PHTY208 Lecture Notes - Lecture 16: Terbutaline, Anti-Inflammatory, Aminophylline
Respiratory pharmacology
• Discuss the medications used in the medical management of respiratory disease
• Discuss the usual mode of delivery for these medications
• Modes of delivery
o Per Oral (pa)
• Dose in mouth e.g. paracetamol
o Metered Dose Inhaler (MDI)
• Puffer
• Dose dependent on how effectively the person taking the medication receives
the dose
• Can get adverse reactions
• Inhale and press down on puffer simultaneously
o MDI with spacer
• Inhale at own rate
o Nebulised
• Drug is in liquid form
• Breaks up into particles to be inhaled
• Gas nebulises liquid and turns drug into aerosol
• Mouth piece ideally, otherwise mask
• Cannot be used with certain medications
o Itra‐eous IV
• Very effective
• Increased risk of infection
• Expensive and time consuming
• Airway Obstruction
o Airway obstruction is caused by bronchconstriction, infection, inflammation and
increased mucous secretion
o Airway obstruction leads to hyperinflation of the alveoli as the narrowed airways
allow air to enter the alveoli but impede the movement of air out of the airways.
o Hyperinflation leads to impaired gas exchange
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• Control of bronchial smooth muscle tone
o Sympathetic Nervous System
• Alpha & Beta receptors (adrenergic)
• Stimulation causes bronchodilation and decreased mucous production
o Parasympathentic Nervous System
• Muscarinic and nicotinic receptors (cholinergic)
• Stimulation causes bronchoconstriction and increased mucous production
• Nucelotides
o cAMP causes bronchodilation by
• Facilitating smooth muscle relaxation
• Inhibiting mast cell degeneration
o cGMP causes bronchoconstriction
• Facilitating smooth muscle contraction
• Enhancing mast cell release of histamine and other mediators
• Bronchodilators
o β2 agoists
• Relievers
▪ “tiulate β2 reeptors o rohial sooth usle
▪ Atiate β2 reeptors o the ast ells ihiiting the release of
mediators
▪ Increase the cilia beat frequency
▪ Short acting effect on bronchodilation therefore used for rapid reversal
of an acute attack
▪ Salbutamol (ventolin)
▪ Terbutaline (bricanyl)
• Preventers
▪ “tiulate β2 reeptors o the rohial all
▪ Also hae ati‐iflaator effet
▪ Up to 12 hours effect
▪ Do not give relief in an acute attack
▪ Salmeterol (serevent)
o Adverse Effects
• Fine tremor
• Palpitations (taccycardia)
• Vasodilatation which may lead to hypotension
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• Overuse or overdosing may result in hypokalaemia and raised blood sugar
levels
• Can be combined with corticosteroids – Seretide, serevent
o Symbicort
• Symbicort contains a combination of budesonide and formoterol.
• Budesonide is a steroid that reduces inflammation in the body
• Formoterol is a bronchodilator that relaxes muscles in the airways to improve
breathing.
• Use
▪ Used once the initial acute symptoms have settled.
▪ Maintenance and Reliever
▪ Dosage 2 inhalations in the morning and 2 in the afternoon
• Possible to use up to 8 inhalations throughout the day
▪ This gives the patient both the reliever and the preventer at the same
time which helps to increase compliance
o Seretide
• Cotais to agets, flutiasoe propioate ati‐iflaator ad
salmeterol xinafoate (bronchodilator).
• This decrease swelling, redness, sensitivity and mucus in the airways and
assists in relaxing the smooth muscles.
• Patiets hoeer otiue to utilise their Vetoli i additio to oat flare‐
ups
• Antimuscarinic Agents
o Theory that they have an effect on the viscous mucous which can cause
bronchoconstriction
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