Drugs used in Asthma and COPD Flashcards
What is Clenil?
Beclametasone- ICS
What is salbutamol?
SABA
What is salmeterol?
LABA
What is montelukast?
LTRA
What is Tiotropium?
LAMA
What is ipatropium?
SAMA
What is a budesonide turbohaler?
ICS
What is Qvar?
Beclametasone- ICS
What is terbutaline?
SABA
What is formoterol?
LABA
What is glycopronium?
LAMA
What is indacaterol?
LABA- COPD only
What is Ventolin?
Salbutamol- SABA
What is Fostair?
Beclometasone + Formoterol (ICS + LABA)
What is a secretive evohaler?
Fluticasone and salmeterol (ICS + LABA)
What does Uniphyllin continue contain?
Theophyline (xanthine)
What should a healthy patients respiratory rate be?
12-18 bpm
What does PEFR stand for?
Peak expiratory flow rate- measures the volume of air forcefully expelled in one exhalation.
what should a patients PEFR be?
The ideal PEFR value will depend on the patient but their reading should be at least 80% of of the patients best (calculate)
What should a patients O2 saturation be?
At least 96%
What could a patient taking hay fever medication signify
Hayfever can worsen symptoms of asthma as pollen can be a trigger and would cause further inflammation of the airways.
Can people with asthma take Ibuprofen?
People with asthma should take care when taking NSAIDs and should speak to a doctor first (e.g. in a patient records scenario, if you collect it from them but it isn’t stated in their records, bring it up) as it can cause a bronchospasm.
If on a patients record, ‘Beclametasone’ inhaler is written down, what must you do?
Clarify the brand- is it Qvar or clonal?
As they have different particle sizes and so are not interchangeable- Qvar has smaller particles and is also not licensed for use in children under 12
If on a patients record, ‘Beclametasone’ inhaler is written down, what must you do?
Clarify the brand- is it Qvar or clonal?
As they have different particle sizes and so are not interchangeable- Qvar has smaller particles and is also not licensed for use in children under 12
Can you give 2 topical corticosteroid products (e.g. inhaler and nasal spray) at once?
Yes- it would increase the likelihood of systemic effects but this combination os very common and suitable.
- if on a high dose of lots of steroids it can cause suppression of natural steroids so would need to stop taking slowly.
What would you give if a patient goes into hospital with an acute asthma exacerbation in an emergency situation?
Give IV hydrocortisone 100mg every 6 hours until can be converted to oral prednisolone.
Also give a salbutamol via a nebuliser in an emergency situation to act as a bronchodilator
May also be given oxygen
If you are adding a LABA to a patient already on an ICS, what might you do?
Give it as a MART therapy which contains an ICS + LABA so usually Budesonide and Formoterol ( has both long and short acting bronchodilator effects) e.g. Symbicort turbohaler
or Fostair- contains beclometasone and formoterol
What does MART therapy stand for?
Maintenance and relieve therapy
How do you use MART therapy?
Patients on MART therapy only need one inhaler that they take morning and evening (1-2 puffs)
- This same inhaler is also used as a reliever if needed
What can a too high does of theophylline cause?
- Can cause symptoms such as nausea, vomiting and a tremor. It has such a narrow therapeutic window that these symptoms are a sign of toxicity.
What is the therapeutic and optimal range for theophylline?
Therapeutic window is 10-20 mg/L, however the optimal range is just 10-12 mg/L
What might a serum theophylline level of >20 cause?
Nausea and vomitting
What might a serum theophylline level of >25 cause?
cardiac arrhythmia
What might a serum theophylline level of >30 cause?
seizures
What therapeutic drug monitoring should be taken when taking theophylline?
- l would need to observe plasma and potassium levels. plasma levels should be taken every 6 months
can cause hypokalaemia if used alongside a B2 agonist - Also need to take blood tests 5 days after starting treatment- should be 4-6 hours after taking medication if it is a MR tablet or IV aminophylline.
What is important when giving out prescriptions of theophylline?
Must be given the same brand each time, they are not interchangeable.
What is the dose of theophylline?
MR BD
Who would need a higher dose of theophylline?
- People who smoke heavily as chemicals in the nicotine smoke induces the CYPIA2 responsible for the breakdown of theophylline. if the patient quits, the dose must be adjusted.
What does theophylline interact with?
Many antibiotics- mainly macrocodes e.g. clarithromycin.
This is because theophylline is metabolised by CYP450 enzyme- broken down, however, clarithromycin inhibits the CYP450 enzyme so causes theophylline to not be broken down hence the side effects.
would swap clarithromycin for doxycycline
What does the ultibro breezehaler contain?
indaceterol (LABA) + Glycopyrronium (LAMA)
What could you give to a COPD patient with a chest infection that is not improving with antibiotics and has chronic sputum production?
A mucolytic agent e.g. carbocisteine that will reduce suit viscosity to make it easier to clear from the airways.
What class of drugs can cause urine retention?
LAMA
What is the recommended inspiratory flow rate for a pMDI?
20-60 L/min
if were too inhale at a high rate e.g. 90- it would hit the back of the throat and be swallowed- won’t relieve eh symptoms as there would be no localised effect
How can using a spacer help patients using a pMDI?
- don’t have to coordinate the breathing and pressing of the device
- prevents deposition of drug in the upper airways that can lead to oral thrush
What are some therapeutic monitoring parameters for salbutamol?
- less wheezing and coughing
- less night time waking
- lower peak flow and spirometry readings
- less breathlessness
What are some toxic monitoring parameters for salbutamol?
- tachycardia
- tremors
- nervous tension
- headache
- decrease in potassium levels- hypokalaemia
What do LTRAs do?
block the effects of cytseinyl leukotrienes in the airways (LTC4, LTD4, LTE3)
- receptors for cysteinyl leukotrienes are present on airway smooth muscle cells and infiltrating immune cells
- By blocking leukotriene 1 receptor, they can decrease both early and late response to allergens in asthma
- Blocking it van slide prevent smooth muscle contraction and migration of eosinophils to the airways
HAS BOTH BRONCHODILATORY AND ANTI-INFLAMMATORY EFFECTS.
Are LTRA’s used in asthma?
no, copd only
