inhalation therapies

Question 1

what are examples of a SABA? effect time

Answer 1

salbutamol, terbutaline (4 hours )

1-2 puffs up to four times a day (8 puffs max daily)
-up to 10 if having an asthma attack

Question 2

what are examples of a LABA? effect time

Answer 2

salmeterol, formoterol, vilanterol (12 hours )

Question 3

what are some cations for SABA/LABA?

Answer 3

-Cautious in diabetes= can cause DKA exotically after IV admin
-can cause increase risk in arrhythmias
-causes hypokalaemia= increased risk of QT prolongations

Question 4

what are some side effects of SABA/LABA?

Answer 4

-fine tremor, palpation , headaches, seizures and anxiety

Question 5

what other drugs cause QT prolongation?

Answer 5

-corticosteroids, diuretics, theophylline

Question 6

what happened if a patient is taking digoxin with a SABA?

Answer 6

can increase risk of digoxin toxicity (due to hypokalaemia)

Question 7

what are examples of a SAMA?

Answer 7

Ipratropium

Question 8

what’s an example of a LAMA?

Answer 8

tiotropium aclidinium glycopyrronium umeclidinium

Question 9

what are some side effects of SAMA/LAMA?

Answer 9

-antimuscarinic complications
-dry mouth, constipation, increased ocular pressure (report halo or blurred vision)

Question 10

what are some interactions with SAMA/ LAMA?

Answer 10

OTHER ANTIUMUSCARINC DRUGS

Question 11

what are some examples of inhaled corticosteroid?

Answer 11

beclometasone, budesonide, ciclesonide, fluticasone, mometasone
-all twice daily. apart from ciclesonisde (once daily)

Question 12

which ICS needs to be prescribed as a brand?

Answer 12

beclometasone
Qvar and Kelhale have extra fine particles and are 2 x stringer than inhalers. Clenil is only half the strength compared to the others

Question 13

what should everyone on a ICS be given and what needs to be monitored?

Answer 13

-steriod card for long term treatment with high doses of
ICS
-children: height and weight in prolonged treatment monitored annually. Slow growth = paediatrician referral

Question 14

what are some ICS aside effects?

Answer 14

-taste and voice alterations
-sore mouth= candidiasis, reduced by using a soccer and rings mouth with water after
-paradoxical bronchospasm= mild- prevented by inhalation of a SABA beforehand
change from an aerosol inhalation to a dry powder inhalation

Question 15

what is an example of a LTRA?

Answer 15

montelukast

Question 16

what are some side effects of LTRA?

Answer 16

-RISK OF NEUROPHYCHIATRIC REACTION - seek medical attention if speech and behaviour changes occur
-churg-strauss syndrome= eosinophilia,, vasculitic rash, worsening pulmonary symptoms, cardiac complications or peripheral neuropathy
-interactions: CYP450 enzyme substrate meaning CYP450 inducers will reduce the conc of LTRA and inhibitors will increase one of LTRA

Question 17

WHAT IS THE THERAPEUTIC RANGE OF THEOPHYLLINE ?

Answer 17

10-20MG/L

Question 18

what other drugs have a therapeutic range of 10-20mg/l

Answer 18

phenytoin

Question 19

when do you check theophylline drug plasma levels?

Answer 19

-4-6 hrs after dose
-five days after starting treatment
-at least 3 days after a dose adjustment

Question 20

why do you want to prescribe by brand for theophylline?

Answer 20

as different brand don’t have the same bioavailability
-maintain same brand
prescribe by brand

Question 21

what are some side effects of theophylline ?

Answer 21

sick and fast

-vomiting , tremor, palpitations arrhythmias

Question 22

what are some interaction with theophylline?

Answer 22

-smoking: smoking increases theophylline clearance, if patient wants to stop smoking need a dose adjustment
-Fever: reduces clearance of theophylline
-CYP enzymes inducers (reduce conc) and inhibitors (increase conc)
-Hypokalaemia: corticosteriods, SABA/LABAs, diuretics