Respiratory system

Question 1

list antihistamines (H1- receptor antagonists) (4)

Answer 1

chlorphenamine

certirizine

loratidine

fexofenadine

Question 2

common indications for antihistamines (3)?

Answer 2

1. first line for allergies (particularly hay fever)
2. aid relief of pruritus (itchiness) and urticaria (hives)
3. adjunctive Tx in anaphylaxis following adrenaline

Question 3

MOA of antihistamines?

Answer 3

antagonists of the H1 receptor blocking effects of excess histamine

Question 4

what is the difference between first and second generation antihistamines?

Answer 4

first generation- cause sedation

(chlorphenamine)

second generation- non sedative

(loratidine, cetirizine, fexofenadine)

Question 5

why do newer second generation antihistamines not exert a sedative effect?

Answer 5

they do not cross the BBB

Question 6

sedating antihistamines (chlorphenamine) should be avoided in which pt group?

Answer 6

severe liver disease as may precipitate hepatic encephalopathy

Question 7

list drugs belonging to the antimuscarinic class (bronhcodilators) (4)?

Answer 7

ipatropium

tiotropium

glycopyrronium

aclidinium

Question 8

common indications for antimuscarinics (2)?

Answer 8

1. COPD
2. Asthma

Question 9

MOA of antimuscarinics?

Answer 9

bind to muscarinic receptors competitively inhibiting acetylcholine

blocks parasympathetic effect- reduce smooth muscle tone and reeduce secretions in the RT

Question 10

common adverse effects (respiratory) of antimuscarinics (3)?

Answer 10

nasopharyngitis

sinusitis

cough

Question 11

antimuscarinics should be used with caution in which pt groups (3)?

Answer 11

angle-closure glaucoma (can precipitate rise in IOP)

those with or at risk of arrhythmias

urinary retention

Question 12

how can you communicate antimuscarinics to the pt?

Answer 12

Tx to open up the airways and improve their breathing

Question 13

monitoring of antimuscarinics (resp)?

Answer 13

ask patients about their symtpoms and review peak flow

should check their inhaler technique

Question 14

list common B₂-agonists (5)

Answer 14

salbutamol

terbutaline

salmeterol

formoterol

indacaterol

Question 15

common indications for B₂-agonists (3)?

Answer 15

1. asthma
2. COPD
3. hyperkalaemia

Question 16

where are B₂-receptors found?

Answer 16

smooth muscle of the bronchi gut, uterus and blood vessels

Question 17

stimulation of B₂-receptors has what effect on smooth muscle?

Answer 17

smooth muscle relaxation

Question 18

like insulin what effect do B₂-agonists have on potassium?

Answer 18

stimulate Na+/K+ (ATPase) pumps causing shift of K+ from the extracellular to intracellular compartment

Question 19

long acting B2 agonists can have what side effect due to a rise in serum lactate levels?

Answer 19

muscle cramps

Question 20

LABAs should lonly be used in asthma if what other drug is also being prescribed?

Answer 20

Inhaled Corticosteroid (ICS)

(without LABAs are assoc with inc in asthma deaths)

Question 21

B2 agonists should be prescribed with care in which pt group due to risk of angina or arrhythmias?

Answer 21

cardiovascular disease

Tachycardia may provoke angina/arrhythmia

Question 22

give the common preparation of B2 agonists prescribed for the following indications 1) as reuired for asthma

2) asthma/COPD exacerbation
3) maintainence of asthma

Answer 22

1) SABA- inhaled
2) nebulised therapy
3) combi inhaler to ensure co-admin with steroid

Question 23

what does MDI stand for when refering to drugs delivered in aerosol such as B2 agonists?

Answer 23

MDI- metered dose inhaler

Question 24

how could you communicate the action of B2 agonists to the patient?

Answer 24

treatment is to help their airways relax and improve their breathing

*treats their symtpoms not the disease

Question 25

how should pts taking B2 agonists be monitored?

Answer 25

symtpom severity/ exacerbations

Question 26

when prescribing nebuliser therapy which of air or oxygen should be used in 1) asthma and 2) COPD?

Answer 26

1) oxygen in asthma 2) medical air in COPD (risk of CO₂ retention)

Question 27

name corticosteroids (inhaled) (3)

Answer 27

beclometasone budesonide fluticasone

Question 28

common indications for inhaled corticosteroids (2)?

Answer 28

1) asthma 2) COPD

Question 29

MOA of inhaled corticosteroids?

Answer 29

reduces mucosal inflammation, widens the airways and reduces mucous secretion by modififying gene transcription: pro-inflammatory/ cytokines are downregulated antiinflammatory proteins are upregulated

Question 30

common adverse effects of inhlaed corticosteroids? (3)

Answer 30

oral candidiasis (thrush) hoarse voice v little absorbed into blood so few systmeic adverse effects unless taken at very high dose

Question 31

high dose inhaled corticosteroids should be used with caution in which pt groups? (2)

Answer 31

1) COPD pts with history of pneumonia 2) children where there is potential fro growth suppression

Question 32

how could you communicate the action of inhaled corticosteroids to the pt?

Answer 32

offering a steroid inhaler to 'dampen down' inflammation in the lung (advise them to rinse mouth/gargle after taking it to help prevent sore mouth/ hoarse voice)

Question 33

how should inhaled corticosteroids be monitored?

Answer 33

symptom severity review after 3-6months to see if therapy should be maintained/ reduced/ intensified

Question 34

which of asthma/COPD is more responsive to inhaled corticosteroids and why?

Answer 34

Asthma- poorly controlled airway inflammation can lead to remodelling and fixed airflow obstruction, as inflammation is generally steroid responsive pts should be encouraged to take steroid to prevent disease progression

Question 35

montelukast is what kind of drug?

Answer 35

leukotriene receptor antagonist

Question 36

common indications for montelukast by pt age group (3)?

Answer 36

1) adults add on for asthma when ICS/LABA not adequate 2) 5-12yr olds- alternative to LABAs as add on therapy where ICS in insufficeint 3) \<5yrs first line preventative when unable to take ICS

Question 37

MOA of montelukast?

Answer 37

leukotrienes (produced by mast cells and eosinophils) activate G protein coupled leukotriene receptor CysLT1 activating pathwasy in inflammation and bronchiconstriction Montelukast blocks CysLT1 receptor reducing inflammation and bronchoconstriction in asthma dampening down inflammatory cascade

Question 38

common adverse effects of montelukast?

Answer 38

headache abdo pain URTI

Question 39

when should montelukast be prescribed?

Answer 39

only when asthma is incompletely controlled with ICS and LABAs

Question 40

who can prescribe montelukast?

Answer 40

those with the appropriate knwoledge in the management of asthma as they are a third line therapy

Question 41

how is montelukast taken?

Answer 41

orally as a tablet, chewable tablet or granule form

Question 42

how could you communicate the action of montelukast to the pt?

Answer 42

helps to reduce inflammation and relax their airways to hopefullt improve their symptoms and control their disease

Question 43

common indications for oxygen therapy (3)?

Answer 43

1) to increase tissue oxygen delivery in **acute hypoxaemia** 2) accelerate reabsorption of pleural gas in **pneumothorax** 3) reduce carboxyhaemoglobin half-life in **CO poisoning**

Question 44

oxygen should be given with care in which pt group?

Answer 44

chronic type 2 resp failure (severe COPD) can results in rise in PaCO2 leading to resp acidosis, depressed consciousness and worsened tissue hypoxia

Question 45

what is the target SpO2 in 1) most pts 2) those with Type 2 resp failure?

Answer 45

1) 94-98% 2) 88-92%

Question 46

what should the conc and flow of oxygen be in venturi and in nasal cannulae?

Answer 46

Venturi: 60-80%, high flow 15L/m Nasal cannulae: 24-50% 2-6L/m

Question 47

common indications for sildenafil?

Answer 47

1. erectile dysfunction 2. Primary pulmonary hypertension

Question 48

what typ of drug is sildenafil?

Answer 48

phosphodiesterase (type 5) inhibitor

Question 49

what type of drug is sildenafil?

Answer 49

Phosphodiesterase (type 5) inhibitor

Question 50

finish PDE-5 pg 190