Respiratory

Question 1

What is ipratropium? Name a related drug

Answer 1

A short acting anti-muscarinic: it binds to muscarnic receptors to reduce activity of cholinergic nerve ( through acetyl choline ) acting on smooth muscle.
Thus, lessens airway constriction, mucous secretion and inflammation and remodelling effects.

tiotropium (Long Acting)

Question 2

Define life-threatening asthma, and specifically, near-death asthma. How is this emergency treatment approached?

Answer 2

Silent chest
Exhaustion, altered consciousness
No speech
Acidotic
PC02 normal---- raised = life threatening
Hypotensive
Severe tachycardia
PEF: <33%
Sats <92% PO2<8
cyanosis
poor resp effort
arrythmia

supplement oxygen to achieve sats 94-98%
high dose salbutamol, terbutaline (NEB)
if not responding

ipratropium NEB

IV corticosteroids–> oral

MgSO4

IV aminophylline

Question 3

Name two SABAs?

Side effects?

Answer 3

Salbutaoml
Terbutaline
muscle tremors; dizziness; headache;
nausea; palpitations; tremor (transient- 20 mins).
In high doses it will induce hypokalaemia
Should be used in caution in patients be
CV problems, hyperthyroidism and
diabetes

Question 4

When might you use terbutaline rather than salbutamol?

Answer 4

If person is hypo-kalaemic

Question 5

What is a LABA, examples.

How would you prescribe?

Answer 5

Salmeterol and Formoterol

always with an inhaled corticosteroid

Question 6

how would you prescribe Ipratropium?

Answer 6

They are used during acute exacerbations in
conjunction with salbutamol for maximum
bronchodilator effect.
• SAMA’s are most effective for this and only one
LAMA is actually licensed for the treatment of
asthma.
• Spiriva tiotropium (soft mist) Respimat FYI.
• Muscarinic receptors are in many body systems so
they can have many down stream side effects
because of this.
• LAMA therapy is usually reserved for difficult to treat
asthma

Question 7

oi slumbag, what are the anti-muscarinic side effects?

Answer 7

Salivation, secretions, sweating (lack of)
Lacrimation (lack of)
Urinary retention (defecation)
Miosis
Bradycardia, bronchoconstriction, bowel movement
Adbo cramps, anorexia
GI upset

Question 8

When would you use MgSO4?

Answer 8

Adjunctive therapy refractory to SABA treatment
inhibits calcium channels that influences smooth muscle contraction, potentially also inhibiting Acetylcholine release
2g IV 20 mins
avoid in renally impaired

Question 9

What are xanthine derivatives and why do they have narrow TWs?

Answer 9

they are purine analogues, similar effect to caffeine

because they interact with a broad range of drugs

Question 10

Examples of XDs? and beware of what?

Answer 10

theophylline and aminophylline (IV formulation)
high dosages can lead to convulsions that are resistant to anti-convulsants

be cautious with hepatic dysfunction- they are cp450 metabolised
half-life affected by various factors
prescribe by brand

Question 11

side effects of theophylline or aminophylline?

Answer 11

Common side effects include nausea, vomiting,

GORD at night and weight loss.

Question 12

Compare theophylline to aminophylline

Answer 12

the former is more potent, and very brand specific, metabolised in the lvier and eliminated in the kidney
aminophylline is highly soluble with a variable half-life, brand specific by bioavailabiluty, dosage calculated by IBW because it’s not stored in the fat

Question 13

what factors decrease half-life of XD?

Answer 13

Smokers
• Alcohol consumption
• Drugs that induce metabolism

Question 14

what factors increase half-life of XD?

Answer 14

• Heart failure
• Hepatic impairment
• Viral infections
• Elderly
• Drugs that inhibit its metabolism
• Drug interactions

Question 15

How do you calculate IBW?
If IBW is more than actual body weight- which weight do you prescribe by?
What drug is this important for?

Answer 15

50kg + 2.3kg for every inch above 5 ft
45.5kg + 2.3kg for every inch above 5ft

aminophylline bc it doesn’t distribute in fat

Question 16

Can you calculate a loading dose and maintenance dose?

Answer 16

LD= BNF LD  x IBW
MD= BNF MD x IBW

Question 17

Name some Leukotriene receptor
antagonists
use?

Answer 17

antagonists, such as
montelukast, zafirlukast,
and pranlukast
adjunctive

Question 18

inhaled corticosteroids- examples? use?

Answer 18

beclomethasone, fluticasone (in
combination and alone)
• Come in a variety of formulations; IV,
oral and inhaled.

in conjunction with LABA
can be used as a preventer

Question 19

Type 1 resp failure vs type 2

Answer 19

type 1: Lung damage prevents adequate oxygenation of the blood
(hypoxaemia); however, the remaining normal lung is still sufficient to
excrete the carbon dioxide being produced by tissue metabolism.
type 2: Also known as ‘ventilatory failure’. It occurs when alveolar ventilation is insufficient to excrete the carbon dioxide being produced.Inadequate ventilation is due to reduced ventilatory effort, or inability to overcome increased resistance to ventilation – it affects the lung as a whole, and thus carbon dioxide accumulates.

Question 20

treatment approach to resp failure?

Answer 20

supplemental oxygen – given initially via face mask
• control of secretions (physiotherapy)
• treatment of lung infection (antibiotics)
• control of airways obstruction (e.g. using
bronchodilators, corticosteroids)
• limiting pulmonary oedema
• reducing load on respiratory muscles