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Respiratory pharmacology Flashcards

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1
Q

What are two categories of cough? Both beginning with ‘U’

A

Useless (persistant, unproductive, dry) and useful (productive)

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2
Q

What are four causes of a useless cough?

A

Asthma, oesophageal reflux, sinusitis, psychogenic

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3
Q

What are the two mechanisms for treatment of dry coughs?

A

Afferent and efferent action

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4
Q

What might cause a useful cough?

A

Chest infection

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5
Q

How would you treat a productive cough? Would you supress it?

A

Do not supress unless exhausting and dangerous. Treat underlying cause e.g. antibiotics

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6
Q

What are 3 common causes of a chronic cough?

A
  1. Upper airway cough syndrome (post nasal drip, rhinitis)
  2. Asthma/COPD
  3. Gastroesophageal reflux disease
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7
Q

How would you treat a cough caused by gastroesophageal reflux?

A

Antacids

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8
Q

What is the chronic lung disease triad?

A

Inflammation, bronchoconstriction, secretions

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9
Q

Does most asthma mortality occur in children or adults?

A

Adults >45yo

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10
Q

What are the 4 types of asthma?

A
  1. Allergy associated
  2. Intrinsic (no identifiable allergen)
  3. Exercise induced
  4. COPD associated
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11
Q

Which type of asthma is the most common?

A

Intrinsic

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12
Q

In asthma treatment mechanisms, what are five possible options?

A
  1. Avoid the antigen
  2. Reduce activity of allergic response
  3. Dilate bronchi
  4. Stabilise mast cells so they don’t produce the mediator
  5. Directly antagonise the mediator
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13
Q

Does cAMP inhibit or stimulate bronchodilation?

A

Stimulate

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14
Q

Does acetylcholone stimulate bronchodilation or bronchoconstriction?

A

Bronchoconstriction

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15
Q

Does adenosine inhibit or stimulate bronchodilation?

A

Inhibit- it stimulates bronchoconstriction.

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16
Q

Is obstruction in COPD reversible?

A

No

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17
Q

What are three afferent action treatments of a dry cough? Do they act above or below the vocal cords?

A
  1. Linctuses (e.g. strepsils) coat airway so isn’t irritated. Above vocal cords.
  2. Steam (initiates mucus production) below vocal cords.
  3. Nebulised local anaesthetics (numbs irritation) below vocal cords.
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18
Q

What are three antitussive (efferent action) treatments of a dry cough?

A

1, Opiods (e.g. codein)

  1. Non- opiods (e.g. dextromethorphan) (16+ yo)
  2. Sedatives (e.g. diphenhydramine) (use in children)
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19
Q

What can opiods cause at a higher than needed dose?

A

Respiratory depression

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20
Q

Why aren’t sedatives used in a productive cough?

A

Could thicken secretions and worsen the cough.

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21
Q

What are the two treatments for a productive cough?

A
  1. Expectorants (e.g. guaiphesin) increase volume of secretion (not used regularly)
  2. Mucolytics (e.g. acetyl cysteine) decreases viscosity of mucus by breaking disulphide bonds. Cystic fibrosis treatment.
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22
Q

What are 5 long term treatments for asthma?

A
  1. Leukotrine pathway inhibitors
  2. Mast cell stabilisers
  3. Corticosteroids
  4. Anti IgE monoclonal antibodies
  5. Ketotifen
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23
Q

What are 5 short term treatments for asthma?

Study These Flashcards
A
  1. Sympathomimetics
  2. Methylxanthines
  3. Anticholinergics
  4. Magnesium
  5. Ketamine
24
Q

What are the two types of leukotriene pathway inhibitors? What are their actions?

Study These Flashcards
A
  • Synthesis inhibitors (inhibits 5-lipoxygenase that synthesises leukotriene from arachidonic acid)
  • Receptor antagonists e.g. montelukast (antagonise the leukotriene recpetor that would = bronchospasm)
25
What are side effects of leukotriene pathway inhibitors?
Headache, gastritis, flu
26
Which two types of asthma are treated by leukotriene pathway inhibitors?
Allergen or exercise induced
27
What is the route of leukotriene pathway inhibitors?
Oral
28
What is the action of mast cell stabilisers?
Inhibit release of mast cell mediators
29
What are some side effects of mast cell stabilisers?
Throat irritation, cough, dermatitis, myositis, gastroenteritis
30
What is the route of mast cell stabilisers?
Inhaled
31
What type of asthma do mast cell stabilisers best treat?
Allergic
32
What two routes are possible for corticosteroids?
Inhaled (beclomethasone) or oral (prednisone)
33
What is the action of corticosteroids?
Reduces bronchial hyperactivity, inhibits inflammatory response, decreases oedema
34
Do corticosteroids relax smooth muscle? Are they of any use acutely?
No and no
35
What is cyclesonide?
A pro drug corticosteroid with fewer side effects but expensive.
36
What are 4 side effects of corticosteroids?
1. Iatrogenic Cushing's syndrome 2. Inhibition of pituitary hypothalamic axis 3. Oral thrush 4. Hoarse voice
37
What is the action of anti IgE monoclonal antibodies
Inhibit binding of IgE to mast cells
38
What is an example of an anti IgE monoclonal antibody?
Omalizumab
39
What are the pros and cons of anti IgE monoclonal antibodies?
Pros: lessens asthma severity and reduces requirement for steroids. Con: very expensive
40
What is the action of Ketotifen? Does it work?
Histamine receptor antagonist. Some anti-asthma effect but no proven benefit.
41
What is a side effect of ketotifen?
Drowsiness
42
Name 2 examples of short acting sympathomimetics. How long do they last for?
Salbutamol, terbatuline. 3-4hrs
43
Name a longer acting sympathomimetic. How long does it last for?
Salmetrol. 12hrs
44
What are some side effects of sympathomimetics?
Palpitation, tachycardia, cardiac arrhythmia, tremor, restlessness, nervousness, hypokalaemia.
45
What routes can sympathomimetics be given via?
IV, nebuliser, inhaler
46
Name an oral and an IV methylxanthine
Oral - theophylline | IV- aminophyline
47
What is the action of methylxanthine?
Bronchodilator- inhibits phosphodiesterase which breaks down cAMP (so like a reuptake inhibitor) and inhibits adenosine which causes bronchoconstriction.
48
What are some side effects of methylxanthine?
Palpitation, cardiac arrythmia, hypotension, GI irritation, diuresis, hypokalaemia, anxiety, headache, seizure
49
What are the two routes methylxanthine can be given via?
Oral and IV
50
Wht must patients on methylxanthine have their plasma concentration checked frequently?
It has a very narrow therapeutic window.
51
Name an anticholinergic
Ipratropium
52
What is the action of anticholinergics?
Bronchodiolator- inhibits muscarinic receptors (e.g. receptor for acetylcholine which stimulates bronchoconstriction). Inhibits effects of vagus nerve stimulation.
53
What are some side effects of anticholinergics?
Airway irritation, anticholinergic effects, GI upset, urinary retention, mouth dryness
54
What route are anticholinergics taken via?
Inhaled
55
When is magnesium used in asthma treatment?
Acute IV for patients who fail to respond to inhaled bronchodilators
56
What is the action of ketamine in asthma treatment?
Anaesthetic agent with bronchodilator properties
57
When is ketamine used in asthma treatment?
Not in routine management. For life threatening or near fatal asthma.

Respiratory (12 decks)

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