Inhalation Therapies

Question 1

What are SABA and LABA

Answer 1

SABAS- short term relievers
LABAS-long term reliever
Works by expanding your airway. SABA/LAMA are anti-muscarinic so they reduce the constriction in your airway. Inhaled corticosteroids reduces the inflammation

Short acting beta-2 agonist (SABA): salbutamol, terbutaline (4 hours)
Long acting beta-2 agonist (LABA): salmeterol, formeterol, vilanterol (12 hours)

1-2 puff up to FOUR TIMES A DAY (* PUFF MAX DAILY)

Question 2

What cautions and and symptoms can SABA/LABA cause

Answer 2

Caution in diabetes- can cause DKA especially after IV administration

Can increase risk of arrhythmias

Causes hypokalaemia- increases risk of QT prolongation increases risk of arrhythmias

Question 3

What are the side effects of SABA/LABA

Answer 3

Side effects included: fine tremors, palpitations, headaches, seizures and anxiety

QT prolongation (these other drugs also causes QT prolongation as they cause hypokalaemia)
-corticosteroids, diuretics and theophylline and Amiodarone

Digoxin- increased risk of digoxin toxicity (due to hypokalemia)

Question 4

SAMA + LAMA- side effects and interactions

Answer 4

Short acting muscarinic antagonists (SAMA): ipratropium
Long acting muscarinic antagonist (LAMA) tiotropium, aclidinium, glycopyrronium, umeclidinium

Side effects: anti muscarinic complications
- constipation, dry mouth, increased ocular pressure (report halos or blurred vision). Acting on the parasympathetic pathway

Interaction: other anti-muscarinic drugs such as atropine, scopolamine, glycopyrrolate and ipratropium bromide, hycosine, TCAs, solifenacin, benign prostatic hyperplasia

Question 5

Inhaled corticosteroids

Answer 5

Beclomethasone, budesonide, ciclesonide, fluticasone, mometasone
- twice daily apart from ciclesonide (once daily)

Beclomethasone- SHOULD BE PRESCRIBED AS A BRAND
- Qvar and Kelhale have extra fine particles and are 2x stronger than inhalers

-steroid card: carry steroid card if receiving long term treatment with high doses of inhaled corticosteroid

-monitoring in children: height and weight in prolonged treatment monitored annually. Slow growth = paediatrician referral

Question 6

What are the side effects of inhaled corticosteroid

Answer 6

Taste and voice alteration

Sore mouth (oral thrush)
- candidiasis: reduced by using a spacer and finishing mouth with water after

Paradoxical bronchospasms
- mild: prevented by inhalation of a SABA beforehand
Change from an aerosol inhalation to a dry powder inhalation

Question 7

What are leukotriene receptor antagonist (LTRA)

Answer 7

Montelukast ( zafirlukast has been discontinued)

Side effects:
MHRA warning: warning risk of neuropsychiatric reactions
- seek medical attention if speech and behavioural changed occur

Churg-Strauss syndrome
- eosinophilia, vasculitic rash, worsening of pulmonary symptoms, cardiac complications, or peripheral neuropathy

Interactions:
CYP450 enzyme substrate
Induces reduces conc of montelukast
Inhibitors increases conc of montelukast

Question 8

Theophylline

Answer 8

Therapeutic range is 10-20 mg/l has the same range as phenytoin

Check plasma levels:
-4-6 hours after dose
Five days after starting treatment
At least 3 days after a dose adjustment

Brands do not have to be the same bioavailability
-maintain the same brand
-prescribe by brand

Question 9

What are the side effects and interactions of theophylline

Answer 9

SICK AND FAST
Side effects: vomiting, tremors, palpitations, arrhythmias

Interactions:
SMOKING: smoking reduces clearance- if patient wants to stop smoking dose adjustments need to be made

FEVERS: reduces clearance of theophylline

CYP enzymes: inducers-reduces conc
Inhibitors- increases conc

HYPOKALAEMIA: corticosteroids, SABA/LABA, diuretics and Amiodarone