Asthma Flashcards by Yazan adnan

Common asthma triggers

5 majour indoor triggers 
Molds 
Dust mites 
Cockroaches 
Animal dander 
Second hand smoking

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What are the acute symptoms of asthma

Bronchospasm and wheezing

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How are acute symptoms of asthma reversed

With bronchodilators

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How is asthma inflammation and exacerbations controlled

By anti inflammatory drugs

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How can we treat airway remodelling

No treatment

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What are the advantages of inhaled therapy

Direct delivery of the drug to the site of action
Rapid onset of action
Lower dose to produce desired effects
Minimise systemic adverse effects

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What are the inhalation devices

Devices used to make an aerosol out of the drug solution

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What are the types of inhalation devices

Inhaler - generate aerosols of solid particles

Nebulizer - generate aerosols of liquid particles in gas cloud

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What to avoid deposition of solid particles from an inhaler in the mouth

By using a spacer

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How is the drug absorbed from a dry powder inhaler

Drug is absorbed on a lactose carrier

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What’s the preferred deliver in asthma treatment (rescue medication)

Low dose ICS + formoterol

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What is the optimal route of administration for corticosteroids in inflammatory lung disease

Inhaled

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What are inhaled corticosteroids used for

Used in asthma prophylactic therapy not to reverse acute asthma attack symptoms

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What’s the best combination of corticosteroids in asthma

ICS + formoterol

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List of ICS used in asthma

All are prodrugs
Beclomthasone
Dipropionate
Ciclesonide

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How are the prodrugs of ICS activated

They admire metabolised in to active form by esterases in the lung

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Which ICS is metabolised in the liver

Prednisone-> prednisilone

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What are the characteristics that enhance the efficacy of inhaled ICS

Lung pulmonary residence time due to

lipophilicity
lipid conjugation

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What are the ICS with the best lipophilicty

Ciclesonide

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What are the ICS with the worst lipophilicty

Budesonide

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What are the ICS with the best lipid conjugation

Budesonide

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What are the ICS with the worst lipid conjugation

Ciclesonide

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What are the topical adverse effects of Inhaled ICS

Dry mouth
Pharyngeal irritation
Increase frequency of oral condidiasis

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How to reduce the topical adverse effects of ICS

Proper technique, using spacer and rinsing mouth after inhalation

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What ICS is used in long term treatment of asthma

Inhaled ICS

What ics is used in acute asthma exacerbations and chronic severe asthma

Oral corticosteroids like Prednisone Prednisilone Methyprednisolone

What ICS is used in severe acute asthma

I.V corticosteroids like Hydrocrotisone Methylprednisilone

Mode of administration of leukotrienes modifying drugs - what’s their effect on CYP450

Oral - they inhibit CYP450

What are leukotrienes

Receptor antagonists

What is montelukast and zafirlukast and what’s their drug interactions

Leukotrienes synthesis inhibitors | Interaction with warfarin

Zileuton mechanism of action and drug interactions

Inhibit 5-LOX | Interacts with theophylline and warfarin

What is leukotrienes treatment ineffective in

Acute bronchospasm

What is leukotrienes treatment effective in

In aspirin and excercise asthma

What can leukotrienes do to B2 agonists effect

Enhances the effect

What type of asthma are leukotrienes used for

Mild to severe asthma

What leukotrienes is approved in children over 6 months

Montelukast

What leukotrienes is used in children over 5 years

Zafirlukast

What does corticosteroids inhibit

Phospholipase A2

Mechanism of action of zafirlukast and montelukast

Bind to leukotriene receptors

Zileuton mechanism of action

Inhibits 5 lipooxygenase

What are the similarities between leukotrienes and corticosteroids uses

They can both be used as a controller but not for acute bronchospasm

What is the B2 receptors agonists actions

Relaxation of bronchi smooth muscle and decrease airway resistance

List SABA

Short acting B agonist Albuterol Fenoterol

What are SABA used for

active inhalation treatment of bronchospasm ( with low dose ICS - budesonide)

SABA onset and duration of action

1-5 mins quick | Lasts for 2-6 hours short

What are SABA most effective in

Most effective drugs in relaxing airway smooth muscles

LABA

Long acting B agonist Formoterol Slameterol

What are formoterol and salmeterol used for

Both are used for prevention of asthmatic attacks since they are long acting BUT. Formoterol can be used for relief from asthma attacks

How often is LABA given

It’s given twice daily by inhalation for long treatment of asthma

What are LABA USED FOR

Useful in - preventing nocturnal asthmatic attacks - prevent Late phase of allergen induced bronchoconstriction

Why shouldn’t LABA be used alone

Masks the symptoms and lacks anti inflammatory action

What should LABA be used with

ICS

LABA adverse effects

Tremors and tachycardia

What’s the corticosteroids and B2 agonist drug interactions

Corticosteroids prevent the desensitisation of B2 receptors and increase synthesis of B2 receptors

What’s the rescue dose of LABA + ICS

4,5 ug , 160 ug or 4.5 ug, 80ug | E.g-> formoterol + budesonide

Other name for methylxanthines

Theophylline

Theophylline mode of administration

Oral

Theophylline mechanism of action

Inhibits phosphodiesterase -> causing an increase in CAMP with in the cell leading to smooth muscle relaxation

What’s wrong with theophylline therapeutic index

Has a narrow therapeutic index 5-15 mg/ml

Theophylline indications

Bronchodilator in COPD

Theophylline metabolism

Metabolised in the liver

How do anticholinergic agents prevent contraction

Antagonist of M3 receptors in the bronchial smooth muscles

Where are parasympathetic pathways more important

In bronchospasm than in some asthmatics

What are anticholinergic agents used with

Used with ICS and LABA | CANT REPLACE LABA

Anticholinergic agent effect on COPD AND ASTHMA

COPD >> Asthma

Can ipratropium work alone

It is ineffective in reversing bronchospasm on its own

Ipratropium onset and duration of action

15 mins | 6 hours

Tiotropium onset and duration of action

30 mins | More than 24 hours

What’s a good combination with ipratropium

Ipratropium with a SABA usually with FENOTEROL | Instead of either alone

Mechanism of action of omalizumab

Antibody against IGE. Blocks it from binding to mast cells

Omalizumab is used in which patients

Patients with sensitisation to perinnial aeroallergens - frequent asthma exacerbation

IL 5 antagonists suffix

Zumabs but not omalizumab

What does IL 5 do

Recruitment of eosinophils

What are IL5 antagonists indicated for

Given for eosinophilic asthma as it decreases the production and survival of eosinophils