Drugs used in Asthma and COPD

Question 1

What is Clenil?

Answer 1

Beclametasone- ICS

Question 2

What is salbutamol?

Answer 2

SABA

Question 3

What is salmeterol?

Answer 3

LABA

Question 4

What is montelukast?

Answer 4

LTRA

Question 5

What is Tiotropium?

Answer 5

LAMA

Question 6

What is ipatropium?

Answer 6

SAMA

Question 7

What is a budesonide turbohaler?

Answer 7

ICS

Question 8

What is Qvar?

Answer 8

Beclametasone- ICS

Question 9

What is terbutaline?

Answer 9

SABA

Question 10

What is formoterol?

Answer 10

LABA

Question 11

What is glycopronium?

Answer 11

LAMA

Question 12

What is indacaterol?

Answer 12

LABA- COPD only

Question 13

What is Ventolin?

Answer 13

Salbutamol- SABA

Question 14

What is Fostair?

Answer 14

Beclometasone + Formoterol (ICS + LABA)

Question 15

What is a secretive evohaler?

Answer 15

Fluticasone and salmeterol (ICS + LABA)

Question 16

What does Uniphyllin continue contain?

Answer 16

Theophyline (xanthine)

Question 17

What should a healthy patients respiratory rate be?

Answer 17

12-18 bpm

Question 18

What does PEFR stand for?

Answer 18

Peak expiratory flow rate- measures the volume of air forcefully expelled in one exhalation.

Question 19

what should a patients PEFR be?

Answer 19

The ideal PEFR value will depend on the patient but their reading should be at least 80% of of the patients best (calculate)

Question 20

What should a patients O2 saturation be?

Answer 20

At least 96%

Question 21

What could a patient taking hay fever medication signify

Answer 21

Hayfever can worsen symptoms of asthma as pollen can be a trigger and would cause further inflammation of the airways.

Question 22

Can people with asthma take Ibuprofen?

Answer 22

People with asthma should take care when taking NSAIDs and should speak to a doctor first (e.g. in a patient records scenario, if you collect it from them but it isn’t stated in their records, bring it up) as it can cause a bronchospasm.

Question 23

If on a patients record, ‘Beclametasone’ inhaler is written down, what must you do?

Answer 23

Clarify the brand- is it Qvar or clonal?
As they have different particle sizes and so are not interchangeable- Qvar has smaller particles and is also not licensed for use in children under 12

Question 24

If on a patients record, ‘Beclametasone’ inhaler is written down, what must you do?

Answer 24

Clarify the brand- is it Qvar or clonal?
As they have different particle sizes and so are not interchangeable- Qvar has smaller particles and is also not licensed for use in children under 12

Question 25

Can you give 2 topical corticosteroid products (e.g. inhaler and nasal spray) at once?

Answer 25

Yes- it would increase the likelihood of systemic effects but this combination os very common and suitable. - if on a high dose of lots of steroids it can cause suppression of natural steroids so would need to stop taking slowly.

Question 26

What would you give if a patient goes into hospital with an acute asthma exacerbation in an emergency situation?

Answer 26

Give IV hydrocortisone 100mg every 6 hours until can be converted to oral prednisolone. Also give a salbutamol via a nebuliser in an emergency situation to act as a bronchodilator May also be given oxygen

Question 27

If you are adding a LABA to a patient already on an ICS, what might you do?

Answer 27

Give it as a MART therapy which contains an ICS + LABA so usually Budesonide and Formoterol ( has both long and short acting bronchodilator effects) e.g. Symbicort turbohaler or Fostair- contains beclometasone and formoterol

Question 28

What does MART therapy stand for?

Answer 28

Maintenance and relieve therapy

Question 29

How do you use MART therapy?

Answer 29

Patients on MART therapy only need one inhaler that they take morning and evening (1-2 puffs) - This same inhaler is also used as a reliever if needed

Question 30

What can a too high does of theophylline cause?

Answer 30

- Can cause symptoms such as nausea, vomiting and a tremor. It has such a narrow therapeutic window that these symptoms are a sign of toxicity.

Question 31

What is the therapeutic and optimal range for theophylline?

Answer 31

Therapeutic window is 10-20 mg/L, however the optimal range is just 10-12 mg/L

Question 32

What might a serum theophylline level of >20 cause?

Answer 32

Nausea and vomitting

Question 33

What might a serum theophylline level of >25 cause?

Answer 33

cardiac arrhythmia

Question 34

What might a serum theophylline level of >30 cause?

Answer 34

seizures

Question 35

What therapeutic drug monitoring should be taken when taking theophylline?

Answer 35

- l would need to observe plasma and potassium levels. plasma levels should be taken every 6 months can cause hypokalaemia if used alongside a B2 agonist - Also need to take blood tests 5 days after starting treatment- should be 4-6 hours after taking medication if it is a MR tablet or IV aminophylline.

Question 36

What is important when giving out prescriptions of theophylline?

Answer 36

Must be given the same brand each time, they are not interchangeable.

Question 37

What is the dose of theophylline?

Answer 37

MR BD

Question 38

Who would need a higher dose of theophylline?

Answer 38

- People who smoke heavily as chemicals in the nicotine smoke induces the CYPIA2 responsible for the breakdown of theophylline. if the patient quits, the dose must be adjusted.

Question 39

What does theophylline interact with?

Answer 39

Many antibiotics- mainly macrocodes e.g. clarithromycin. This is because theophylline is metabolised by CYP450 enzyme- broken down, however, clarithromycin inhibits the CYP450 enzyme so causes theophylline to not be broken down hence the side effects. would swap clarithromycin for doxycycline

Question 40

What does the ultibro breezehaler contain?

Answer 40

indaceterol (LABA) + Glycopyrronium (LAMA)

Question 41

What could you give to a COPD patient with a chest infection that is not improving with antibiotics and has chronic sputum production?

Answer 41

A mucolytic agent e.g. carbocisteine that will reduce suit viscosity to make it easier to clear from the airways.

Question 42

What class of drugs can cause urine retention?

Answer 42

LAMA

Question 43

What is the recommended inspiratory flow rate for a pMDI?

Answer 43

20-60 L/min if were too inhale at a high rate e.g. 90- it would hit the back of the throat and be swallowed- won't relieve eh symptoms as there would be no localised effect

Question 44

How can using a spacer help patients using a pMDI?

Answer 44

- don't have to coordinate the breathing and pressing of the device - prevents deposition of drug in the upper airways that can lead to oral thrush

Question 45

What are some therapeutic monitoring parameters for salbutamol?

Answer 45

- less wheezing and coughing - less night time waking - lower peak flow and spirometry readings - less breathlessness

Question 46

What are some toxic monitoring parameters for salbutamol?

Answer 46

- tachycardia - tremors - nervous tension - headache - decrease in potassium levels- hypokalaemia

Question 47

What do LTRAs do?

Answer 47

block the effects of cytseinyl leukotrienes in the airways (LTC4, LTD4, LTE3) - receptors for cysteinyl leukotrienes are present on airway smooth muscle cells and infiltrating immune cells - By blocking leukotriene 1 receptor, they can decrease both early and late response to allergens in asthma - Blocking it van slide prevent smooth muscle contraction and migration of eosinophils to the airways HAS BOTH BRONCHODILATORY AND ANTI-INFLAMMATORY EFFECTS.

Question 48

Are LTRA's used in asthma?

Answer 48

no, copd only