asthma

Question 1

whats the treatment for an acute attack

Answer 1

(OSHITMMAN)

oxygen = 100% non-rebreather mask
Salbutamol (nebulised)
Hydrocortisone IV or prednisalone (oral)
Ipratropium (nebulised) 
Theophylline IV or aminophylline IV
Magnesium IV
Anaesthetist

Question 2

is asthma restrictive or obstructive

Answer 2

obstructive

Question 3

what is the main cell found in asthma

Answer 3

eosinophil

Question 4

what would be found in a FBC

Answer 4

blood eosinophilia>4%

Question 5

what would be heard when percussing

Answer 5

hyper-resonant

Question 6

what would you expect from pulmonary function tests

Answer 6

decreased FEV1
decreased PEFR
normal FVC

Question 7

describe FEV1

Answer 7

decreased

Question 8

describe FVC

Answer 8

normal

Question 9

describe PEFR

Answer 9

decreased

Question 10

what investigations are used (6)

Answer 10

spirometry 
peak flow
provocation testing 
exercise testing
skin prick test 
FBC

Question 11

what is the 1st line of treatment

Answer 11

SABA

Question 12

what is the 2nd line of treatment

Answer 12

SABA + ICS

Question 13

what is the 3rd line of treatment

Answer 13

LABA + ICS + SABA

Question 14

what is the 4th line of treatment

Answer 14

add 4th drug e.g
methylxanthines
CysLT1 Receptor Antagonists

Question 15

what is the 5th line of treatment

Answer 15

add oral steroid and refer to a specialist

Question 16

what is the mechanism of action of SABA

Answer 16

Agonist binds to beta-2-adrenoceptor and initiates chain of reactions that causes ATP to be converted into cAMP leading to relaxation of airway smooth muscle

Question 17

give examples of SABAs

Answer 17

salbutamol

terbutaline

Question 18

what are the side effects of SABAs

Answer 18

fine tremor, tachycardia, hypokalaemia

Question 19

what is the mechanism of action of LABAs

Answer 19

Agonist binds to beta-2-adrenoceptor which initiates chain of reactions that causes ATP to be converted into cAMP leading to relaxation of airway smooth muscle

Question 20

what are the side effects of LABAs

Answer 20

may worsen asthma is given as a monotherapy

Question 21

what should LABA be administered with

Answer 21

ICS

Question 22

give examples of LABAs

Answer 22

salmeterol

formeterol

Question 23

what is particularly useful in nocturnal asthma

Answer 23

LABA

Question 24

what is the mechanism of action of ICS

Answer 24

anti-inflammatory effects. Act by mediating transcription of specific genes to alter mRNA levels + rate of synthesis of inflammatory/anti- inflammatory mediator proteins

Question 25

give examples of ICS

Answer 25

beclometasone | budesonide

Question 26

what is the mechanism of action of methylxanthines

Answer 26

anti-inflammatory and limited bronchodilator action. Uncertain mechanisms

Question 27

give examples of methylxanthines

Answer 27

theophylline | aminphylline

Question 28

when would methylxanthines be used

Answer 28

4th step

Question 29

side effects of methylxanthines

Answer 29

many due to narrow therapeutic window

Question 30

when would ICS be used

Answer 30

2nd step

Question 31

when would SABA be used

Answer 31

1st step

Question 32

when would LABA be used

Answer 32

3rd step

Question 33

what is the mechanism of action of CysLT1 Receptor Antagonists

Answer 33

act competitively at the CysLT1 receptor cause smooth muscle | contraction, mucous secretion and oedema

Question 34

what are CysLTs derived from?

Answer 34

mast cells and infiltrating | inflammatory cells

Question 35

how are CysLTs administered

Answer 35

orally

Question 36

give examples of CysLTs

Answer 36

montelukast

Question 37

what Ig__ is present in asthma

Answer 37

IgE

Question 38

give an example of a monoclonal antibody therapy in asthma

Answer 38

Omalizumab

Question 39

what is the mechanism of action of Omalizumab

Answer 39

binds to IgE via Fc to prevent FCE receptor attachment

Question 40

how is Omalizumab administered

Answer 40

IV

Question 41

what type of hypersensitivity disease is asthma

Answer 41

type I

Question 42

what is asthma

Answer 42

recurrent and reversible obstruction of the airways in response to a stimuli/substance