asthma

Question 1

What are the first line drugs for asthma? (for bronchodilation)

Answer 1

Fast-acting B2 agonists SABA (Reliever)
Long-acting B2 agonists LABA (Controller)

Question 2

What is the first line anti-inflammatory drug?

Answer 2

Glucocorticoid (Corticosteroids)

Question 3

What is the MOA of B2-adrenoceptor agonists?

Answer 3

It promotes airway smooth muscle relaxation, mast cell stabilization which decrease microvascular leakiness and increase mucociliary clearance.

Question 4

Name one SABA

Answer 4

Salbutamol

Question 5

Name one LABA

Answer 5

Salmeterol/Formoterol

Question 6

In the treatment of Asthma, Salbutamol is used as a ____ as it is fast/slow acting while _____ is used as a controller as it is fast/slow acting.

Answer 6

In the treatment of Asthma, Salbutamol is used as a reliever as it is **fast-acting **while Salmeterol is used as a controller as it is slow-acting.

Question 7

What is one bronchodilator that can be used as both a reliever and controller?

Answer 7

Formoterol

Question 8

What is the duration of action for Formoterol as a fast-acting agent?

Answer 8

2-3min

Question 9

What is one medication used IV/SC in an emergency as a bronchodilator?

Answer 9

Adrenaline

Question 10

What are the side effects of B2-adrenoceptor agonists?

Answer 10

Tremor
Muscle Cramps
Peripheral vasodilation
Palpitations & tachycardia
Hypokalaemia & hyperglycaemia
B2 adrenoreceptors tolerance

Question 11

Why should LABA not be prescribed alone for asthma?

Answer 11

LABAs downregulate B2-adrenoreceptor expression hence increasing the risk of asthma-related death as responsiveness to B2-adrenoreceptor agonism decreases

Question 12

What medication should LABA always be used with?

Answer 12

Inhaled corticosteroid

Question 13

When is SAMA / LAMA used for the treatment of Asthma?

Answer 13

When patient is intolerant of B2 agonists and to prevent bronchoconstriction

Question 14

What is the MOA of Muscarinic Receptor Antagonists?

Answer 14

It inhibits M3 receptor-Mediated bronchoconstrictions and reverses vagal nerve Mediated bronchospasm and Mucus secretion.

Question 15

What are the adverse effects of muscarinic receptor antagonists?

Answer 15

Dry Mouth
Urinary retention

Question 16

Name one SAMA and one LAMA

Answer 16

SAMA: Ipratropium
LAMA: Tiotropium Bromide

Question 17

What are some examples of Methylxanthines?

Answer 17

Theophylline
Aminophylline (Theophylline + Ethylenediamine 2:1)

both can be administered via oral/IV

Question 18

what is the MOA of methyxanthines

Answer 18

inhibits PDEs and blocks adenosine receptors

NOT a clinical anti-inflammatory but has effects

Question 19

Name one bronchodilator which can be used via the rectal route?

Answer 19

Aminophylline

Question 20

What are the adverse effects of Methylxanthines?

Answer 20

GIT, CNS, CVS effects
(CNS - tremor/anxiety
CVS - arrhythmias)

have to consider pt caffeine intake!!!!

Question 21

What is the adjunct treatment of severe acute asthma?

Answer 21

Magnesium Sulphate

IV or Neb

Question 22

Name 3 examples of inhaled corticosteroids that are commonly used for the treatment of Asthma

Answer 22

Budesonide
Fluticasone
Ciclesonide

Question 23

Which corticosteroid is associated with greater risk of adrenal suppression?

Answer 23

Fluticasone

Question 24

what are the effects of corticosteroids

Answer 24

reduce pro inflammatory mediators
increase anti-inflammatory mediators

Question 25

What is the MOA of corticosteroid?

Answer 25

It decreases airway hyper-responsiveness in 4 to 6 weeks, decreases frequency of acute asthma exacerbations, possibly prevent airway wall remodelling, reduce need for B2 agonist and reduce risk of death from asthma.

Question 26

What is corticosteroid indicated for?

Answer 26

First line prophylactic for asthma treatment Nocturnal asthma

Question 27

What are the adverse effects of corticosteroids?

Answer 27

Cough Oropharyngeal candidiasis Dysphonia (below are esp common in elderly) Easy bruising Osteoporosis Posterior subcapsular cataracts

Question 28

What are leukotriene pathway inhibitors indicated for?

Answer 28

Prophylaxis and chronic treatment of asthma Exercise / Aspirin-induced / NSAID exacerbated asthma

Question 29

What are the 2 leukotriene pathway inhibitor?

Answer 29

Montelukast (Cysteinyl-leukotrine receptor antagonist) Zileuton (5-Lipoxygenase Inhibitor)

Question 30

How can leukotriene pathway inhibitors be administered

Answer 30

Oral only

Question 31

What syndrome is leukotriene pathway inhibitors associated with?

Answer 31

Churg-Straus Syndrome Likely due to concomitant glucocorticoid withdrawal

Question 32

what are CysLT (Cysteinyl-Leukotriene) Receptors also known as

Answer 32

weak bronchodilators, mainly prevent bronchoconstriction pathway

Question 33

Montelukast can be used as adjunct for ____ to ____ asthma

Answer 33

Mild to moderate asthma(but cannot be used alone as reliver, is a weak bronchodialator at clinical dose)

Question 34

What medication is effective in aspirin-sensitive asthma and exercise-induced asthma?

Answer 34

Montelukast

Question 35

What group of drug does Cromoglicic acid belong to?

Answer 35

Mast Cell stabiliser

Question 36

what is the MOA of cromoglicic acid (cromolyn)?

Answer 36

decreeases mast cell degranulation and inflammatory mediators secretion

Question 37

What is cromoglicic acid indicated for in the treatment of asthma?

Answer 37

Prophylactic control of asthma Prophylactic control of allergic rhinitis, allergic conjunctivitis and vernal keratoconjunctivitis

Question 38

Cromoglicic acid should be taken _____ before antigen-challenge or exercise to prevent bronchospasm

Answer 38

Single dose

Question 39

What are the adverse effect of cromoglicic acid?

Answer 39

Throat and nasal irritation Mouth dryness Cough Unpleasant taste

Question 40

Omalizumab is a _____ monoclonal antibody

Answer 40

Anti-IgE

Question 41

In what cases of asthma is Omalizumab used?

Answer 41

Severe asthmatics with allergies and an elevated IgE level

Question 42

How often is Omalizumab given?

Answer 42

Subcutaneous injection every 2 to 4 weeks

Question 43

Omalizumab _____ levels of free ____ in serum and decreases FcER expression on _____.

Answer 43

Omalizumab **depletes** levels of free **IgE** in serum and decreases FcER expression on **mast cells.**

Question 44

What are some limitations or adverse effects of Omalizumab?

Answer 44

Expensive Associated with small increase in risk of heart attack, transient ischemic attack and blood clot.

Question 45

What is one medication used for eosinophilic asthma?

Answer 45

Reslizumab

Question 46

what type of antibody is reslizumab

Answer 46

Anti- IL-5/IL-4

Question 47

Can a 10 year old patient with eosinophilic asthma be prescribed Reslizumab?

Answer 47

No. Reslizumab only approved for severe, persistent eosinophilic asthma in patient >18 years old.

Question 48

How often should Reslizumab be given?

Answer 48

IV once every 4 weeks

Question 49

What is one common adverse effect of reslizumab?

Answer 49

Oropharyngeal pain

Question 50

Seretide is the combination of ____ and _____

Answer 50

Salmeterol (LABA) + Fluticasone (Corticosteroid)

Question 51

Symbicort is the combination of ____ and _____

Answer 51

Formoterol (Fast acting LABA) + Budesonide (Corticosteroid)