Respiratory

Question 1

Salbutamol

Brand: Albuterol, Ventolin, Asmasal, Salamol, Ventmax

Answer 1

Beta 2 Adrenoreceptor agonists. Compound inhalers ensure that long-acting B2-agonists (LABA) are not taken without an inhaled corticosteroid (suppresses inflammation).

Question 2

Mechanism of Salbutamol

Answer 2

Relaxes and dilates bronchioles.

Question 3

Indications of Salbutamol

Answer 3

1. Asthma

2. COPD

Question 4

Side effects of Salbutamol

Answer 4

Tremor,tachycardia, arrhythmias and muscle cramps

Oral thrush and hoarse voice, Adrenal suppression Growth retardation in children, Osteoporosis

Question 5

Elimination of Salbutamol

Answer 5

Onset within 5-15mins

Duration 3-5 hours

Question 6

Ipratropium Bromide

Answer 6

Anti-cholinergic/anti-muscarinic bronchodilator

Question 7

Mechanism of Ipratropium

Answer 7

Inhibits muscarinic acetylcholine receptors, inhibiting bronchoconstriction and mucous secretion

Question 8

Indications for Ipratropium

Answer 8

1. Short-term relief in acute asthma (but B2-agonists preferred as act more quickly)
2. COPD

Question 9

Side effects of Ipratropium Bromide

Answer 9

Blurred Vision, dry mouth, urinary retention, gluacoma

Paroxysmal bronchospasm

Question 10

Patient information for Ipratropium Bromide

Answer 10

Should not be used alone for acute symptoms

Patient should have short-acting B2 agonist for use as required

Question 11

Prednisolones

Answer 11

Corticosteroids

Question 12

Mechanism of Prednisolone

Answer 12

Anti-inflammatory effect by inhibiting phospholipase A2 activity and decreasing production of arachidonic acid which is used as a precursor for prostaglandin and leukotriene synthesis

Immunosuppressive as decrease B and T lymphocyte response to antigens

Question 13

Indications for Prednisolone

Answer 13

Suppression of allergic/ inflammatory disorders
IBD
Asthma
Rheumatoid disease
Immunosuppression

Question 14

Contraindications for Prednisolone

Answer 14

Systemic infection 
Hypersensitivity
Osteoporosis
Glaucoma
Recent MI 
Pregnancy

Question 15

Side effects of Prednisolone

Answer 15

Adrenal suppression for long term use, bruising, hirsutism, moon-face, HTN, weight gain, oedema, impaired glucose tolerance, mood changes, muscle weakness, head ache, hirsutism, menstrual cycle irregularities, risk of severe chicken pox

Question 16

Interactions of Prednisolone

Answer 16

Phenytoin and Rifampicin decrease effect of prednisolone

Question 17

Carbocysteine, Acteylcysteine, Erdosteine

Answer 17

Mucolytics

Question 18

Mechanism of Carbocysteine

Answer 18

Liquifies and reduces sputum viscosity

Question 19

Contraindications for Carbocysteine

Answer 19

Active peptic ulceration. Can disrupt the gastric mucosal barrier

Question 20

Side effects of Carbocysteine

Answer 20

Gastrointestinal haemorrhage, skin reactions, Stevens-Johnson syndrome, vomiting, allergic reactions, blood in the stool, low blood sugar symptoms

Question 21

Indications for Acetylcysteine

Answer 21

1. Antidote for Paracetamol poisoning
2. Prophylaxis contrast nephropathy
3. Reduce viscosity of respiratory secretion

Question 22

Mechanism of Acetylcysteine

Answer 22

1. Metabolism of paracetamol produces a small amount of N-acetyl-p-benzoquinone imine (NAPQI) which is hepatotoxic. This is detoxified with conjugation with gluthathione. Acetylcysteine replenishes the body’s supply of gluthathione
2. Liquifies mucus

Question 23

Side effects

Answer 23

In large IV doses can cause anaphylactoid reaction presenting with nausea, tachycardia, rash and wheeze and involves histamine release independent of IgE antibodies.

Question 24

Theophylline

Answer 24

Xanthines

Question 25

Mechanism of Theophylline

Answer 25

Bronchodilator: relaxes smooth muscle | Non-bronchodilator prophylactic effects: suppresses the response of airways to stimuli

Question 26

Indications for Theophylline

Answer 26

As a second-or third-line drug for asthma and COPD

Question 27

Contraindication for Theophylline

Answer 27

Active coronary heart disease as Theophylline will increase cardiac inotropy and heart rate

Question 28

Side effects of Theophylline

Answer 28

Nausea, vomiting, headache, insomnia tremor, seizures, restlessness, irregular heartbeat

Question 29

Interactions of Theophylline

Answer 29

Has a narrow therapeutic index and interactions. | Ciprofloxacin can increase blood levels of theophylline

Question 30

Montelukast

Answer 30

Leukotriene Receptor Antagonists

Question 31

Mechanism of Montelukast

Answer 31

Binds with CysLT1 receptor on mast cells and block the secretion of Leukotriene (LTD4). Preventing bronchoconstriction and inflammation of airways.

Question 32

Indications of Montelukast

Answer 32

1. To ease allergy signs 2. To prevent exercise-induced breathing problems 3. Treat or prevent asthma

Question 33

Side effects of Montelukast

Answer 33

Diarrhoea, fever, abdominal pain, headache, nausea, skin reactions, upper respiratory tract infection, vomiting

Question 34

Contraindications of Montelukast

Answer 34

Pregnancy and breast feeding

Question 35

Dose of Montelukast

Answer 35

10mg orally OD

Question 36

Indications for Oxygen

Answer 36

Acute treatment of arterial hypoxemia: PaO2 <8.0kPa or sats <94%

Question 37

Contraindications of giving Oxygen

Answer 37

Caution if patient has type II respiratory failure as patient has lost their CO2 drive and relies on hypoxic drive to keep breathing

Question 38

Side effects of oxygen

Answer 38

Irritate throat | Parenchymal lung damage/ tracheobronchitis

Question 39

Delivery of Oxygen

Answer 39

Supplementary oxygen (supplementary level of oxygen to room air required): nasal cannula, venturi mask, rebreathe mask, non-rebreathe/ reservoir mask High Flow Oxygen (flow up to 100% required): Non-rebreathe/ reservoir mask, humidified high flow nasal cannula Positive Pressure Delivery (CPAP/NIV)