Respiratory Drugs

Question 1

What class of drug is Salmeterol (Serevent)?

Answer 1

Long-acting β2 agonist (LABA)

Question 2

What class of drug is Salbutamol (Ventolin)?

Answer 2

Short-acting β2 agonist (SABA)

Question 3

What class of drug is Fluticasone (Flixotide)?

Answer 3

Inhaled corticosteroid

Question 4

What class of drug is Montelukast (Singulair)?

Answer 4

LT receptor antagonist

Question 5

What class of drug is Cromoglycate (Intal)?

Answer 5

Mast cell stabiliser

Question 6

What class of drug is Terbutaline (Bricanyl)?

Answer 6

Short-acting β2 agonist (SABA)

Question 7

What class of drug is Eformoterol (Symbicort)?

Answer 7

Long-acting β2 agonist (LABA)

Question 8

What class of drug is Ipratropium (Atrovent)?

Answer 8

Short-acting anticholinergic (antimuscarinic)

Question 9

What class of drug is Tiotropium (Spiriva)?

Answer 9

Long-acting anticholinergic (antimuscarinic)

Question 10

What class of drug is Theophylline (Nuelin)?

Answer 10

Phosphodiesterase inhibitor/non-selective adenosine receptor antagonist

Question 11

What class of drug is Budesonide (Pulmicort)?

Answer 11

Inhaled corticosteroid

Question 12

What class of drug is Omalizumab?

Answer 12

Recombinant humanised monoclonal antibody (directed against IgE)

Question 13

What is the mechanism of action of Salmeterol (Serevent)?

Answer 13

Stimulation of β2 adrenergic receptors, causing smooth muscle relaxation → bronchodilation

LABAs have a longer half-life than SABAs due to their increased lipophilicity – stay in the lipid membrane and act for longer.

Question 14

What is the mechanism of action of Salbutamol (Ventolin)?

Answer 14

Stimulation of β2 adrenergic receptors, causing smooth muscle relaxation → bronchodilation

Question 15

What is the mechanism of action of Fluticasone (Flixotide)?

Answer 15

Modulates protein synthesis in the nucleus → inhibition of phospholipase A2 → inhibition of arachidonic acid formation → inhibition of inflammatory mediator formation → reduction of airway inflammation and bronchial hyperreactivity

Question 16

What is the mechanism of action of Montelukast (Singulair)?

Answer 16

Inhibits the cysteinyl leukotriene receptor; antagonises airway smooth muscle contraction and inflammation caused by leukotrienes.

Question 17

What is the mechanism of action of Cromoglycate (Intal)?

Answer 17

Acts by inhibiting release of inflammatory mediators from mast cells.

Generally well tolerated as it does not gain access to systemic circulation.

Question 18

What is the mechanism of action of Terbutaline (Bricanyl)?

Answer 18

Stimulation of β2 adrenergic receptors, causing smooth muscle relaxation → bronchodilation

Question 19

What is the mechanism of action of Eformoterol (Symbicort)?

Answer 19

Stimulation of β2 adrenergic receptors, causing smooth muscle relaxation → bronchodilation

LABAs have a longer half-life than SABAs due to their increased lipophilicity – stay in the lipid membrane and act for longer.

Question 20

What is the mechanism of action of Ipratropium (Atrovent)?

Answer 20

Promote bronchodilation by inhibiting cholinergic bronchomotor tone.

Blocks muscarinic actions of ACh

Question 21

What is the mechanism of action of Tiotropium (Spiriva)?

Answer 21

Promote bronchodilation by inhibiting cholinergic bronchomotor tone.

Blocks muscarinic actions of ACh

Question 22

What is the mechanism of action of Theophylline (Nuelin)?

Answer 22

Inhibition of PDE → raised intracellular cAMP → activation of PKA → inhibition of TNF-α and LT-synthesis → reduces inflammation

Question 23

What is the mechanism of action of Budesonide (Pulmicort)?

Answer 23

Reduces airway inflammation and bronchial hyper-reactivity.

Question 24

What is the mechanism of action of Omalizumab?

Answer 24

Recombinant humanised monoclonal antibody directed against immunoglobulin E (IgE); reduces the immune system’s response to allergen exposure

Question 25

What are the side effects of Salmeterol (Serevent)?

Answer 25

Tremor Palpitation Headache Tachycardia Muscle cramps Agitation Insomnia

Question 26

What are the side effects of Salbutamol (Ventolin)?

Answer 26

Tremor Palpitation Headache Tachycardia Muscle cramps Agitation Insomnia

Question 27

What are the side effects of Fluticasone (Flixotide)?

Answer 27

Dysphonia Oropharyngeal candidiasis (esp. if spacer not used) Bruising Facial skin irritation following nebulisation Allergic reaction

Question 28

What are the side effects of Montelukast (Singulair)?

Answer 28

Headache Abdominal pain Diarrhoea Allergy

Question 29

What are the side effects of Cromoglycate (Intal)?

Answer 29

Cough Throat irritation Bitter taste Transient bronchospasm

Question 30

What are the side effects of Terbutaline (Bricanyl)?

Answer 30

Tremor Palpitation Headache Tachycardia Muscle cramps Agitation Insomnia

Question 31

What are the side effects of Eformoterol (Symbicort)?

Answer 31

Tremor Palpitation Headache Tachycardia Muscle cramps Agitation Insomnia

Question 32

What are the side effects of Ipratropium (Atrovent)?

Answer 32

Headache Nausea Taste disturbance Dry mouth Throat irritation Blurred vision Dizziness Urinary retention

Question 33

What are the side effects of Tiotropium (Spiriva)?

Answer 33

Headache Nausea Taste disturbance Dry mouth Throat irritation Blurred vision Urinary retention

Question 34

What are the side effects of Theophylline (Nuelin)?

Answer 34

Nausea Vomiting Diarrhoea GORD Headache Insomnia Irritability Anxiety Tremor Palpitations Theophyllines have a narrow therapeutic range; toxicity is closely related to plasma concentration.

Question 35

What are the side effects of Budesonide (Pulmicort)?

Answer 35

Dysphonia Oropharyngeal candidiasis (esp. if spacer not used) Bruising Facial skin irritation following nebulisation Allergic reaction

Question 36

What are the side effects of Omalizumab?

Answer 36

Common (\>1%) * injection site reactions * rash * bleeding (nosebleeds, heavy menstrual bleeding, haematoma) Infrequent (0.1–1%) * decrease in platelet count (mild) Rare ( * anaphylaxis (usually occurs within 2 hours but can be delayed to \>24 hours) * angioedema * urticaria * serum sickness-like syndrome

Question 37

What are the indications for use of Salmeterol (Serevent)?

Answer 37

Administration: puffer, accuhaler Symptomatic relief of asthma * Can be used in conjunction with an inhaled corticosteroid (e.g. fluticasone) Must be combined with inhaled glucocorticoid as monotherapy is associated with increased morbidity/mortality in asthma.

Question 38

What are the indications for use of Salbutamol (Ventolin)?

Answer 38

Administration: inhaler, nebuliser * Acute asthma * Symptom relief during maintenance treatment of asthma and COPD * Protection against exercise-induced asthma

Question 39

What are the indications for use of Fluticasone (Flixotide)?

Answer 39

Administration: inhaler, IV for acute severe episodes * Maintenance treatment of persistent asthma

Question 40

What are the indications for use of Montelukast (Singulair)?

Answer 40

Administration: oral tablet * Maintenance treatment in asthma * Allergic rhinitis * Prevention of exercise-induced asthma

Question 41

What are the indications for use of Cromoglycate (Intal)?

Answer 41

Administration: inhaler (MDI/DPI) * Maintenance treatment in persistent asthma * Prevention of exercise-induced asthma Do not use for relief of acute asthma – use short-acting reliever instead.

Question 42

What are the indications for use of Terbutaline (Bricanyl)?

Answer 42

Administration: inhaler (DPI) * Acute asthma * Symptom relief during maintenance treatment of asthma and COPD * Protection against exercise-induced asthma SC route may be used in acute severe asthma

Question 43

What are the indications for use of Eformoterol (Symbicort)?

Answer 43

Administration: inhaler (DPI) * Maintenance treatment of asthma in patients receiving inhaled or oral corticosteroids * Maintenance treatment of COPD * Symptom relief of asthma in adults already receiving inhaled corticosteroids and regular eformoterol SC route may be used in acute severe asthma Must be combined with inhaled glucocorticoid as monotherapy is associated with increased morbidity/mortality in asthma.

Question 44

What are the indications for use of Ipratropium (Atrovent)?

Answer 44

Administration: inhaler (DPI), nebuliser * Symptom relief of asthma and COPD Contraindications: Bladder outlet obstruction Stop ipratropium if treatment with tiotropium is required for COPD

Question 45

What are the indications for use of Tiotropium (Spiriva)?

Answer 45

Administration: inhaler (DPI) * COPD Contraindications: Bladder outlet obstruction

Question 46

What are the indications for use of Theophylline (Nuelin)?

Answer 46

Administration: oral tablet, liquid * Maintenance treatment in severe asthma and COPD Contraindications: Diabetes (oral liquid contains 50% sugar), GORD, Arrhythmias, Heart failure, pulmonary oedema, severe hypoxia, Thyroid dysfunction, Epilepsy, Acute infection, Treatment with β2 agonists

Question 47

What are the indications for use of Budesonide (Pulmicort)?

Answer 47

Administration: inhaler (DPI), nebuliser * Maintenance treatment of persistent asthma * Croup (nebulised budesonide) May be used in fixed-dose combination with eformoterol (Symbicort turbuhaler)

Question 48

What are the indications for use of Omalizumab?

Answer 48

Administration: Injection (IV) Maintenance treatment of moderate-to-severe allergic asthma in patients treated with inhaled corticosteroids and with raised serum IgE levels