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Airway Therapeutics Overview Flashcards

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1
Q

What are the 4 steps in teh asthma treatment pyramid, starting with least severe?

A
  1. Short acting B2 agonist PRN
  2. Inhaled steroid (cromoglycate)
  3. Theophylline, Leukotriene antagonist, long-acting B-agonist/LAMA, Anti-IgE
  4. Oral steroid
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2
Q

What are the BTS general guidelines for asthma?

A
  1. Short-acting B2 agonists PRN
  2. Inhaled sterroids
  3. Add on LABA/LAMA
  4. Add on LTRA/Theo/Anti-IgE
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3
Q

Name an oral steroid?

A

Prednisolone

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4
Q

What is prednisolone only used for and what is its therapeutic ratio like?

A

Low therapeutic ratio

Only used for acute exacerbations

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5
Q

Name an inhaled steroid?

A

Beclomethasone

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6
Q

What is the therapeutic ratio of beclamethasone like and what is it used for?

A

Higher therapetutic ration

Used for maintenance therapy

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7
Q

What can you use to maximise the lung delivery for corticosteroids?

A

Large volume spacer

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8
Q

What can be used to reduce oropharyngeal and laryngeal side effects of corticosteroids?

A

Spacer device

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9
Q

What are anti-inflammatory cromones only used in?

A

Asthma

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10
Q

What drugs are mast cell stabilisers?

A

Cromones

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11
Q

What patients is cromoglycate effective in?

A

Atopic children (exercise asthma)

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12
Q

How are cromones delivered?

A

Inhaled route only

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13
Q

What are the three cysteinyl LTs?

A

LTC4
LTD4
LTE4

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14
Q

Which leukotriene causes oedema, increased mucus secretion, decreased mucus transport, eosinophil influx, epithelial cell damage and contraction and proliferation?

A

LTD4

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15
Q

Which drugs are only used in asthma, are bronchodilators and anti-inflammatory drugs?

A

Leukotriene receptor antagonists

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16
Q

What can be said about the route of administration, dose and therapeutic ratio for Montelukast?

A

Oral route
Once daily
High therapeutic ratio

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17
Q

Are leukotriene receptor antagonists (Montelukast), more potent thant inhlaed steroids?

A

No

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18
Q

What line of treatment is Montelukast for asthma?

A

2nd line: complimentary non-steroidal anti-inflammatory additive to inhaled steroid

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19
Q

What kind of induced asthma is Montelukast effective in?

A

Exercise

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20
Q

Alongside an anti-histamine, what can leukotriene receptor antagonists be effective for?

A

Allergic rhinitis

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21
Q

When are anti-histamines of value?

A

When known allergic trigger (i.e. in atopic asthma)

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22
Q

How are anti-histamines deivered?

A

Oral route

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23
Q

What drugs are HI receptor antagonists?

A

Anti-histamines

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24
Q

Name a first generation anti-histamine?

A

Chlorpheniramine-sedative

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25
Name a 2nd generation anti-histamine?
Cetirizine, Loratadine - non sedative
26
Name a 3rd generation anti-histamine?
Levocetirizine, Desloratadine - non sedative
27
What are anti-histamines more effective in than asthma?
Allergic rhinitis
28
What combination with anti-histamines cause additive effects?
Leukotriene antagonist
29
Name an anti-IgE monoclonal antibody?
Omalizumab
30
How does Omalizumab work?
Inhibits the binding to the high-affinity IgE receptor and inhibit mediator release from basophils and mast cells
31
How is omalizumab administered?
Injection every 2-4 wekks
32
What kind of patients are Anti-IgE monoclonal antibody Omalizumab used for?
Patients with severe persistent allergic asthma despite maximum therapy
33
What one thing does Omalizumab not have an effect on, and what two things does it reduce?
No effect on pulmonary function but reduces exacerbations and steroid sparing
34
Name three long-acting B2 agonists?
Salmeterol Formoterol Indacaterol
35
Name three combination B2 agonist inhalers?
Fluticasone/salmeterol Budesonide/formoterol Beclometasone/formoterol
36
What does down regulation and tachyphylaxis occur with?
LABA
37
What drugs are given in high nebulised doses given in acute attacks?
B2 agonists
38
What do M1 receptors enhance?
The cholinergic reflex
39
What do M2 receptors inhibit?
Acetylcholine release
40
What do M3 receptors mediate?
Bronchoconstriction and mucus secretion
41
What type of bronchodilators block post junctional end plate M3 receptors?
Anticholinergics
42
Name 4 anticholinergics?
Short acting ipratropium qid | Long acting tioropium od, aclinidium bid, Glycopyrronium od
43
How are anticholinergics adminsitered?
Inhaled route only
44
What condition are anticholinergics used mostly in?
COPD - reduce exacerbations
45
What is a high nebulised dose of ipratroipum used in?
Acue COPD and in acute asthma
46
Name an oral methylxanthine?
Theophylline
47
Are methylxanthines anti-inflammatory?
YES
48
What is the slow release formulation of theophylline (methylxanthine) useful for?
Nocturnal dips
49
What is theophylline added to in the asthma treatment steps?
Added to inhaled steroid as complimentary non steroidal anti-inflammatory
50
Name an IV methylxanthine used for acute attacks?
Aminophylline
51
Name an adenosine antagonist?
Methylxanthine aminophylline
52
Name a non-selective phosphodieterase inhibitor (increased cAMP)
Methylxanthine - aminophylline or theophyilline
53
What can be said about the therapeutic ration for methylxanthines?
Low
54
Name a PDE4 inhibitor?
Roflumilast - oral tablet od
55
What is Roflumilast indicated for only?
COPD
56
Which drug reduces exacerbations and is an additive to LABA or LAMA?
Roflumilast
57
Give four adverse effects of Roflumilast (PDE4 inhibitor)?
Nausea Diarrhoea Headache Weight loss
58
Name two oral mucolytics?
Oral carbocisteine and erdosteine
59
What are mucolytics used for in COPD?
To reduce sputum viscosity and aide sputum expectoration [and reduce exacerbations]
60
In COPD, what type of infections are more common than alveolar infections (i.e. pneumonia)?
Endobronchial (infective bronchitis)
61
What disease treatment aims are these: abolish symptoms, minimise B2 use, normalise FEV1, reduce PEF variability, reduce exacerbations, prevent long term airway remodelling?
Chronic asthma
62
In chronic asthma, what is used to supress the inflamamtory cascade?
Inhaled steroid
63
In chronic asthma, give three types of drugs used as non-steroidal anti-inflammatories?
Theophylline, anti-leukotirene, anti-histamine
64
In chronic asthma treatment, what can be used to stabilise smooth muscle, only once optimal anti-inflamm therapy in place?
LABA
65
What are the 4 steps of treatment in acute asthma?
1. Oral prednisolone (or IV hydrocortisone) 2. Nebulised high dose salbutamol, +/- ipratropium, =/- IV aminophylline/magnesium 4. 60% O2 5. ITU assisted mechanical intubated ventilation if falling PaO2 and rising PaCO2
66
What two classes of drugs can be used for airflow obstruction drug therapy?
Preventers (anti-inflammatory) | Relievers (bronchodilators)
67
What are the 7 steps of treatment in acute COPD?
1. Nebulised high dose salbutamol + ipratropium 2. Oral prednisolone 3. Antibiotic (amoxycillin/deoxycyline) if infection 4. 24-28% O2 titrated against PsO2, PaCO2 5. Physio to aide sputum expectoration 6. Non invasive ventilation to allow higher FiO2 7. ITU intubated assisted ventilation only if reversible component (e.g. pneumonia)

Resp JL (27 decks)

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