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
Who is oxygen CI for?
o Chronic type 2 resp. failure (severe COPD) – have persistent hypoxaemia and hypercapnia so have changed adaptive state
High inspired oxygen will disrupt this and cause an increase in PaCO2 resp. acidosis
What are the side effects of oxygen?
- Discomfort of mask – nasal cannula is more comfortable
- Dry throat – humidify oxygen to solve
- Hyperoxaemia – increased oxygen levels – happens when supplemental oxygen is given to non-hypoxic patients
Patient information and monitoring for oxygen
- Oxygen poses a fire risk if exposed to any heat source or naked flame, even from smoking
- Frequent SPO2 monitoring for acute illnesses and adjust as needed
- ABG for those with critical illnesses like type 2 resp failure, hypercapnia risk, acute hypoxaemia
What are the types of antihistamines?
First gen.: Chlorphenamine
Second gen.: Cetirizine, Loratadine, Fexofenadine
Indications of antihistamines
- First-line for allergies in particular hay fever
- Relief from itchiness (pruritis) and hives (urticaria)
- Adjunctive treatment in anaphylaxis after giving adrenaline
Who should not be given antihistamine? Which one should be avoided?
o Avoid Chlorphenamine in severe liver disease – may cause hepatic encephalopathy
What are the side effects of antihistamines? Why do they occur?
- Sedation – first gen cause as cross BBB and affect Histamine in brain which has a role in wakefulness there
What patient information and monitoring needs to be carried out for antihistamines?
- Patients may prefer to take Chlorphenamine in evening as has sedating effects
- If taking Chlorphenamine – avoid driving or tasks that require concentration
- Symptom management
- Ask about adverse effects
What are leukotriene receptor antagonist?
Montelukast
What are leukotriene receptor antagonist used for?
- Add-on therapy for asthma in adults when symptoms are not adequately managed by LABA + ICS
- Alternative to LABA for children when ICS is insufficient to manage asthma
- First-line preventative therapy from asthma in children under 5 years who are unable to take ICS
Can leukotriene receptor antagonist be used during pregnancy?
Yes
How should leukotriene receptor antagonist be prescribed for asthma?
o Should only be prescribed for asthma if it is uncontrollable with ICS + LABA
What are the SE of leukotriene receptor antagonist?
- Headaches
- Abdominal pain
- Increased rate of URTI
- Less common – hyperactivity, low concentration
What are the different forms of leukotriene receptor antagonist?
o Oral – tablet or granule form
o Granules can be given to children as dissolvable in liquid
What are patient information and monitoring carried out for leukotriene receptor antagonist?
o Make patients aware that it will not help in episodes of acute breathlessness
o Need to take alongside inhalers
o Symptom diary and PF measurements to monitor effects
