Resp drugs Flashcards
Asthma
Chronic inflammatory airway disease
intermittent airway obstruction and hyper-reactivity
reversible both spontaneously and with drugs
Bronchospasm Wheezing Coughing
Mucosal oedema and plugging
Steroids – inhaled corticosteroids (ICS)
example
beclometasone
fluticasone
budesonide
Steroids – inhaled corticosteroids (ICS) mechanism
Reduces mucosal inflammation, widens airways, reduces mucus • Reduces symptoms, exacerbations and prevents death
• Pass through plasma membrane, activate cytoplasmic receptors, activated receptor then passes in to nucleus to modify transcription
slow dissolution in aqueous bronchial fluid
, X, Δ Steroids – inhaled corticosteroids (ICS)
Can cause a local immunosuppressive action – candidiasis, horse voice
X Pneumonia risk possible in COPD at high doses
Δ If taken correctly very few significant ADRs
beta 2 agonist
examples
Fast&short: salbutamol, terbutaline
Fast& long: formoterol
slow&long: salmeterol
beta 2 agonist mechanism
SABA: symptom relief through reversal of bronchoconstriction
LABA: add on therapy to ICS and p.r.n SABA
Major action on airway smooth muscle
Also increase mucus clearance by action of cilia • Prevention of bronchoconstriction prior to exercise (SABA)
, X, Δ beta 2 agonist
Adrenergic - fight or flight effects
Tachycardia, palpitations, anxiety and tremor
↑Glycogenolysis (liver) ↑renin (kidney)
SVT
X LABA should only be prescribed alongside ICS
- alone can mask airway inflammation and near-fatal and fatal attacks
CVD – tachycardia may provoke angina
Δ β-blockers may reduce effects of β2 agonists!
Leukotriene receptor antagonist (LTRA) p.o.
mechanism, #
montelukast
Leukotrienes released by mast cells/eosinophils – ↑bronchoconstriction, ↑mucus, ↑oedema
• # Headache, GI disturbance, dry mouth, hyperactivity
Long acting muscarinic antagonist (LAMA) mechanism, #
tiotropium bromide
– severe asthma and COPD
block vagally mediated contraction of airway smooth muscle
• # dry mouth, urinary retention, dry eyes, cough
Short acting: ipratropium
Acute severe asthma
• Unable to complete sentences
• Peak flow 33-50% best or predicted
• Respiratory rate ≥ 25/min
• Heart rate ≥ 110/min
life-threatening asthma
• Unable to complete sentences
• Peak flow 33-50% best or predicted
• Respiratory rate ≥ 25/min
• Heart rate ≥ 110/min
Plus any of the following considered life-threatening:
• Peak flow < 33% best or predicted (if recordable)
• Arterial oxygen saturation (SpO2) < 92% • Partial arterial pressure of oxygen (PaO2) < 8 kPa
• Silent chest, Cyanosis, Poor respiratory effort, Arrhythmia, Exhaustion, Altered conscious level, Hypotension
treating Acute severe and life-threatening asthma
• Oxygen! SPO2 level between 94-98%
1.• High dose (nebulised) β2 agonist – oxygen driven
2. • Oral steroids should be prescribed minimum 5 days prednisolone+ continue ICS alongside
3.• Nebulised ipratropium bromide – (SAMA) alongside β2 agonist if poor response alone
4.• Consider i .v. aminophylline if life threatening/near fatal and no success with above
COPD 5 tasks
confirm diagnosis
smoking cessation
breathlessness score
flu/pnumococcal vaccination
medication
COPD In acute exacerbations – requiring hospitalisation
- nebulised salbutamol and/or ipratropium should be prescribed
If patient is hypercapnic or acidotic nebuliser should be driven by air and not oxygen
2.• Oral steroids - • Antibiotics
inhaler options
• Pressurised metered dose inhalers (pMDI)
slow breath in and hold
can be used with a spacer to improve delivery
• Dry powder inhalers (DPI)
micro ionised drug plus carrier powder
own inspiratory flow – fast deep inhalation
