BMA New Guide to Medicines

Question 1

What are the 3 main drug classes that are bronchodilators?

Answer 1

1. Sympathomimetics inc Beta 2 agonists- Salbutamol, Salmeterol, Terbutaline,Bambuterol, Ephedrine, Epinephrine
2. Anticholinergics- Atropine, Ipratropium bromide, Oxitropium
3. Xanthines- Theophylline, aminophylline
4. Corticosteroids- Beclomethasone, Budesonide, Fluticasone, Prednisolone
5. Others- antihistamines, sodium cromoglycate

Question 2

What are bronchodilators?

Answer 2

Drugs that widen the bronchi/bronchioles and improve breathing. Used to relieve and prevent Asthma attacks.

Question 3

Why are bronchodilators used?
How do they work?

Answer 3

To help dilate the bronchioles of people suffering from asthma and bronchitis. Little benefit to those suffering from severe chronic bronchitis

Relax the muscles surrounding the bronchioles. Achieve this by interfering with nerve signals passed to the muscles through the autonomic nervous system.

Xanthines-

Question 4

The action of bronchodilators?

Question 5

Risks and special precautions of bronchodilators

Answer 5

Xanthines (Affect HR)
Prescribe with caution for patients with:
- Heart problems, hypertension, overactive thyroid

Anticholinergic drugs- mostly unsuitable for:
- urinary retention
- tendency to glaucoma

Question 6

When are differrent bronchodilators used?

Answer 6

Sympathomimetic= Rapid relief
Xanthines and Anticholinergic= Long term

Question 7

What are examples of cardio-selective beta blockers?

Non-selective?

Answer 7

Atenolol, Bisoprolol, Betaxolol, Celiprolol, Metoprolol

Propanalol, Acebutolol, Oxprenolol, Timolol

Question 8

What are some common vasodilators? (6)

Answer 8

ACE Inhibitors
Angiotensin ll receptor blockers
Nitrates
Potassium channel activators- Nicorandil
Calcium Channel blockers
Sympatholytics

Question 9

What are some common drug classes of Diuretics?

Answer 9

Loop
Thiazid-like
Potassium-sparing

Question 10

What are the lipid-lowering drug classes?

Answer 10

Fibrates
Statins
Bile acid sequestrants
Nicotinic acid and derivatives
Other

Question 11

Blood clotting:
What is the clotting mechanism?

Answer 11

When a blood vessel is damaged, platelets accumulate at the site of damage and form a PLUG.
1. Platelets clumped together release chemicals that activate blood clotting factors
2. These factors together with vitamin K act on a substance called fibrinogen and convert it to FIBRIN
3. Strands of fibrin become enmeshed in the platelet plug to form a BLOOD CLOT

Question 12

Inhaler technique pMDI:

Answer 12

• Hold upright and remove cap, check nothing is inside
• Shake well
  Sit down or Stand up
• Tilt chin upwards
  Breathe out gently away from the inhaler until you feel as though lungs are empty
• Create tight seal around the inhaler with lips
• Breathe in slowly and steadily whilst pressing down on canister once
• Breathe in slowly until you feel that lungs are full
• Remove inhaler and seal lips
• Hold breath for around 10 seconds then breathe out gently away from inhaler
• Wait 30 secs for second puff

SE
Salbutamol in high doses= Palpitations & Tremor
Steroid inhalers= Oral thrush