Drugs for the MAU.ppt

Drugs for the MAU Clive Roberts So what are drugs good at treating (or preventing)? Pain Inflammation Infection Fluid retention Heart problems High blood pressure Epilepsy Parkinsonism Asthma / COPD Peptic ulcer disease Diarrhoea/constipation Depression Anxiety/sleeplessness Psychosis Metabolic /endocrine diseases Malignant disease Degenerative disease Haematological problems Etc Etc A 45 year old lady presents with increasing wheeze over the previous 6 months. No past history of asthma. She is wheezy throughout both lungs and has a tachycardia. Her peak flow is 150 l/min. What immediate investigations are indicated? What immediate measures should be taken? Acute asthma and COPD - available approaches Oxygen Bronchodilators Salbutamol Ipratropium Aminophylline Anti-inflammatories Corticosteroids Intravenous Oral Anti-biotics Severe asthma Sit patient up and give high flow O2 Check PEFR O2 sats Nebulised bronchodilators salbutamol 5mg + ipratropium 500mcg (repeat after 15 min if needed) Prednisolone 40-50mg po stat Consider IV Magnesium sulphate 1.2-2g over 20 mins ABGs, CXR, FBC, UEs General rules about Oxygen therapy Correct hypoxia with an appropriate delivery device Check ABGs if SaO2 93% or suspicion of ventilatory impairment or acidosis Some patients (esp. COPD) with chronic hypoxia rely on hypoxic drive and will hypoventilate on high flow O2 Oxygen delivery devices Hudson mask: variable performance Nasal cannulae Venturi devices: fixed performance Key drug features Salbutamol – beta 2 stimulant Easy to administer Watch for tremor and potassium level Ipratropium – muscarinic blocker Nebuliser and inhaler Few side effects Aminphylline – phosphodiesterase inhibitor Major dosing problems Severe adverse effects on CNS and heart Great caution needed Key drug features Corticosteroids Safe in acute situations IV hydrocortisone or oral prednisolone Avoid long term or rapidly repeated courses because lead to BP+, fluid retention, hypokalaemia, weight gain,