Respiratory Flashcards
Salbutamol
Brand: Albuterol, Ventolin, Asmasal, Salamol, Ventmax
Beta 2 Adrenoreceptor agonists. Compound inhalers ensure that long-acting B2-agonists (LABA) are not taken without an inhaled corticosteroid (suppresses inflammation).
Mechanism of Salbutamol
Relaxes and dilates bronchioles.
Indications of Salbutamol
- Asthma
2. COPD
Side effects of Salbutamol
Tremor,tachycardia, arrhythmias and muscle cramps
Oral thrush and hoarse voice, Adrenal suppression Growth retardation in children, Osteoporosis
Elimination of Salbutamol
Onset within 5-15mins
Duration 3-5 hours
Ipratropium Bromide
Anti-cholinergic/anti-muscarinic bronchodilator
Mechanism of Ipratropium
Inhibits muscarinic acetylcholine receptors, inhibiting bronchoconstriction and mucous secretion
Indications for Ipratropium
- Short-term relief in acute asthma (but B2-agonists preferred as act more quickly)
- COPD
Side effects of Ipratropium Bromide
Blurred Vision, dry mouth, urinary retention, gluacoma
Paroxysmal bronchospasm
Patient information for Ipratropium Bromide
Should not be used alone for acute symptoms
Patient should have short-acting B2 agonist for use as required
Prednisolones
Corticosteroids
Mechanism of Prednisolone
Anti-inflammatory effect by inhibiting phospholipase A2 activity and decreasing production of arachidonic acid which is used as a precursor for prostaglandin and leukotriene synthesis
Immunosuppressive as decrease B and T lymphocyte response to antigens
Indications for Prednisolone
Suppression of allergic/ inflammatory disorders IBD Asthma Rheumatoid disease Immunosuppression
Contraindications for Prednisolone
Systemic infection Hypersensitivity Osteoporosis Glaucoma Recent MI Pregnancy
Side effects of Prednisolone
Adrenal suppression for long term use, bruising, hirsutism, moon-face, HTN, weight gain, oedema, impaired glucose tolerance, mood changes, muscle weakness, head ache, hirsutism, menstrual cycle irregularities, risk of severe chicken pox
Interactions of Prednisolone
Phenytoin and Rifampicin decrease effect of prednisolone
Carbocysteine, Acteylcysteine, Erdosteine
Mucolytics
Mechanism of Carbocysteine
Liquifies and reduces sputum viscosity
Contraindications for Carbocysteine
Active peptic ulceration. Can disrupt the gastric mucosal barrier
Side effects of Carbocysteine
Gastrointestinal haemorrhage, skin reactions, Stevens-Johnson syndrome, vomiting, allergic reactions, blood in the stool, low blood sugar symptoms
Indications for Acetylcysteine
- Antidote for Paracetamol poisoning
- Prophylaxis contrast nephropathy
- Reduce viscosity of respiratory secretion
Mechanism of Acetylcysteine
- Metabolism of paracetamol produces a small amount of N-acetyl-p-benzoquinone imine (NAPQI) which is hepatotoxic. This is detoxified with conjugation with gluthathione. Acetylcysteine replenishes the body’s supply of gluthathione
- Liquifies mucus
Side effects
In large IV doses can cause anaphylactoid reaction presenting with nausea, tachycardia, rash and wheeze and involves histamine release independent of IgE antibodies.
Theophylline
Xanthines
Mechanism of Theophylline
Bronchodilator: relaxes smooth muscle
Non-bronchodilator prophylactic effects: suppresses the response of airways to stimuli
Indications for Theophylline
As a second-or third-line drug for asthma and COPD
Contraindication for Theophylline
Active coronary heart disease as Theophylline will increase cardiac inotropy and heart rate
Side effects of Theophylline
Nausea, vomiting, headache, insomnia tremor, seizures, restlessness, irregular heartbeat
Interactions of Theophylline
Has a narrow therapeutic index and interactions.
Ciprofloxacin can increase blood levels of theophylline
Montelukast
Leukotriene Receptor Antagonists
Mechanism of Montelukast
Binds with CysLT1 receptor on mast cells and block the secretion of Leukotriene (LTD4). Preventing bronchoconstriction and inflammation of airways.
Indications of Montelukast
- To ease allergy signs
- To prevent exercise-induced breathing problems
- Treat or prevent asthma
Side effects of Montelukast
Diarrhoea, fever, abdominal pain, headache, nausea, skin reactions, upper respiratory tract infection, vomiting
Contraindications of Montelukast
Pregnancy and breast feeding
Dose of Montelukast
10mg orally OD
Indications for Oxygen
Acute treatment of arterial hypoxemia: PaO2 <8.0kPa or sats <94%
Contraindications of giving Oxygen
Caution if patient has type II respiratory failure as patient has lost their CO2 drive and relies on hypoxic drive to keep breathing
Side effects of oxygen
Irritate throat
Parenchymal lung damage/ tracheobronchitis
Delivery of Oxygen
Supplementary oxygen (supplementary level of oxygen to room air required): nasal cannula, venturi mask, rebreathe mask, non-rebreathe/ reservoir mask
High Flow Oxygen (flow up to 100% required): Non-rebreathe/ reservoir mask, humidified high flow nasal cannula
Positive Pressure Delivery (CPAP/NIV)
