Respiratory pharmacology

Question 1

Beta-2 agonists

Answer 1

Salbutamol

Salmeterol

Used as bronchodilators

Question 2

Salbutamol

Answer 2

A short acting beta-2 agonist (SABA)

Stimulates increased of cAMP in bronchial smooth muscles= bronchodilation

Use: Asthma and COPD

Question 3

Salmeterol

Answer 3

A long-acting beta-2 agonist

Also known as serevent and found in seretide.

Stimulates increased of cAMP in bronchial smooth muscles= bronchodilation

Begins working between 2-30mins and lasts for 10-12 hrs.

Route of administration”
Inhaled

Question 4

Antiocholinergics

Answer 4

Tiotropium

Ipratropium

Used as bronchodilators, inhibits M2 receptors.

Increases cAMP by blocking M2.

Question 5

Tiotropium

Answer 5

Long acting anticholinergic- 24 hrs

Inhibits M3 receptors in bronchus= bronchodilation.

Indications:
Stable COPD- symptoms despite SABA
Asthma- step 3 indication

Question 6

Use of salmeterol/ serevant

Answer 6

Asthma- when requiring long-term bronchodilator therapy on inhaled corticosteroids

COPD: persistent symptoms despite therapy.

Question 7

Methylxanthines

Answer 7

Phosphodiesterase inhibitors that raise cAMP and PKA levels in smooth muscles.

Examples:
Aminophylline

Theophyllines

Question 8

Steriods

Answer 8

Anti-inflammatory drugs

Examples:
Prednisolone

Beclomethasone

Question 9

Theophylline

Answer 9

Methylxanthine- phosphodiesterase inhibitor
- Prevents inactivation of cAMP. Increases cAMP= bronchial smooth muscle relaxation.

Route of administration:
IV
PO- orally

Question 10

Indications for theophylline

Answer 10

PO- persistent symptoms for COPD and asthma

IV- medical emergencies for COPD and asthma.

Question 11

Side effects for bronchodilators

Answer 11

Tachycardia- due to effect on L-type Ca2+ channels in the heart.

Nervousness, irritability and tremor.

More common when taken orally than inhaled:
Tachyarrythmia
Angina

Question 12

Route of administration for salbuterol

Answer 12

Inhaled

Iv

Orally

Question 13

Metered dose inhalers (MDIs)

Answer 13

Inhaled drug device

Method:
1. Deep exhale

2. Inhale and puff
3. Hold breath for slow count of 10.
4. Exhaled slowly
5. Wait one minute before second puff.

Question 14

Dry powder inhalers

Answer 14

Inhaled drug device

Method:
One inhalation needed- no puff required.

Question 15

Nebuliser

Answer 15

Inhaled drug device that administers drug via a mist.

Question 16

Route of administration for tiotropium

Answer 16

Inhaled:

• Dry powder hand inhaler
• Mist respimat

Question 17

Systemic glucocorticoids

Answer 17

Steroids.

Administration:
IV
Orally

Not affected by lung restriction

Side effects with long-term therapy.

Example: Prednisolone

Question 18

Inhaled glucocorticoids

Answer 18

Steroids that have a localised action.

Fewer side effects that systemic glucocorticoids as there is less absorption.

Disease may prevent penetration of drug to affected area

Question 19

Airway effects of glucocorticoids.

Answer 19

Decreases release of inflammatory mediators.

Decreases airway oedema and mucus production.

Increases number and sensitivity of beta-2 receptors.

Decreases infiltration and action of WBCs.

Question 20

Prednisolone

Answer 20

Systemic glucocorticoids- reduces inflammation with a stronger effect to beclometasone.

Question 21

Beclometasone

Answer 21

Inhaled glucocorticoids.

Has a more localised effect- weaker than prednisolone.

Disease may prevent its penetration to affected areas.

Indications:
Airway diseases
Allergic rhinitis

Question 22

Adverse effects of inhaled/ gargled/ spacer of glucocorticoids

Answer 22

Oral candidiasis

Dysphonia

Question 23

General adverse effects of steroids used for obstructive airway disease

Answer 23

Adrenal suppression:

Bone loss

Slow growth in children

Increased risk of cataracts and glaucoma

Increased risk of infection

Gastric ulceration

Hypertension

Diabetes

Mood disturbance

Question 24

Monteleukast

Answer 24

A leukotriene inhibitor

Question 25

Antihistamines

Answer 25

Histamine-1 antagonist: used for allergic rhinitis medication. Examples: Cetirizine Chlorpheniramine

Question 26

Side effects of anti-histamines

Answer 26

Drowsiness Dry mouth and eyes Confusion

Question 27

Cetirzine

Answer 27

An antihistamine Blocks H1 receptor

Question 28

Chlorpheniramine

Answer 28

An antihistamine Blocks H1 receptor

Question 29

Montelukast

Answer 29

Leukotriene receptor inhibitor ``` Reduces: Inflammation Bronchoconstriction Oedema Mucus production Eosinophil recruitment ```

Question 30

Amoxicillin

Answer 30

Penicillin used to treat certain respiratory infections- against Gram positive and negative bacteria. Use: Community acquired pneumonia COPD exacerbations Bronchitis

Question 31

Co Amoxiclav

Answer 31

Amoxicillin + clavulanic acid Prevents degradation of beta-lactam ring in amoxicillin by beta-lactamase produced by bacteria. Uses: Community acquired pneumonia COPD exacerbations Bronchitis

Question 32

Tazobactam

Answer 32

Used to treat hospital acquired infection and Gram negative bacteria.

Question 33

Tetracyclines

Answer 33

Antibiotics that inhibits protein synthesis Targets a broad spectrum of Gram positive and negative bacteria. Use: atypical infections like mycoplasma. Administration: oral Side effects: GI upset, staining of teeth, lupus, allergy, photosensitivity.

Question 34

Quinolones

Answer 34

Antibiotics that causes DNA fragmentation. Bacteria targeted: Positive and negative Administration: Oral, IV, inhaled. Side effects: GI upset, C difficile, Tendonitis, Liver upset, Prolonged QT interval, arrhythmias. Examples: Ciprofloxacin Moxifloxacin

Question 35

Macrolides

Answer 35

Antibiotics that inhibit protein synthesis. Common used in respiratory infections. Administration: IV, Orally. Bacteria targeted: Gram positive, some negative. Side effect: GI upset, Liver damage, allergy, prolonged QT interval, interactions.

Question 36

TB standard treatment

Answer 36

Duration: minimum 6 months. Treatment has to be taken altogether on an empty stomach, 1 hr before breakfast. ``` Initial phase: 2 months of Isoniazid Rifampicin Pyrazinamide Ethambutol ``` Continuation phase: 4 months Isoniazid Rifampicin Any noted CNS involve extends the continuation phase to 10 months,

Question 37

DOT

Answer 37

Directly observed treatment Used for cases of TB where patient is at risk of not adhering to treatment. Professional caseworker, DOT observer or family/friend watches patient take TB medication.

Question 38

CFTR modulating drugs

Answer 38

Ivacaftor: Increases channel opening probability of G551D CFTR Used for those with Class III mutation. Lumakaftor: Used for Class III mutation.

Question 39

Drugs used for some idiopathic interstitial pneumonias

Answer 39

Prednisolone Azathioprine MMF (Mycophenolic acid)

Question 40

Treatment for sarcoidosis

Answer 40

Prednisolone

Question 41

Treatment for IPF

Answer 41

Prednisolone: anti-inflammatory. Reduces fibroblast proliferation, thus collagen production.