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Year 1: Drug Revision > Resp: Treatment of Asthma > Flashcards

Resp: Treatment of Asthma Flashcards

1
Q

Which drugs have a bronchodilator effect but little effect on underlying inflammation?

A

SABAs
LABAs
CysLT receptor antagonists

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2
Q

Which drugs act as anti-inflammatory agents that reduce airway inflammation?

A

Glucocorticoids
Cromoglicate
Monoclonal IgE antibodies

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3
Q

Which drugs have both bronchodilator and anti-inflammatory effects?

A

Methylxanthines

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4
Q

Which drug is given for very mild intermittent asthma? (Step 1)

A

SABA. e.g. salbutamol

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5
Q

If a SABA is needed more than once a day, which drug is added? (Step 2)

A

A regular inhaled glucocorticoid. e.g. beclometasone

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6
Q

What is step 3 in the step up pathway of asthma management?

A

Add a LABA, e.g salmeterol, and monitor benefit.
If good benefit, continue LABA.
If of benefit but not adequate, increase dose of ICS.
If no response to LABA, stop administration increase dose of ICS

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7
Q

If after step 3 of the treatment pathway asthma is still poorly controlled which drugs can be added? (Step 4)

A

CysLT receptor antagonist, e.g. montelukast

Methylxanthine, e.g. theophylline

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8
Q

Which drug is added in step 5 of the asthma treatment pathway?

A

oral prednisolone

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9
Q

What is the mode of action of B2 adrenoreceptor agonists? (SABAs/LABAs)

A

Act as physiological antagonists of all spasmogens - have a bronchodilator effect.
Inhibit mediator release from mast cells + TNF alpha release from monocytes
Increase mucus clearance

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10
Q

What are some of the adverse effects of SABAs?

A

fine tremor
tachycardia
cardiac dysrhythmia
hypokalaemia

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11
Q

Which form of B2 adrenoreceptor MUST be administered in combination with an ICS?

A

LABAs

Use as a mono therapy may worsen asthma

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12
Q

Which drug is useful in treatment of nocturnal asthma?

A

LABAs due to long acting effect

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13
Q

What can happen if B2 adrenoceptors are persistently activated?

A

Desensitisation of the receptor

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14
Q

The adrenal cortex produces two major classes of corticosteroids: glucocorticoids and mineralocorticoids. Give an example of each.

A

Glucocorticoid - cortisol (when used as a medication it is called hydrocortisone)
Mineralocorticoid - aldosterone (regulates retention of salt and water by the kidney)

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15
Q

How do glucocorticoids affect gene transcription?

A

Increase transcription of genes encoding anti-inflammatory proteins + decrease transcription of genes encoding inflammatory proteins.

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16
Q

What cellular effects do glucocorticoids have?

A

Decrease numbers eosinophils + mast cells + cytokines
Decrease IgE production
Decrease TH2 formation
Decrease mucus secretion

17
Q

What is a side effect of incorrect use of inhaled corticosteroids?

A

Oral candidiasis

18
Q

How are CysLT receptor antagonists such as montelukast administered?

A

Orally

19
Q

Give two examples of methylxanthines

A

Theophylline

Aminophylline (used IV in acute attacks)

20
Q

What is the mode of action of methylxanthines?

A

Inhibit phosphodiesterase to increase cAMP - relaxation of bronchial smooth muscle
Also increase mucus clearance and inhibit mediator release from mast cells

21
Q

What are some adverse side effects of methylxanthines?

A

Seizures
Dysrhythmia
Hypotension

22
Q

Which anti-inflammatory drug is more useful in treating atopic asthma in children rather than adults?

A

Sodium chromoglycate (a cromone)

23
Q

What is the mode of action of sodium chromoglycate?

A

Mast cell stabiliser

24
Q

Which treatment can be given to patients with severe persistent asthma despite maximum therapy?

A

Omalizumab (Anti-IgE Monoclonal antibody)

25
Q

What is the mode of action of omalizumab?

A

Binds to IgE via Fc to prevent attachment to receptors

This suppresses mast cell response to allergens and reduces expression of receptors on inflammatory cells

26
Q

How is omalizumab administered?

A

IV

27
Q

Outline the management of an acute asthma attack

A 
O SHIT MAN
Oxygen- 100% through non-rebreather 
Salbutamol - nebulised 
Hydrocortisone - IV
Ipratropium - nebulised
Theophylline - oral (or aminophylline IV) 
Magnesium sulphate- IV
Anaesthetist

Year 1: Drug Revision (15 decks)

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