9.2.2 Inhalers Flashcards
What are some examples of long acting muscarinic antagonists?
Tiotropium
Theophylline
How do LAMAs work?
Block vagally mediated contraction of airway smooth muscle - Ach at muscarinic receptors
When do you use LAMAs?
Severe asthma and COPD
What are the adverse effects of LAMAs?
Infrequent but anticholinergic effects - opposite to SLUDGE:
* Dry mouth
* Urinary retention
* Dry eyes
When is theophylline used?
Taken orally for chronic poorly controlled asthma
How do long acting muscarinic antagonists work?
Adenosine receptor antagonist- Decreases bronchoconstriction
Phosphodiesterase inhibitor, would normally catalyse hydrolysis of cAMP
What are the contraindications/warnings of theophylline?
Narrow therapeutic index - potentially life threatening as narrow window between therapeutic and deadly concentrations - potential arrhythmias, must measure plasma concentration
What are some important drug to drug interactions for theophylline?
CYP450 inhibitors
Increases concentration of theophylline
Where is asthma very prevalent?
Elite athletes
What treatment is available for acute severe and life-threatening asthma?
- High dose (nebulised) beta 2 agonist - oxygen driven, aim for 94-98% O2
- Oral steroids (eg prednisolone) for minimum of 5 days (paranteral if oral not possible)
Continue ICS alongside - Nebulised ipratropium bromide- short acting muscarinic antagonist alongside B2 agonist if poor response
- Consider IV aminophylline if life threatening/near fatal, caution with oral theophylline
What are the 5 steps of COPD management?
- Confirm diagnosis
- Smoking cessation
- Breathlessness score
- Vaccination
- Medication
What medications are given for COPD acute exacerbations requiring hospitalisation?
- Nebulised salbutamol and/or ipatropium if hypercapnic/acidotic nebulisershould be driven by air and not O2
- Oral steroids - less effective in eosinophilic asthma due to reduced action on neutrophils
- Antibiotics - narrow spectrum in less severe, broader in more severe asthma
- Review of chronic treatment and action plan
How do we select and prescribe inhalers?
- Need to find inhaler patient can use
- Should be assessed by trained healthcare professionals
- Dose titrated against clinical response
- Re-assessed as part of regular medication review
What are some inhaler options?
Pressurised meter dose inhalers (pMDI)
Slow breath in and hold, can be used with spacer to improve deliver
Breath actuated pMDI
Automatic release upon inspiring
Dry powder inhalers
Micro ionised drug and carrier powder, needs faster and deeper inhalation
How are inhalers prescribed?
By brand
Why is inhalation technique so important? Fill out the table
To get drug to correct place
How to check if you can use inhaler correctly?
In-check DIAL device - measure inspiratory flow for different devices
