AMH Summary: Chapter 19 – Respiratory 1

AMH SUMMARY: CHAPTER 19 – RESPIRATORY

- BRONCHODILATORS -

Beta2 agonists
Precautions: hypertension, IHD, heart failure, arrthymias, hyperthyroidism, diabetes
Side Effects: tremor, palpitations, headache, serious hypokalaemia (high doses of beta2 agonists)

Short acting beta2 agonists

Indications: acute asthma, symptom relief during maintenance of asthma and COPD, prevention of
exercise-induced asthma
- Rapid onset of action (5-15min); Short duration of action (3-6 hours)
Dosage: 1-2 qid prn

• SALBUTAMOL – Airomir, Asmol, Ventolin

• TERBUTALINE – Bricanyl

Long acting beta2 agonists

Indications: maintenance of asthma and COPD
- Long duration of action (>12 hours)
- Eformoterol has a quicker onset of action than salmeterol and is marketed for acute relief of
symptoms in adults with asthma already receiving inhaled corticosteroids and regular
eformoterol. The Symbicort combination is marketed for symptom relief in patients receiving
maintenance treatment.
Dosage: 1 bd

• EFORMOTEROL – Oxis Turbuhaler; Foradile; Symbicort (Eformoterol + Budesonide)

• SALMETEROL – Serevent; Seretide (Salmeterol + Fluticasone)
• INDACATEROL – Onbrez (1 daily)

Anticholingerics (inhaled)

Indications: maintenance COPD and severe asthma

Side Effects: dry mouth, throat irritation

• IPRATROPIUM – Atrovent, Ipratrin

Dosage: 3-4 times daily

• TIOTROPIUM – Spiriva
Dosage: 1 d

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AMH Summary: Chapter 19 – Respiratory 2

Theophyllines

Indications: severe obstruction, maintenance in severe asthma and COPD

Interactions: many
Precautions: GORD, arrhythmia, heart failure, thyroid, epilepsy, smoking
Side Effects: nausea, vomiting, diarrhoea, gastro-oesophageal reflux, headache, insomnia,
irritability, anxiety, tremor, palpitations. Narrow therapeutic range.

• AMINOPHYLLINE injection
Dosage: do not give aminophylline if previously treated with theophylline. Reserve use in acute
severe asthma is unresponsive to combined treatment with inhaled short acting beta2 agonists,
inhaled ipratropium and systemic corticosteroids.

• THEOPHYLLINE – Nuelin
- Narrow TI
- Dosage: 1 d cc
- Concentration monitoring: Monitor plasma concentration at initiation of treatment, if drug
regimen is altered, if there is prolonged fever, if adverse effects suspected and if patient
stops or starts smoking.

- CORTICOSTEROIDS (INHALED) -

Indications: maintenance of persistent asthma, severe COPD

Side Effects: dysphonia, oropharyngeal candidiasis, bruising, facial skin irritation following
nebulisation
Systemic Adverse Effects (due to high doses or systemic absorption): adrenal suppression, bone
density loss, glaucoma/cataract, skin thinning and bruising, impaired growth
Counselling: rinse mouth with water, gargle and spit

• BECLOMETHASONE (inhaled) – Qvar

Dosage: 1 bd

• BUDESONIDE (inhaled) – Pulmicort

Dosage: 1 bd

• CICLESONIDE – Alvesco
Dosage: 1 d

• FLUTICASONE (inhaled) – Flixotide

Dosage: 1 bd

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AMH Summary: Chapter 19 – Respiratory 3

- CROMONES -

Indications: maintenance persistent asthma, prevention of exercise-induced asthma

Mode of Action: inhibits release of inflammatory mediators from mast cells
Side Effects: cough, throat irritation, bitter taste, transient bronchospasm

• CROMOGLYCATE (inhaled) – Intal

Dosage: 2-4 times daily

• NEDOCROMIL – Tilade
Dosage: 1 qid
Side Effects: headache, nausea, vomiting, abdominal pain

- LEUKOTRIENE-RECEPTOR ANTAGONISTS -

Mode of Action: inhibits smooth muscle contraction caused by leukotrienes

Indications: maintenance treatment in asthma
Side Effects: headache, abdominal pain, diarrhoea

• MONTELUKAST – Singulair
- can be used in kids >2 years
- Dosage: 1 at bedtime

- IgE ANTIBODIES –
Mode of Action: reduces the immune system’s response to allergen exposure
Indications: treatment of moderate-to-severe allergic asthma in patients treated with inhaled
corticosteroids and with raised serum IgE levels
Side Effects: injection site reactions, rash, bleeding, increased risk of malignancies

• OMALIZUMAB – Xolair
- Dosage: Injection every 2-4 weeks
- Monitor for 2 hours after each dose

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AMH Summary: Chapter 19 – Respiratory 4

- DRUGS FOR COUGH -

Cough suppressants
Contraindications: respiratory failure, asthma, COPD
Side Effects: drowsiness, constipation, nausea, vomiting. CNS adverse effects (drowsiness,
respiratory depression) are more likely with codeine. Dependence and withdrawal symptoms have
been described.

• CODEINE – Codeine Linctus, Actadone

Dosage: 3-4 times daily
• DEXTROMETHORPHAN – Bisolvon Dry, Benadryl
• DIHYDROCODEINE – Rikodeine
Dosage: 3-4 times daily
• PHOLCODINE – Tussinol, Durotuss
Dosage: 3-4 times daily

Mucolytics

• ACETYLCYSTEINE – Mucomyst
o Indication: adjunct treatment in respiratory disease with excessive mucus
o Dosage: inhale 3-5ml q6h. Dilute with equal volume of sodium chloride.

• BROMHEXINE – Bisolvon
o Dosage: 8-16mg tid

• DORNASE ALPHA – Pulmozyme

o Indication: prevention of respiratory complications in cystic fibrosis
o Side effects: voice alteration, pharyngitis, laryngitis, rash
o Note: regular administration required and highly costly.

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AMH Summary: Chapter 19 – Respiratory 5

Reference

Australian Medicines Handbook. Adelaide: Australian Medicines Handbook Pty Ltd; 2011

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