Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Y4 Respiratory > Respiratory pharmacology > Flashcards

Respiratory pharmacology Flashcards

(67 cards)

Start Studying
1
Q

What are the 2 main groups of Beta2 adrenoreceptor agnoists and what do they do ?

A

Short-acting (SABA) & long-acting (LABA) - both cause airway smooth muscle relaxation, increase mucus clearance and decrease mediator release from mast cells and monocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 2 main SABA’s used ?

A

Salbutamol aka albuterol & terbutaline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the use of SABA’s ?

A

1st line treartment of asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the main side effects of SABA use?

A
  • Fine tremor the most common.
  • However, tachycardia, cardiac dysrhythmia and hypokalaemia can occur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the 2 main LABA’s ?

A

Salmeterol & formoterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What must LABA’s always be co-administered with ?

A

A glucocorticoid [for this purpose combination inhalers such as Symbicort (budesonide and formoterol) and Seratide (fluticasone and salmeterol) are available, but costly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The use of non-selective b-adrenoceptor antagonists (e.g. propranolol) in asthmatic patients is contraindicated, why?

A

Due to risk of bronchospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the mechanism of action of LTRA’s?

A
  • Antagnoists of the CysLT1 receptor on mast cells and inflammatory cells
  • Resulting in relaxation of bronchial smooth muscle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 2 main LTRA’s ?

A

Montelukast & zafirlukast - think ‘lukast’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When are LTRA’s used ?

A

As an add on therapy in the treatment of asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the main side effects of LTRA’s?

A

Headache and GI upset sometimes seen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the 2 main Methylxanthines?

A

Theophylline and aminophylline - think ‘phylline’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the mechanism of action of methylxanthines ?

A

Uncertain molecular mechanism of action - might involve inhibition of isoforms of phosphodiesterases that inactivate cAMP and cGMP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the effect of methylxanthines ?

A
  • Relax smooth muscle, anti-inflammatory and increase mucus clearance
  • Also increase diaphragmatic contractility and reduce fatigue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is important to remember about methylxanthines and what would suggest going outwidth this ?

A

They have a very narrow theraputic window

If supratheraputic dose given then may develop:

  • Dysrhythmia
  • Seizures
  • Hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the main side effects of methylxanthines seen at theraputic concentrations ?

A
  • Nausea & vomiting
  • Abdominal discomfort and headache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the 2 major classes of steroid hormones released into the body from the adrenal cortex ?

A

Glucocorticoids and Mineralocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the main glucocorticoid produced in the body and what are its effects on the body ?

A

The main hormone (in man) is cortisol (hydrocortisone) regulates numerous essential processes:

  • It decreases inflammatory & immunological responses
  • Increases liver glycogen deposition ­
  • Increases gluconeogenesis ­
  • Increases glucose output from liver ­
  • Decreases glucose utilization
  • Increases protein catabolism ­
  • Increases bone catabolism ­
  • Increases gastric acid and pepsin secretion ­
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the main mineralocorticoid produced in the body and what is its main effects ?

A

Aldosterone - regulates the retention of salt (and water) by the kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

In the treatment of inflammatory conditions what main group of steroids do exogenous steroids want to have a similar action to ?

A

Glucocorticoids (but they may also have unwanted mineralocorticoid actions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Glucocorticoids have no direct bronchodilator action and are ineffective in relieving bronchospasm when given acutely - T or F?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the use of glucocorticoids in the treatment of asthma?

A

They are the mainstay for the prophylaxis of asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the mechanism of action of glucocorticoids relevant to asthma ?

A

They act via the glucocorticoid receptor in cells to increase transcription of genes encoding anti-inflammatory proteins and decrease transcription of genes encoding inflammatory proteins.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the effects of glucocorticoids relevant to asthma ?

A
  • They suppress the inflammatory component of asthma – (1) prevent inflammation and (2) resolve established inflammation
  • Short term, they do not alleviate early stage bronchospasm but long term treatment is effective in doing so (particularly in combo with a LABA)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
List some of the main glucocorticoids used in the treatment of asthma ?
* Beclometasone, Budesonide, Fluticasone - used for prophylaxis/maintanence treatment of asthma * Prednisolone or hydrocortisone - used for acute severe asthma/exacerbations
26
What are the 2 most common adverse effects (due to deposition of steroid in the oropharynx) of glucocorticoid use in the treatment of asthma ?
1. Dysphonia (hoarse and weak voice) 2. Oropharyngeal candidiasis (thrush)
27
List the common side effects seen from glucocorticoid use in general
* Endocrine: impaired glucose regulation, increased appetite/weight gain, hirsutism, hyperlipidaemia * Cushing's syndrome * Musculoskeletal: osteoporosis, proximal myopathy, AVN of the femoral head * Immunosuppression: increased susceptibility to severe infection, reactivation of tuberculosis * Psychiatric: insomnia, mania, depression, psychosis * Gastrointestinal: peptic ulceration, acute pancreatitis * Ophthalmic: glaucoma, cataracts * Suppression of growth in children * Intracranial hypertension * Neutrophilia
28
Patients on long-term steroid use should have what done during intercurrent illness?
Their doses doubled during this period
29
What is the main cromone drug ?
Sodium cromoglicate
30
What is the mechanism of action of cromones ?
Mast cell stabiliser - with weak anti-inflammatory effects
31
What is the use of sodium chromoglicate ?
Now infrequently used prophylactically in the treatment of allergic asthma (particularly children)
32
What are the 2 new drug classes used in the treatment of asthma which are very expensive ?
* Monoclonal antibodies directed against IgE (e.g. omalizumab) * Monoclonal antibodies directed against IL-5 (e.g. mepolizumab)
33
When are Monoclonal antibodies directed against IgE (e.g. omalizumab) used in the treatment of asthma ?
For patients with severe persistent allergic asthma (raised IgE)–ie despite max therapy (step 5).
34
How are the 2 different types of monoclonal antibodies used in the treatment of asthma given?
Via injection
35
When are Monoclonal antibodies directed against IL-5 (e.g. mepolizumab) used in the treatment of asthma ?
For patients with severe refractory eosinophilic asthma (raised blood eosinophils \>300 cell/ul) – despite max therapy (step 5)
36
Give a very general overview of the effect of the parasympathetic and sympathetic divisions of the ANS in the regulation of airway function:
Stimulation of parasympathetics (cholinergic fibres) which act via M3 muscarinic ACh receptors, causes: 1. Bronchial smooth muscle contraction 2. Increased mucus secretion Sympathetic stimulation which acts via via b2-adrenoceptors, causes: 1. Bronchial smooth muscle relaxation 2. Decreased mucus secretion 3. Increased mucociliary clearance
37
In relation to parasympathetic innervation of the airways what is an important treatment of COPD ?
* Reducing parasympathetic neuroeffector transmission with muscarinic receptor antagonists (act as *pharmacological* antagonists of bronchoconstriction caused by smooth muscle M3 receptor activation)
38
What are the 2 types of Muscarinic Receptor Antagonists used in the treatment of COPD ?
1. Short acting muscarinic antagonist (SAMA) 2. Long acting muscarinic antagonists (LAMAs)
39
What is the name of the main SAMA ?
Ipratropium
40
List the names of the different LAMAs
* Tiotropium * Glycopyrronium * Aclidinium * Umeclidinium
41
What part of the name suggests the drug is a muscarinic anatagonist ?
'ium' at the end
42
What are the effects of Muscarinic Receptor Antagonists?
* Delayed onset of bronchodilator action * Reduce bronchospasm caused by irritant stimuli and also block ACh-mediated basal tone * Decrease mucus secretion
43
Do muscarnic receptor antagnoists have any effect on disease progression of COPD ?
No - they have little effect on the progression of COPD, their effect is mainly palliative
44
Muscarinic Receptor Antagonists have few adverse effects - T or F?
True
45
What is the benefit of LAMAs over Ipratropium (SAMA)?
* LAMAs (tiotropium, glycopyrronium, aclidinium, umeclidinium) selectivley block M3 receptors * Whereas Ipratropium is a non-selective blocker of M1, M2 and M3 receptors * And Block of M3 (and M1) is desirable, but block of M2 is not because release of ACh from parasympathetic post-ganglionic neurones is increased by autoreceptor antagonism
46
What is the effect of b-adrenoceptor agonists in the treatment of COPD ?
They provide bronchodilatation, but have no effect on underlying inflammation
47
A combination of what? is superior to either drug alone in increasing FEV1 in the treatment of COPD?
A combination of a β2 agonist and a muscarinic antagonist
48
What are Indacaterol and olodaterol?
Ultra-LABAs
49
Go over this list of example combinations of muscarinic receptor antagnoists and beta-adrenoreceptor agnoists in the treatment of COPD
50
What type of drug is Rofumilast and when may it be used in the treatment of COPD ?
A selective PDE4 inhibitor, suppresses inflammation and emphysema in animal models of COPD. Approved as oral treatment for severe COPD accompanied by chronic bronchitis, but has limiting adverse gastrointestinal effects
51
What 3rd drug may be used in the treatment of COPD alongside b-adrenoceptor agonists and/or muscarinic receptor antagonists?
Glucocorticoids
52
Triple inhalers (e.g. fluticasone/umeclidinium/vilanterol) have very recently been approved as once daily treatment for what?
Moderate/severe COPD
53
What is the mechanism of action of glucocorticoids in the treatment of rhinitis ?
They reduce vascular permeability, recruitment and activity of inflammatory cells and the release of cytokines and mediators
54
Give examples of the glucocorticoids used in the treatment of rhinitis
* Beclometasone * Fluticasone * Prednisolone (oral)
55
What types of rhinitis are glucocorticoids used in?
Mainstay of therapy for SAR and PAR and are of value in NARES and vasomotor rhinitis
56
What is the mechanism of action of anti-histamines ?
H1 Receptor Antagonists which reduce the effects of mast cell derived histamine including: * Vasodilatation and increased capillary permeability * Activation of sensory nerves * Mucus secretion from submucosal glands
57
What are the uses of anti-histamines in the treatment of rhinitis ?
Effective in SAR, PAR and EAR, less so in non-allergic rhinitis
58
What is the name of the intranasal antihistamine spray?
Azelastine
59
Give examples of the 1st and 2nd gen anti-histamines and state why second gen are preferred ?
Examples of 1st gen antihistamines: * chlorpheniramine Examples of 2nd gen antihistamines: * loratidine * cetirizine * fexofenadine 1st generation antihistamines are **sedating** and have some antimuscarinic side-effects e.g. urinary retention, dry mouth
60
What Anti-Cholinergic Drug (Muscarinic Receptor Antagonists) may be used in the treatment of rhinitis ?
Ipratropium
61
What symptom is Ipratropium mainly useful for in the treatment of rhinitis ?
Rhinorrhoea
62
What side-effects may be seen from the use of Ipratropium in the treatment of rhinitis ?
May cause dryness of nasal membranes, but no other adverse effects
63
What is the mechanism of action of sodium chromoglycate ?
Allegedly mast cell stabilization, but this is uncertain
64
If the person has ongoing symptoms and a history of asthma whilst using a regular intranasal corticosteroid preparation, what should be done ?
Consider adding in a leukotriene receptor antagonist such as montelukast to an oral or intranasal antihistamine.
65
What is the mechanism of action of vasoconstrictors and what is the main one which may be used in the treatment of rhinitis ?
* They act as directly, or indirectly, to mimic the effect of noradrenaline. Produce vasoconstriction via activation of a1-adrenoceptors to decrease swelling in vascular mucosa * Oxymetazoline, a selective a1-adrenoceptor agonist is the main one
66
Nasal administration of oxymetazoline for more than a few days is not recommended, why?
Due to the development of a rebound increase in nasal congestion upon discontinuation (rhinitis medicamentosa).
67
What are the benefits of using a spacer ?
* Avoids coordination problems with pMDI * Reduces oropharyngeal and laryngeal side effects * Reduces systemic absorption from swallowed fraction * Acts a holding chamber for aerosol * Reduces particle size and velocity * Improves lung deposition

Y4 Respiratory (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions