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RESP & GIT Pharmacology > Asthma, Allergic Rhinitis, Anaphylaxis > Flashcards

Asthma, Allergic Rhinitis, Anaphylaxis Flashcards

1
Q

Asthma

A 
Hyperresponsive airways (inflammatory condition)
-wheezing
-tight chest
-cough
-dyspnea
(Worse early morning)
  • constriction of smooth muscles
  • chronic inflammation leading to narrowed airways
  • overproduction of mucus
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2
Q

Controllers in asthma

A

Anti-inflammatory and/or sustained bronchodilator action

  • Inhaled, oral and IV corticosteroids
  • Leukotriene receptor antagonists
  • Cromolyns
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3
Q

Beclomethasone

A

Inhaled corticosteroid
-controller

SE: dysphonia, oral candidiasis

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4
Q

Oral corticosteroid indications

A
  • poorly controlled asthma at high doses of ICS and controller medication
  • rescue medication (to regain control of Sx)
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5
Q

Leukotrine receptor antagonists

A

-Controller in asthma (oral agent)
-blocks receptor for cysteinyl leukotrines
(Leukotrines released from activated mast cells and eosinophils causing oedema, smooth muscle contraction and enhanced mucus secretion)

  • prevent early and late bronchoconstrictor responses (allergens, aspirin sensitive asthma, exercise induced asthma)
  • prevention of chronic asthma
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6
Q

Sodium chromoglycate

A
  • controller in asthma

- prevents histamine release form mast cells

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7
Q

Long acting B2 agonists

A

-controllers: bronchodilators, but weak/unproven anti-inflammatory effect

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8
Q

Relievers

A

SABA

Ipratropium bromide - anticholinergic

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9
Q

Short acting B agonists mechanism

A
  • stabilize mast cells (inhibit mediator release)
  • enhance mucociliary clearance
  • stimulate B2 receptors of airway smooth muscle

-may be used as sole therapy in mild intermittent asthma and exercise induced asthma

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10
Q

Salmeterol

A

Long acting B2 agonist

-sustained bronchodilator action but weak/unproven anti-inflammatory effect

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11
Q

Formoterol

A

Long acting B2 agonist

-sustained bronchodilator action but weak/unproven anti-inflammatory effect

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12
Q

Corticosteroid side effects

A

Inhaled: dysphonia, oropharyngeal candidiasis

Systemic with oral

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13
Q

Budenoside

A

Inhaled corticosteroid

-controller for asthma

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14
Q

Ciclesonide

A

Inhaled corticosteroid

-controller in asthma

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15
Q

Fluticasone

A 
Inhaled corticosteroid (long acting!!)
-controller in asthma

-T1/2 = 14h (others ICS only 3h)

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16
Q

Methylxanthines

A

Aka. Phosphodiesterase inhibitors
-Sustained release theophylline

-narrow therapeutic index NB

17
Q

Salbutamol

A

Short acting B2 agonist

-reliever in asthma

18
Q

Fenoterol

A

Short acting B2 agonist

-reliever in asthma

19
Q

Terbutaline

A

Short acting beta 2 agonist

-reliever in asthma

20
Q

B agonist side effects

A
  • tachycardia
  • irritability
  • headaches
  • tremor
  • metabolic effects and hypokalemia in large systemic doses
21
Q

Long acting B2 agonist indications

A

-bd use with low dose ICS (NEVER MONOTHERAPY)

  • control Sx
  • reduce frequency of exacerbations

-useful for nocturnal Sx and exercise induced asthma

22
Q

Ipratropium bromide

A

Anticholinergic
-reliever in asthma

-used in pts who cannot tolerate B2 agonist SE (esp elderly)

  • potent inhibitor of vagus-mediated bronchoconstriction
  • not a preferred reliever, more useful in COPD
23
Q

Anticholinergic SE

A
  • dry mouth
  • nausea
  • constipation
  • tiotropium - may cause urinary retention in prostatism
  • arrhythmias
24
Q

Theophylline

A

Phosphodiesterase inhibitor aka methylxanthine

-reliever in asthma

25
Q

Aminophylline

A 
Phosphodiesterase inhibitor (aka methylxanthines)
-reliever in asthma
26
Q

Phosphodiesterase inhibitors mechanism

A
  • inhibit enzymes that degrades cAMP -> increased cAMP lvls -> bronchodilation
  • narrow therapeutic index
27
Q

GINA step 1

A

Controller: Consider low dose ICS

Reliever: SABA as needed

28
Q

GINA step 2

A

Controller: low dose ICS

Other controller options: Leukotriene receptor antagonist or low dose theophylline

Reliever: SABA

29
Q

GINA Step 3

A

Controller: Low dose ICS + LABA

Other controller options:
-med/high dose ICS
OR
-low dose ICS + leukotriene receptor antagonist / theophylline

Reliever:
-SABA as needed
OR
-low dose ICS/formoterol

30
Q

GINA Step 4

A

Controller: med/high dose ICS + LABA

Other controller option:
-Triotropium bromide, High dose ICS + leukotriene receptor antagonist (or theophylline)

Reliever:
-SABA as needed
OR
-low dose ICS/formoterol

31
Q

GINA step 5

A

Controller: refer for add-on Rx eg anti-IgE

Other controller options:
- add tiotropium bromide and low dose oral corticosteroids

Reliever:
-SABA as needed
OR
-low dose ICS/formoterol

32
Q

Asthma Rx plan

A

All pts: 2 puffs SABA as needed

All pts: ICS as baseline Rx

If not well controlled: add LABA (preferred over raising the ICS dose, never use LABA alone)

Alternative: double ICS dose, or add LTRA (montelukast) or PDI (theophylline)

Oral steroids and IgE therapy only to be used as maintenance with extreme caution

33
Q

1st Gen antihistamine SE

A 
Dry mouth
Urinary retention
Tachycardia
Sedation
Weight gain
Constipation
34
Q

Antihistamine mechanism

A

Competitive antagonist at H1 receptor site

35
Q

Chlorpheniramine

A

1st gen antihistamine

36
Q

Fexofenadine

A

2nd gen antihistamine

37
Q

Levocetirizine

A

2nd gen antihistamine

38
Q

Promethazine

A

1st gen antihistamine

RESP & GIT Pharmacology (4 decks)

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