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Pharmacology > Treatment Of Diarrhea > Flashcards

Treatment Of Diarrhea Flashcards

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1
Q

Results in

A

Contraction of bronchial smooth muscles
Inflammation of bronchial wall
Increased secretion of mucus

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2
Q

Inflammation of the Airways co tributes to

A

Hyperrespknsiveness
Airflow limitation
Respiratory symptoms
Disease chronicity

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3
Q

Asthma therapy

A

Brincho ds
Anti inflammatory

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4
Q

Bronchods

A

Beta agonists
Methylxanthines
Antimuscarinic drugs

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5
Q

Antinflammatory

A

Corticos
LT antagonists
Mast cell stabilisers
Targeted monoclonal antibody therapy

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6
Q

Theophylline works through 2 mechanisms

A

Inhibits PDE
Decreases adenosine

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7
Q

Beta agonists

A

AC stimulation for CAMP (decreased Ca and activation of protein kinase) for bronchod.
Inhibits mast cell degranulation
Inhibits microvascular leakage
Increasing mucociliry transport so no congestion from secretions

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8
Q

Beta agonists can be given

A

Orally paranterally or inhalation but best
Inhalation as this gives Greatest local effect with least systemic toxicity

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9
Q

Beta blockers either

A

Selective or non selective

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10
Q

Non selective beta agonist : adr ephedrine isoprenaline

A

Cardiac side effects - overstimultion so arrhythmia and the rest

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11
Q

Selective beta 2

A

Broncho dilation.
Replaced non selective

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12
Q

Selective beta 2 - short term relievers

A

SABA
LABA
Ultra long

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13
Q

SABAs

A

Inhalation quick relief peak in 3p mins 3 - 4 hrs half life
Can be given orally but what’s the point

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14
Q

Terbutaline

A

SC in severe asthma
When aerosolised therapy is unavailable or ineffective
But longer half life so cumulative effect after repeated SC injections

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15
Q

LABAs - inhalation

A

Salmeterol
Formoterol

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16
Q

Long duration of action as a result of Hugh lipid solubility

A

LABAs
Given with inhaled corticos as long term central medications of asthma

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17
Q

Bambi In Ola’s Vila

A

Ultra long
Once a day only but prolonged bronchod. masks bronchial inflammatory symptoms

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18
Q

Taken as monotherapy in COPD ttt

A

Ultra long but with corticos for bronchial asthma

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19
Q

Adverse selective beta 2 effects

A

Tachycardia - loses its selectivity jn high doses
Tremors - beta facilitating neuromuscular transmission
Nervous tension - bbb
Tolerance eventually
Hypokalemia which may predispose arrhythmia
Increase asthma related death if not combined with corticos

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20
Q

Methylxanthines - barely used because beta 2 agonists for acute ande antinflammatory fo chronic

A

Theophylline~

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21
Q

Take Theophylline

A

As salts to improve absorption
As SR tabs for less frequent administration every 12 hrs
Low therapeutic index so measure blood levels

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22
Q

Therapeutic Theophylline

A

5 to 20 mg/l

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23
Q

Greater than 40

A

Arrhythmia or siezure

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24
Q

Even from 15

A

Symptoms start

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25
Metabolised by p450
So drug drug and stuff interactions
26
No PDE (Inhibited by theophylline)
Reduces release of cytokines inhibiting migration
27
There's also no Adenosine
Decreases histamine
28
Theophylline on skeletal muscle
Increased CAMP so all the Contraction and reversal of fatigue - patients with COPD
29
Improves response to hypoxia
Theophylline on RC
30
Adverse effects
GIT - all motile, anorexia, hyperacidity Neurological - Headache Insomnia Irritability Confusion Tremors Dizziness Tinnitus CVS - arrhythmia, hypotension and syncope cardiac arrest velocity reaction flushing Allergic - rashes pruritis fever
31
Enzyme inhibitors - cimetidine and erythromycin
Increase methylxanthines
32
Enzyme inducers - smoking phenobarbitone carbamazepine
Reduce methylxanthine
33
Beta 2 agonists plus methulxanthines
Arrhythmia
34
Theophylline is very good in both acute and chronic bronchial asthma but
The others are so good It has a lot of side effects And there's need for constant monitoring of its blood concentration
35
Give IV theophylline
As a quick reliever of asthma
36
Give SC theophylline
As it reduces severity and chronic (asthma controller)
37
Anti muscarinic
Ipa and tiotropium plus glycoperoniun
38
Ipatropium
Short
39
Tiotropium
Long acting
40
Glyco
Ultra long
41
Antimuscarinic used
When intolerant to inhaled beta 2 agonists
42
Potentiate antimuscarinic action
B2 agonistS
43
COPD drugs
Antimuscarinic Ultra long beta 2 agonists
44
Inhaled ipatropium - with its much slower onset
Not recommended alone for acute bronchial asthma
45
Antimuscarinic over atropine
Selective broncho d. Decreased augmented mucus in bronchial asthma Increased mucociliary secretion Can't bbb as they are quaternary
46
Inflammatory
Corticos Mast cell stabilisers LT antagonists
47
Used on bronchial asthma since 1950
Corticos
48
Decrease bronchial hyperactivity, increae airway calibre and decreasing frequency of asthmatic attacks
Corticos
49
Mechanism of action of Corticos
Inhibit inflammatory cytogenetics IL 1 2 3 4 and TNF Inhibit phospholipase A2 so no arachidonic acid breakdown and non of its metabolic products Inhibit eosinophil and lymphocyte on airway Inhibit antibody formation so no antigen antibody reaction Potentiate beta 2 as well
50
Potentiate with beta 2
Antimuscarinics Corticos
51
Good for systemic
Corticos (plus inhalation)
52
Long term control inhalation route corticos - no systemic side effects
Beclomethasone Budesonide Fluticasone Ciclesonide Mometasone furoate
53
Cheapest and oldest
Bromethasone
54
Prodrug with high lung disposition
Less dysphonia And less candidiasis
55
Systemic acute bronchial asthma route
When inhaled corticos aren't enough: Oral Prednisolone IV methylprednisolone, sodium succinate, hydrocortisone sodium succinate
56
Discontinue systemic therapy
One week to ten days after starting TO AVOID SYSTEMIC SIDE EFFECTS
57
When switching to inhaled corticos
Oral should be reduced gradually to avoid adrenal suppression
58
Inhaled actually has side effects - ciclesonide has less
Oropharyngeal candidiasis - gargle water Hoarseness of voice
59
Mast cell stabilizers
Cromolyn and nedocromil
60
Mechanism of cromolyn action
Reduce bronchial hyperactivity Stabilize membrane by altering chloride channel permeability Mild anitinflammatory NO EFFECT ON SMOOTH MUSCLE
61
Little clinical use
Cromolyn As it is not a bronchodilator so not useful in acute asthma Plus short half life - three to four doses per day
62
Nedocromil sodium and cromolyn
Used before exposure (prophylaxis) to decrease severity, need for bronchods and hyperactivity
63
In combination with corticos
Nedocromil sodium and cromolyn
64
Nedo and cromo
Used by inhalation
65
Nasal spray
Allergic rhinitis
66
Eye drops
Allergic conjunctivitis
67
Mast cell stabilizers
Rarely cause Anaphylaxis
68
LT antagonists - no more hyperactivity, reactivity or edema
Zileuton - LOX inhibitor Zafirlukast - LDT4 antagonists Montelukast - LDT4A
69
Allergic rhinitis drugs
Mast cell stabilizers- cromolyn and nedocromil LT antagonists
70
LT antagonists
Orally
71
Approved for lids as young as 6 months
Montelukast
72
Zileuton - 600mg
4 times daily with liver toxicity
73
Zafirleukast - 20 mg
Twice daily
74
Montelukast- 4mg
Once daily 10mg for asukts
75
Rare side effects
LT antagonists: Vivid dreams Insomnia and Irritability Vssculitis Eosinophilia - Chrug DmStrauss syndrome
76
Targeted monotherapy
Monoclonal antibodies against IgE, IL 5 and receptors for IL4 and 3
77
Anti IgE - Omalizumab from recombinant DNA tech (SC)
Binds to IgE so it's not able to bind to it's receptors on mast cells And lowers IgE to undetectable levers after 10 mins
78
Anti IgE - Omalizumab from recombinant DNA tech (SC)+
In bronchial asthma
79
Anti il5 - Mepolizumab reslizumab benralizumab
No eosinophilairway inflammatory for peripheral action
80
Anti il4 dupilumab - moderate to severe asthma
Targets the il4 alpha receltor for both 3 and 4 - reduces exacerbation frequency - I proves pulmonary function - measures asthma control
81
Given with an eosinophilic phenotype corico
Dupilumab - SC every 2 weeks

Pharmacology (29 decks)

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