RESP DRUGS Flashcards
What is first-line treatment for asthma?
SABA/Salbutamol
What are the two types of beta agonists?
- SABA
- LABA
What are the indications for beta agonists?
- Asthma – SABA given to relieve breathlessness and LABA to treat chronic asthma when ICS alone are insufficient
- COPD – SABA to relieve breathlessness
LABA for second-line treatment of COPD - Hyperkalaemia – nebulised salbutamol is given – stabilises heart
Which beta agonist helps with hyperkalemia? In which form? How does it work?
Nebulised salbutamol
Stabilises the heart
stimulates Na/K ATPase pump on cell surface membranes
Causes K to move from EC to IC
How do beta agonist work?
Work on beta 2 receptors (type of GPCR)
Beta 2 receptors – found on smooth muscles of bronchi, gut, uterus, and blood vessels
Stimulation of B2 receptor smooth muscle relaxation
Better airflow = reduced breathlessness
What is a key note for LABA?
o LABA should be used with ICS only, alone is associated with asthma deaths
What are the CI/ cautions for beta agonists?
o Caution for prescribing to patients with CVD as will cause tachycardia angina
o BB will reduce efficacy of B2 agonist
What are side effects of beta agonists?
- Tachycardia, palpitations
- Anxiety
- Tremors
- Increased glucose levels – promote glycogenolysis
- LABA – muscle cramps
How should beta agonist be used?
- Inhaler given in two forms:
1. Aerosol – metered dose inhaler
o Given with spacer to improve airway deposition and reduce oral adverse effects
2. Dry powder - Patient should rinse mouth after use
What needs to be monitored when using beta agonist?
- Monitor serum potassium if use B2 agonist with theophylline and CS
- Salbutamol – use as required
- May be given a combination inhaler to better manage symptoms for asthma and COPD
What happens if too much beta agonist is used in a short-time period?
- Know that multiple doses in short time will lead to feelings of shakiness and anxiety
What are antimuscarinic drugs?
SAMA - Ipratropium, Tiotropium
LAMA - Glycopyrronium, Aclidinium
What are antimuscarinic drugs used for?
- COPD – short-acting anti muscarinic used to relieve breathlessness
Long-acting used to prevent breathlessness - Asthma – SAMA used to help relieve breathlessness during acute exacerbations
LAMA used with ICS and LABA as maintenance treatment for severe asthma
Who is cautioned for antimuscarinic use?
o Caution for angle-closure glaucoma – will increase IOP
o Caution for patients at risk of arrhythmia or urinary retention
What are the side effects of antimuscarinics?
- Respiratory tract irritation
- Cough
- GI disturbance – dry mouth, constipation
- Urinary retention
- Blurred vision
- Headaches
What monitoring is required for antimuscarinic drugs?
- Need to check inhaler technique at each appointment
- Check side effects in particular for dry mouth
What are the indications of corticosteroids?
- Asthma – treats airway inflammation and controls symptoms when SABA is not enough alone
- COPD – control symptoms and prevent exacerbations for those that have severe airflow obstruction
Prescribed with LABA
What are the cautions for using corticosteroids?
o Caution for use with patients with COPD and history of pneumonia
o Caution for children if risk growth suppression
What are side effects of using CS?
- Oral candidiasis – thrush infection
- Hoarse voice
- COPD patients have risk of pneumonia
What are the side effects of using high doses of corticosteroids?
High doses:
- Adrenal suppression
- Growth retardation
- Osteoporosis
What does the patient need to be informed of or monitored for using ICS?
- Rinse mouth and gargle after use to prevent sore throat/ hoarse voice
- Inform that little will be absorbed into body so will not have serious side effects
- Monitor management by symptoms
- Review of therapy after 3-6 months to see if dose needs to be adjusted
How many types of corticosteroids are there?
Two forms of inhaled:
1. Dry powder
2. Aerosol – MDT given with spacer
How do ICS work?
Pass through plasma membrane and interact with receptors on cytoplasm
Activated receptors pass into nucleus and modify transcription of genes
Pro-inflammatory interleukins, cytokines, and chemokines – all down-regulated
Anti-inflammatory proteins get upregulated
Leads to reduced mucosal inflammation and secretion and wider airways
When is oxygen used?
- Acute hypoxia – increases oxygen delivery to tissues
- Pneumothorax – accelerate reabsorption of pleural gas
- CO poisoning – reduce carboxyhaemoglobin half-life
