Respiratory Flashcards
(26 cards)
Salbutamol
- Brand names
- Mechanism, duration
- Indications
- Side effects
Ventolin
Short acting beta-2 agonist
- Relaxation of smooth muscle = bronchodilation
Duration= 3-5 hours.
Indications
- Symptomatic asthma, COPD
- Hyperkalaemia
Side effects
- Sinus Tachycardia, palpatations (beta-2 agonist on heart)
- Tremors
- Hypokalaemia
Marketed name for salbutamol is…
Ventolin
Types of inhaled drug devices
Metered dose inhalers (MDIs)
- can be used with space to increase time of use
Dry powder inhaler
- Not puffs, one inhalation
Nebuliser
- delivers drug in form of mist
Instructions on how to used meter ed dose inhaler
- Exhale fully
- Inhale and puff
- Hold breath, slow count to ten
- Exhale slowly
- wait 1 min before second puff
Salmeterol
- Brand names
- Mechanism, duration
- Indications
- Side effects
Long actin beta-2 agonist
- Smooth muscle relaxation in bronchi= bronchodilation
Onset and duration
- Onset: 2-30 mins
- Acts: 10-12 hrs
Indications
- Asthma (in those on ICS)
- COPD (persistent symptoms despite therapy
Side effects
- Tremors
- palpitations
Brand name for salmeterol is…
Serevent
Salmeterol
- Administration
- Indication
Only inhaled.
In asthma
- In those with ICS
- After SABA alone is not effective
In COPD
- When symptoms persist
LABA
Long acting beta-2 agonist
Acts on smooth muscle in bronchi to relax= bronchodilation
Duration= 10-12 hrs onset= 15-45 mins
Examples
- Salmeterol (serevent)
- Formoterol (Oxeze) (faster onset)
Tiotropium
- Brand names
- Mechanism, duration
- Indications
- Side effects
Spiriva
Mechanism
- LAMA/ anticholinergic
- Ats on M1-5
- In airways, acts on M3= inhibits contraction= bronchodilation.
Indication
- Stable COPD, symptoms with SABA
- Asthma: step 3.
Ipratropium
- Brand name
- Onset
- Duration
- Administration
- Indication
Short acting antimuscarinic
- Atrovent
Onset= 30 mins
- Lasts 6 hours
administration
- MDI
- Nebs
Acute COPD/ asthma
Theophylline
- Mechanism
- Routes
- Indications
Phosphodiesterase inhibitor
- Relaxant of smooth muscle= bronchodilation
Routes
- PO
- IV
Indications
- IV: Acute asthma exacerbation
- PO: Persistent symptoms in asthma/ COPD
Theophylline
- Metabolism
- Side effects
Narrow therapeutic index
- Metabolised by cytochrome p450
- Clearance declines with age/ comorbidities.
Level= 10-20mg/L
stop infusion 20 mins before taking level
Drugs that increase levels of theophylline/ aminophylline
Drugs that inhibit cytochrome P450
- Ciprofloxacin
- Erythromycin
Drugs that decrease levels of theophylline/ aminophylline
Inducers of cytochrome P450
- Rifampicin
- Ritonavir
Smoking induces metabolism of theophylline
Side effects of methylxanthines
Headache, nausea
Insomnia
Toxicity signs of theophylline
Vomiting, tachycardia
Ventricular arrhythmia
Convulsions
Aclidinium
LAMA
Corticosteroid mechanism in asthma
Decreases cytokines that activate eosinophils
- Reduced IgE expression and production
Inhibits COX2 induction= anti-inflammatory
Inhibits leukotrienes
- Smooth muscle relaxation, anti-inflammatory
ICS
- examples
- side effects
- Beclamethasone
- Budesonide
- Fluticasone
- Memetasone
Oral candidiasis
Hoarse voice
- Can be avoided by rinsing mouth, gargling with water after inhaler/ using spacer.
- Or treat with nystatin
Treatment of COPD patients with asthmatic features.
- LABA + ICS
- If symptoms persist, add LAMA.
- Symptoms interfering with ADLs (trial triple therapy for 3 months)
- Severe exacerbation requiring hospitalisation
- 2 moderate exacerbation in a year
If symptoms do not improve after triple therapy for LAMA+LABA group, revert back.
SMART therapy
- Description
- Indications
Single maintenance and reliever therapy
- Single inhaler that contains combination of drugs
Indications
- Poorly Step 3 asthmatic patients
SMART therapy
- Examples
Symbicort
- Budesonide+ formorterol
Fostair
- Beclamethasone + formeterol
DuoResp
- Formeterol + budesonide
Use of oral corticosteroids
On in severe asthma/COPD
Administration
- Short course, High dose prednisolone for acute attacks
Oral prophylactic antibiotic therapy for COPD
- Indications
- Frequent (4+ a year) exacerbations with sputum
- Prolonged exacerbations with sputum
- Exacerbations requiring hospitalisation
