2017

Nasal decongestants for administration by mouth may not be as effective as preparations for local application but they do not give rise to rebound nasal congestion on withdrawal. Pseudoephedrine is available over the counter; it has few sympathomimetic effects. Systemic decongestants should be used with caution in diabetes, hypertension, hyperthyroidism, susceptibility to angle-closure glaucoma, prostatic hypertrophy, renal impairment, pregnancy, and ischaemic heart disease, and should be avoided in patients taking monoamine oxidase inhibitors.

Expectorant and demulcent cough preparations Expectorants are claimed to promote expulsion of bronchial secretions but there is no evidence that any drug can specifically facilitate expectoration. […]

Pulmonary surfactants are used in the management of respiratory distress syndrome (hyaline membrane disease) in neonates and preterm neonates. They may also be given prophylactically to those considered at risk of developing the syndrome. Continuous monitoring is required to avoid hyperoxaemia caused by rapid improvement in arterial oxygen concentration. Pulmonary haemorrhage has been rarely associated with therapy especially in more preterm neonates; obstruction of the endotracheal tube by mucous secretions has also been reported.

Mucolytics are prescribed to facilitate expectoration by reducing sputum viscosity. In some patients with chronic obstructive pulmonary disease and a chronic productive cough, mucolytics can reduce exacerbations; mucolytic therapy should be stopped if there is no benefit after a 4-week trial. Steam inhalation with postural drainage is effective in bronchiectasis and in some cases of chronic bronchitis. Mucolytics should be used with caution in those with a history of peptic ulceration because they may disrupt the gastric mucosal barrier.

The selective beta2 agonists (selective beta2-adrenoceptor agonists, selective beta2 stimulants) such as salbutamol or terbutaline are the safest and most effective short-acting beta2 agonists for asthma. Less selective beta2 agonists such as orciprenaline should be avoided whenever possible. Adrenaline (epinephrine) (which has both alpha- and beta-adrenoceptor agonist properties) is used in the emergency management of allergic and anaphylactic reactions and in the management of croup

Corticosteroids are used for the management of reversible and irreversible airways disease. An inhaled corticosteroid used for 3–4 weeks may help to distinguish asthma from chronic obstructive pulmonary disease; clear improvement over 3–4 weeks suggests asthma. Corticosteroids are effective in asthma; they reduce airway inflammation (and hence reduce oedema and secretion of mucus into the airway). An inhaled corticosteroid is used regularly for prophylaxis of asthma when patients require a beta2 agonist more than twice a week, or if symptoms disturb sleep more than once a week, or if the patient has suffered exacerbations in the last 2 years requiring a systemic corticosteroidor a nebulised bronchodilator. Regular use of inhaled corticosteroids reduces the risk of exacerbation of asthma.

Dose and Administration:Prophylaxis of asthma, adult and child over 15 years, 10 mg once daily in the evening; child 6 months–6 years 4 mg once daily in the evening, 6–15 years 5 mg once daily in the evening. Seasonal allergic rhinitis, adult and child over 15 years, 10 mg once daily in the evening.

Statins: Simvastatin: Indications: primary hypercholesterolaemia, homozygous familial hypercholesterolaemia or combined (mixed) hyperlipidaemia in patients who have not responded adequately to diet and other appropriate measures; prevention […]