18) Respiratory

Question 1

What are the goals for Asthma Control

Answer 1

1) Minimal symptoms during day and night
2) Minimal Need for Reliver Medication
3) No Exacerbations
4) No Limitations to Physical Activity
5) Normal Lung Function

Question 2

Before stepping up or stepping down in treatment plan what must be considered ?

Answer 2

> Adherence
Inhaler Technique
Eliminate trigger factors

Question 3

Outline the treatment plan for managing Asthma

Answer 3

1) Low dose ICS
2) ADD LABA
3) Consider increasing ICS dose or Add LTRA
4) Refer to specialist

Question 4

What is the mechanism of action of Inhaled Corticosteroids ?
> Give Examples
> When is it used
> Side Effects

Answer 4

Beclometasone, Budesonide, Fluticasone

• Pass through plasma membrane and activate cytoplasmic receptors which then modify gene transcription
  => Leads to Transactivation (Increase B2 Receptors) and Transrepression (Decrease in Inflammatory Mediators and Cytokines)
• Regular preventer when reliever alone is not sufficient

Side Effects:
> Local Immunosuppressive Action => Candidiasis, Hoarse Voice
> Pneumonia Risk possible in COPD

Question 5

Define Uncontrolled Asthma

Answer 5

Asthma that has an impact on a person’s lifestyle or restricts their normal activities
> 3 or more days a week with symptoms
>3 or more days a week with required use of a SABA for symptomatic Relief
> 1 or more nights a week with awakening due to asthma

Question 6

What is the mechanism of action of SABA
> Give Examples
> When is it Used
> Side Effects

Answer 6

Salbutamol

> Beta 2 Angonist leading to bronchodilation
GPCRs

> Used as symptom relief

Side Effects:
> Tachycardia
> Palpitations
> Tremor

Question 7

What is the mechanism of action of LABA
> Give Examples
> When is it Used
> Side Effects

Answer 7

Formoterol, Salmeterol

> Used as an add on to ICS

Side effects same as SABA
+ Muscle Cramps

Question 8

What is the mechanism of action of Leukotriene receptor Antagonist (LTRA)
> Give Examples
> When is it Used
> Side Effects

Answer 8

Montelukast

> Leukotriene is an inflammatory mediator released by mast cells and eosinophils which leads to increased mucus, bronchoconstriction and mucosal oedema

> Used as an Alternative to LABA

Side Effects:
> Dry Mouth 
> Angio Oedema 
> Anaphylaxis 
> Fever 
> GI Disturbance

Question 9

What is the mechanism of action of Muscarinic Antagonist (LAMA)
> Give examples
> When is it used
> Side Effects

Answer 9

Tiotropium
Ipratropium

Anticholinergic effect through inhibition of Muscarinic Receptors

> Not used often due to its many side effects
But when used it can be given for Severe Asthma or COPD

Side Effects:
> Dry mouth
> Urinary Retention
> Glaucoma

Question 10

What is the mechanism of action of Methylxanthines
> Give Examples
> When is it Used
> Side Effects

Answer 10

Theophylline

> Adenosine Receptor Antagonist

Side Effects:
> May induce Arrhythmia
> Convulsions