Respiratory medication

Question 1

Bronchodilators - B2 agonists (SABA/ LABA)

Answer 1

SABA = Salbutamol, Terbutaline
LABA = Salmeterol, Formoterol 

A: B2 adrenoreceptors are bound to G-proteins. B2 agonist binds to receptors to activate G-protein (ATP –> cAMP) to cause relaxation of smooth muscle.

T: SABA is a reliever inhaler (BLUE) - Used when required
LABA is a maintainer inhaler (BROWN)is taken twice daily (morning and evening - 2 puffs)

H: Inhaler

L: LABA is lifelong. SABA is as an when required

E: Effects of LABA are slow. SABA is effective quickly.

T: Monitor K+ and glucose in severe asthmatics/diabetics

I: Tachycardia, myocardial ischaemia, arrhythmia, paradoxical bronchospasm, tremor, hypokalaemia

C: Caution in Pre-eclampsia

S:

Question 2

Bronchodilators = Anti-muscarinics

Answer 2

SAMA = Ipratropium Bromide
LAMA = Tiotropium 

A: Antagonise muscarinic acetylycholine receptors in the smooth muscle to cause relaxation

T: SAMA is taken as and when required (similar to SABA but less effective). LAMA is taken once daily.

H: Inhaled

L: Lifelong

E: SAMA is effective in 30-60mins.

T: no monitoring required

I: Dry mouth, headache, nausea, constipation; cough; diarrhea, gastro-intestinal motility disorder; sinusitis

C: Bladder outflow obstruction; paradoxical bronchospasm; prostatic hyperplasia;

S:

Question 3

Bronchodilators = Xanthine Agents

Answer 3

Xanthine agents = Theophylline, Aminophylline

A:prevents cAMP degradation to increase cAMP and cause bronchodilation

T: Theophylline is inhaled twice daily. Aminophyilline is only used in severe acute asthma exacerbation.

H: Theophylline is inhaled
Aminophylline is injected (theophylline + ethylenediamine,)

L: For as long as adjunct is required

E:

T: Measure plasma theophylline levels 5 days after commencing treatment. Usually requires 10-20mg to be effective, but adverse effects can occur in this range too

I: hypokalaemia, tachycardia, agitation, convulsion, toxic sepsis

C: Cardiac arrhythmias or other cardiac disease; elderly, epilepsy; fever; hypertension; hyperthyroidism; peptic ulcer; risk of hypokalaemia

S:

Question 4

Anti-inflammatory corticosteroids

Answer 4

Inhaled = Beclometasone, Budesonide
Oral = Prednisolone
IV = Hydrocortisone

A: Inhibit the production of inflammatory cytokines and therefore reduce the hyper-reactivity

T: Beclometasone is given once daily at night
Prednisolone given once daily (3-14 days)
Hydrocortisone given 6-hourly (life-threatening)

H: Inhaled, oral or IV

L: For as long as needed

E: IV is immediate

T: Monitor height and weight of children on long-term therapy (can stunt growth)

I: Osteoporosis, Growth restriction, Hoarseness, candidiasis, Adrenal suppression

C: Avoid using long-term

S: Need to wash mouth after use

Question 5

Anti-inflammatory leukotriene receptor antagonists

Answer 5

LTRA = Montelukast

A: Block the binding of LTD4 leukotriene) to its receptor on target tissues and therefore decrease the inflammatory response.

T: Once daily, in the evening

H: Tablet

L: As needed

E:

T: No monitoring required

I: Abdominal pain; headache; hyperkinesia (in young children); thirst

C: Avoid in pregnancy + breastfeeding

S:

Question 6

Mucolytics

Answer 6

Mucolytic: Mannitol

A:Reduces sputum viscosity

T: Twice daily, as required.

H: Inhaler

L: Until no longer needed

E:

T: Monitor fluid and electrolyte balance

I: cough; haemoptysis; headache; pharyngolaryngeal pain; throat irritation; vomiting; wheezing

C: caution in asthma

S: