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pre reg afsha > Asthma drugs > Flashcards

Asthma drugs Flashcards

1
Q

Doses for montelukast

A

6 months - 5 years: 4mg OD evening
6-14: 5mg OD evening
15-17, adults: 10mg OD evening

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2
Q

Indications for montelukast

A
  • asthma prophylaxis
  • symptomatic relief of seasonal allergic rhinitis in pt with asthma
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3
Q

Safety info: montelukast

A
  • risk of neuropsychiatric reactions
  • e.g. speech impairment, obsessive compulsive symptoms
  • read list of neuropsychiatric reactions in PIL and seek immediate medical attention if they occur
  • evaluate benefits and risks of continuing treatment if they occur
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4
Q

Common SE montelukast

A
  • diarrhoea, GI discomfort
  • n/v
  • headache, fever
  • upper RTI
  • skin reactions
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5
Q

Churg-Strauss syndrome - montelukast

A
  • rare
  • inflammation within small blood vessels which results in blood flow restriction which can cause organ damage throughout body if untreated
  • in many of the reported cases, reaction followed reduction or withdrawal of oral CCs
  • alert: vasculitis rash, worsening pulmonary symptoms, cardiac complications, peripheral neuropathy
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6
Q

Montelukast in pregnancy and BF

A
  • avoid unless essential
  • however can be taken as normal in pregnant women who have shown a significant improvement in asthma not achievable with other drugs before becoming pregnant
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7
Q

Montelukast - how to administer granules

A
  • swallowed or mixed with cold, soft food (NOT LIQUID) and taken immediately
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8
Q

Common side effects of SABAs - salbutamol, terbatuline

A

arrhythmias
headache
palpitations
tremor
HYPOkalaemia (high doses, if taking other meds that also cause this e.g. CCs and theophylline)

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9
Q

True or false - patients with diabetes who use SABAs and LABAs (b2 adrenoceptor agonists) should have their BG levels monitored because there is a risk of HYPERglycaemia and ketoacidosis, esp when they are given IV

A

True
Use is cautioned in pt with DM because of this

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10
Q

True or false - susceptibility to QT interval prolongation is a caution for all b2 adrenoceptor agonists

A

True
Can cause hypokalaemia with high doses and if on other drugs that cause this e.g. CCs and theophylline

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11
Q

Signs of theophylline overdose

A
  • vomiting (can be severe and intractable)
  • agitation
  • restlessness
  • dilated pupils
  • sinus tachycardia
  • hyperglycaemia
  • more serious effects: haematemesis, convulsions, SV and V arrhythmias
  • severe hypokalaemia can develop rapidly
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12
Q

Theophylline and smoking -how does smoking affect levels and when are dose adjustments needed

A
  • smoking INCREASES clearance of theophylline so HIGHER doses needed
  • adjustments needed if smoking has started or stopped during treatment
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13
Q

A patient on theophylline has mentioned they have started smoking. What does this mean

A

Smoking INCREASES clearance so INCREASED dose is required

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14
Q

A patient on theophylline mentions that they have finally stopped smoking. What does this mean

A

Smoking INCREASES clearance so higher dose is needed. If smoking has STOPPED, this means the patient will need a DECREASED dose.

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15
Q

Where is theophylline metabolised?

A

Liver

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16
Q

plasma theophylline conc is increased in the following (5)

A

smoking
viral infection
HI
HF
elderly

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17
Q

plasma theophylline concentration is decreased in the following 2 scenarios

A

smokers
alcohol consumtpion

18
Q

theopheylline dose is every … hours

A

every 12 hours

19
Q

When to measure plasma-theophylline concentration after starting oral treatment & after dose adjustments

A

5 days after starting oral treatment
3 days after dose adjustment

20
Q

True or false: plasma-theophylline conc needs to be measured 5 days after starting oral treatment and after any dose increase

A

FALSE
5 days after starting oral treatment
3 days after dose adjustment

21
Q

What is the plasma-theophylline concentration required for satisfactory bronchodilation?

A

10-20mg/L (in most patients)
although lower conc of 5-15 mg/L may be effective in some

22
Q

True or false: adverse effects can occur within the rangr 10-20mg/L (even though this is the concentration required in most pt for effective bronchodilation) and both the freq and severity of adverse effects increases above 20mg/L

A

True

23
Q

How many HOURS after an oral dose of MR prep theophylline should blood sample be taken? (measure conc 5 days after starting oral treatment and at least 3 days after any dose adjustment)

A

take blood sample 4-6 hours after oral dose

24
Q

true or false - dispense theophylline by brand

A

true
the rate of absorption from MR Preps can vary between brands

25
Q

true or false - plasma potassium conc should be monitored in severe asthma

A

true
this is bc potenitally serious hypokalaemia can result from B2 agonist therapy
particular caution required in severe asthma - effect can be potentiated by concomitant treatment with theophylline and its derivatives, CCs, diuretics and by hypoxia

26
Q

signs of theophylline overdose

A

vomiting (may be severe and intractable)
agitation
restlessness
dilated pupils
sinus tachycardia
hyperglycaemia
more serious effects include haematemsis, convulsions, SV and venticular arrhtyhmias

27
Q

theophylline poisoning - how to eliminate theophylline

A

repeated doses of activated charcoal can be used even if >1h after ingestion
especially good if MR prep taken

28
Q

theophylline poisoning - which anti emetic may be effective for severe vomiting that is resistant to other antiemetics?

A

ondansetron

29
Q

theophylline poisoning - how would you correct hypokalaemia

A

IV infusion of potassium chloride
may be so severe as to require 60mmol/h
high doses need ECG monitoring

30
Q

theophylline poisoning - how to control convulsions

A

IV lorazepam or diazepam

31
Q

theophylline poisoning - how to manage agitation

A

sedation with diazepam may be necessary

32
Q

true or false - if someone has theophylline poisoning and they DO NOT suffer from asthma, a SABA can be given IV to reverse severe tachycardia, hypokhalaemia and hyperglycaemia

A

true

33
Q

true or false - theophylline can cause hyperglycaemia

A

true

34
Q

Theophylline is predicted to cause HYPOkalaemia, potenitally increasing risk of TDP, when given with the following drugs

A

amiodarone, dronedarone
antipsychotics
promethazine
apomorphine, methadone,
citalopram, escitalopram
erythromycin
fluconazole, voriconazole
quinine
ondansetron
hydroxyzine
CCs
Loop and thiazides
SABAs and LABAs

35
Q

the following drugs are predicted to INCREASE risk of bronchospasm when given with theophylline so avoid

A

beta blockers

36
Q

true or false - COC can INCREASE exposure to theophylline. monitor and adjust dose

A

true

37
Q

the folllowing drugs increase the exposure to theophylline. monitor and adjust dose

A

clarithromycin
azithromycin
ciprofloxacin
COC
valaciclovir
aciclovir

38
Q

name the 4 LAMA

A

Tiotropium

Aclidinium, glycopyrronium and umeclidinium (black triangle)

39
Q

Name the SAMA

A

ipratropium

40
Q

use inhaled antimuscarinics with caution in the following (4) …

A

bladder outflow obstruction
paradoxical bronchospasm
prostatic hyperplasia
susceptibility to CAG

41
Q

name 7 common SE of inhaled antimuscarinics

A
  • arrhtyhmias
  • constipation
  • cough
  • dizziness
  • dry mouth
  • nausea
  • headache

pre reg afsha (60 decks)

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