Bronchodilators Flashcards
When are short-acting beta-2 agonists (SABAs) used?
For immediate relief of asthma symptoms.
Give examples of SABAs.
Salbutamol, terbutaline.
When are long-acting beta-2 agonists (LABAs) used?
Alongside ICS in patients requiring prophylactic treatment.
What electrolyte disturbance is sometimes seen in beta-2 agonist therapy?
Hypokalaemia.
Concomitant use with which drugs increases the risk of hypokalaemia with beta-2 agonist use?
Theophylline, corticosteroids, diuretics.
When should prophylactic treatment be considered in asthma patients?
SABA needed more than three times weekly, night-time symptoms, an asthma attack in the last 2 years.
Give examples of long-acting beta-2 agonists (LABAs)?
Formoterol and salmeterol.
Why should salmeterol not be used in an asthma attack?
It has a slower onset of action than salbutamol or terbutaline.
Is formoterol licensed for short-term symptomatic relief of asthma?
Yes.
If control of asthma symptoms with regular ICS has failed, should formoterol or salmeterol be added?
Yes.
Should formoterol or salmeterol be initiated in a patient with rapidly deteriorating asthma?
No.
Describe how formoterol or salmeterol should be initiated in patients with asthma (with respect to dose).
Started at the lowest effective dose and effects monitored before dose increase.
Should formoterol or salmeterol be used for the relief of exercise-induced asthma?
No, unless regular ICS also used.
Describe the management of formoterol and salmeterol treatment once good long-term control of asthma is achieved.
Consideration of stepping down therapy.
Give examples of antimuscarinics licensed for short term relief in chronic asthma and COPD.
Ipratropium.
Give examples of antimuscarinics licensed for maintenance treatment in patients with COPD.
Aclidinium, glycopyrronium, tiotropium, umeclidinium.
Which antimuscarinic drug is licensed for use alongside ICS and LABA for the maintenance of patients with asthma who have suffered one or more exacerbations in the last year?
Tiotropium.
What are the cautions for use of antimuscarinics?
Prostatic hyperplasia, bladder outflow obstruction, those susceptible to angle-closure glaucoma. May also be associated with paradoxical bronchospasm.
Acute angle-closure glaucoma has been reported with the use of which antimuscarinic agent in nebulised form, particularly when given with nebulised salbutamol?
Ipratropium bromide.
How can the risk of acute angle-closure glaucoma seen with the use of nebulised ipratropium be reduced?
Protecting the patient’s eyes.
What is the therapeutic range of theophylline?
10-20 mg/L (plasma concentration of 5-15 mg/L may be effective).
Is a loading dose of theophylline required?
Sometimes.
Give the signs of theophylline toxicity.
Vomiting, agitation, restlessness, dilated pupils, sinus tachycardia, hyperglycaemia, severe hypokalaemia may develop rapidly, haematemesis, convulsions, cardiac arrhythmias.
Give the symptoms of uncontrolled asthma.
Cough, wheeze, tight chest.
What may frequent courses of antibiotics and/or oral corticosteroids being taken by an asthmatic patient suggest?
Poor asthma control.
What monitoring is required when a patient is taking theophylline?
Serum potassium, plasma theophylline concentration.
An increased plasma concentration of theophylline is seen when used with which drugs?
Diltiazem, cimetidine, ciprofloxacin, erythromycin, oestrogens, fluvoxamine, verapamil.
The plasma concentration of theophylline may increase when the patient is suffering from which conditions?
Heart failure, hepatic impairment, viral infections, the elderly.
An increased risk of convulsions is seen when theophylline is used alongside which drugs?
Quinolones.
A reduced plasma concentration of theophylline is seen when used with which drugs?
Alcohol, carbamazepine, primidone, phenobarbital, phenytoin, ritonavir. Smokers - dose adjustment may be needed.
