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PHARMACOLOGY > Asthma > Flashcards

Asthma Flashcards

1
Q

State the sympathetic and parasympathetic innervation of the resp system and effects thereof

A

B2 adrenoceptors (cause relaxation of bronchial smooth muscle, leading to dilation)

M3 receptors: cause bronchial muscle contraction&raquo_space; bronchoconstriction

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2
Q

Common symptoms of pulmonary disease

A

Wheezing
SOB
Cough (wet or dry), or hemoptysis
chest pain

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3
Q

What causes respiratiory conditions? (2)

A

Infection
Malignancy

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4
Q

What is asthma? Explain. (2)

A

Inflammatory condition with
recurrent reversible airway
obstruction in response to
irritant stimuli.
* Intermittent attacks

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5
Q

Common sysmptoms of asthma(4)

A

Symptoms include wheezing,
shortness of breath, difficulty
breathing out, sometimes cough
(worse at night)

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6
Q

Who mostly become affected by asthma?

A

Common in children with atopy
(allergic rhinitis and atopic
dermatitis) = allergic asthma

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7
Q

Asthma is characterised by: (3)

A

Inflammation of the
airways
* Bronchial
hyperreactivity
* Reversible airway
obstruction

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8
Q

What happens in the immediate phase of asthma?

A

Inciting agent: alletgen or non-specific stimulant» activation of mast cells and mononuclear cells&raquo_space; release of H, cystLTs, and PGD2, AND release of chemokines and chemotaxins&raquo_space; Bronchospasm

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9
Q

What is the treatment of immediate phase asthma?

A

M3 antagonists
B2 adrenoceptor agonists
cysLT antagonists
Theophylline

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10
Q

Explain the late phase of asthma

A

The chmokines released during the immediated phase will lead to the production of chemokine releasing Th2 cells, mononuclear cells and inflammatory cells esp eosinophils&raquo_space; release of cysLT, NO, adenosine, neuropeptides, AND Eosinophil Major Basic Protein (EMBP) and Eosinophil Cationic Protein (ECP).

EMBP and ECP cause epithelial cell damage, which causes airway hyperactivity. Together with other secretions, also causes Airway inflammation.

All this ultimately leads to bronchospasm, wheezing, and coughing

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11
Q

Treatment of the late phase

A

Glucocorticoids

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12
Q

What does PEFR do? Why is it important?

A

Volume of air forcefully
expelled from the lungs in
one quick exhalation
* Reliable indicator of
ventilation adequacy as
well as airflow obstruction.

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13
Q

List 3 factors leading to differences in PEFR

A

Age, Height, Sex

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14
Q

How does one calculate predicted peak flow rate? (4)

A

CALCULATING % PREDICTED PEAK
FLOW RATE
* Take the best of 3 of the patient’s observed peak flow rate
* Find the patient’s sex, age and height predicted value from nomogram or table:
* Divide patient’s observed peak flow rate over their predicted peak flow.
rate
* Multiply by 100

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15
Q

List 5 drug classes used in the treatment of asthma

A

B2 agonists
M3 antagonists
Glucocorticoids
Xanthines
Leukotrine receptor antagonist

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16
Q

Examples of B2 adrenoceptor agonists. Classify into short acting and long acting

A

Salbutamol and fenoterol, terbutaline - SABA,
Salmeterol and Formoterol - LABA

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17
Q

Examples of M3 antagonists and ROA

A

iptratropium bromide, tiotropium (Inhaled)

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18
Q

Examples of Glucocorticoids and ROA

A

Beclomethasome, budesonide, fluticasone (INHALED)

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19
Q

Examples of Xanthines and ROA

A

Aminophylline, theophylline (IV, Oral)

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20
Q

Examples of Leukotriene receptor antagonists and ROA

A

Montelukast, ORAL

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21
Q

What is the MOA of B2 agonists?

A

β₂ activation causes relaxation of the bronchial smooth muscle
* May increase mucous clearance by an action on cilia

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22
Q

SABA clinical use/indication, ROA,
Onset of action (time),
Max effect (time),
overall duration of action (time)

A

Clinical use/indication: acute bronchospasm
* Inhaled (Onset of Action: 5-15 min)
* Max effect within 30 min
* Duration of Action: 4-6 hrs

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23
Q

Salbutamol dosage

A

1 or 2 puffs, prn as required

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24
Q

________________ can develop to bronchodilator effects
with continuous/inappropriate use.

A

Tolerance

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25
Indication of LABA
COPD, Uncontrolled persistent asthma
26
LABA must always be used with ________________ in asthma
steroid
27
Give the following info for LABA ROA Duration of action Administer how many times?
Inhaled (onset of action – longer than for SABAs) * Duration of action: 8-12 hours * Administer twice daily consistently
28
You cannot use salmeterol in which circumstance?
– do not use salmeterol in an acute attack
29
Give Adverse effects of B2 agonists (9)
Skeletal muscle tremor, headache dizziness, tachycardia, palpitations – dose-related * Nervousness (β₂ stimulation increase the release of catecholamine's at nerve terminals) * Dry mouth, taste alteration and discolouration of teeth
30
T/F: B2 Agonists adverse effects are less pronounced with oral administration
F
31
B2 agonist cautions
Cardiac arrhythmias, IHD, CHF, uncontrolled HT, hyperthyroidism Pregnancy
32
Why is B2 agonist cautioned in pregnancy?
may delay labour, asthma need to be well controlled, inhaled preparations preferred
33
Which drug class may cause interactions if/when used with B2 agonists?
(non-selective) B-Blockers
34
Importance of glucocorticoids:
Anti-inflammatory – mainstay in preventing acute attacks. * NOT bronchodilators * Prevent progression of chronic asthma
35
MOA of glucocorticoids in asthma
Restrain clonal proliferation of Th cells by reducing the transcription of the gene for IL-2 and decrease formation of cytokines, in particular the Th2 cytokines that recruit and activate eosinophils and are responsible for promoting the production of IgE and the expression of IgE receptors.
36
MOA of glucocorticoids in asthma cont... (5)
Inhibit the allergen-induced influx of eosinophils into the lung. *Up-regulate β 2 adrenoceptors, *Decrease microvascular permeability *Indirectly reduce mediator release from eosinophils by inhibiting the production of cytokines (e.g. IL-5 and granulocyte–macrophage colony-stimulating factor) that activate eosinophils. *Reduce synthesis of IL-3 (the cytokine that regulates mast cell production) i.e. may explain why long-term steroid treatment eventually reduces the number of mast cells in the respiratory mucosa, and hence suppresses the early-phase response to allergens and exercise
37
which glucocorticoids are inhaled and what is their effect?
Inhaled corticosteroids (ICS) (beclomethasone, budesonide, fluticasone): chronic treatment of persistent asthma
38
which glucocorticoids are taken oral and what is their effect?
Oral treatment (prednisone): for exacerbation (attack) or when asthma is uncontrolled.
39
which glucocorticoids are taken IV and what is their effect?
IV treatment (hydrocortisone): severe bronchospasm, not able to take oral.
40
Frequency of dose for glucocorticoids
2x a day
41
How much of glucocorticoid is distributed to the lung?
10-15%
42
After how long can u see improvement from glucocorticoid use?
1-4 WEEKS adherence is important for optimal effectiveness (educate on prophylactic use, continue treatment even when symptom free)
43
What education can u give a pt regarding glucocorticoid use?
continue Tx even when symptom free (prophylaxis) Rinse mouth after use to prevent oral candida
44
adverse effects of inhaled glucocorticoids (3)
Oral candida, hoarseness, sore throat
45
MOA of M3 antagonist
block contraction of airway smooth muscle mediated via M₃-receptors and inhibit augmentation of mucous secretion that occurs in response to vagal stimulation. Increase mucociliary clearance of bronchial secretions. Response vary among individuals: only inhibit portion of bronchoconstrictive response mediated via parasympathetic pathways, more effective in COPD and the elderly
46
Onset of action and duration of action of Ipratropium
Onset of action: 30 minutes * Duration of action: 4 hours
47
Cautions and adverse effects of ipratropium
* Cautions: prostatic hypertrophy & narrow angle glaucoma * Adverse effects: dry mouth, bitter taste
48
MOA of Xanthines
unclear. Relax smooth muscle via inhibition of phosphodiesterase isoenzymes. Antagonise adenosine receptors General CNS and resp stimulation
49
Pharmacokinetics of Xanthines: Therapeutic index and absorption
Pharmacokinetics: narrow therapeutic index * Oral absorption good (sustained release preferred, do not change formulation is patient has been stabilised on it)
50
Pharmacokinetics of Xanthines: Half life and metabolism
Half-life variable * prolonged in infants and older patients, heart failure, hepatic disease, concurrent infections, * shortened by smoking and drug-interactions * Metabolised in the liver * Only use when other bronchodilators have failed
51
Common side effects of theophylline: GI effects
GI effects and CNS stimulation. * GI irritation may be minimised by taking with food to prevent N/V, epigastric pain and intestinal bleeding.
52
Common Adverse effects of theophylline: CNS effects (6)
* CNS effects: headache, irritability, nervousness, tremor, insomnia, convulsions
53
UNCOMMON ADVERSE EFFECTS OF Theophylline
Uncommon: tachycardia, palpitations, hypotension, arrhythmias, hyperglycaemia, depression
54
Cautions of theophylline (8)
IHD, Hypertension, hyperthyroidism, epilepsy, hx of PUD, liver disease, CCF, older patients
55
Theophylline drug interactions
Hepatic enzyme inhibitors: cimetidine, erythromycin, ciprofloxacin, ritonavir, etc. * Hepatic enzyme inducers: smoking, alcohol, barbiturates rifampicin, phenytoin, carbamazepine * Sympathomimetic agents: potentiate cardiac effects
56
Montelukast indication
prophylaxis and chronic treatment of atopic asthma (also treat allergic rhinitis), inhibit exercise-induced asthma
57
MOA of montelukast
exhibit bronchodilator and anti-inflammatory activity by blocking effects of cysteinyl leukotrienes in the airways
58
ROA of montelukast
Administered orally * Not indicated for acute attack (controller, take regularly)
59
Adverse effects of Montelukast
Uncommon in general * Hypersensitivity * Eosinophilia (rarely) * Neuropsychiatric events: agitation, aggression, anxiousness, hallucinations, depression, insomnia, irritability, suicidal thinking and behaviour – Warn patient
60
How to treat mild and moderate acute asthma attack
Salbutamol, inhalation using a metered-dose inhaler (MDI), 4–8 puffs, using a spacer. * Inhale one puff at a time. Allow for 4 breaths through the spacer between puffs. * If no relief, repeat every 20–30 minutes in the first hour. * Thereafter, repeat every 2–4 hours if needed. * Note: Administering salbutamol via a spacer is as effective as, and cheaper than, using a nebuliser. * OR * Salbutamol 0.5%, solution, nebulised, with oxygen. * 1 mL (5 mg) salbutamol 0.5% solution, in 4 mL of sodium chloride 0.9%. * If no relief, repeat every 20–30 minutes in the first hour. * Thereafter, repeat every 2–4 hours if needed. * AND * Corticosteroids (intermediate-acting) e.g.: Prednisone, oral, 40 mg immediately * Follow with prednisone, oral, 40 mg daily for 7 days.
61
Tx of severe acute asthma
Give oxygen with care (preferably by 24% or 28% facemask, if available). Observe patients closely, as a small number of patients’ condition may deteriorate. * AND * Salbutamol 0.5%, solution, nebulised, with oxygen. * 1 mL (5 mg) salbutamol 0.5% solution, in 4 mL of sodium chloride 0.9%. * If no relief, repeat every 20–30 minutes until PEF > 60% of predicted. * Once PEF > 60% of predicted, repeat every 2–4 hours if needed. Corticosteroids (intermediate-acting) e.g.:  Prednisone, oral, 40 mg immediately. * Follow with prednisone, oral, 40 mg daily for 7 days. ADD (If poor response after first salbutamol nebulisation/inhalation): * Ipratropium bromide solution, nebulised, 2 mL (0.5 mg) added to salbutamol solution every 20–30 minutes for 3 doses depending on clinical response. OR using MDI, 80–160 mcg (2–4 puffs), using a spacer every 20–30 minutes as needed for up to 3 hours.
62
Management of chronic persistent asthma (patient eductaion)
Non-pharmacological advice and patient education: * No smoking by an asthmatic or in the living area of an asthmatic. * Avoid contact with household pets. * Avoid exposure to known allergens and stimulants or irritants. * Education on early recognition and management of acute attacks. * Patient and caregiver education: * emphasise the diagnosis and explain the nature and natural course of the condition; * teach and monitor inhaler technique; and * reassure parents and patients of the safety and efficacy of continuous regular controller therapy
63
Medical management of severe persistent asthma
Medicine treatment is based on the severity of the asthma and consists of therapy to: (1) prevent the inflammation leading to bronchospasm (controller) ICS: beclomethasone – use twice daily (2) relieve bronchospasm (reliever) SABA: salbutamol – use as needed
64
Mx of exercise induced asthma
Administer: SABA: salbutamol 30 minutes before exercise

PHARMACOLOGY (30 decks)

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