Respiratory drugs

Question 1

Give 4 example of Beta-2 agonists

Answer 1

salbutamol + terbutaline} short acting

salmeterol + formoterol } long acting

Question 2

What are the indications of Beta-2 agonists? 3

Answer 2

Asthma- short acting for breathlessness, long acting with corticosteroids for chronic

COPD

Hyperkalaemia- nebulised salbutamol may be used with insulin, glucose and Ca gluconate

Question 3

what are the contraindications of Beta-2 agonists?

Answer 3

Long acting should only be used with a corticosteroid

care in cardiovascular disease may provoke tachycardia–> angina or arrhythmias

Question 4

What are the side effects of B2-agonists? 7

Answer 4

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

Question 5

What are the interactions for B2-agonists?

Answer 5

Beta-blockers may decrease their effectiveness

High dose nebulised B-2 agonist with theophylline and corticosteroids can –> hypokalaemia} should be monitored

Question 6

Give 3 examples of antimuscarinics/ bronchodilators

Answer 6

ipratropium
tiotropium
glycopyronium

Question 7

How do antimuscarinics work?

Answer 7

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

Question 8

What are the indications for antimuscarinics? 2

Answer 8

COPD

asthma

Question 9

What are the contraindications for antimuscarinics? 2

Answer 9

Patients susceptible to angle closure glaucoma

Caution withPatients at risk of arrhythmias

Question 10

What are the side effects of antimuscarinics?

Answer 10

Relatively little systemic effect –> no side effects

except dry mouth

Question 11

Give 3 examples of corticosteroids

Answer 11

prednisolone
hydrocortisone
dexamethasone

Question 12

What are the indications for corticosteroids? 7

Answer 12

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

Question 13

What are the contraindications for corticosteroids?

Answer 13

caution with patients with infections

may suppress growth in children

Question 14

what are the side effects of corticosteroids? 16

Answer 14

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

Question 15

What are the interactions of corticosteroids?

Answer 15

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

Question 16

what is carbocysteine?

Answer 16

A mucolytic

Question 17

how does carbocysteine work?

Answer 17

Dissolves thick mucus

Question 18

What are the indications for carbocysteine?

Answer 18

COPD

chronic productive cough

Question 19

What are the contraindications of carbocysteine? 2

Answer 19

Peptic ulcers

first trimester of pregnancy

Question 20

What are the side effects of carbocysteine? 3

Answer 20

rarely causes GI bleeding
diarrhoea
nausea

Question 21

what dose theophylline do?

Answer 21

relaxes smooth muscle

Question 22

What are the indications for theophylline? 4

Answer 22

COPD
asthma
ephysema
bronchitis

Question 23

What are the contraindications for theophylline? 2

Answer 23

Using large amounts of other products that contain xanthine e.g. chocolate and cafeinated drinls

alcohol may increase the side effects

Question 24

what are the side effects of theophylline? 5

Answer 24

irritability 
mild, temporary caffeine like effects 
changes in behaviour 
restlessness 
temporary increased urination

Question 25

What are theophylline’s interactions? 9

Answer 25

barbituates
 carbamezapine, 
amunigluthethimide,
 phenytoin, 
isoproterenol, 
moricizine, 
rifampcin, 
St John's wart 
or sulfinpyrazone} reduce effectiveness

Question 26

What are the indications for O2? 3

Answer 26

hypoxaemia
Pneumothoraz- accelerate re-absorption of pleural gas
CO poisoning

Question 27

What are the contraindications for O2?

Answer 27

Chronic type 2 respiratory failure (e.g. severe O2)- ruins adaptive changes–. rise in blood CO2

Question 28

What are the side effects of O2?

Answer 28

dry throat- if not humdified