Respiratory

Question 1

Inhaled Corticosteroids

Answer 1

Beclamethasone 50-400mcg bd (>800mcg/d under specialist advice)

Budesonide TH 200-800mcg d in 2-4 doses (max 2400mcg/d), respules 500-2000mcg bd

Fluticasone MDI/DPI 100-250mcg bd (up to 1000mcg bd), Neb 2mg bd

Ciclesonide 80-320microg once daily

M-oral inhalation technique, compliance, asthma management, systemic AE

C- does not give emergency relief, used everyday to reduce symptoms, use every day even if you feel no different, asthma action plan, CAL 14 rinse mouth after use, AE- hoarseness, oral thrush, bruising, use spacer (or mouth piece for nebs)

Question 2

LABAs (long acting beta2 agonists)

Answer 2

Eformoterol- 6-24mcg bd (max 72mcg bd)

Indacaterol 150-300mcg once daily

Salmeterol 50-100mcg bd

Olodaterol, vilanterol (both only available in combinations)

M- compliance, asthma/COPD management, eformoterol- serum potassium for patients taking digoxin, inhaler technique

C- preventer not reliever should be used everyday even if you feel no different to prevent attacks, AE- tremor, palpitations, headache (indacterol- dry mouth and short duration post inhalation cough), asthma/COPD action plan, rinse mouth if using combinations with steroids, correct inhaler technique, correct priming and cleaning of devices, eformoterol alone can be used as a reliever

Question 3

LAMAs

Answer 3

LAMA- long acting muscarinic antagonist (anticholinergics): promote bronchodilation by inhibiting cholinergic bronchomotor tone

I- COPD (may be rarely used in asthma- mostly tiotropium)

D-
Aclidinium- 1 puff (322microg) bd
Glycopyronium- 1 capsule (50microg) inhaled daily
Tiotropium- handihaler 18mcg once daily. Respimat 5microg (2 puffs) mane
Umeclidinium- 1 inhalation (62.5microg) once daily

M- inhaler technique, asthma/COPD control, compliance, anticholinergic AE (may worsen BPH/other bladder obstruction), angle-closure gluacoma (rarely precipitates attack), renal function (increased risk of anticholinergic AE due to reduced clearance)

AE- dry mouth, headache, dizziness, constipation, urinary retention

C- not a reliever don’t use in emergency, used everyday to prevent and should be used even if you feel no different, inhaler technique, device cleaning, do not allow powder to come in contact with eyes- rinse well with water if it occurs and tell dr if you get blurred vision eye pain vision disturbances or difficulty urinating, dry mouth- saliva substitute, asthma/COPD action plan, don’t drive until you know how it affects you

CALS- 
Aclidinium- 7b
Glycopyrronium- 13, 22
Tiotropium- capsules 7b (5 days for strip in use), 22. Respimat (7b 3 months)
Umeclidinium- nil

Question 4

Montelukast

Answer 4

Leukotriene receptor antagonist- antagonises leukotriene mediated airway smooth muscle contraction and inflammation

I- asthma, exercise induced bronchoconstriction

D- 2-5yo 4mg d, 6-14yo 5mg d, 15-adult 10mg d (for exercise induced give 2 hours before exercise max 1 dose/24h)

M- asthma control, changes in mood/behaviour

AE- headache, abdo pain, diarrhoea, dizziness

C- take in evening, chew completely then swallow (do not swallow whole), notice difference in a few days, preventer not reliever don’t use in asthma attack, see dr if you notice mood changes, nightmares, insomnia, sleep walking, tremor, asthma action plan

Question 5

SABA

Answer 5

Short acting beta 2 agonists

I- asthma, COPD

Salbutamol- 100-200mcg q4-6h prn via spacer (5-15min before exercise). Asthma attack- 400mcg repeat after 4 min call ambulance if no improvement

Terbutaline- DPI 1-3 inhalation’s (500-1500mcg) tds or qid prn (5-15min before exercise)

M- frequency of use, asthma/COPD management, inhaler technique, preventer compliance

C- asthma action plan- knowing what to do in an emergency, tell dr if needing more frequently or higher doses (2 or more per week), use spacer, clean mouth piece regularly, AE- tremor, palpitations, headache, nausea, inhaler technique, bandaid effect, priming mdi, no smoking

Question 6

Ipratropium

Answer 6

SAMA- short acting muscarinic antagonist, promotes bronchodilation

I- COPD (rarely asthma)

D- MDI 40-80mcg tds or qid prn, Neb 250-500mcg qid

AE- dry mouth, cough, headache, dizziness, nausea, constipation, urinary retention

M- asthma/COPD control, anticholinergic AE, inhaler technique

C- correct inhaler technique, do not allow contact with eyes rinse well if occurs and see dr if visual disturbance eye pain, dry mouth saliva substitute, asthma/COPD action plan, do not drive until you know how it effects you

Question 7

Theophylline

Answer 7

Xanthine bronchodilator

I- severe asthma/COPD

D 10-16mg/kg d (max 900mg)

M- serum trough conc, COPD/asthma control, serum potassium when used with beta agonist- risk of hypokalaemia

AE- NVD, dyspepsia, loss of appetite, palpitations, headache, tremor, insomnia

C- take with food, check with HCP before starting other medications or starting/stopping smoking, dr may monitor you closely while on this medication, asthma/COPD action plan, preventer not reliever don’t use in asthma attack