Respiratory Treatments

Annotations:

• MOA: Reduce Air Inflammation by inhibiting infiltration of inflammatory cells and decrease oedema by an action on vascular endothelium.

1. Beclometasone
2. Budesonide
3. Fluticasone
4. Mometasone
5. Prednisolone

   Annotations:

   • ORAL: Morning dose to mimic circadian rhythm, for 3 to 5 days.

1. Candidiasis

   Annotations:

   • Use spacer, or rinse mouth (feed infants) after inhaler use. If facemask used, wipe face & apply emollient. Regular new toothbrush. 
2. Cataracts

   Annotations:

   • Minimize by applying good seal around inhaler or mask, and use  'lowest effective dose' (LED)
3. Indigestion, Peptic Ulceration

   Annotations:

   • Give tablets with breakfast or morning milk
4. Adrenal suppression

   Annotations:

   • May occur >1.6mg beclometasone equivalent: Use LED.
5. Cushing Syndrome

   Annotations:

   • Use LED
6. Osteoporosis

   Annotations:

   • Provide calcium supplements

1. Increase Effects
   1. Ciclosporin

      Annotations:

      • Increase Steroid Effect
2. Decrease Effect
   1. Anticonvulsants

      Annotations:

      • Decrease steroid effects
   2. Antidiabetics

      Annotations:

      • Hypoglycaemic Effect
   3. Antihypertensives

      Annotations:

      • Hypotensive effect
   4. Diuretics

      Annotations:

      • Decrease Diuretic Effect
   5. Vaccines

      Annotations:

      • Decrease immune response
3. Anticoagulants
   1. May enhance or reduce

Annotations:

• Leukotrienes D4 (LTD4), LTC4 and LTE4 are potent bronchoconstrictors that contribute to early phase bronchospasm and late phase inflammation

1. Montelukast
2. Zafirlukast

1. GI common
2. Headache
3. Hyperkinesia (in children)
4. Hypersensitivity Reactions