Mrs Brown is a 45 year old female who is married with 2 children.

She
does not work, does very little exercise and has smoked for 20 years.
She attends the Emergency Department with difficulty breathing.
Medical History
 Chronic asthma (2005)
 Hypertension (BP 161/108 at diagnosis, 1 month ago).
Symptoms/Signs/Investigations
 Weight 85 kg
 peak flow 40% of best
 RR 28 breaths/min
 Unable to complete full sentences
 HR 115/min
 SpO2 92%
 BP currently 125/94 mmHg
 K+ 3.3 mmol/l and fasting blood glucose 6.2 mmol/l; other FBC, EC and LFTs normal
 Allergic to lisinopril and candesartan (cough)
Current Medication
 Salbutamol 100mcg/puff MDI via spacer, inhaled, 2 puffs when required (uses max 3 per year)
 Beclomethasone diproponate (Clenil Modulite) 100mcg/puff MDI via spacer, inhaled, 2 puffs twice
a day
 Formoterol 12mcg/dose easyhaler, inhaled, 1 inhalation twice a day
 Atenolol 25mg tablet, oral, 25mg once a day – started 2/7 ago
 Echinacea – started 2/7 ago as “winter coming”, no other OTC, herbal, ilicit drug use
Recent Medications
 Prednisolone 5mg tablet, oral, 40mg each morning for 5 days, then reduce by 5mg a day until
stopped (course completed 1 month ago)
 Lisinopril 10mg tablet, oral, 10mg once a day – discontinued two weeks ago
 Candesartan 8mg tablet, oral , 8mg once a day – discontinued by patient 10 days ago

Exercise 2
How do beclomethasone and prednisolone work (the pharmacodynamics)?
 In your explanation, define the type of receptor.
 Are they an agonist or antagonist?
 How do they treat asthma?
 How do any side effects relate to the pharmacodynamics (predictable) and are any
unpredictable?
 What is hypothalamic-pituitary-adrenal suppression? Why do you need to know about
previous steroid therapy?
 What is the difference between beclomethasone and salbutamol?
Try to use these guidelines/questions as a starting point to your investigations. What resources will
you use to find the information that you need? Remember that this exercise is to support your revision
and understanding of basic pharmacology. You should apply the same approach when researching
the medications you use in your own clinical practice.