Bronchodilators

Question 1

When are short-acting beta-2 agonists (SABAs) used?

Answer 1

For immediate relief of asthma symptoms.

Question 2

Give examples of SABAs.

Answer 2

Salbutamol, terbutaline.

Question 3

When are long-acting beta-2 agonists (LABAs) used?

Answer 3

Alongside ICS in patients requiring prophylactic treatment.

Question 4

What electrolyte disturbance is sometimes seen in beta-2 agonist therapy?

Answer 4

Hypokalaemia.

Question 5

Concomitant use with which drugs increases the risk of hypokalaemia with beta-2 agonist use?

Answer 5

Theophylline, corticosteroids, diuretics.

Question 6

When should prophylactic treatment be considered in asthma patients?

Answer 6

SABA needed more than three times weekly, night-time symptoms, an asthma attack in the last 2 years.

Question 7

Give examples of long-acting beta-2 agonists (LABAs)?

Answer 7

Formoterol and salmeterol.

Question 8

Why should salmeterol not be used in an asthma attack?

Answer 8

It has a slower onset of action than salbutamol or terbutaline.

Question 9

Is formoterol licensed for short-term symptomatic relief of asthma?

Answer 9

Yes.

Question 10

If control of asthma symptoms with regular ICS has failed, should formoterol or salmeterol be added?

Answer 10

Yes.

Question 11

Should formoterol or salmeterol be initiated in a patient with rapidly deteriorating asthma?

Answer 11

No.

Question 12

Describe how formoterol or salmeterol should be initiated in patients with asthma (with respect to dose).

Answer 12

Started at the lowest effective dose and effects monitored before dose increase.

Question 13

Should formoterol or salmeterol be used for the relief of exercise-induced asthma?

Answer 13

No, unless regular ICS also used.

Question 14

Describe the management of formoterol and salmeterol treatment once good long-term control of asthma is achieved.

Answer 14

Consideration of stepping down therapy.

Question 15

Give examples of antimuscarinics licensed for short term relief in chronic asthma and COPD.

Answer 15

Ipratropium.

Question 16

Give examples of antimuscarinics licensed for maintenance treatment in patients with COPD.

Answer 16

Aclidinium, glycopyrronium, tiotropium, umeclidinium.

Question 17

Which antimuscarinic drug is licensed for use alongside ICS and LABA for the maintenance of patients with asthma who have suffered one or more exacerbations in the last year?

Answer 17

Tiotropium.

Question 18

What are the cautions for use of antimuscarinics?

Answer 18

Prostatic hyperplasia, bladder outflow obstruction, those susceptible to angle-closure glaucoma. May also be associated with paradoxical bronchospasm.

Question 19

Acute angle-closure glaucoma has been reported with the use of which antimuscarinic agent in nebulised form, particularly when given with nebulised salbutamol?

Answer 19

Ipratropium bromide.

Question 20

How can the risk of acute angle-closure glaucoma seen with the use of nebulised ipratropium be reduced?

Answer 20

Protecting the patient’s eyes.

Question 21

What is the therapeutic range of theophylline?

Answer 21

10-20 mg/L (plasma concentration of 5-15 mg/L may be effective).

Question 22

Is a loading dose of theophylline required?

Answer 22

Sometimes.

Question 23

Give the signs of theophylline toxicity.

Answer 23

Vomiting, agitation, restlessness, dilated pupils, sinus tachycardia, hyperglycaemia, severe hypokalaemia may develop rapidly, haematemesis, convulsions, cardiac arrhythmias.

Question 24

Give the symptoms of uncontrolled asthma.

Answer 24

Cough, wheeze, tight chest.

Question 25

What may frequent courses of antibiotics and/or oral corticosteroids being taken by an asthmatic patient suggest?

Answer 25

Poor asthma control.

Question 26

What monitoring is required when a patient is taking theophylline?

Answer 26

Serum potassium, plasma theophylline concentration.

Question 27

An increased plasma concentration of theophylline is seen when used with which drugs?

Answer 27

Diltiazem, cimetidine, ciprofloxacin, erythromycin, oestrogens, fluvoxamine, verapamil.

Question 28

The plasma concentration of theophylline may increase when the patient is suffering from which conditions?

Answer 28

Heart failure, hepatic impairment, viral infections, the elderly.

Question 29

An increased risk of convulsions is seen when theophylline is used alongside which drugs?

Answer 29

Quinolones.

Question 30

A reduced plasma concentration of theophylline is seen when used with which drugs?

Answer 30

Alcohol, carbamazepine, primidone, phenobarbital, phenytoin, ritonavir. Smokers - dose adjustment may be needed.