Respiratory Meds Flashcards
What are the medications for stage 2 respiratory stations?
- SABA
- LABA
- LAMA
- ICS
- Prednisolone
What is a SABA and give an example
- Short acting beta 2 agonist
- Salbutamol
- Blue reliever inhaler
What are the indications for Salbutamol
- First line in both
- Asthma
- COPD
What are some contraindications and side effects of salbutamol?
- Used in caution with hyperthyroidism and cardiovascular disease, hypertension
- Contraindications: Corticosteroids & Diuretics - hypokalaemia
- Side effects include: Fine tremor, palpitations, headache, arrythmias, muscle cramps
What are some counselling points for salbutamol
- After starting or adjusting meds, review the response in 4-8 weeks
- Ensure person with asthma can use inhaler device. Shake
- Advised to seek medical advice when inhaler does not provide the usual degree of symptomaic relief - could be worsening of asthma
- 100-200 micrograms (1/2 puffs) upto 4 times do not exceed
- If needed for more than 3 weeks - should be on ICS
How to administer asthma inhaler?
- If using for the first time or after 14, release one puff into the air
- Stand/ sit in an upright position
- Remove protective cap and check mouth piece is clean
- Breathe out slowly and deeply as possible
- Hold canister vertically and puts lips around mouthpiece
- Breathe slowly and deeply through mouth and press down
What is LABA and give an example
- Long acting beta 2 agonists
- Salmeterol
- In combo with ICS for asthma
- Seretide: w/ fluticasone - purple inhaler
What are the indications of LABA
- In COPD: 2nd line: LABA+LAMA w/ no asthmatic features. LABA+ICS w/ asthmatic features. 3rd line: LABA+LAMA+ICS
- In asthma: 4th line. LABA with ICS, SABA and w/wo LRTA
What are some contraindications of salmeterol and side effects
- In caution with hyperthyroidism, CVD, hypertension
Contraindicated with Corticosteroids and Diuretics (hypokalaemia), Clarithromycin (avoid) - Arrythmias, headache, muscle cramps, hypokalaemia
What are some counselling points of salmeterol
- Twice a day for asthma
- Seek medical advice if the dose doesnt provide relief - worsening of asthma
- Check inhaler technique
- Follow manufacturers instructions on care and cleaning
- Shouldnt be used to relieve acute attacks
- Should be given with ICS in asthma. Can be given without in COPD (no asthmatic features)
What is LAMA and give an example
- Long acting muscarinic antagonist
- Spiriva (tiotropium)
What are the indications of LAMA
- COPD: 2nd line LAMA+LABA w/ no asthmatic features
- 3rd line: LABA+LAMA+ICS
What are contraindications and side effects of LAMA
- Arrythmias, dizziness, dry mouth, GI disorders, nausea, palpitations
Interactions with other anticholinergic agents
What are some counselling points for LAMA
- Regularly review adherence and inhaler technique
- If person is limited by breathlessness seek medical advice/ add on treatment. Usually feel better after 3-7 days if not contact
- Use at same time each day even without symptoms
What is ICS and give examples
- Inhaled corticosteroids
- Beclometasone (Clenil) and fluticasone
- Brown preventer inhaler
- Used 1/2 times a day to control inflammation
What are the indications of ICS
- Asthma
- COPD
- Inflammation
What are side effects and contraindications of inhaled corticosteroids
- Clarithromycin (monitor SE), Diuretics, LABA, SABA (hypokalaemia), Ibuprofen (bleed), warfarin (monitor INR)
- Increased risk of infections, skin reactions and headaches, oral thrush
What are some counselling points for ICS
- Offer low dose initially and titrate up if needed (steroid card)
- keep using even if no symptoms and check inhaler technique. Come back if symptoms not improved
- Rinse mouth with water after using the inhaler
- Avoid rapid reduction in dose
What are some indications of Prednisolone
- COPD
- Used in Asthma attacks
- Inflammation and allergic disorders
- Ulcerative colitis
- Crohns
What are some contraindications and side effects of prednisolone
- Avoid live virus vaccines, Clarithromycin, diuretics,SABA,LABA (hypokalaemia), Ibuprofen (bleed), Warfarin (monitor INR)
- Side effects: GI discomfort, headache, increased risk of infections
What are some counselling points for prednisolone
- Baseline: BP, BMI, potassium and eye examination measurements taken and at regular intervals
- Abrupt withdrawal can lead to acute adrenal insufficiency or hypotension
- Patient info leaflet should be supplied and steroid treatment card should be issued (details of dose/duration of treatment)
Take with/ immediate food - avoid stomach disturbances
