Inhalation Therapies

Question 1

SABA - which one for 4 hours)

Answer 1

Short acting beta 2 agonist - sabutamol, terbutaline (4 hours)

Question 2

LABA - examples ( which one for 12 hrs)( remember OL)

Answer 2

Long acting beta agonist - salmeterol,formoterol,vilanterol (12 hrs)

Question 3

Puffs- how many a day - what’s the max?

Answer 3

1-2 puffs up to 4 times a day - 8 puffs max daily

Question 4

SABA/LABA cautions - which conditions? What can they increase the risk of? What can they cause?

Answer 4

• caution in diabetes - can cause DKA especially after IV admin
• can increase risk of arrhythmias
• can cause hypokalaemia

Question 5

SABA LABA SE( 4) 2 interaction groups?

Answer 5

• Fine tremor , palpitations, headache.seizures,anxiety
• QT interval prolongation - corticosteroids,diuretics, theophylline
• digoxin - increased risk of digoxin toxicity (due to hypokalaemia)

Question 6

SAMA LAMA - SE AND INTERACTIONSS- what are they? Give examples? ( what do we report with one of the side effects )

Answer 6

SHORT ACTING Muscarinic antagonist = ipratropium
LONG ACTING Muscarinic antagonist = Tiotropium, aclidinium, glycopyrronium, umeclidinium

Side effects - anti Muscarinic complications= constipation, dry mouth, increased ocular pressure (report halos or blurred vision)
Interactions - other anti Muscarinic drugs

Question 7

Anti Muscarinic drugs examples are…

Answer 7

• atropine, hyoscine butylbromide,

Question 8

Inhaled corticosteroids examples and how often are they used? all used twice daily apart from which one( circle one)

Answer 8

Beclomethasones, budesonide, ciclesonide, fluticasone,mometasone
- all twice a day apart from ciclesonide (once daily)

Question 9

Beclomethasone should be prescribed as a what? And what do Qvar and Keyhole have? Which makes them what?

Answer 9

Prescribed as a brand
-Qvar and keyhole have extra fine particles and are 2x stronger than inhalers

Question 10

Steroid cards - if receiving? With high dose of what?

Answer 10

Carry steroid card if receiving long term treatment with high doses of inhaled corticosteroids

Question 11

Monitoring in children

Answer 11

Height and weight in prolonged treatment monitored annually

Slow growth = paediatric referral

Question 12

Side effects of iCS - what can it cause in terms of voice and taste?what can a paradoxal bronchospasm be reversed by? Change from what to what?

Answer 12

• Taste and voice alteration
• sore mouth - candidiasis - reduced by using a spacer and rinsing mouth with water after
  Paradoxical bronchospasm: Mild - prevente by inhalation of SABA beforehand
• change from aerosol inhalation to dry powder inhalation

Question 13

Leukotriene Receptor Antagonist - LTRA - which one has been discontinued? What is the MHRA alert surrounding one? What other things are a se? What is Churg- Strauss syndrome? And major interaction?

Answer 13

Montelukast - (zafirlukast has been discontinued)
Side effects:
- MHRA warning - risk of neuropsychiatric reactions - 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