Antimuscarinic bronchodialators, β₂-agonists Flashcards
List 5 antimuscarinic bronchodialators and state the common brands they are available in (5)
1) Aclidinium bromide - Eklia
2) Glycopyrronium bromide- Seebri breezhaler
3) Ipratropium bromide- Atrovent
4) Tiotropium- Spiriva, Braltus
5) Umeclidinium- Incruse ellipta
Outline the role of antimuscarinic bronchodilators in COPD, with reference to SAMAs and LAMAs
1) SAMA- used to RELIEVE breathlessness e.g. brought on by exercise
2) LAMA- used to PREVENT breathlessness and exacerbations
Outline the role of antimuscarinic bronchodilators in asthma, with reference to SAMAs and LAMAs
1) SAMAs- used to help relieve breathlessness during acute exacerbations
2) LAMAs- (tiotropium) can be added to high dose ICS and LABAs as maintenance treatment in patients with severe asthma
List the common side effects of antimuscarinic bronchodilators
1) Dry mouth
2) Cough
3) Arrhythmias
4) Dizziness
5) Headache
6) Nausea, constipation, GI disturbance
7) Urinary retention
Who should antimuscarinic bronchodilators be used in caution with?
1) Angle-closure glaucoma- can cause a dangerous rise in IOP. (Reported with nebulised ipratropium esp when given with salbutamol . Protect patients eyes from drug)
2) Those at risk of arrhythmias
3) Those at risk of urinary retention e.g. bladder outflow obstruction, prostatic hyperplasia
4) Paradoxical bronchospasm
How often should SAMAs such as Ipratropium be taken?
To be taken 3-4 times a day or as needed for breathlessness
How often should LAMAs such as tiotropium, glycopyrronium, aclidinium be taken?
Once or twice daily for regular administration
What counselling should be given regarding side effects to patients taking antimuscarinic bronchodialators
1) Can cause dry mouth - chew or suck gum
2) When to take it: for acute symptoms, pre-emptively before exercise, or regularly for LAMAs
3) Check inhaler technique
What was the MHRA advice provided regarding Braltus (tiotropium) inhalers?
Risk of inhalation of capsule if placed in the mouthpiece of the inhaler. Always store capsules in screw-top bottle provided
Outline three indications for β₂-agonists
1) Asthma
2) COPD
3) Hyperkalaemia- nebulised may be used to decrease potassium concentration (along with insulin and glucose; and calcium gluconate)
Describe how SABAs and LABAs are used in the management of asthma
1) SABAs: used to relieve breathlessness
2) LABA: used in chronic asthma when ICS alone are insufficient
↳ LABA must always be given in combination with ICS
Describe how SABAs and LABAs are used in the management of COPD
1) SABA: used to relieve breathlessness
2) LABA: second line for COPD, to improve symptoms and reduce exacerbations
Outline the MoA of β₂-agonists
β₂-receptors found in smooth muscle of the bronchi, gut, uterus and blood vessels. Stimulation of this receptor leads to smooth muscle relaxation. This improves airflow in constricted airways
List four LABAs and state which brands they are commonly found in
1) Salmeterol- Serevent
2) Formoterol- Oxis turbohaler
3) Indacaterol- striverdi
4) Bambuterol- bambec
List the common side effects caused by β₂-agonists
1) Tachycardia, arrhythmias, palpitations
2) Anxiety
3) Tremor
4) Headache and dizziness
5) Nausea
Why should β₂-agonists be used in caution in diabetics?
1) they promote glycogenolysis and might increase glucose levels
2) hyperglycaemia and ketoacidosis especially a problem when β₂ given IV
1) why should LABAs always be given alongside an ICS in asthma?
2) name 2 common brands of combination LABA+ICS inhalers
1) Without a steroid, LABAs are associated with increased asthma deaths
2) seretide and symbicort
who should β₂-agonists be used in caution with
1) C/I in severe pre-eclampsia
2) Cardiovascular disease- Tachycardia might provoke angina or arrithmias ( esp careful with high doses e.g. treating hyperkalaemia )
3) Diabetes
4) Hypokalaemia- esp with high doses and by concomitant treatment with theophylline, corticosteroids, diuretics and by hypoxia
when prescribing nebuliser therapy, you should always indicate whether the nebuliser should be driven by oxygen or air. Explain why
1) Oxygen should be used in asthma
2) Medical air should be used in COPD due to risk of hypoxic drive/ hypercapnia
Outline the monitoring requirements for β₂-agonists
1) In sever asthma - plasma potassium concentration should be monitored (risk of hypokalaemia)
2) monitor blood glucose in diabetics
Outline the important safety information provided by the MHRA/CHM regarding the safe use of LABAs (salmeterol and formoterol) in the management of chronic asthma
1) Add-on only if standard dose of ICS fails
2) Not be initiated in those with rapidly deteriorating asthma
3) Start low and monitor before increasing
4) Stop in the absence of benefit
5) Not for relief of exercised-induced asthma unless regular ICS are also used
6) Review and step down treatment when good control is achieved
1) what is the maximum number of puffs that can be taken by adults and children in moderate and severe acute asthma using salbutamol
2) what is the duration of action of salbutamol?
1) 10 puffs - each puff is to be inhaled seperately, repeat every 10-20 minutes if required
2) 3 to 5 hours if inhaled
Name two SABAs and state which brands they are commonly found in
1) Salbutamol: Ventolin, Salamol
2) Terbutaline: Bricanyl
what advice should be provided to patient and carers regarding β₂-agonists
1) The dose, frequency and maximum number of inhalations in 24h should be stated explicitly
2) seek medical advice when the prescribed dose fails to provide the usual degree of relief
