Resp System MHRA alerts

Question 1

Montelukast has a risk of which type of reactions? What should patients do if they experience these?

Answer 1

Be alert for neuropsychiatric reactions, including speech impairment and obsessive-compulsive symptoms, in adults, adolescents, and children taking montelukast.

Patients should seek medical attention if occurs.
Evaluate risk-benefit if this occurs.

Question 2

What is the important safety information associated with tiotropium inhalers?

Answer 2

Risk of inhalation of capsule if placed in the mouthpiece of the inhaler - can cause airway obstruction, coughing and aspiration

Don’t store caspules in inhaler and always check capsule

Question 3

Corticosteroids carry a rare risk of a disorder with both topical and systemic administration.

Answer 3

Rare risk of central serous chorioretinopathy with local as well as systemic administration.

Patients should report and blurred vision or other visual disturbances.

Consider referral to an ophthalmologist for evaluation of possible causes if a patient presents with vision problems.

Question 4

Beclometasone diproprionate, which inhalers should never be changed?

Answer 4

Qvar and Clenil are not interchangeable and should be prescribed by brand name.

Question 5

How do the potency of Qvar and Clenil differ?

Answer 5

Qvar has extra-fine particles and is around 2x more potent than traditional beclomethasone dipropionate CFC-containing inhalers.

Question 6

Beclometasone with formoterol

Answer 6

Fostair contains extra-fine particules of beclomethasone dipropionate and is more potent than traditional beclomethasone dipropionate CFC-free inhalers.

The dose of beclomethasone in Fostair should be lower than non-extra-fine formulations and will need to be adjusted based on the individual needs of the patients.

Question 7

Which age group should OTC cough and cold remedies not be sold to?
For older children, what should the maximum treatment length be?
Which active ingredients would you be concerned about?

Answer 7

OTC cough and cold remedies should not be used in children under 6.
Children 6-12 can continue to be treated in pharmacies if needed but treatment should be restricted to 5 days or less.

Don’t give more than 1 cough/cold preparation as different brands may have the same active ingredient.

OTC cough and cold medicines containing the following active ingredients are affected by the advice:

• antitussives (dextromethorphan and pholcodine)
• expectorants (guaifenesin and ipecacuanha)
• nasal decongestants (ephedrine, oxymetazoline, phenylephrine, pseudoephedrine, and xylometazoline)
• antihistamines (brompheniramine, chlorphenamine, diphenhydramine, doxylamine, promethazine, and triprolidine)

Question 8

Hydroxyzine is associated with cardiac effects. What are these cardiac effects, and what are the max doses that should be used?

Answer 8

Risk of QT-interval prolongation and torsade de pointes.

These events are most likely to occur in patients who have risk factors for QT prolongation e.g. concomitant use of other drugs that prolong the QT interval, elderly, CV disease, family history of sudden cardiac death, significant electrolyte imbalance (low plasma-potassium or plasma-magnesium concentrations), or significant bradycardia.

• In children with body weight up to 40kg, the maximum daily dose is 2mg/kg
• In adults the maximum daily dose is 100mg
• In the elderly the maximum daily dose is 50mg (if use cannot be avoided)