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Pharma From Sure Success > Respiratory System > Flashcards

Respiratory System Flashcards

1
Q

Pathology of cough

A

Irritation of lungs- stretch receptors get activated-vagus nerve takes the impulse (sensory) to cough Center in the brain-motor nerve takes it from brain to muscles: diaphragm and respiratory muscles

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2
Q

Drugs for cough (4)

A

Expectorants
Antitussives
Antihistamines
Demulcents

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3
Q

Moa of action of expectorants and types

A

Bronchus -> mucus->expel as sputum.
Rx for productive cough. Mc infection.

Mucolytic:
Mucus gets liquified by breaking disulphide bonds
Eg: B: bromhexol
A: Ambroxol
N: N-acetylcysteine

Mucokinetic- increased ciliary movements
Guaiphenesin

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4
Q

What are the antitussives?

A

Peripherally acting : act on stretch receptors and vagus nerve

Prenoxdiazine
Benzonotate + local anaesthetic

Centrally acting : act on brain

Opioids- morphine, codiene
Dexomethorphan- NMDA antagonist
Noscapine - sigma agonist

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5
Q

Antihistamines for cough and. Demulcents

A

Antihistamines: act on both central and peripheral
Cetrizine
Promethazine
Diphenhydramine

Demulcents: soothens bronchus and relieves irritation.
Mulethi + honey

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6
Q

What are the bronchodilators for acute asthma ? (5)

A

B2 agonists: selective: salbutamol
Non selective : adrenaline

Anticholinergics
Methylxanthines : Theophylline
Iv MgSO4
Iv hydrocortisone

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7
Q

Drug given for acute exacerbation of asthma

A

ICS+ formoterol

Formoterol although is a LABA; has quick onset while longer action.

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8
Q

LABA should not be used alone. Why?

A

They alone can’t control the underlying I.F and should always be given with ICS.

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9
Q

Drug given for prophylaxis of asthma

Drug given for acute asthma when the patient is taking beta blockers :

A

LABA > AMA

AMA> LABA ie; iprotropium bromide

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10
Q

MOA of theophylline (3)

A
  1. PDE inhibitor
  2. Adenosine A1 antagonist
  3. Histone deacetylation
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11
Q

Adverse effects of adenosine A1 receptor

A
  1. CNS : Sedation
  2. Anti diuretics

Therefore theophylline and caffeine ; which are methylxanthines inhibit these actions .

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12
Q

Increased dose of theophylline is required in: (3)

A
  1. Smokers
  2. Children
  3. CYP 450 inducers :
    Rifampicin, Barbiturates, Phenytoin
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13
Q

Theophylline decreased dosage is required in :

A
  1. Old age
  2. Liver failure
  3. CYP450 inhibitors:
    Erythromycin, Clarithromycin
    Ciprofloxacin
    Allopurinol
    Cimetidine
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14
Q

Theophylline is given orally why?

A

Coz it’s poorly water soluble , hence aminophylline- theophylline + ethylenediamine is water soluble and can be given iv

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15
Q

Theophylline toxicity symptoms. Normal level:

A

Normal level: 5-15microgm/ml

  1. Gi symptoms: N/V/ab pain
  2. Cardiovascular: decreased Bp ->reflex tachycardia -> arrhythmias
  3. CNS: insomnia —> seizures
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16
Q

Exercise induced asthma. Pathology
DOC

Drug given 20 mins before exercise

A

Hyperventilation—> increased osmolarity of airways —> mast cell release.

DOC : inhaled CS daily

SABA.

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17
Q

S/e of ICS (2)
Prevented by:

Rx: for s/e

A

Oral Candida
Hoarseness of voice

Prevented by : gargles, spacer

Rx: nystatin, fluconazole

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18
Q

MOA of ICS (2)

A
  1. Inhibit synthesis of all cytokines
  2. Inhibit NFkB transcription factor that induces production of TNF-a
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19
Q

Egs of mast cell stabilisers (3) MOA

A

Nedocromil sodium
Cromolyn sodium
Ketotifen

Stabilizes mast cells and recruitment of eosinophils

20
Q

MOA of monteleukast and zileuton

A

Monteleukast:
LT receptor inhibitor: blocks production /activity of leukotrienes involved in I.F and bronchospasm.

Zileuton:
5 lipo oxygenase inhibitor.
Decreases leukotriene production.

21
Q

S/e of monteleukast (2)

It is useful in ……asthma

A
  1. Suicidality
  2. Churg Strauss syndrome

Aspirin induced asthma

22
Q

PDE inhibitor with respect to respiratory system

A

Roflumilast -PDE4 inhibitor - used for COPD

23
Q

Anti-IgE antibody

Anti-IL5 antibody

Anti-IL5R antibody

Anti-TSLP (thymic stromal lipoprotein)

A
  1. Omalizumab
  2. Mepolizumab, Reslizumab
  3. Benralizumab
  4. Tezepelumab
24
Q

Paradoxical bronchoconstriction occurs with ..(2)

A
  1. Nebulised SABA : salbutamol, albuterol
  2. Ipratropium bromide
    —with high flow oxygen saturation >92%
25
Q

MOA of paradoxical bronchoconstriction (4)

A
  1. Hypotonic nebuliser solution
  2. Antibacterial addictives : EDTA
  3. Prejunctional M2 blockade: ipratropium
  4. IgE mediated reaction to recipients in metered dose inhaler : soybean,lecithin
26
Q

MOA of INH

INH resistance is associated with ….(2) activity.

A

Inhibit mycolic acid synthesis by inhibiting INH -A gene responsible for carrier of FAS2.

Catalase and peroxidase activity

27
Q

Drugs metabolised by acetylation

A

CHIPPS
C- clonazepam
H- hydralazine
I- INH
P- propanamide
P- PAS
S- sulfonamide+ dapsone

28
Q

Most hepatotoxic drug is …..

Least hepatotoxic drug is ….

Other side effects of INH (3)

A

Pyrazinamide

Ethambutol and streptomycin

  1. Peripheral neuritis
  2. Hemolysis in G6PD
    3 drug induced SLE
29
Q

MOA of rifampicin

A

Blocks RNA synthesis by inhibiting DNA dependent RNA polymerase : gene : rpoB gene

30
Q

Light chain proteinuria is a side effect of ….

A

Rifampicin

31
Q

Mycobacterium drug most effective against :
1. Rapidly growing ( wall of Cavitary lesion)
2. Slow growing
3. Spurters ( caseous material)

A
  1. INH
  2. Pyrazinamide
  3. Rifampicin
32
Q

Longest post antibiotic lag period for:

1st line drugs

2nd line drugs

A
  1. Streptomycin : 8-10d.
  2. Maxifloxacin : 15 d
33
Q

Ethambutol is avoided in children due to …

A

Vision disturbance (red-green disturbance difficult to detect in children)

34
Q

Most potent first line ATT
Least potent first line ATT

A
  1. Most potent : Rifampicin
  2. Least potent : Ethambutol
35
Q

Second line ATT that are bactericidal (2)

A
  1. Bedaquiline
    Delamanind
36
Q

ATT used in for HIV coinfected individuals
S/e (3)

A

Rifabutin

  1. Uveitis
  2. Clostridium difficicle diarrhoea
  3. Pseudojaundice coloured skin
37
Q

Drug most useful in MDR tb
It comes under ……gp. It is bacterio….

A

Ethionamide- INH group of drug, but is bacteriostatic

38
Q

A polypeptide antibiotic used in TB
MOA

A

Capreomycin
Inhibit cell wall permiability

39
Q

MOA of cycloserine

A

Structural analogue of D Alanine
Inhibit cell wall synthesis

40
Q

S/e of cycloserine
Drug used to prevent it.

A

CNS toxicity
Suicidal seizures, peripheral neuropathy

100mg/ day pyridoxine is used to prevent it

41
Q

Tuberculostatic drug. S/e

A

PAS
s/e goiter

42
Q

S/e of thiacetazone (4)
Avoid in……patients. Why?

A

Agranulocytosis
SJS syndrome
Hepatitis
Ototoxicity

Avoid in HIV patients due to high skin/GI toxicity

43
Q

ATT used for mycobacterium avium

A

Clarithromycin
Azithromycin

44
Q

Linezolid MOA
Gp of ……

S/e (2)

A

Inhibit 70S ribosomal complex
Gp of oxazolidinones

  1. Bone marrow suppression
  2. Peripheral neuropathy
45
Q

Use of bedaquiline and delamanind

MOA

A

MDRTb only

MOA:
Bedaquiline: blocks ATP synthase of mycobacteria

Delamanind: inhibit mycolic acid synthesis

46
Q

S/e of bedaquiline, Delamanind (3)

A
  1. Increase AST/ALT
  2. Serum amylase,lipase
  3. Qt prolongation

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