Asthma+COPD drugs Flashcards
Doses for montelukast
6 months - 5 years: 4mg OD evening
6-14: 5mg OD evening
15-17, adults: 10mg OD evening
Indications for montelukast
- asthma prophylaxis
- symptomatic relief of seasonal allergic rhinitis in pt with asthma
Safety info: montelukast
- risk of neuropsychiatric reactions
- e.g. speech impairment, obsessive compulsive symptoms
- read list of neuropsychiatric reactions in PIL and seek immediate medical attention if they occur
- evaluate benefits and risks of continuing treatment if they occur
Common SE montelukast
- diarrhoea, GI discomfort
- n/v
- headache, fever
- upper RTI
- skin reactions
Churg-Strauss syndrome - montelukast
- rare
- inflammation within small blood vessels which results in blood flow restriction which can cause organ damage throughout body if untreated
- in many of the reported cases, reaction followed reduction or withdrawal of oral CCs
- alert: vasculitis rash, worsening pulmonary symptoms, cardiac complications, peripheral neuropathy
Montelukast in pregnancy and BF
- avoid unless essential
- however can be taken as normal in pregnant women who have shown a significant improvement in asthma not achievable with other drugs before becoming pregnant
Montelukast - how to administer granules
- swallowed or mixed with cold, soft food (NOT LIQUID) and taken immediately
Common side effects of SABAs - salbutamol, terbatuline
arrhythmias
headache
palpitations
tremor
HYPOkalaemia (high doses, if taking other meds that also cause this e.g. CCs and theophylline)
True or false - patients with diabetes who use SABAs and LABAs (b2 adrenoceptor agonists) should have their BG levels monitored because there is a risk of HYPERglycaemia and ketoacidosis, esp when they are given IV
True
Use is cautioned in pt with DM because of this
True or false - susceptibility to QT interval prolongation is a caution for all b2 adrenoceptor agonists
True
Can cause hypokalaemia with high doses and if on other drugs that cause this e.g. CCs and theophylline
Signs of theophylline overdose
- vomiting (can be severe and intractable)
- agitation
- restlessness
- dilated pupils
- sinus tachycardia
- hyperglycaemia
- more serious effects: haematemesis, convulsions, SV and V arrhythmias
- severe hypokalaemia can develop rapidly
Theophylline and smoking -how does smoking affect levels and when are dose adjustments needed
- smoking INCREASES clearance of theophylline so HIGHER doses needed
- adjustments needed if smoking has started or stopped during treatment
A patient on theophylline has mentioned they have started smoking. What does this mean
Smoking INCREASES clearance so INCREASED dose is required
A patient on theophylline mentions that they have finally stopped smoking. What does this mean
Smoking INCREASES clearance so higher dose is needed. If smoking has STOPPED, this means the patient will need a DECREASED dose.
Where is theophylline metabolised?
Liver
plasma theophylline conc is increased in the following (4)
viral infection
HI
HF
elderly
plasma theophylline concentration is decreased in the following 2 scenarios
smokers
alcohol consumtpion
theopheylline dose is every … hours
every 12 hours
When to measure plasma-theophylline concentration after starting oral treatment & after dose adjustments
5 days after starting oral treatment
3 days after dose adjustment
True or false: plasma-theophylline conc needs to be measured 5 days after starting oral treatment and after any dose increase
FALSE
5 days after starting oral treatment
3 days after dose adjustment
What is the plasma-theophylline concentration required for satisfactory bronchodilation?
10-20mg/L (in most patients)
although lower conc of 5-15 mg/L may be effective in some
True or false: adverse effects can occur within the rangr 10-20mg/L (even though this is the concentration required in most pt for effective bronchodilation) and both the freq and severity of adverse effects increases above 20mg/L
True
How many HOURS after an oral dose of MR prep theophylline should blood sample be taken? (measure conc 5 days after starting oral treatment and at least 3 days after any dose adjustment)
take blood sample 4-6 hours after oral dose
remember: THEO = 4
true or false - dispense theophylline by brand
true
the rate of absorption from MR Preps can vary between brands
true or false - plasma potassium conc should be monitored in severe asthma
true
this is bc potenitally serious hypokalaemia can result from B2 agonist therapy
particular caution required in severe asthma - effect can be potentiated by concomitant treatment with theophylline and its derivatives, CCs, diuretics and by hypoxia
signs of theophylline overdose
vomiting (may be severe and intractable)
agitation
restlessness
dilated pupils
sinus tachycardia
hyperglycaemia
more serious effects include haematemsis, convulsions, SV and venticular arrhtyhmias
theophylline poisoning - how to eliminate theophylline
repeated doses of activated charcoal can be used even if >1h after ingestion
especially good if MR prep taken
theophylline poisoning - which anti emetic may be effective for severe vomiting that is resistant to other antiemetics?
ondansetron
theophylline poisoning - how would you correct hypokalaemia
IV infusion of potassium chloride
may be so severe as to require 60mmol/h
high doses need ECG monitoring
theophylline poisoning - how to control convulsions
IV lorazepam or diazepam
theophylline poisoning - how to manage agitation
sedation with diazepam may be necessary
true or false - if someone has theophylline poisoning and they DO NOT suffer from asthma, a SHORT ACTING BETA BLOCKER can be given IV to reverse severe tachycardia, hypokhalaemia and hyperglycaemia
true
true or false - theophylline can cause hyperglycaemia
true
Theophylline is predicted to cause HYPOkalaemia, potenitally increasing risk of TDP, when given with the following drugs
amiodarone, dronedarone
antipsychotics
promethazine
apomorphine, methadone,
citalopram, escitalopram
erythromycin
fluconazole, voriconazole
quinine
ondansetron
hydroxyzine
CCs
Loop and thiazides
SABAs and LABAs
the following drugs are predicted to INCREASE risk of bronchospasm when given with theophylline so avoid
beta blockers
true or false - COC can INCREASE exposure to theophylline. monitor and adjust dose
true
the folllowing drugs increase the exposure to theophylline. monitor and adjust dose
VA CAC COC
clarithromycin
azithromycin
ciprofloxacin
COC
valaciclovir
aciclovir
name the 4 LAMA
Tiotropium
Aclidinium, glycopyrronium and umeclidinium (black triangle)
Name the SAMA
ipratropium
use inhaled antimuscarinics with caution in the following (4) …
bladder outflow obstruction
paradoxical bronchospasm
prostatic hyperplasia
susceptibility to CAG
name 7 common SE of inhaled antimuscarinics
- arrhtyhmias
- constipation
- cough
- dizziness
- dry mouth
- nausea
- headache
