⚡️ Salbutamol

• lung function tests are used to identify if a restrictive condition is obstructive or restrictive

• examples:

  • spirometry

  • peak expiratory flow (PEF)

  • diffusing capacity of the lungs for carbon monoxide (DLCO)

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⚡️ Ipratropium

• measures how much air can be breathed in and out of the lungs

• it can help diagnose obstructive lung disease and restrictive lung disease by taking into account two important measurements:

  • forced expiratory volume in 1 second (FEV1): how much air that can be forcefully exhaled in 1 second from maximal inhalation

  • forced vital capacity (FVC): the total amount of air that can be exhaled from maximal inhalation

  • the ratio of the FEV1 to the FVC can then be calculated (see below)

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⚡️ Corticosteroids

• measured using a peak flow meter to help with the diagnosis of asthma

• measures the diurnal variability

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⚡️ Methylxanthines

• assesses the efficiency of gas transfer from the alveoli into the surrounding capillaries

• it measures the quantity of carbon monoxide that is transferred from alveolar gas to red blood cells per minute

• carbon monoxide is used because it has a greater affinity to haemoglobin than oxygen (200-250X more)

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⚡️ Montelukast​

• FEV1: significantly reduced

• FVC: reduced

• FEV1/FVC ratio < 70%

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• Causes of obstructive lung disease ('ABCO')

  • Asthma

  • Bronchiectasis

  • COPD / Cystic fibrosis

  • Obstruction

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⚡️ Fostair

• combination of formoterol (fast-acting LABA) + beclometasone

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⚡️ Nintedanib

• FEV1: normal or reduced

• FVC: significantly reduced

• FEV1/FVC ratio > 70%

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• Causes ('PAINT')

  • Pleural disease (e.g. asbestosis)

  • Alveolar (e.g. pus, oedema)

  • Interstitial lung disease (e.g. idiopathic pulmonary fibrosis)

  • Neuromuscular (e.g. myasthenia gravis)

  • Thoracic (e.g. kyphoscoliosis, obesity, ankylosing spondylitis)

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⚡️ Pirfenidone

• mechanism of action

  • antifibrotic agent

• uses

  • reduces progression of idiopathic pulmonary fibrosis (IPF)

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⚡️ Rifampicin

• mechanism of action

  • acts on ribosomes

  • inhibit DNA-dependent RNA polymerase

• side effects

  • increased activity of cytochrome P450 enzymes

  • orange-red body fluids

• uses

  • latent tuberculosis

  • active tuberculosis

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⚡️ Isoniazid

• mechanism of action

  • decreases synthesis of mycolic acid (remember, the cell wall of mycobacteria is made of mycolic acid)

• side effects

  • decreased activity of cytochrome P450 enzymes

  • vitamin B6 deficiency —> peripheral neuropathy, sideroblastic anaemia

• uses

  • latent tuberculosis

  • active tuberculosis

• cautions

  • must be administered with pyridoxine (vitamin B6) to avoid peripheral neuropathy and sideroblastic anaemia

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⚡️ Pyrizinamide

• side effects

  • hyperuricaemia leading gout

  • arthritis

  • hepatotoxicity

• uses

  • active tuberculosis

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⚡️ Ethambutol

• side effects

  • optic neuritis

• uses

  • active tuberculosis

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