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RESP > RESP DRUGS > Flashcards

RESP DRUGS Flashcards

1
Q

What is first-line treatment for asthma?

A

SABA/Salbutamol

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2
Q

What are the two types of beta agonists?

A
  1. SABA
  2. LABA
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3
Q

What are the indications for beta agonists?

A
  1. Asthma – SABA given to relieve breathlessness and LABA to treat chronic asthma when ICS alone are insufficient
  2. COPD – SABA to relieve breathlessness
    LABA for second-line treatment of COPD
  3. Hyperkalaemia – nebulised salbutamol is given – stabilises heart
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4
Q

Which beta agonist helps with hyperkalemia? In which form? How does it work?

A

Nebulised salbutamol
Stabilises the heart
stimulates Na/K ATPase pump on cell surface membranes
Causes K to move from EC to IC

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5
Q

How do beta agonist work?

A

 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

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6
Q

What is a key note for LABA?

A

o LABA should be used with ICS only, alone is associated with asthma deaths

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7
Q

What are the CI/ cautions for beta agonists?

A

o Caution for prescribing to patients with CVD as will cause tachycardia  angina
o BB will reduce efficacy of B2 agonist

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8
Q

What are side effects of beta agonists?

A
  • Tachycardia, palpitations
  • Anxiety
  • Tremors
  • Increased glucose levels – promote glycogenolysis
  • LABA – muscle cramps
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9
Q

How should beta agonist be used?

A
  • 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
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10
Q

What needs to be monitored when using beta agonist?

A
  • 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
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11
Q

What happens if too much beta agonist is used in a short-time period?

A
  • Know that multiple doses in short time will lead to feelings of shakiness and anxiety
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12
Q

What are antimuscarinic drugs?

A

SAMA - Ipratropium, Tiotropium
LAMA - Glycopyrronium, Aclidinium

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13
Q

What are antimuscarinic drugs used for?

A
  1. COPD – short-acting anti muscarinic used to relieve breathlessness
    Long-acting used to prevent breathlessness
  2. Asthma – SAMA used to help relieve breathlessness during acute exacerbations
    LAMA used with ICS and LABA as maintenance treatment for severe asthma
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14
Q

Who is cautioned for antimuscarinic use?

A

o Caution for angle-closure glaucoma – will increase IOP
o Caution for patients at risk of arrhythmia or urinary retention

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15
Q

What are the side effects of antimuscarinics?

A
  • Respiratory tract irritation
  • Cough
  • GI disturbance – dry mouth, constipation
  • Urinary retention
  • Blurred vision
  • Headaches
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16
Q

What monitoring is required for antimuscarinic drugs?

A
  • Need to check inhaler technique at each appointment
  • Check side effects in particular for dry mouth
17
Q

What are the indications of corticosteroids?

A
  1. Asthma – treats airway inflammation and controls symptoms when SABA is not enough alone
  2. COPD – control symptoms and prevent exacerbations for those that have severe airflow obstruction
    Prescribed with LABA
18
Q

What are the cautions for using corticosteroids?

A

o Caution for use with patients with COPD and history of pneumonia
o Caution for children if risk growth suppression

19
Q

What are side effects of using CS?

A
  • Oral candidiasis – thrush infection
  • Hoarse voice
  • COPD patients have risk of pneumonia
20
Q

What are the side effects of using high doses of corticosteroids?

A

High doses:
- Adrenal suppression
- Growth retardation
- Osteoporosis

21
Q

What does the patient need to be informed of or monitored for using ICS?

A
  • 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
22
Q

How many types of corticosteroids are there?

A

Two forms of inhaled:
1. Dry powder
2. Aerosol – MDT given with spacer

23
Q

How do ICS work?

A

 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

24
Q

When is oxygen used?

A
  1. Acute hypoxia – increases oxygen delivery to tissues
  2. Pneumothorax – accelerate reabsorption of pleural gas
  3. CO poisoning – reduce carboxyhaemoglobin half-life
25
Q

Who is oxygen CI for?

A

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

26
Q

What are the side effects of oxygen?

A
  • 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
27
Q

Patient information and monitoring for oxygen

A
  • 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
28
Q

What are the types of antihistamines?

A

First gen.: Chlorphenamine
Second gen.: Cetirizine, Loratadine, Fexofenadine

29
Q

Indications of antihistamines

A
  1. First-line for allergies in particular hay fever
  2. Relief from itchiness (pruritis) and hives (urticaria)
  3. Adjunctive treatment in anaphylaxis after giving adrenaline
30
Q

Who should not be given antihistamine? Which one should be avoided?

A

o Avoid Chlorphenamine in severe liver disease – may cause hepatic encephalopathy

31
Q

What are the side effects of antihistamines? Why do they occur?

A
  • Sedation – first gen cause as cross BBB and affect Histamine in brain which has a role in wakefulness there
32
Q

What patient information and monitoring needs to be carried out for antihistamines?

A
  • 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
33
Q

What are leukotriene receptor antagonist?

A

Montelukast

34
Q

What are leukotriene receptor antagonist used for?

A
  1. Add-on therapy for asthma in adults when symptoms are not adequately managed by LABA + ICS
  2. Alternative to LABA for children when ICS is insufficient to manage asthma
  3. First-line preventative therapy from asthma in children under 5 years who are unable to take ICS
35
Q

Can leukotriene receptor antagonist be used during pregnancy?

A

Yes

36
Q

How should leukotriene receptor antagonist be prescribed for asthma?

A

o Should only be prescribed for asthma if it is uncontrollable with ICS + LABA

37
Q

What are the SE of leukotriene receptor antagonist?

A
  • Headaches
  • Abdominal pain
  • Increased rate of URTI
  • Less common – hyperactivity, low concentration
38
Q

What are the different forms of leukotriene receptor antagonist?

A

o Oral – tablet or granule form
o Granules can be given to children as dissolvable in liquid

39
Q

What are patient information and monitoring carried out for leukotriene receptor antagonist?

A

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

RESP (6 decks)

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