What are two main types of inhalers?

Answer 14

1) Breath actuated metered dose (i.e. mine)

2) Dry powder inhalers

Question 15

What are two main drug classes of resp drugs?

Answer 15

• Bronchodilators

- Anti-inflammatory

Question 16

Mechanism of action of beta-2-agonists?

Answer 16

• Treat asthma/COPD
• Targets ANS - sympathetic innervation
• Bronchial smooth muscle relaxation, mucocilary clearance => breathe easier

Question 17

Example of short acting beta-2-agonist, with onset/duration?

Answer 17

Salbutamol

Onset 5 mins, lasts 4-6 hours.

Question 18

Example of long acting beta-2-agonist, with onset/duration?

Answer 18

Salmeterol

Onset 10-20 mins, lasts 12 hours.

Question 19

How do beta-1 and beta-2 blockers differ in location of effect?

Answer 19

B1= Heart
B2= Lungs

Question 20

Antimuscarinic/anticholinergic MoA?

Answer 20

Blocks muscarinic receptors on bronchial smooth muscle, preventing bronchoconstriction mediated by parasympathetic NS

Question 21

Antimuscarinic/anticholinergic side effects?

Answer 21

• Dry mouth
• Headache
• Dizziness
• Cough
• Dry throat

Question 22

Example of short-acting antimuscarinic with onset/duration?

Answer 22

Ipratopium - onset 15-30 mins, lasts 6-8 hours.

Question 23

Example of long-acting antimuscarinic with onset/duration?

Answer 23

Tiotropium - onset 3-7 days, lasts 24 hours

Question 24

Methylxanthines MoA?

Answer 24

Direct effect on bronchial smooth muscle, affecting contraction. Inhibits phosphodiesterase, increasing cAMP

Question 25

Methylxanthines side effects?

Answer 25

GI effects (nausea, vomiting etc) CVS (hypotension, tachycardia, arrhythmias) CNS (irritability, headaches, insomnia, seizures) Hypokalaemia

Question 26

Why do we need to be cautious about Theophylline?

Answer 26

It has a narrow therapeutic index.

Question 27

Factors affecting Theophylline levels?

Answer 27

``` Increase: - Congestive HF - Liver disease - Concurrent enzyme inhibitors Decrease: - Smoking - Use of enzyme inducing drugs ```

Question 28

MoA of corticosteroids?

Answer 28

Inhibit synthesis/release of mast cells. Inhibits migration of inflammatory cells and decreases capillary permeability, decreasing oedema.

Question 29

Side effects of inhaled steroids?

Answer 29

- Oropharyngeal candidiasis - Hoarseness/dysphonia - Suppress adrenal function?

Question 30

Side effects of oral steroids?

Answer 30

- Hyperglycaemia - Hypokalaemia - Fluid retention - Infection risk - Suppress hypothalamic-pituatary axis

Question 31

Why is it important for resp medications to targets leukotrienes?

Answer 31

They are linked to increases mucus production, airway wall oedema and bronchoconstriction

Question 32

MoA of leukotriene receptor antagonists?

Answer 32

Blocks effect of leukotriene by binding to receptors i.e. antagonist

Question 33

Side effects of leukotrienes?

Answer 33

- Headache - Nausea - Dyspepsia - Diarrhoea - Dizziness