Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharmacy Year 2 Semester 2 > Asthma > Flashcards

Asthma Flashcards

1
Q

Triggers

A
  • cold air
  • dust mites
  • pollen/animal fur/dust mites
  • smoke/fumes/pollution
  • NSAIDs
  • emotion e.g. stress/laughter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pathology of asthma

A

immune condition mediated by IgE
IgE formed in response to a trigger.
Re-exposure to the allergen casues this specific IgE on mast cells, causing an inflammatory response:
-Histamine, prostaglandins, leukotrienes and eosinophils infiltrate the airway
-goblet cells over-produce mucous
-T lymphocytes produce cytokines that potentiates the inflammatory response
-This cascade causes bronchospasm - hyper-responsive smooth muscle on airway to narrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Diagnosis of asthma

A
  • No single test can diagnose asthma
  • Combination of history, examination, tests to access the probability of asthma
  • Diagnosis is through lung function testing and reversibility tests with either a SABA or an corticosteroid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Lung function tests to help diagnose asthma

A

-FVC
-FEV1
-FEV1:FVC ratio
-PEFR
FeNo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define FVC

A

Forced vital capacity

Total volume expelled by the lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define FEV1

A

Forced expiratory volume exhaled in first second of FVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

FEV1:FVC ratio normal values

improvement?

A

Normal 0.7
Below this indicates obstruction
Obstruction is reversible in asthmatic patients whom should see an increase of 400ml to lung capacity after taking salbutamol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PEFR

A

Peak expiratory flow rate
Done via peak flow meter
Maximum rate of airflow which can be achieved during a sudden forced expiration from a position of full inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What do you do with the spirometry results?

A

Compare against predicted values for those patients that took it
Based on: age, height, race and sex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Uncontrolled asthma has what spirometry test results?

What happens after administration of salbuatmol?

A

Decrease if PEF and FEV1 in uncontrolled asthma

400mL increase in lung capacity after salbutamol administration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

FeNO

A

Functional exhaled nitric oxide
indicates airway inflammation
elevated levels in asthma patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Other non-spirometry tests

A

Blood eosinophils - inflammation
allergies
IgE levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Presentation of asthma

A

wheezing
shortness of breath (dysponea
coughing - particularly at night and on waking
triggers from allergens
if severe - cyanosis, drowsiness, difficulty speaking full sentences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

aims of asthma treatment

A
  • control symptoms, including nocturnal and exercise-induced exacerbations
  • Reduce reliance on rescue therapy
  • Prevent exacerbations
  • Achieve best possible lung function: FEV1 and/or PEF >80% predicted or best
  • minimising side effects of medication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

“Control” of asthma is defined as

A
  • no daytime symptoms
  • no nighttime symptoms
  • no need for rescue medication
  • no limitations on activity, including exercise
  • no exacerbations
  • normal lung function: FEV1 and/or PEF >80% predicted or best
  • minimal side effects of treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Non-pharmacological management of asthma

A
  • Avoiding triggers
  • stop smoking
  • lose weight if obese
  • avoid exercise in cold air
  • minimise occupational stimuli
  • avoid NSAIDs and Beta-blockers (including eye drops)
  • Hollistic remedies (immunotherapy, Buteytco breathing technique)
  • Breast feeding
  • -air ionisers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatment of chronic ashtma

A
  • inhaled (with spacer/nebuliser) and oral routes of administration
  • this makes side effects and ADRs more common due to the route being more systemic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Reliever

A

SABA e.g. salbutamol
produces quick symptomatic relief
Normally PRN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Preventer

A

Corticosteroids i.e. beclomethasone
Act on underlying inflammation
Usually PRN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Controller

A

:LABA e.g. salmeterol

Slow onset, long-acting, usually BD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Nebulisers

A

Vaporise aqueous solution of drug (normally salbutamol or ipratropium) to mist for inhalation through a mask or mouthpiece
They offer high dose delivery and are particularly useful in acte or chronic/severe asthma as
co-ordination not needed
Often used in hospitals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

B2-agonists

A

Caause smooth muscle relaxation and enhance mucociliary clearance

  • SABA
  • LABA
  • 3rd line controllers
23
Q

SABAs
2 examples
onset and duration

A

Salbutamol and terbutaline
Onset 1-5minutes
Duration 4-6 hours
1st line relievers offer quick symptomatic relief

24
Q

LABAs
2 examples
onset and duration

A

Salmeterol

  • onset 10-20 minutes
  • duration 12hours

Formoterol
-onset 1-3 minutes
duration 12 hours

25
B2 agonists ADRS
- fine tremor - nervous tension - headache - peripheral vasodilation - tachycardia - hypokalaemia
26
Corticosteroids
2nd line preventers | Anti-inflammatory reducing bronchial hyper-response
27
ICS | 3 examples
``` Inhaled corticosteroids Beclomethasone Budesonide Ciclesonide Available in combination with LABA ICS are classed as either low, medium or high doses ```
28
Oral corticosteroids
Prenisolone Usually 40-50mg for 5 days for acute attacks 40-50mg =minimum effective dose in step 5
29
IV corticosteroid
Hydrocortisone used in acute severe situations suppresses inflammatory processes
30
When are corticosteroids indicated?
- exacerbation of asthma in last 2 years - using inhaled B2 agnoist >3times/week - symptomatic >3times/week - waking one night a week due to symptoms
31
Inahled corticocosteroid ADRs | and solutions
-hoarseness or dysphonia (difficulty speaking) if this happens, use spacer/dry powder - oral candidiasis -rinse mouth after use or use spacer - adrenal suppression - only in sustained doses >1500mcg Beclomethasone daily
32
Oral corticosteroid ADRs
-hypertension -osteoporosis -skin thinning -hyperglycaemia -adrenal suppression -moon face -acne which is why for oral corticosteroids, we use the lowest dose that will control symptoms for the shortest time possible
33
Leukotriene antagonists | examples
- 3rd/4th line controller/preventer - oral montelukast and zafirlukast - antagonise bronchoconstriction, airway oedema and mucous production
34
ADRs for leukotriene antagonists
- abdominal pain - headache - thirst - rash - sleep disturbances/CNS effects
35
Cromones
Necocromil - preventer in 5-12 year olds | -mast cell stabilisers, inhibits mediator (histamine) release from mast cells
36
Cromones ADRs
- nausea and vomiting - bitter taste - dispepsia
37
Immunosuppressants
-Methotrexate -ciclosporin -gold specialist use - used rarely
38
Methylxanthines - how they work
Think INTERACTIONS and ADRs! phosphodiesterase inhibitors that inhibit leukotriene synthesis and therefore inhibit inflammation and bronchoconstriction 3rd/4th line controller/preventer therapy
39
Methylxanthine examples
- oral: theophylline - IV/oral - aminophylline (salt of theophylline) - Narrow therapeutic index - SR preparations available to give predictable effect - Brand MUST remain constant
40
Therapeutic range for methylxanthines
10-20mg/L
41
Side effects of methylxanthines dependent on plasma concentrations
- <20mg/L - nausea, diarrhoea, nervousness, headache - >20mg/L vomiting, insomnia, arrhythmias - >35mg/L - hyperglycaemi, arrhythmias, convulsions, death
42
Methylxanthine clearance affected by
CYP450 metabolism - CCF (congestive heart failure) - liver disease - obesity
43
How to work out methylxanthine dose
by IBW (ideal body weight)
44
Methylxanthine interactions
1) enzyme inhibitors - these interactions can lead to toxicity e. g. - cimetidine - erythromycin - allopurinol - ciprofloxacin 2) enzyme induction - these interactions can lead to sub-therapeutic doses e. g. - carbamazepine - rifampicin - phenytoin - smoking - alcohol
45
Anti IgE monoclonal antibodies
-Omalizumab inhibits binding of IgE to mast cell receptors, therefore preventing inflammatory response to triggers -licensed as add-on therapy in adults and children>12yrs for severe, persistent asthma -S/C injection every 2-4 weeks -only initiated by specialist centres -patients must fulfil specific NICE criteria -discontinue after 16 weeks if inadequate response (4-8 injections)
46
Outline the BTS/SIGN guidelines for adult management of acute+severe asthma
Patients should be reviewed every 3-6 months with a view of stepping down treatment Steps If asthma suspected, give SABA PRN 1) Monitored initiation of low dose ICS ↓ 2) Add LABA (LABA+low dose ICS as combo inhaler) ↓ 3)Additional add on therapies -No response to LABA→stop LABA, consider ↑ICS dose -Benefit from LABA but control still bad→continue LABA, ↑ICS to medium dose OR Continue LABA and ICS and consider a trial of a LTRA, SR Theophylline or LAMA ↓ 4) High dose therapies Refer to specialist care Consider trials of: -↑ICS up to high dose -Adding on a 4th drug e.g. LTRA, SR theophylline, B2-agonist tablet, LAMA ↓ 5) Continuous or frequent use of oral steroids -refer to specialist care -use daily steroid tablet in the lowest dose providing adequate control -Maintain high dose ICS -consider other treatments to minimise use of steroid tablets NB- SABA PRN is on ALL steps
47
Outline the management of chronic and acute asthma in children
Asthma suspected - consider very low dose→low dose ICS 1) Infrequent, short-lived wheeze. Asthma diagnosed Regular preventer - very low (paediatric) dose ICS or LTRA <5 years ↓ 2) continue v.low dose ICS plus -children > or equal to 5yrs - add inhaled LABA -children<5yrs- add LTRA ↓ 3) Additional add-on therapies: -no response to LABA→stop LABA and increase dose of ICS to low dose -if benefit from LABA but still inadequate control, continue LABA and ↑ICS to low dose -If benefit from LABA but control still inadequate, continue LABA and consider trial of a LTRA ↓ 4) High dose therapies -refer patient to specialist care consider trials of: -↑ICS to medium dose -Addition of a 4th drug - SR theophylline ↓ 5) Continuous or frequent use of inhaled steroids -refer to specialist care -use daily steroid tablet in the lowest dose providing adequate control -maintain medium dose ICS -consider use of other treatments to minimise use of steroid tablets
48
General advice for acute asthma in adults
- do not underestimate risk of death - emergency admissions are avoidable - patients who die have well-recognised risk factors which can be modified - PEF<50% - severe - PEF <33% - life-threatening - RR>25/min - HR>110/min - O2 saturation <92%
49
Severe/life threatening exacerbations present with what symptoms?
- cyanosis - difficulty speaking - unconciousness - tachycardia - severe dysponea
50
If an asthma patient requires hospitalisation due to an asthma attack, what do you do?
immediate prescription - oxygen at highest possible concentration 40-60% aiming for arterial oxygen saturation of 94-98% - B2-agonist nebulised - 5mg QDS or multiple doses (2-10 puffs of sabutamol 100mcg at 10-20 minute intervals via spacer, depending on severity) - corticosteroid: prednisolone 40-50mg oral at least 5 days OR IV hydrocortisone every 6 hours (hold ICS) - Consider: - Ipratropium nebules 500mcg 4-6 hourly - single dose IV magnesium sulphate if PEF<50% - IV theophylline/IV salbutamol
51
Magnesium sulphate
smooth muscle relaxant, T cell and mast cell stabiliser
52
Monitoring requirements if you've just admitted someone having an asthma attack
- PEF - O2 saturation (aim 94-98%) - arterial blood gases - HR/RR - tachycardia/ponea - CRP - WCC if infection is suspected - Theophylline levels (if continued >24h) - serum K+ (nebulised SABA) - glucose - hydration - Blood pH~7.4 (check for risk of acidosis)
53
When do you refer an asthma patient who is having an asthma attack to ITU?
- deteriorating PEF - persistent hypoxia - exhaustion, drowsiness - coma, respiratory arrest
54
During hospitalisation, after attack is dealt with
- IV→nebuliser→inhaler - oral steroid 40mg/50mg for 5 days at least, depending on severity - restart steroid inhaler - write and meet discharge criteria - make action plan - inhaler technique education

Pharmacy Year 2 Semester 2 (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions