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CPT > Respiratory Pharmacology > Flashcards

Respiratory Pharmacology Flashcards

1
Q

Whereas BTS guidelines suggest adding a LABA after low dose ICS, NICE suggests trying a LTRA before moving to a LABA.

Why?

A

LTRAs are cheaper (but most end up on LABAs anyway

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2
Q

Beclometasone, Budesonide and Fluticasone are members of what class of drugs?

When are these prescribed?

A

Inhaled Corticosteroids (ICS)

First line management of Asthma, used as preventers

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3
Q

How do ICS drugs work?

A
  • Pass through plasma membrane, activate cytoplasmic receptor-> Modified transcription
  • Reduce mucosal inflammation, widen airways and reduce mucus
  • Reduce Arachidonic acid production-> reduced production of Leukotrienes and Prostaglandins
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4
Q

List ADRs, Contraindications and DDIs of ICS therapies

A

ADRs;
- Local Immunosuppression (Candidiasis, hoarse voice)

Contraindications;
- Risk of pneumonia in COPD, if taken at high doses

DDIs;
- Very few if taken correctly

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5
Q

ICS therapies have a poor oral bioavailability and high affinity for glucocorticoid receptors.

At high doses, which ICS therapies can cause systemic effects?

A

All of them

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6
Q

List 2 Short Acting Beta Agonists (SABAs)

Compare the LABAs, Salmeterol and Formoterol

A
  • Salbutamol
  • Terbutaline
  • Salmeterol: Slow onset of action
  • Formoterol: Fast onset of action
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7
Q

Compare SABA and LABA use

A

SABA: Symptom relief, used only when required

LABA: Used as add-on therapy to ICS, SABAs still used when required

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8
Q

How do Beta agonists work to alleviate asthma symptoms

A
  • Major action on airway smooth muscle
  • Increase mucus clearance by cilia action

(SABAs can be used to prevent constriction prior to exercise)
(Regular SABA use can lead to poor asthma control/ tolerance?)

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9
Q

List 7 ADRs of Beta agonists

A
  • Tachycardia
  • Palpitations
  • Anxiety
  • Tremor
  • Increased renin
  • Increased glycogenolysis
  • Possible SVT
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10
Q

List 2 contraindications of Beta agonists

A
  • LABAs should ONLY be prescribed alongside ICS (often as a combined inhaler)
  • CVD (tachycardia may cause angina)

(LABAs alone can mask airway inflammation and fatal/ near-fatal attacks

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11
Q

List DDIs of Beta agonists

A

Beta blockers may reduce effectiveness of Beta agonists

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12
Q

What kind of drug is Montelukast?

(These drugs are used as additional controller therapies in asthma)

How does it work?

A

Leukotriene Receptor Antagonist (LTRA)

Prevents Leukotrienes (from Mast cells/ Eosinophils) binding to CysLT1 (a GPCR) therefore reducing;

  • Bronchoconstriction
  • Mucus production
  • Oedema
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13
Q

List 4 ADRs of LTRAs

What are the DDIs of LTRAs?

A

Headache, Hyperactivity
GI disturbance, Dry mouth

  • No major DDIs reported
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14
Q

What kind of drug is Tiotropium?
What are 2 uses for these drugs?

How do they work?

A
  • Long Acting Muscarinic Antagonist (LAMA)
  • Severe asthma and COPD
  • Block Vagal mediated contraction of airway smooth muscle
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15
Q

Compare LAMAs to SAMAs in terms of receptor selectivity

A

LAMAs are more selective for M3 receptors

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16
Q

List 3 ADRs for LAMAs

A

Infrequent Anticholinergic effects;

  • Dry mouth
  • Urinary retention
  • Dry eyes
17
Q

What kind of drug is Theophylline?
How do these work?

(Theophylline is taken orally for poorly controlled asthma)

A
  • Methylxantine

- Adenosine receptor antagonist = Less bronchoconstriction

18
Q

Suggest an ADR for Theophylline

A

Has a narrow therapeutic index so can-> Arrhythmia (SVT)

Can also cause seizures

19
Q

Suggest a DDI for Theophylline

A

If taken with CYP450 inhibitors, higher dose needed

20
Q

Describe the treatment of acute severe/ life threatening asthma

A
  • Get O2 sats to 94-98%
  • High dose Beta agonist
  • Oral steroids for 5 days minimum, alongside ICS
  • Nebulised SAMA alongside Beta agonist, if response is poor
  • Consider IV Aminophylline if no success with above and life threatening (caution if also on Theophylline)
21
Q

Name an oral steroid and a SAMA that can be used in treating life threatening asthma

A

Oral steroid: Prednisolone (Hydrocortisone in emergency)

SAMA: Ipratropium

22
Q

What are the 5 ‘tasks’ of managing COPD

A
  1. Confirm diagnosis
  2. Smoking cessation
  3. Breathlessness/ MRC Dyspnea score (+ lifestyle advice)
  4. Vaccination (flu, pneumococcal)
  5. Medication
23
Q

How would you treat an acute exacerbation of COPD?

What if patient is hypercapnic/ acidotic?

A
  • Nebulised Salubutamol or Ipratropium
  • Drive nebuliser by air not O2
  • Antibiotics (narrow or broad)
  • Oral steroids (can be less effective than in eosinophilic asthma, due to reduced action on neutrophils)
24
Q

Compare 3 broad categories of inhalers

Inhalers often prescribed by brand

A

pressured Metered Dose Inhalers (pMDI);

  • Inhalation and actuation of device
  • Slow breath in and hold
  • Can be used with a spacer to improve delivery

Breath-actuated pMDI;
- Automatic actuation upon inspiration

Dry Powder Inhalers (DPI);

  • Micro ionised drug + carrier powder
  • Fast deep inhalation
25
Q

State the major site of drug deposition, using an inhaler if Inspiratory Flow is;

  • Too fast
  • Too slow
  • Optimal
A

Fast: Throat

Slow: Mouth

Optimal: Lungs

CPT (19 decks)

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