Respiratory Drugs Flashcards

Question

Obs for moderate acute asthma

Answer 1

Increasing symptoms PEF >50-75% of best or predicted No features of acute severe asthma

Answer 2

Any one of: PEF 33-50% best or predicted Resp rate greater or equal to 25 Heart rate greater or equal to 110 Inability to complete sentences in one breath

Answer 3

In a patient with severe asthma, anyone of the following: PEF less 33% best or predicted SpO2 < 92% PaO2 <8KPa ‘Normal’ PaCO2 (4.6-6.0 kPa) Altered conscious level Exhaustion Arrhythmia Hypotension Cyanosis Silent chest Poor resp effort

Answer 4

Raised PaCO2 and or requiring mechanical ventilation with raised inflation pressures

Answer 5

Clinical features: breathlessness, tachycardia, cyanosis, silent chest PEF or FEV1 Pulse oximetry ABG CXR sometimes

Answer 6

§ Treatment of severe asthma in adults if life-threatening features are present. § Adjunct in very severe cases of life-threatening asthma if PEF <50%. § Bronchodilates by blocking calcium channels in smooth muscle cell membranes, therefore reducing calcium influx into the cell. § Side effects § including atrioventricular block so administration requires the patient to have continuous ECG monitoring. § Other side effects include potentiation of the hypotensive effects of calcium channel blockers

Answer 7

If exercise induced asthma is a specific problem in patients taking ICS who are otherwise well controlled, consider adding one of the following therapies – § Leukotriene receptor antagonist § Long acting B2 agonist (LABA) § Sodium cromoglicate or nedocromil sodium § Oral B2 agonists § Theophylline (aminophylline) Immediately before exercise, inhaled short acting B2 agonists are the drug of choice

Answer 8

§ To make an accurate diagnosis of COPD § Treat bronchospasm and obstruction § Treatment of hypoxia and respiratory failure § Treat Infection if present § To provide Smoking Cessation § To Provide pulmonary rehabilitation § Manage acute exacerbations of COPD § Assessment for long term oxygen therapy § Ensure yearly Influenza & pneumococcal vaccines

Answer 9

§ For breathlessness and/or exercise limitation use as required short acting beta 2-agonts such as salbutamol or terbutaline. § And/or a short acting antimuscarinic drug such as Ipratropium use as required § Short acting beta2 agonists can be continued with any further additional treatment § Short acting antimuscarinic antagonists however must be stopped if longer acting muscarinic agents (such as Tiotropium) are introduced.

Answer 10

Eg sama/lama Ipatropium/tiotropium § Main benefit is in the treatment of COPD and are of less benefit in mild to moderate asthma. § Nebuliser for severe exacerbations of asthma § Antimuscarinic drugs have a slower onset of action (30-60minutes) compared to salbutamol (5-10 minutes) § Given exclusively by inhalation (dry powder or aerosol) or via a nebuliser. (caution glaucoma)

Answer 11

§ Its effect last 24 hours § Side effects include § dry mouth (suck on boiled sweets) § in men in particular - difficulties in passing urine § Used once daily and should not be used with any short acting antimuscarinic drug such as Ipratropium (Atrovent). § Aclidinium (Ekilira Genuair) is a further new LAMA to the UK market. § The drug is used twice daily usually morning and evening § Tiotropium (Spiriva) & Glycopyrronium (Seebri breezhaler)

Answer 12

§ Controversial and is the subject of ongoing debate. § Not recommended as monotherapy as they § have only modest effect in relieving dyspnoea and improving lung function § less effect than long-acting bronchodilators. § Some suggestion that use of ICS inhalers in COPD patients increases the risk of serious pneumonia. § The risk is particularly increased and dose dependent with the ICS, fluticasone

Answer 13

Prednisolone Maintenance use of oral corticosteroid therapy in COPD is not recommended Some patients with advanced COPD may require maintenance oral corticosteroids when these cannot be withdrawn following an exacerbation. The does of oral corticosteroids should be kept as low as possible For exacerbations usually 30mg Prednisolone for 5 to 7 days

Answer 14

§ Vasodilator, anti-inflammatory and apparently an immunomodulatory actions. § Additive effect with short or long acting beta2- adrenoceptors and prolong the duration and action of the drugs compared to when used alone. § Narrow therapeutic index § Aminophylline hydrolysed rapidly after absorption from the gut to theophylline § Measurement of theophylline concentrations is valuable as a guide to effective dosing of the drug.

Answer 15

§ Gastrointestinal upsets include nausea, vomiting and diarrhoea. § CNS stimulation, § including insomnia, irritability and occasional seizures at very high plasma concentrations § Cardiac stimulation § can produce various arrhythmias at higher doses or unexpected higher blood levels. § Hypokalaemia can occur acutely after IV injection which can also promote cardiac arrhythmias § Drug interactions with many drugs. § such as ciprofloxacin, erythromycin, clarithromycin, fluconazole, and ketoconazole can all precipitate theophylline toxicity.

Answer 16

A diagnosis of Cor pulmonale should be considered if patients have: § Peripheral oedema, § Raised venous pressure § systolic parasternal heave § A loud pulmonary second heart sound.

Answer 17

§ Patients with distressing/ disabling breathlessness despite maximal therapy using inhalers should be considered for nebuliser therapy. § Should not be prescribed without an assessment of the patient’s and/or carer’s ability to use the device.

Answer 18

§ LTOT is indicated in patients with COPD who have PaO2 less than 7.3kPa when stable or a PaO2 greater than 7.3 and less than 8 kPa when stable and one of the following § Secondary polycythaemia § Nocturnal hypoxaemia (oxygen saturation (SaO2) of arterial blood less than 90% for more than 30% of the time) § Peripheral oedema or pulmonary hypertension § Reminder – Clinicians should always be aware that inappropriate oxygen therapy in patients with COPD may cause respiratory depression (type 2 Respiratory Failure)

Answer 19

§ Used in patients with chronic productive cough with thick viscous sputum. § Not be used routinely to prevent exacerbations in patients with stable COPD. § Carbocisteine should be avoided in those patients with history of peptic ulceration. § Can cause bleeding from the GI tract (blood in vomit or black tarry stools) § Carbocisteine & Erdosteine

Answer 20

§ Oxygen – Sats 88-92% if risk of retaining C02 § Steroids – 30mg for 7-14 days § Bronchodilators – salbutamol & ipratropium § Antibiotics – if purulent sputum First choice oral antibiotics include: § Amoxicillin 500 mg three times a day for 5 days. § Doxycycline 200 mg on first day, then 100mg once a day for 5-day course in total. § Clarithromycin 500 mg twice a day for 5 days. § Aminophylline § Consider RESCUE PACKS on discharge - ANTIBIOTICS & STEROIDS § END stage – opioids / benzodiazepines

Answer 21

§ Oral prophylactic antibiotic therapy eg low dose azithromycin 500mg § Consider azithromycin (usually 250 mg 3 times a week) for people with COPD if they: • donotsmokeand • haveoptimisednon-pharmacologicalmanagementand inhaled therapies, relevant vaccinations and (if appropriate) have been referred for pulmonary rehabilitation and • continuetohave1ormoreofthefollowing,particularlyifthey have significant daily sputum production: • frequent(typically4ormoreperyear)exacerbationswith sputum production • prolongedexacerbationswithsputumproduction • exacerbationsresultinginhospitalisation.

Answer 22

¡ Dexamethasone is a corticosteroid ¡ Given to patients hospitalised for COVID-19 who are requiring supplemental O2 therapy to maintain O2 saturations of >92% ¡ Dose: 6mg PO ¡ Given for 10 days or the duration the patient is on O2, whichever is shorter ¡ No proven benefit to patients who do not require O2

Answer 23

For very immuno suppressed ¡ Monoclonal antibody ¡ IL-6 Inhibitor ¡ Established use in inflammatory arthritis ¡ Works to block the IL-6 release in the inflammatory cascade ¡ Causes immunosuppression – patients are at increased risk of developing infections for the following 12 weeks

Answer 24

REMDESIVIR ¡ Blocks an enzyme required for viral replication ¡ Given for 3-5 days ¡ Only useful in first 10 days of illness as it works to shorten the illness ¡ Can cause abnormal LFTs – must check! Becca doesn’t like as can be more harm than good (shorten illness by 2days but affect liver a lot)