Therapeutics- Respiratory

Question 1

Which drugs can provoke asthma in some individuals?

Answer 1

Aspirin and NSAIDs

Question 2

What four symptoms may be seen in asthma?

Answer 2

Wheeze
Cough
Shortness of Breath
Chest Tightness

Question 3

For which drug is asthma a contraindication?

Answer 3

Beta blockers- prevent beta 2 mediated bronchodilatation

Question 4

What is the first line treatment for mild intermittent asthma?

Answer 4

Inhaled Beta 2 Agonist- Salbutamol

Question 5

How might inhaled drugs be taken?

Answer 5

Inhaler
May also have a spacer device
Nebuliser

Question 6

What is the second line treatment to add?

Answer 6

Inhaled corticosteroid

Question 7

Give an example of an inhaled corticosteroid

Answer 7

Beclamethasone/Becotide

Question 8

When should ICS be used?

Answer 8

2 x per day as they are a preventer therapy

Question 9

What criteria indicate that an ICS should be added?

Answer 9

Exacerbation in the last 2 years
Symptoms at least one night per week
Symptoms needing SABA more than twice per week

Question 10

What infection are patients using an ICS more at risk of?

Answer 10

Oral candidas
Risk is reduced by using a spacer device and rinsing mouth with water after inhalation
Anti-fungal oral suspension or lozenges can be used to treat oral candidas without discontinuing asthma therapy

Question 11

What is the third line treatment to add?

Answer 11

LABA- Long acting beta agonist

Question 12

Give an example of a LABA

Answer 12

Salmeterol

Formoterol

Question 13

What is seretide?

Answer 13

This is a combination inhaler with salmeterol and fluticasone
It is the purple inhaler

Question 14

What are the add on therapies for difficult to control asthma?

Answer 14

Leukotriene receptor antagonist
Muscarinic antagonist
Xanthine Derivative

Question 15

Give an example of a leukotriene receptor antagonist

Answer 15

Montelukast

Question 16

When are leukotriene receptor antagonists contraindicated?

Answer 16

Pregnancy

Liver cirrhosis

Question 17

Give an example of a xanthine derivative

Answer 17

Theophyline

Question 18

How do xanthine derivative work?

Answer 18

PDE inhibitors- prevent signalling that lead to bronchoconstriction

Question 19

Give an example of a long acting muscarinic antagonist

Answer 19

Tiotropium

Question 20

How do LAMAs work?

Answer 20

Prevent parasympathetic mediated bronchoconstriction

Question 21

What should be done for poorly controlled asthma after the normal algorithms has been used?

Answer 21

Increase ICS to highest dose
Refer for specialist care
Oral steroid use should be considered (lots of associated side effects)

Question 22

What are some causes of a poor response to treatment?

Answer 22

Poor compliance
Poor inhaler technique
Presence of triggers
Wrong diagnosis

Question 23

What are the features of acute severe asthma?

Answer 23

Unable to complete sentences
HR>110
RR>25
PEFR less than 50% predicted

Question 24

When is acute severe asthma life threatening?

Answer 24

Quiet chest on auscultation
Becoming tired and dehydrated
Oxygen saturations <92%
Cyanosis
Low HR
Low BP
Confusion
PEFR <33% predicted

Question 25

What is the management for acute severe asthma?

Answer 25

Requires hospitalisation
Oxygen therapy
Nebulised salbutamol (repeat if no improvement)
Steroids- Prednisolone 40-50mg PO or hydrocortisone 100mg IV
If response poor…
Ipratropium bromide 500mcg every 4-6 hours
IV beta 2 agonist, magnesium sulphate or aminophylline

Question 26

What are the two diseases of COPD?

Answer 26

Emphysema and bronchitis

Question 27

What drugs are used in the management of COPD?

Answer 27

Beta 2 Agonists- SABA and LABA
Anti-muscarinics- Short acting (ipratropium) and long acting (tiotropium)
Inhaled corticosteroids
Mucolytics- carbocisteine
Oxygen therapy for respiratory failure

Question 28

What pharmacological therapies are available for smoking cessation?

Answer 28

Nicotine replacement therapy
Bupropion- antidepressant with effect on smoking cessation
Varenicline- selective nicotine receptor partial agonists

Question 29

What contraindications exist for bupropion and varenicline?

Answer 29

Pregnancy
Breast feeding
Bupropion is an antidepressant with effect on smoking cessation
Varenicline is a nicotine receptor partial agonists

Question 30

What is the ideal size of particle for inhaled drugs?

Answer 30

2-5 microns
Increasing particle sizes correlates with reduced penetration of the respiratory tract.
Very small particles will be exhaled

Question 31

What are some of the benefits of spacers?

Answer 31

Reduce the need for co-ordination of inhalers

Reduce the risk of adverse effects with ICS (E.g oral candidas)