inhalation therapies Flashcards
SABA/LABA imp points - SEs and interactions
SABA - salbutamol, terbutaline (4 hours)
LABA - salmeterol, formoterol, vilanterol (12 hours)
- work by expanding your airways
1-2 puffs upto 4 times a day (max 8 puffs a day)
- upto 10 puffs in acute
- can cause DKA - especially with IV administration
- increases risk of arrhythmia
- causes hypokalaemia - QT prolongation
SEs - fine tremor, palpitations, seizure, anxiety
increased risk of digoxin toxicity - due to hypokalaemia
SAMA/LAMA imp points - SEs and interactions
SAMA - ipratropium
LAMA - tiotropium, alicidinium glycopyrronium, umeclidinium
antimuscarinic complications - dont give SAMA and LAMA together
- constipation, dry mouth, increased ocular pressure (report halos, blurred vision)
interactions - other antimuscarinic drugs
ICS - imp points
beclametasone, budesonide, ciclesonide, fluticasone, mometasone
- all BD except ciclesonide (OD)
- beclometasone must be prescribed by BRAND
- QVAR and kelhale have extra fine particles - 2x stronger than others
- qvar 100 same as clenil 200
steroid card
monitor height and weight of children as steroids stunt growth - if slowed growth - paed referral
SEs: taste and voice alteration, sore mouth oral thrush - reduced by using spacer and rinsing mouth after
paradoxical bronchospasm:
- mild - prevent by inhaling SABA before
- change from aerosol to DPI
LTRA - imp points
montelukast
MHRA warning: risk of neuropsychiatric reactions
- seek medical attention if speech and behavioural changes occur
- churg strauss syndrome - eoisonophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications or peripheral neuropathy
interactions - cyp450 enzyme substrate
- inducers reduce conc
- inhibitors increase
theophylline - imp points
therapeutic range - 10-20mg/L
check plasma levels:
- 4 to 6 hrs after dose
- 5 days after starting treatment
- at least 3 days after dose adjustment
brands don’t have same bioavailability
- maintain same brand
- prescribe by brand
SEs - sick + fast
- n&v, tremor, palpitations, arrhythmias, tachycardia
interactions:
- smoking increases theophylline clearance - stopping will require dose adjustment
- fevers - reduce theophylline clearance
- cyp450 enzymes - inducers and inhibitors
- hypokalaemia - steroids, SABA/LABA, diuretics
