Respiratory

Question 1

SABA (Short Acting Beta Agonist)

Answer 1

= Salbutamol, Terbutaline (blue inhaler)

= Bronchodilator, delivered via metered dose aerosol
= Activates B2-adrenoreceptor -> dilates bronchi -> improved breathing
= Activates adenyl cyclase

+++ Acute relief, TNF-a/MC inhibition
- - - Tremor, tachycardia, nocturnal asthma, hypokalaemia, increased HR, palpitations

Question 2

Inhaled Corticosteroids

Answer 2

= Fluticasone, Beclomethasone, Budesonide

= Anti-inflammatory & immunosuppressive

+ Inc. in Lipocortin = dec. of AA
+ Inc. in B2-adrenoreceptors –> relieves of muscle spasm
+ Dec. IL-2, MC & T-cells

• Oral candidiasis (thrush), lack of acute relief
• Immunosuppression = pneumonia risk
• Poor GI tract absorption (Fluticasone)

Question 3

LABA (Long Acting Beta Agonist)

Answer 3

= Salmeterol, Formoterol

= Maintenance therapy only, give with steroid

• • • Muscle cramps, acute relief

Question 4

Which of the following potential adverse effects may be associated with the chronic use of oral B2-adrenoceptor agonists in asthma therapy?

Answer 4

Hypokalaemia (hence used in treatment in for hyperkalaemia)

Question 5

A 21 year old patient is admitted with 8 hours of severe breathlessness. He has just started smoking and has a previous history of asthma. His only medication is a salbutamol inhaler which is providing little benefit. His expiratory peak flow is 280mL/min (best 620mL/min).On examination a widespread polyphonic wheeze is detected throughout his chest. His respiratory rate is 32/min, SaO2 is 80% on air and he has just begun to receive oxygen. Which would be the first drug regimen to be prescribed to improve the dyspnoea?

Answer 5

Nebulised salbutamol

Question 6

Which of the following drugs is a bronchodilator used in the relief of an acute attack of asthma?

Answer 6

Salbutamol

Question 7

Which of the following statements is most appropriate concerning the use of fluticasone delivered via a metered dose aerosol?

Answer 7

Allows the maintenance dose of oral prednisolone to be reduced

Question 8

A 47 year old man has been admitted to the respiratory ward with an acute exacerbation of asthma. Despite treatment with nebulised salbutamol and ipratropium he remains symptomatic and is started on an infusion of aminophylline. Which test would be best to check for signs of aminophylline toxicity?

Answer 8

Serum theophylline to avoid cardiac arrhythmias

Question 9

Which drug is a B2 adrenoceptor agonist delivered by inhalation in the maintenance therapy of asthma?

Answer 9

Salmeterol

Question 10

Which of the following adverse drug effects is most likely to occur following treatment with theophylline?

Answer 10

Cardiac arrhythmias

Question 11

A 20 year old woman, diagnosed with asthma 6 months ago, has been using a salbutamol inhaler 0.1mg, 2 puffs every 12 hours. She has allergic rhinitis and eczema, managed by oral cetrizine 10mg and various topical agents. She reports worsening of her nocturnal cough and tremor which has developed over the last month together with a 25% drop in peak expiratory flow. The cough has responded to an increased use of the inhaler. Select the most appropriate treatment option to manage her asthma.

Answer 11

Add a steroid inhaler + counsel about salbutamol use

Question 12

Which steroid is administered orally in more severe forms of asthma and exacerbations of COPD?

Answer 12

Prednisolone (+ Amoxicillin/Clarythromycin)