Respiratory drugs Flashcards
Give 4 example of Beta-2 agonists
salbutamol + terbutaline} short acting
salmeterol + formoterol } long acting
What are the indications of Beta-2 agonists? 3
Asthma- short acting for breathlessness, long acting with corticosteroids for chronic
COPD
Hyperkalaemia- nebulised salbutamol may be used with insulin, glucose and Ca gluconate
what are the contraindications of Beta-2 agonists?
Long acting should only be used with a corticosteroid
care in cardiovascular disease may provoke tachycardia–> angina or arrhythmias
What are the side effects of B2-agonists? 7
Fight or flight symptoms: tachycardia palpitations anxiety tremor
Promote glycogenolysis–> increases serum glucose
At high doses serum lactate may rise
Long acting B2-agonists can cause muscle cramps
What are the interactions for B2-agonists?
Beta-blockers may decrease their effectiveness
High dose nebulised B-2 agonist with theophylline and corticosteroids can –> hypokalaemia} should be monitored
Give 3 examples of antimuscarinics/ bronchodilators
ipratropium
tiotropium
glycopyronium
How do antimuscarinics work?
Bind to muscarinic receptor where they act as a competitive inhibitor of acetylcholine
–> increases heart rate and conduction, reduces smooth muscle tone and reduces secretion from glands in resp and GI tract
Also –> relaxation of pupillart constrictor and ciliary body in eye
What are the indications for antimuscarinics? 2
COPD
asthma
What are the contraindications for antimuscarinics? 2
Patients susceptible to angle closure glaucoma
Caution withPatients at risk of arrhythmias
What are the side effects of antimuscarinics?
Relatively little systemic effect –> no side effects
except dry mouth
Give 3 examples of corticosteroids
prednisolone
hydrocortisone
dexamethasone
What are the indications for corticosteroids? 7
Allergic or inflammatory disorders:
anaphylaxis
asthma
Suppression of autoimmune disease
IBD
inflammatory arthritis
As part of some chemo or to reduce tumour associated swelling
Hormone replacement in adrenal insufficiency or hypopituitarism
What are the contraindications for corticosteroids?
caution with patients with infections
may suppress growth in children
what are the side effects of corticosteroids? 16
immunosuppression–> infections
DM
osteoporosis
increased catabolism–> proximal muscle weakness, skin thinning with easy bruisinh, gastritis
insomnia
confusion
psychosis
suicidal ideas
hypertension
hypokalaemia
oedema
adrenal atrophy
If they are withdrawn suddenly –> acute Addisonian crisis
What are the interactions of corticosteroids?
NSAIDs increase the risk of peptic ulcers and GI bleeding
Increase risk of hypokalaemia with B2-agonists, theophylline, loop or thiazide diuretucs
Efficacy may be reduced by P450 inducers
what is carbocysteine?
A mucolytic
how does carbocysteine work?
Dissolves thick mucus
What are the indications for carbocysteine?
COPD
chronic productive cough
What are the contraindications of carbocysteine? 2
Peptic ulcers
first trimester of pregnancy
What are the side effects of carbocysteine? 3
rarely causes GI bleeding
diarrhoea
nausea
what dose theophylline do?
relaxes smooth muscle
What are the indications for theophylline? 4
COPD
asthma
ephysema
bronchitis
What are the contraindications for theophylline? 2
Using large amounts of other products that contain xanthine e.g. chocolate and cafeinated drinls
alcohol may increase the side effects
what are the side effects of theophylline? 5
irritability mild, temporary caffeine like effects changes in behaviour restlessness temporary increased urination
What are theophylline’s interactions? 9
barbituates carbamezapine, amunigluthethimide, phenytoin, isoproterenol, moricizine, rifampcin, St John's wart or sulfinpyrazone} reduce effectiveness
What are the indications for O2? 3
hypoxaemia
Pneumothoraz- accelerate re-absorption of pleural gas
CO poisoning
What are the contraindications for O2?
Chronic type 2 respiratory failure (e.g. severe O2)- ruins adaptive changes–. rise in blood CO2
What are the side effects of O2?
dry throat- if not humdified
