Respiratory Drugs

Question 1

BETA 2 AGONISTS
(Salbutamol, Terbutaline) Short Acting Beta Agonist
(Salmetrol, Formetrol) Long Acting Beta Agonist

Answer 1

I: Asthma (1st SABA, LABA for when ICS is insufficient) , COPD (1st SABA, 2nd LABA), Hyperkalaemia (Nebulised salbutamol)
MOA: Smooth muscle relaction by stimulating NA+/K+ ATPase pumps causing a shift of K+ from extracellular to intracellular compartment.
SE: Tachycardia, Palpitations+ Anxiety + Tremor (SABA), LABA can cause muscle cramps
KI: BB can ↓ efficacy of b2 agonists
CI: LABA alone can ↑ mortality
C: CVS disease as tachycardia can provoke angina + arrythmias
M: Symptoms , Peak flow

Question 2

ANTI MUSCARANICS
(Ipatropium Bromide) Short Acting Muscaranic Antagonist
(Triotripium, Glycopyrronium, Aclidinium) Long Acting Muscaranic Antagonist

Answer 2

I: COPD (SAMA - relieve, LAMA - prevention), Asthma (LAMA can be added to high dose ICS)
MOA: Act as a competitive inhibitor of acetylcholine. It reduces smooth muscle tone and reduces and secretions.
SE: Respitatory tract irrititation (Nasopharyngitis, sinusitis and cough), GI disturbance ( dry mouth, constipation, urinary retention, blurred vision and headaches)
C: risk of angle-closure glaucoma, arrythmias or urinary retention.
M: Symptoms especially dry mouth, review peak flow, check inhaler technique

Question 3

INHALED CORTICOSTERIODS

Beclomethasone, Budesonide, Flucticasone

Answer 3

I: Asthma, COPD (with LABA)
MOA: reduces mucosal inflammation, widens the airways and reduces mucus secretion. This improves symptoms + exacerbations
SE: Oral cadidiasis (Thrus infection), Hoarse voice, Pneumonia
C: Hx of pneumonia, children - cause growth suppression
M: Symptoms, peak flow, review 3-6 months of therapy (if ↓ / ↑)
PC: Rinse mouth and gargle to prevent development of sore mouth and hoarse voice)

Question 4

OXYGEN

Answer 4

I: Acute hypoxaemia, reabsorption pneumothorax, CO poisoning
SE: Face discomfort (mask), Dry throat, too ↑ Pa02 can be harmful (non hypoxaemic pts w/ stroke, MI)
CI: Chronic type 2 respiratory failure (severe COPD)- ↑ PaC02 hypercapnia, flammable
M: Frequent Sp02 monitoring. ABG in critical illnesses (chronic type 2 resp failure, risk at hypercapnoea)

Question 5

ANTI HISTAMINES
(Chlorphenamine) Sedating
(Cetrizine, Loratadine, Fexofenadine) Non Sedating

Answer 5

I: 1st line allergies and hayfever, Itching, adjunctive treatment for anaphylaxis, nausea and vomiting
SE: Sedation (chlorphenamine)
CI: Severe liver disease as it can precipitate hepatic encephalopathy
PC: If taking chlorphenamine, it can make them sleepy/lose concentration. Avoid driving or any other activity which requires concentration. Avoid alcohol as it can exacerbate effect

Question 6

Mucolytic

Carbocisteine

Answer 6

I: Reduce viscosity in respitatory secretions (sputum)
SE: GI haemorrhage, skin reaction, vomiting, steven-johnson syndrome
CI: Active peptic ulceration
C:Hx peptic ulcerations

Question 7

LEUKOTRIENE RECEPTOR ANTAGONIST

Montelukast

Answer 7

I: Add on therapy in Asthma, children aged 5-12 as an alternative to LABA as add on, chldren aged <5 as 1st line preventative therapy with Asthma
SE: Headache and abdominal pain (common), hyperactivity, reduced ability to concentrate. Churg-Strauss syndome (?)
CI: Should not be given to pt. unless asthma is incompletely controlled ICS +LABA
M: symptoms diary, peak flow

Question 8

THEOPHYLLINE

Answer 8

I: Chronic Asthma
SE: Anxiety, arrhythmias, diarrhoea, dizziness, gastrointestinal discomfort
KI: Smoking can increase theophylline clearance and increased doses of theophylline are therefore required.
C: Cardiac arrhythmias or other cardiac disease, elderly (increased plasma-theophylline concentration) epilepsy, fever, hypertension, peptic ulcer, risk of hypokalaemia, thyroid disorder
M: a plasma-theophylline concentration of 10–20 mg/L (55–110 mmol) is required for satisfactory bronchodilation. Measured 5 days after starting treatment and at 3 days after dose adjustment. A blood sample is taken 4–6 hours after an oral dose.