Respiratory drugs

Question 1

How do metered dose inhalers differ in administration to dry-powder inhalers?

Which other types of inhaled drug devices are there?

Answer 1

MDI- Deep exhale, inhale and puff, hold breath for slow 10s, exhale slowly, wait 1min for 2nd puff

DPIs usually one inhalation, not a puff

Nebulisers

Question 2

Which drugs would you administer in the case of allergic rhinitis?

Answer 2

Antihistamines
Intranasal glucocorticoids
Sympathomimetrics (decongestants)

Question 3

What is the asthma treatment ladder?

Answer 3

5 steps

Step 1- short term salbutamol
Step 5- steroid therapy

Move up and down depending on symptoms and success of current drugs

If side effects it is important to move up/down ladder- too many people left on steroids for too long

Question 4

A patient has COPD. The patient has breathlessness and exercise limitation. What would you prescribe?

Answer 4

Short-acting B2-agonist (salbutamol)

or

Short-acting muscuarinic agonist (ipratropium, tiotropium)

Question 5

A patient has COPD. The patient has exacerbations or persistent breathlessness. What would you prescribe?

Answer 5

If FEV1 >50%
Long-acting b2-agonist (salmetarol) or;
Long-acting muscuranic antagonist (ipratropium, tiotropium)

If FEV1<50%
Long-acting b2-agonist and inhaled corticosteroid
or
Long-acting muscarinic antagonist

Question 6

A patient has COPD. The patient has persistent exacerbations or breathlessness. What would you prescribe?

Answer 6

Combination treatment

LABA + Inhaled corticosteroid + LAMA

Question 7

Describe treatment for TB

Answer 7

6 months long (2 months initial phase- 4 drugs, 4 months continuous phase- 2 drugs)

If CNS involvement, continuous phase os extended to 10months

Treatment taken on empty stomach 1 hour before breakfast- compliance is key to cure

DOT/VOT used to ensure compliance