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PHAR2803 > Asthma > Flashcards

Asthma Flashcards

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1
Q

What is asthma?

A

Widespread narrowing of the airways.

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2
Q

Is asthma reversible?

A

Yes

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3
Q

What is asthma characterised by?

A

Increased responsiveness of bronchi to various stimuli

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4
Q

Host factors influencing the development of asthma

A

Genes predisposing to allergy

Genes affecting 𝞫2 receptors

Obesity

Female

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5
Q

Environmental factors influencing the development of asthma

A

Allergens
Viral Infections
Occupational Irritants
Tobacco Smoke
Air Pollution
Diet

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6
Q

Symptoms of asthma

A

Wheezing
Breathlessness
Chest tightness
Coughing +- sputum
Shortness of breath

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7
Q

What causes the symptoms of asthma?

A

Airway narrowing

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8
Q

Symptoms of severe asthma

A

Cyanosis
Tachycardia
Hyperventilation
Inability to talk

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9
Q

Presentation of asthma

A

Occurs at night or early morning

Recurrent episodes

Vary in duration and severity

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10
Q

Causes of airway narrowing in asthma

A

Smooth muscle contraction (bronchial hyperreactivity)

Inflammation (eosinophils and Th2 cells)

Airway oedema
Airway wall thickening (fibrosis)

Mucus hypersecretion

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11
Q

What is the early phase of an allergic asthmatic response to an allergen?

A

Bronchospasm

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12
Q

What is the late phase of an allergic asthmatic response to an allergen?

A

Inflammation

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13
Q

How long does the early phase of an allergic asthma response to an allergen last?

A

2-3 hours

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14
Q

How long does the late phase of an allergic asthma response to an allergen last?

A

3-4 hours

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15
Q

Which cells are involved in mediating the pathophysiology of asthma?

A

Dendritic cells
T lymphocytes
B lymphocytes
Mast cells
Eosinophils

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16
Q

How are dendritic cells involved in mediating the pathophysiology of asthma?

A

Present allergens to lymphocytes

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17
Q

How are T lymphocytes and B lymphocytes involved in mediating the pathophysiology of asthma?

A

Produce IgE antibodies against the allergen

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18
Q

How are mast cells involved in mediating the pathophysiology of asthma?

A

IgE produced by the lymphocyytes is inserted onto the surface of mast cells.

The allergen binds to these IgEs and lead to the release of inflammatory mediators from mast cells

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19
Q

How are eosinophils involved in mediating the pathophysiology of asthma?

A

Attracted by IgEs and mast cells

Release mediators and cause bronchospasm, mucus production and tissue damage

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20
Q

Describe the role of a dendritic cell in the detection of allergens in allergic asthma

A
  1. Immature blood dendritic cells migrate into the airway mucosa.
  2. Dendritic cells differentiate and migrate to airway epithelium.
  3. Dendritic cells form a dynamic network in the epithelium and pick up airborne allergens.
  4. Dendritic cells leave the epithelium, differentiate further and migrate to local lymph nodes.
  5. In the lymph node, the mature dendritic cells present the antigen to T cells.
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21
Q

What does the binding of an allergen to mast cells cause?

A

Release of inflammatory mediators:

Histamine
Prostaglandin
Leukotrienes

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22
Q

What is the role of histamine?

A

Bronchoconstriction

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23
Q

What is the target of histamine?

A

H1 receptors

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24
Q

What drugs affect histamine?

A

H1 antagonists - loratadine

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25
Why are antihistamines not used in the treatment of asthma?
Innefective in bronchodilation side effects
26
What is the precursor of prostaglandin?
Arachidonic Acid
27
Where do prostaglandins act?
Prostaglandin receptors
28
What is the role of prostaglandin?
Bronchoconstriction
29
What drugs work on prostaglandin?
Anti-inflammatory steroids reduce synthesis
30
What is the precursor of leukotrienes?
Arachidonic Acid
31
Where do leukotrienes act?
cysLT receptors
32
What is the role fo leukotrienes?
Bronchoconstriction Eosinophilia
33
Which drugs work on leukotrienes?
Anti-inflammatory steroids reduce synthesis cyst receptor antagonists (LTRAs)
34
Triggers of asthma exacerbations
Viral infection Bacterial infection Irritants Exercise Weather changes Gastro-oesophageal reflux Pregnancy/Mensutration Stress
35
What is a reliever used for?
Immediate relief of symptoms
36
What is a controller/preventer used for?
Prevent asthma attacks
37
What are some classes of drugs used as relievers?
B2 adrenoreceptor agonists Phosphodiesterase inhibitors Anti-cholinergics (anti-muscarinics)
38
What do B2 adrenoreceptors agonists do in asthma therapy?
Increase cAMP synthesis in smooth muscle
39
What do phosphodiesterase inhibitors do in asthma therapy?
Increase cAMP by inhibiting its breakdown
40
What is an example of a short acting B2 adrenoreceptor agonist (SABA)?
Salbutamol
41
How long does salbutamol take to exert its effect?
Immediate
42
How long does salbutamol last?
3-5 hours
43
What is an example of a long acting B2 adrenoreceptor agonist (LABA)?
Salmeterol
44
Why is salmeterol taken?
Prevent bronchoconstriction (e.g during exercise)
45
What is an example of a short acting phosphodiesterase inhibitor used as a reliever?
Oral theophylline - aminophylline
46
What is an example of a short acting anti muscarinic (anti cholinergic) (SAMA)?
Ipratropium Bromide
47
What is an example of a long acting anti muscarinic (anti cholinergic) (LAMA)?
Tiotropium Bromide
48
What drug classes are used as controllers and preventors in asthma therpy?
Corticosteroids Leukotriene modifiers Phosphodiesterase inhibitors ANTI-IgE
49
What is an example of an oral corticosteroid?
Prednisolone
50
What is the problem with oral prednisolone?
Side Effects
51
What is an example of inhaled corticosteroids?
Budesonide Fluticasone
52
What is the name of the combination of a fluticasone and salmeterol?
Advair
53
What is an example of a leukotriene receptor antagonist?
Montelukast Pranlukast Zafirlukast
54
What is an example of an inhibitor of leukotriene synthesis?
Zileuton
55
What is an example of a phosphodiesterase inhibitor used as a controller/preventor?
Sustained Release Theophylline Roflumilast
56
What is Roflumilast?
PDE4 Inhibitor
57
What is an example of a ANTI-IgE?
Omalizumab
58
When is omalizumab used?
Severe asthma
59
What is the target of Zileuton?
5-lipoxygenase
60
Clinical Assessment for diagnosis
Clinical History Spirometry PEFR FeNO Histamine/Methacholine Inhalation in difficult cases
61
What two tests are conducted under spirometry?
FEV1/FVC Ratio Bronchodilator Reversibility
62
What are the 4 levels of severity?
Intermittent Mild Moderate Severe
63
Differential Diagnosis
COPD Bronchiectasis Cystic Fibrosis Other respiratory disorders GORD Infections Heart Failure
64
What are the goals of asthma control?
No daytime symptoms No night time awakening No need for rescue medicine No limitations to activity No asthma attacks Normal lung function Minimal side effects from medication
65
Self Management of asthma
Personalised asthma action plans Regular professional reviews
66
What is the pharmacist's role in asthma management?
Patient education Inhaler technqiue Clinical management Improving compliance
67
What is step 1 in the management of asthma by NICE?
SABA - as a reliever alone
68
What is step 1 in the management of asthma by BTS/SIGN?
Low dose ICS AND SABA
69
What is the step 2 in the management of asthma by NICE?
Regular Preventor SABA + low dose ICS
70
What is the step 2 in the management of asthma by BTS/SIGN?
SABA + low dose ICS
71
What is the step 3 in the management of asthma by NICE?
SABA + low dose ICS + LTRA
72
What is the step 3 in the management of asthma by BTS/SIGN?
low dose ICS + fixed dose LABA with SABA or MART regimen
73
What is the step 4 in the management of asthma by NICE?
SABA + low dose ICS + LABA +- LTRA IF STILL UNCONTROLLED: MART regimen low dose ICS/LABA +- LTRA
74
What is the step 4 in the management of asthma by BTS/SIGN?
Stop LABA if no response, consider increased dose ICS Continue LABA if some benefit and increase ICS to medium dose Consider LTRA, theophylline or LAMA
75
What is the step 5 in the management of asthma by NICE?
Increase to high dose ICS +- LABA (fixed dose) + SABA (reliever) OR Trial of LAMA or theophylline OR Specialist referral
76
What is the step 5 in the management of asthma by BTS/SIGN?
Specialist referral
77
What should all patients with symptomatic asthma have?
SABA
78
When may doses of ICS be increased?
Exacerbations in the last 2 years Using inhaled beta 2 agonists 3 times a week or more Symtomatic 3 times a week or more Waking at least one night a week
79
Diagnosis of a moderate acute asthma attack?
Increased symptoms PEF >50-75% best/predicted No features of severe
80
Diagnosis of a severe acute asthma attack?
PEFR 33-50% best/predicted Respirations >25 breaths/min Pulse >110 beats/min Inabilty to complete sentences in one breath
81
Diagnosis of a life-threatening acute asthma attack?
PEFR <33% best/predicted SpO2 < 92% PaO2 <8kpa Silent chest Cyanosis Feeble respiratory effort Bradycardia, dysrhythmia, hypotension Exhaustion, confusion, coma
82
Treatment of an acute asthma attack
High flow oxygen - 40-60% Nebulised B2 agonist (driven by oxygen Oral/IV prednisolone 40-50mg OD 5/7 or until recovery
83
If the acute exacerbation is not improving?
Add ipratropium bromide 500mcg nebs IV magnesium sulphate 1.2-2g CIVI aminophylline IV/SC beta 2 agonist Rehydration Ventilation

PHAR2803 (5 decks)

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