Prescribing - Respiratory Flashcards
What drug class is salbutamol?
Short acting beta 2 agonist
How do SABA work?
Our agonists to the B2 adrenoreceptors in bronchial smooth muscle
causing bronchial smooth muscle relaxation and bronco dilation
When are SABA used?
In asthma or COPD
What are common side effects of SA BA?
Fine tremor
headache
muscle cramps
palpitations
What are important side effects of SA BA?
Arrhythmias
MI
hypokalaemia in high doses
lactic acidosis in high doses
What are contraindications to the use of SA BA?
Arrhythmias
hypertension
hypothyroidism
diabetes mellitus
What must be monitored when using S ABA?
If using in high doses monitor serum potassium (especially if people are taking theophylline, corticosteroids, diuretics)
What should be communicated to patients when taking SA BAs?
Salbutamol is a reliever inhaler should be used only when experiencing asthma symptoms it will not prevent attacks
explain the importance of inhaler technique if patients are having trouble with this they may benefit from the use of a spacer, dry powder inhaler, or breath activated inhaler
What drug class is Tiotropium bromide?
An inhaled anti-muscarinic/anti-cholinergic
long acting
What is a short acting anti-Muscarinic and/anti-cholinergic agent
ipatropium bromide
How do anti-muscarinic’s/anticholinergics work?
Competitive antagonist to M3 receptors
causing bronchial smooth muscle relaxation and bronco dilation
When are anti-muscarinic/anticholinergic’s used in resp medicine?
Reversible airway obstruction mainly COPD
short acting agents I use in acute bronchospasm
What are common adverse effects of anti-muscarinic/anticholinergic’s?
Dry mouth nausea headache constipation cough diarrhoea sinusitis nosebleeds oral thrush taste disturbances
What are important adverse effects of anti-muscarinic/anticholinergic’s?
Atrial fibrillation acute angle closure glaucoma urinary retention paradoxical bronchospasm blurred vision GORD dental caries
What are contraindications to the use of anti-muscarinic/anticholinergic’s?
Prostatic hyperplasia
bladder outflow obstruction
those at risk of acute angle closure glaucoma
What do anti-muscarinic/anticholinergic’s interact with?
None really
What drug monitoring is required for anti-muscarinic/anticholinergic’s?
None really just watch out for adverse effects
What is important to communicate patients when using anti-muscarinic/anticholinergic’s?
They should not exceed the prescribed daily dose
importance of inhaler technique
What drug class is montelukast?
Early leukotriene receptor antagonist (LTRA)
How do LTR A’s work?
Block the action of leukotrienes (which are pro-inflammatory) in airway smooth muscle cells thus reducing our information in asthma and rhinitis
When would you use LTRA’s?
Persistently poor controlled asthma (step four)
symptom relief in allergic rhinitis and asthma patients
of benefit in exercise or aspirin induced asthma
What are common side effects of LTR A’s?
Abdominal pain
headache
hyperkinesia (young children)
thirst
What are important side-effects of LTR A’s?
Churg-strouss syndrome
hypersensitivity - including anaphylaxis and angioedema
Depression
seizures
a granulosis/ hepatotoxicity (with zafirlukast)
What drugs do LTR A’s interact with?
Warfarin – increased anticoagulation
What should be communicated to patients about LTR A’s?
This is for long-term prophylaxis not for acute exacerbations
should be warned of the symptoms of churg-strouss syndrome
should be warned of agranulosis symptoms
what is charge-strouss syndome?
very rare but watch out for eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, or peripheral neuropathy
What is Chlorphenamine?
An antihistamine
How do antihistamines work?
Compete for binding site on H1 receptors with histamine
blocking the acute inflammatory effects of histamine
these are vasodilation, increase vascular permeability
What are common side effects of antihistamines?
Drowsiness blurred vision dry mouth GI disturbance headaches psychomotor impairment urinary retention
What are serious side-effects of antihistamines?
Extrapyramidal effects hypersensitivity reactions (including bronchospasm, angioedema, anaphylaxis, rashes)
When are antihistamines contraindicated?
Avoid in severe liver disease, pregnancy and breastfeeding
caution with sedating antihistamines as they have significant anti-muscarinic activity (don’t use with prostatic hyperplasia, urinary retention, those at risk of angle closure glaucoma)
What do antihistamines interact with?
Antidepressants - increased sedative and and whose chronic effects especially with MAOIs or TCA
What is Pseudoephedrine?
A nasal decongestant
How does Pseudoephedrine work?
Agonist to alpha and beta adrenal receptors meaning there is vascular smooth muscle contraction and vasoconstriction
and bronchial smooth muscle relaxation and bronco dilation
What are common side effects toPseudoephedrine?
Anxiety headache hypertension insomnia nausea restlessness tachycardia vomiting
What are important side-effects to Pseudoephedrine?
Hallucinations
angle closure glaucoma
urinary retention
When is Pseudoephedrine contraindicated?
Diabetes hypertension hyperthyroidism ischaemic heart disease prostatic hypertrophy anyone at risk of angle closure glaucoma
What doesPseudoephedrine interact with?
Alpha blockers – reduced hypotensive effect
MAOIS - risk of hypertensive crisis absolute contraindication!!
What is important to communicate patients about taking Pseudoephedrine?
can cause insomnia so do not take at night
