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General > Respiratory Pharmacology > Flashcards

Respiratory Pharmacology Flashcards

1
Q

How to treat a genetic predisposition to triggers?

A

Avoidance.

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2
Q

How to treat eosinophilic inflammation?

A

Anti-inflammatory, e.g. corticosteroid (prednisolone).

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3
Q

How to treat mediators/TH2 cytokines?

A

Anti-leukotriene/histamines.
Anti-IgE
Anti-IL5

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4
Q

How to treat twitchy smooth muscle, i.e. hyper reactivity.

A

Bronchodilators:

  • beta 2 agonists: salbutamol
  • Muscarinic antagonists: ipratropium bromide.
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5
Q

Describe the asthma “treatment pyramid”.

A

FROM BOTTOM TO TOP.

  1. Reliever: short acting b2-agonist, e.g. salbutamol.
  2. Preventer: inhaled corticosteroid, e.g. beclometasone diproprionate, Cromoglycate or montelukast.
  3. Controller (in + to ICS): Theophylline, LTRA, LABA/LAMA (salmeterol, Anti-IgE/Anti-IL5.
  4. Oral steroid.
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6
Q

What do you give in intermittent asthma?

A

SABA (e.g. salbutamol)

+ Optional: ICS/cromone/LTRA/Theophylline/anti-IgE/anti-IL5.

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7
Q

What would you give in mild persistent asthma?

A

SABA + ICS.

+ Optional: ICS/cromone/LTRA/Theophylline/anti-IgE/anti-IL5.

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8
Q

What would you give in moderate persistent asthma?

A

SABA+ ICS+ LABA /LAMA

+ Optional: ICS/cromone/LTRA/Theophylline/anti-IgE/anti-IL5.

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9
Q

Uses, an example and side effects of corticosteroids?

A

Used in asthma + COPD.
E.g. prednisolone- acute exacerbations.
Beclomethasone- maintenance monotherapy in asthma, ICS/LABA combo in COPD.

S/E: may cause pneumonia in COPD (suppresses immune system + impairs mucociliary clearance).

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10
Q

What are spacers used for?

A

Inhalers.
Avoid coordination issues.
reduces side effects, reduces systemic absorption, a holding chamber for aerosol, reduces particle size and velocity, improve slung deposition.

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11
Q

Uses, an example and down side of cromones?

A

Anti-inflammatories used only in asthma, effective in atopic children.
E.g. cromoglycate INH only.

Mast cell stabilizer. Not used often (poor efficacy)

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12
Q

Uses, an example and down side of LTRA (leukotriene receptor antagonists?

A

An anti-inflammatory used only in asthma.
E.g Montelukast (1st) oral, OD, less potent than ICs.

Effective in allergic rhinitis + anti-histamine

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13
Q

Uses, an example and down side of anti-IgE?

A

Anti-inflammatory use in severe persistent allergic asthma despite max. therapy.

E.g. omalizumab injection 2-4 weeks.,

VERY EXPENSIVE.

Reduces exacerbations.

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14
Q

Uses, an example and down side of anti-IL5?

A

Blocks eosinophilic inflammation.
E.g. mepolizumab
Expensive.
only in those not controlled by step 5.

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15
Q

Use, example, side effect of b2 agonists.

A

Stimulate b2 smooth muscle receptors ^cAMP.
Used in asthma as ICS/LABA or ICS/LABA/LAMA
SABA: salbutamol.
LABA: salmeterol/formeterol.
Combo inhalers: beclometasone/formeterol.

Tremor.

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16
Q

Muscarinic antagonists.

A

block M3 receptors. Used mostly in COPD and asthma stage 4.
short acting: ipratropium
Long acting: tiotropium

17
Q

mucolytics

A

oral carbocisteine

reduces sputum viscosity and aides sputum expectoration, reduces COPD exacerbations.

18
Q

Treatment of chronic asthma?

A

b2 + trigger avoidance + inh steroid.
+/- theophylline, anti-leukotriene, cromoglycate
+/- LABA/LAMA

19
Q

Treatment of acute asthma?

A 
Oral prednisolone/IV hydrocortisone
\+ high dose salbutamol 
\+/- ipratropium
\+/- IV aminophylline/magnesium
O2- at least 60% , if falling PaO2 rising CO2 then intubate.
20
Q

Treatment of COPD?

A 
Smoking cessation
Immunisation 
Pharmacotherapy (CAT and mmRC)
Pulmonary rehab
Oxygen
21
Q

COPD treatment mMRC of 0-1, CAT<10 and >2 exacerbations a year?

A

LABA/LAMA or ICS/LABA
formeterol/ tiotropium
beclometasone/formeterol

22
Q

COPD treatment mMRC of 0-1, CAT<10 and <2 exacerbations a year?

A

SAMA/SABA as required.

23
Q

COPD treatment mMRC of >2, CAT>10 and >2 exacerbations a year?

A

ICS/LABA/LAMA

glycopyrronium/beclometasone/formeterol

24
Q

COPD treatment mMRC of >2, CAT>10 and 0-1 exacerbations a year?

A

LAMA: tiotropium

25
Q

Treatment of acute COPD?

A 
neb. high dose salbutamol + ipratropium.
oral prednisolone
Antibiotic (amoxicillin/doxycycline) if infection
O2
Physio
ventilation

General (24 decks)

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