ABSTRACT
Select the drugs most frequently associated with the adverse effects described below:
1 Seizures 2 Apnoea 3 QTc prolongation 4 Hypertension 5 Anaphylaxis
ANSWERS: see page 108
233 a) False Never give anxiolytics/sedatives in acute asthma. b) True Intravenous fluids are administered to correct/prevent c) True dehydration. Antibiotics are administered if there is d) False history/signs of infection. Refractory cases require an e) True intravenous short-acting beta2 agonist (salbutamol) or as a
last resort theophylline. If these are inadequate, intermittent positive pressure ventilation is required. Nebulized salmeterol is not available and its onset of bronchodilation is too slow to be used acutely
234 a) True Beta2 agonists stimulate the β2 receptor which via linked b) True G-proteins increases adenylyl cyclase activity and increases c) False intracellular cAMP. They cause a tachycardia and d) False vasodilatation e) False
235 a) True Beta2 agonists are generally well tolerated when given by b) True inhalation. Salmeterol, a long-acting beta2 agonist, is c) False inhaled twice daily and reduces the need for shorter-acting d) True agents and possibly the dose of inhaled corticosteroids. e) False Beta2 agonists cause hypokalaemia
236 a) False Omalizumab is a recombinant humanized IgG1 monoclonal b) False anti-IgE antibody. It is used in paediatric patients (12 or c) True older) who have allergic/atopic asthma refractory to d) False maximal regular therapy. If there is no improvement in 16 e) False weeks it should be discontinued, see NICE guidelines 2007
237 a) False Inhaled antimuscarinic drugs such as ipratropium and b) True tiotropium (long acting once daily) are effective as acute c) False and maintenance bronchodilator therapy in asthma. Their d) True action is slower in onset than that of beta2 agonists. High e) True doses usually via a nebulizer may precipitate acute
glaucoma or urinary retention
238 a) True Theophylline has a narrow therapeutic index and its b) True pharmacokinetics show considerable interindividual c) False variation. Because of hepatic metabolism it is prone to a d) True number of drug-drug interactions which may lead to e) True toxicity (see Table 3). Its main side-effects are
gastrointestinal, cardiovascular and CNS
239 a) True Objective improvement does not occur until 6 hours and is b) False maximal 13 hours after the start of intravenous glucocortic) False costeroid treatment in asthma. This delay is due to the d) False pharmacodynamics of glucocorticoids which work via e) False modifying transcription of certain genes and thus affecting
their protein synthesis. They should be administered early in acute asthma
240 a) True Systemic adverse events are rarely significant with inhaled b) True glucocorticoids unless the dose exceeds e.g. 1000μg of c) False fluticasone or its equivalent. They are invaluable in the d) False prophylaxis of asthma and have been shown to reduce e) True asthma deaths and exacerbations in patients with chronic
obstructive pulmonary disease (COPD)
241 a) False Sodium cromoglicate is administered by inhalation of a b) False powder. Used prophylactically it can prevent type I and c) False type III allergic reactions and exercise-induced asthma.
