Respiratory Drugs

Question 1

SALBUTAMOL

Answer 1

Class: Beta 2 agonist, (Terbutaline)
I: Asthma, bronchospasm (allergy/exercise), premature labour, COPD. works for 3-5 hours, onset 5-10mins
Cx: Severe pre-eclampsia,
SE: hypokalaemia, tremor, arrhythmias; dizziness; headache, muscle cramps (beware of high doses/parenteral/oral)
How: Beta 2 selectivity not absolute, Beta 1 is stimulated too, (resulting in cardiac stimulation, vasodilation, hypotension, tremor).

Question 2

TIOTROPIUM

Answer 2

Class: Anti-muscarinic bronchodilator
I: COPD, severe asthma.
Cx: Bladder obstruction; paradoxical bronchospasm; prostatic hyperplasia; glaucoma [ALL Muscarinics]
SE: gastro, increased infection risk, dry mouth,
How: long acting antagonist to M3, relaxes smooth muscle for 24 hours.
Elim: urine.

Question 3

SALMETEROL

Answer 3

Class: Long acting B2 agonist (Formoterol)
I: chronic asthma, COPD, (long term noctural/exercise bronchospasm). 12 hours
Cx: Severe pre-eclampsia
SE: Hypokalaemia (long term tx, theophylline), Hyperglycaemia (glycogenolysis increased)
How: B2 agonist.

Question 4

IPRATROPIUM

Answer 4

Class: Anti-Muscarinic
I: Reversible airways obstruction (COPD), Acute bronchospasm, Asthma
Cx: Bladder obstruction; paradoxical bronchospasm; prostatic hyperplasia; susceptibility to angle-closure glaucoma
SE: Arrhythmias; cough; dizziness; dry mouth; headache; nausea
How: short antagonist M1-5 smooth muscle constriction 4-6 hours, onset 30mins.

Question 5

INDACATEROL (bonus)

Answer 5

Ultra long acting b2 agonist
Maintaince of COPD
Rapid onset - 5mins, lasts 24hours.

Question 6

THEOPHYLLINE

Answer 6

Class: Methylxanthines (AMINOPHYLLINE)
I: Chronic asthma,
Interactions: smoking increases need for higher dose.
Cx: Cardiac disease, hypokalemia.
SE: gastro, neuro, monitor K+,
How: smooth muscle relaxant, bronchial dilation, cardiac and central nervous system stimulant activities.
Elim: metabolised in the liver.

Question 7

PREDNISOLONE

Answer 7

Class: Corticosteroids
I: COPD excab, Severe croup, Asthma, Local inflammation, allegric disorders, UC, Crohns, M.gravis, I.T Purpura. RA, Giant cell.
Cx: untreated infection, TB Hx, Osteoporosis
SE: Cushings, Oedema, HPT, increased weight, nausea (inhalers, oral candida, hoarness)
How: systemic glucocorticoid, not for adrenal.
insuffiency. improvement in 24hr, maxium after 1-2wks.
Elim: Urine

Question 8

HYDROCORTISONE

Answer 8

Class: Corticosteroids
I: Thyroid storm, adrenal insuffciency, acute HS, IBD, eczemas, nappy rash, severe asthma..
Cx: untreated infection.
SE: general steroid SE, adrenal suppression
How: Main steroid secreted by adrenal cortex.
Metabolised in Liver
Elim: Kidneys

Question 9

BECLOMETASONE

Answer 9

Class: Corticosteroids
I: Oral ulcers, Prophylaxis asthma, Prophylaxis rhinitis, severe eczemas, UC,
Cx: untreated infections, liver disease
SE: throat irritation, constipation, muscle cramps,
How: less irritating corticosteroid.

Question 10

CARBOCISTEINE

Answer 10

Class: Mucolytic
I: reduction of sputum viscosity (COPD, bronchiectasis)
Cx: Peptic ulceration
SE: Gastro bleed, stephen johnsons syndrome, vomiting.

Question 11

LOW FLOW OXYGEN

Answer 11

I: <94–98% oxygen saturation. 88–92% for COPD.
RISK OF HYPERCAPNIC RESP FAILURE:
chronic obstructive pulmonary disease;
advanced cystic fibrosis;
severe non-cystic fibrosis bronchiectasis;
severe kyphoscoliosis or severe ankylosing spondylitis;
severe lung scarring caused by tuberculosis;
musculoskeletal disorders with respiratory weakness,
an overdose of opioids, resp. depression.

NB - Long-term 02 prolongs survival in some patients with COPD

Question 12

HIGH FLOW OXYGEN

Answer 12

I: <94-98% Oxygen sats.
Severe Asthma, MI, CO poisoning, neumonia, pulmonary thromboembolism, pulmonary fibrosis, shock, severe trauma, sepsis, or anaphylaxis.