Beta 2 agonists

Question 1

Suffix
Beta2 agonist

Answer 1

LABA
terol

SABA
Salbutamol
terbutaline

Question 2

Two kinds of Beta2 agonists

Answer 2

Short acting SABA
Long acting LABA

Question 3

Generic names
Beta2 agonists

Answer 3

SABA
Salbutamol
Terbutaline
LABA
Formoterol
Indacaterol
Salmeterol

Question 4

MOA
Beta 2 agonists

Answer 4

Relax bronchial smooth muscle by stimulating beta2 adrenoreceptors.

Question 5

Indication
SABA

Answer 5

Symptom relief of asthma and COPD
Prevention of exercise-induced bronchoconstriction

Question 6

Indication
LABA

Answer 6

• Maintenance treatment of asthma in patients receiving inhaled or oral corticosteroids (except olodaterol)
• COPD

Question 7

Precautions
Beta 2 agonists

Answer 7

Cardiovascular disorders (including hypertension, ischaemic heart disease, heart failure, arrhythmias)—risk of cardiovascular adverse effects.

Diabetes—risk of hyperglycaemia with high doses.

Treatment with other sympathomimetic amines—may increase adverse effects (tremor, tachycardia, headache); avoid combination or adjust dose as necessary.

Question 8

Adverse effects
Beta2 agonists

Answer 8

tremor, palpitations, headache
Hyperglycemia in high doses

Question 9

Practice points
Beta2 agonists

Answer 9

• high or increasing** usage of SABAs** indicates poorly controlled asthma and requires review of management
• check inhaler technique and compliance regularly, especially when asthma control is poor
• withhold LABA (24–36 hours) and SABA (4 hours if possible) before diagnostic spirometry; see details in the Spirometry Quick Reference Guide at the National Asthma Council Australia website

Question 10

Drug class and indication

Formoterol

Answer 10

Beta2 agonist - LABA
* Maintenance treatment of asthma in patients receiving inhaled or oral corticosteroids
* Symptom relief of asthma in patients receiving inhaled corticosteroids and regular formoterol
* COPD

Question 11

Drug class and indication

Indacaterol

Answer 11

Beta2 agonist - LABA
COPD

Question 12

Drug class and indication

Indacaterol with glycopyrronium

Answer 12

Beta2 agonist (LABA) + Anticholinergics
COPD

Question 13

Drug class and indication

Indacaterol with glycopyrronium and mometasone

Answer 13

Beta2 agonist (LABA) + Anticholinergic + corticosteroids

Maintenance treatment of severe asthma inadequately controlled with a combination inhaled corticosteroid and long-acting beta2 agonist

Question 14

Drug class and indication

Indacaterol with mometasone

Answer 14

Beta2 agonist (LABA) + corticosteroids
Maintenance treatment of asthma when use of an inhaled corticosteroid and long-acting beta2 agonist is appropriate

Question 15

Drug class and indication

Salbutamol

Answer 15

Beta2 agonist (SABA)
* Symptom relief of asthma and COPD
* Prevention of exercise-induced bronchoconstriction

Question 16

Drug class and indication

Salmeterol

Answer 16

Beta2 agonist (LABA)
* Maintenance treatment of asthma in patients receiving inhaled or oral corticosteroids
* COPD

Question 17

Drug class and indication

Terbutaline

Answer 17

Beta 2 agonist (SABA)
* Symptom relief of asthma and COPD
* Prevention of exercise-induced bronchoconstriction

Question 18

Drug interactions
Beta2 agonists

Answer 18

beta-blockers + beta2 agonists
Beta-blockers antagonise the therapeutic effects of beta2 agonists and may precipitate asthma; seek specialist advice if the combination is felt necessary as a selective beta-blocker may be suitable.

theophylline + beta2 agonists
Theophylline can potentiate hypokalaemia induced by high doses of beta2 agonists; monitor patients with severe asthma closely for hypokalaemia.

Combination with other sympathomimetic amines may overload sympathetic nervous system = tremors, tachycardia