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Pharmacology /Pharm Y2S2 - Respiratory Part 3

Pharm Y2S2 - Respiratory Part 3

Pharmacology36 CardsCreated about 2 months ago

This deck covers key concepts related to respiratory pharmacology, including treatments and mechanisms of action for conditions like COPD and asthma.

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When are PDE4 inhibitors indicated?

Severe persistent COPD associated with chronic bronchitis
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Key Terms

Term
Definition
When are PDE4 inhibitors indicated?
Severe persistent COPD associated with chronic bronchitis
What are the side effects of PDE4 inhibitors?
Diarrhoea Abdominal pain Unexplained weight loss
What is the mechanism of action of monoclonal antibodies in asthma?
Inhibit IgE binding to mast cell receptors, thus reducing inflammation
Give an example of monoclonal antibodies used in asthma. What is the regimen?
Omalizumab SC every 2-4 weeks | Discontinued after 16 weeks if no adequate response is seen
Give examples of immunosuppressants that may be used by specialists in asthma.
Cyclosporin Methotrexate Gold
What are analeptics?
Stimulate chemoreceptors in carotid and aortic bodies to increase respiratory work rate
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Pharm Y2S2 - Respiratory Part 3
TermDefinition
When are PDE4 inhibitors indicated?
Severe persistent COPD associated with chronic bronchitis
What are the side effects of PDE4 inhibitors?
Diarrhoea Abdominal pain Unexplained weight loss
What is the mechanism of action of monoclonal antibodies in asthma?
Inhibit IgE binding to mast cell receptors, thus reducing inflammation
Give an example of monoclonal antibodies used in asthma. What is the regimen?
Omalizumab SC every 2-4 weeks | Discontinued after 16 weeks if no adequate response is seen
Give examples of immunosuppressants that may be used by specialists in asthma.
Cyclosporin Methotrexate Gold
What are analeptics?
Stimulate chemoreceptors in carotid and aortic bodies to increase respiratory work rate
Give an example of an analeptic.
Doxapram
When are analeptics used?
Post-operative respiratory depression Ventilatory failure in COPD Apnoea in neonates
Why is caffeine useful in respiratory disease?
It is a phosphodiesterase inhibitor, increasing levels of cAMP and promoting effects of beta-adrenoceptors
What are cromones? Give an example.
Nedocromil | Mast cell stabilisers, work to reduce inflammation
What is the role of carotid and aortic chemoreceptors?
Activated by increased carbon dioxide levels in the blood increasing respiratory rate and workload
What is the normal level of carbon dioxide in ventilation?
40mmHg
What is the role of acetylcholine at M3 receptors in respiration?
Increases intracellular calcium ion levels Interaction with calmodulin activates myosin light chain kinase Kinase phosphorylates myosin leading to contraction
What occurs upon activation of beta-2 adrenoceptors?
Stimulates adenylyl cyclase, increasing production of cAMP Protein kinase A activates to phosphorylate proteins acting to reduce intracellular calcium Reduces activity of MLCK, causing relaxation of airway muscles
What is allergic asthma?
Hyper-responsiveness to stimulus causing broncho-constriction and mucus secretion that is reversible
Give examples of triggers of asthma.
Stress Cold Allergens Exercise Infection
How do dust mites cause allergic asthma?
Release of casts, secretions and enzymes
What occurs in the initial phase of asthma?
Occurs abruptly due to spasm Allergen interacts with mast cell IgE releasing histamine, leukotriene B4 and prostaglandin D2 Interleukins, TNF and macrophage proteins also released into airway Chemotaxins attract eosinophils to trigger late phase
What occurs in the late phase of asthma?
Allergens interact with dendritic and CD4 cells leading to ThO cell development, leading to Th2 clones B cells produce IgE IL-5 activates eosinophils Cytokines induce IgE receptor expression Eosinophils release cysteine leukotrienes, interleukins and toxic proteins which cause damage to epithelium Inflammatory mediators include adenosine, NO and neuropeptides
What is intrinsic asthma?
Occurs later in life due to precipitating factors such as inhalation of irritants or pollutants Chronic and persistent symptoms
What is the cause and action of COPD?
Exposure to irritants causing epithelial cells to release factors activating neutrophils CD8, B cell and macrophage accumulation accumulation Inflammatory cascade causes mediator release- TNF, interferon, MMP, interleukins
What causes damage in COPD?
Inflammation is sustained and causes tissue damage and systemic effects MMPs destroy elastin fibres causing proteolytic degradation
What is COPD characterised by?
Airflow obstruction that is not fully reversible Does not change markedly over several months but progressive in the long term FEV1/FVC ratio <70%
What are the risk factors of COPD?
Smoking Age Alpha-1 antitrypsin deficiency Occupation
What does COPD present with?
Exertional breathlessness Chronic cough Regular sputum production Wheeze
What is the BODE index?
Measure of COPD based on: BMI Obstruction Dyspnoea Exercise capacity
What are the side effects of anti-muscarinics?
Dry mouth Urinary retention Blurred vision
How can methylxanthines improve COPD symptoms?
Strengthen diaphragm | Increase mucociliary clearance
What are mucolytics used for?
Reduce mucus viscosity making it easier to clear and reducing obstruction
When is oxygen given in COPD?
Long term where FEV1 <35% and oxygen sats <92% | 24-28% oxygen given > 15 hours per day
What are the common causes of infective exacerbations of COPD?
Streptococcus pneumoniae | Haemophilus influenzae
What is the first line treatment of infective exacerbations of COPD?
Amoxicillin 500mg OR tetracycline 100mg with 200mg doxycycline stat Given alongside 30mg prednisone for 7-14 days
What is the second line treatment of infective exacerbations of COPD?
Broad spectrum cephalosporin or macrolide
What is hypercapnia?
Abnormally high carbon dioxide levels
What is cor pulmonale?
Right side heart failure due to pulmonary hypertension
What is polycythaemia?
Increase in RBCs due to chronic hypoxia, increasing blood viscosity