Prescribing - Respiratory

Question 1

What drug class is salbutamol?

Answer 1

Short acting beta 2 agonist

Question 2

How do SABA work?

Answer 2

Our agonists to the B2 adrenoreceptors in bronchial smooth muscle

causing bronchial smooth muscle relaxation and bronco dilation

Question 3

When are SABA used?

Answer 3

In asthma or COPD

Question 4

What are common side effects of SA BA?

Answer 4

Fine tremor
headache
muscle cramps
palpitations

Question 5

What are important side effects of SA BA?

Answer 5

Arrhythmias
MI
hypokalaemia in high doses
lactic acidosis in high doses

Question 6

What are contraindications to the use of SA BA?

Answer 6

Arrhythmias
hypertension
hypothyroidism
diabetes mellitus

Question 7

What must be monitored when using S ABA?

Answer 7

If using in high doses monitor serum potassium (especially if people are taking theophylline, corticosteroids, diuretics)

Question 8

What should be communicated to patients when taking SA BAs?

Answer 8

Salbutamol is a reliever inhaler should be used only when experiencing asthma symptoms it will not prevent attacks

explain the importance of inhaler technique if patients are having trouble with this they may benefit from the use of a spacer, dry powder inhaler, or breath activated inhaler

Question 9

What drug class is Tiotropium bromide?

Answer 9

An inhaled anti-muscarinic/anti-cholinergic

long acting

Question 10

What is a short acting anti-Muscarinic and/anti-cholinergic agent

Answer 10

ipatropium bromide

Question 11

How do anti-muscarinic’s/anticholinergics work?

Answer 11

Competitive antagonist to M3 receptors

causing bronchial smooth muscle relaxation and bronco dilation

Question 12

When are anti-muscarinic/anticholinergic’s used in resp medicine?

Answer 12

Reversible airway obstruction mainly COPD

short acting agents I use in acute bronchospasm

Question 13

What are common adverse effects of anti-muscarinic/anticholinergic’s?

Answer 13

Dry mouth
nausea
headache
constipation
cough
diarrhoea
sinusitis
nosebleeds
oral thrush
taste disturbances

Question 14

What are important adverse effects of anti-muscarinic/anticholinergic’s?

Answer 14

Atrial fibrillation
acute angle closure glaucoma
urinary retention
paradoxical bronchospasm
blurred vision
GORD
 dental caries

Question 15

What are contraindications to the use of anti-muscarinic/anticholinergic’s?

Answer 15

Prostatic hyperplasia
bladder outflow obstruction
those at risk of acute angle closure glaucoma

Question 16

What do anti-muscarinic/anticholinergic’s interact with?

Answer 16

None really

Question 17

What drug monitoring is required for anti-muscarinic/anticholinergic’s?

Answer 17

None really just watch out for adverse effects

Question 18

What is important to communicate patients when using anti-muscarinic/anticholinergic’s?

Answer 18

They should not exceed the prescribed daily dose

importance of inhaler technique

Question 19

What drug class is montelukast?

Answer 19

Early leukotriene receptor antagonist (LTRA)

Question 20

How do LTR A’s work?

Answer 20

Block the action of leukotrienes (which are pro-inflammatory) in airway smooth muscle cells thus reducing our information in asthma and rhinitis

Question 21

When would you use LTRA’s?

Answer 21

Persistently poor controlled asthma (step four)

symptom relief in allergic rhinitis and asthma patients

of benefit in exercise or aspirin induced asthma

Question 22

What are common side effects of LTR A’s?

Answer 22

Abdominal pain
headache
hyperkinesia (young children)
thirst

Question 23

What are important side-effects of LTR A’s?

Answer 23

Churg-strouss syndrome

hypersensitivity - including anaphylaxis and angioedema

Depression

seizures

a granulosis/ hepatotoxicity (with zafirlukast)

Question 24

What drugs do LTR A’s interact with?

Answer 24

Warfarin – increased anticoagulation

Question 25

What should be communicated to patients about LTR A's?

Answer 25

This is for long-term prophylaxis not for acute exacerbations should be warned of the symptoms of churg-strouss syndrome should be warned of agranulosis symptoms

Question 26

what is charge-strouss syndome?

Answer 26

very rare but watch out for eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, or peripheral neuropathy

Question 27

What is Chlorphenamine?

Answer 27

An antihistamine

Question 28

How do antihistamines work?

Answer 28

Compete for binding site on H1 receptors with histamine blocking the acute inflammatory effects of histamine these are vasodilation, increase vascular permeability

Question 29

What are common side effects of antihistamines?

Answer 29

``` Drowsiness blurred vision dry mouth GI disturbance headaches psychomotor impairment urinary retention ```

Question 30

What are serious side-effects of antihistamines?

Answer 30

``` Extrapyramidal effects hypersensitivity reactions (including bronchospasm, angioedema, anaphylaxis, rashes) ```

Question 31

When are antihistamines contraindicated?

Answer 31

Avoid in severe liver disease, pregnancy and breastfeeding caution with sedating antihistamines as they have significant anti-muscarinic activity (don't use with prostatic hyperplasia, urinary retention, those at risk of angle closure glaucoma)

Question 32

What do antihistamines interact with?

Answer 32

Antidepressants - increased sedative and and whose chronic effects especially with MAOIs or TCA

Question 33

What is Pseudoephedrine?

Answer 33

A nasal decongestant

Question 34

How does Pseudoephedrine work?

Answer 34

Agonist to alpha and beta adrenal receptors meaning there is vascular smooth muscle contraction and vasoconstriction and bronchial smooth muscle relaxation and bronco dilation

Question 35

What are common side effects toPseudoephedrine?

Answer 35

``` Anxiety headache hypertension insomnia nausea restlessness tachycardia vomiting ```

Question 36

What are important side-effects to Pseudoephedrine?

Answer 36

Hallucinations angle closure glaucoma urinary retention

Question 37

When is Pseudoephedrine contraindicated?

Answer 37

``` Diabetes hypertension hyperthyroidism ischaemic heart disease prostatic hypertrophy anyone at risk of angle closure glaucoma ```

Question 38

What doesPseudoephedrine interact with?

Answer 38

Alpha blockers – reduced hypotensive effect MAOIS - risk of hypertensive crisis absolute contraindication!!

Question 39

What is important to communicate patients about taking Pseudoephedrine?

Answer 39

can cause insomnia so do not take at night