Respiratory Examination - Asthma, COPD + Corticosteroids Flashcards Preview

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Flashcards in Respiratory Examination - Asthma, COPD + Corticosteroids Deck (33):
1

Name 5 drugs commonly used in the treatment of lung conditions

B2 agonist
Muscarinic Receptor Antagonist
Methylxanthines
Leukotriene Receptor Antagonists
Glucocorticoids
Loop diuretics (Pulmonary oedema)

2

Name some major B2 agonists

Short acting - Salbutamol
Long acting - Salmeterol

3

Mechanism of action of B2 agonists

Act on B2 receptors found on bronchial smooth muscle. The receptors are coupled to Gs Proteins, which cause an increase in cAMP and consequent decrease in intracellular [Ca2+]. This reduces the binding of Ca2+ by light myosin, causing smooth muscle dilation.
- Additionally, the decrease in intracellular Ca2+ will also and increase Ca2+ activated K+ currents, thus hyperpolarising muscle cells further and augmenting bronchodilation.

4

Give two ADRs of b2 agonists

Skeletal muscle tremor
Can act on cardiac B1 receptors to induce tachycardia and cardiac dysrhythmia

5

Give one negative drug-drug interaction of B2 agonists

Propanolol (beta blocker) reduces effects

6

Name a muscarinic receptor antagonist

Ipratropium Bromide
Tiotropium bromide

7

Mechanism of action of muscarinic receptor antagonists?

- Bind to and antagonise M3 cholinergic receptors on bronchial smooth muscle. This blocks the constricting effect of Ach and also inhibits mucus secretions.

8

Give an ADR of muscarinic receptor antagonist

Dry mouth
Systemic effects avoid as not well absorbed

9

When would you use muscarinic antagonists?

COPD and Asthma

10

Name two methylxanthines

Theophylline
Aminophyilline

11

What is the mechanism of methylxanthines?

Competitive antagonist of adenosine

12

What are two complications of methylxanthine use?

Cardiac dysrhymia
Seizure

13

What are some indications for the use of leukotriene receptor antagonists?

Mild asthma

14

What is the mechanism of action of leukotriene receptor antagonists?

Antagonise cysLT1 and prevent early and late responses from inflammatory cells

15

What are two ADRs of Leukotriene Receptor Antagonists?

Headache and gastrointestinal disturbance

16

Name three corticosteroids

Prednisolone
Beclometasone (inhaled)
Hydrocortisone

17

What are three indications for corticosteroids?

Immunosuppression
Anti-inflammatory therapy
Replacement of endogenous corticosteroids

18

Give a contra-indication for glucocroticoids

Systemic infection

19

What is the mechanism of action of glucocorticoids?

Diffuse into cytoplasm and bind receptor. Complex moves to nucleus and binds HRE, causing inducement and inhibition of transcription.

20

Give four of the post-transcriptional effects of glucocorticoids

- Upregulate B2 receptors in lungs
- Reduce production of acute inflammatory mediator by inhibiting arachadonic acid processing (Upreg lipocortin which inhibits phospholipase A2, no Prost and leukotrienes prod)
- Reduce number of circulating immunocompetent cells
- Decreases activity of cells involved in chronic stages of inflammation (macrophages/fibroblast)

21

Give three ADRs of corticosteroids, specifically inhaled

Oral candiadiasis
Suppression of HPA acis
Osteoporosis

22

What is the main cortiosteroid used in asthma and COPD?

Beclametasone

23

How must you stop corticosteroid therpay?

Slowly, to avoid HPA supression

24

Outline the indication for a loop diuretic

Pulmonary oedema

25

Name a diuretic used in pulmonary oedema

Furosemide

26

What is the mech of action of furosemide?

NKCC2 blocker in thick ascending limb of loop of henle

27

Give four ADRs of loop diuretics

- Hypokalaemia, Ototoxicity, hyponatraemia, hyperuricaemia (can precipitate gout)`

28

Give two of the main drug-drug interactions of loop diuretics

- Cardiac glycosides – Hypokalaemia caused by loop diuretic potentiate effects of cardiac glycosides, increasing risk of arrhytmias
- Aminoglycosides – Can compound ototoxicity

29

Give two common bacterial causes of community acquired pneumonia

Strep pneumonia
Haemophilus influenza

30

Give two common causes of hospital acquired pneumonia

Staph aureus
Pseudomonas

31

Give two treatments for two community causes pneumonia

Step pneumonia -Amoxicillin (b-lactam, inhibit transpeptidase synthesis of cell wall)
Haemophilus - Clarithromycin (macrolide, binds to bacterial ribosome and prevents protein synth)

32

Give two treatments for two hospital acquired pneumonias

Staph aureus - Vancomycin (inhibit cell wall synth
Gram -'ve enterococci - Amino glycoside1

33

How does aminoglycoside work?

Inhibit bacterial protein synthetsis