Asthma and COPD Management Flashcards
(141 cards)
1
Q
Where are B2 adrenergic receptors generally located in the lungs?
A
- smooth muscle
- trachea down to terminal bronchioles
- ⬆️ noraadrenalin and adrenaline
2
Q
What are the 5 different methods drugs can be given for asthma and COPD?
A
1 - inhaled (inhaler and nebuliser)
2 - oral
3 - intravenous
4 - intramuscular
5 - subcutaneous
3
Q
What is the main benefit of use inhalers and nebulisers to deliver drugs to the lungs?
A
- direct deposition into the lungs
4
Q
What is the main disadvantage of use inhalers and nebulisers to deliver drugs to the lungs?
A
- technique dependent
- disease can reduce drug accessing lungs
- 8-15% of drugs reaches lungs
5
Q
What is the main benefit of taking asthma and COPD drugs orally?
A
- not technique dependent
6
Q
What is the main disadvantage of taking asthma and COPD drugs orally?
A
- dependent on absorption in GIT
7
Q
What are the 2 main benefits of taking asthma and COPD drugs intravenously?
A
1 - systemic effects
2 - not technique dependent
8
Q
What are the main disadvantage of taking asthma and COPD drugs intravenously?
A
- ⬆️ risk of side effects
9
Q
Are inhales and nebulisers fast acting?
A
- yes
- directly into lungs
10
Q
Why are inhalers and nebulisers associated with low risk of side effects?
A
- majority of drugs remains in lungs
- small amount may enter circulation
11
Q
Does the whole drug dose of the inhaler reach the lungs, even with the best technique?
A
- no
- aprox 8-15% reaches lungs
12
Q
Do all inhalers have the same size particles in the aerosol?
A
- no
- small, medium and large particles
13
Q
Why is it important to know the particle size of drugs delivered as inhalers or nebulisers?
A
- particle size affects where in the lungs drug reaches
14
Q
How can we identify where in the lungs an inhaler or nebuliser reaches?
A
- lung specific radio-labelling
- radio-label appears on gamma camera
15
Q
In addition to particle size, how does flow rate affect drug delivery in inhalers and nebbulisers?
A
- ⬇️ flow rate = poor drug delivery
- ⬆️ flow rate = good drug delivery
16
Q
Do B2 agonists target adrenoreceptors or muscarinic receptors?
A
- adrenergic receptors
- Gas specifically
17
Q
What is the basic pathway once an inhaler has bound to the Gas adrenergic receptor?
A
- adenylyl cyclase converts ATP to cAMP
- cyclic adenosine monophosphate (cAMP)
- cAMP activates protein kinase A (pKA)
- pKA activates intracellular phosphorylation
18
Q
How does protein kinase A cause vasodilation and bronchodilation?
A
- ⬇️ intracellular Ca2+
19
Q
In addition to bronchodilation, what are the other 2 things that inhalers are able to induce in the lungs that can cause problems in obstructive lung disease?
A
1 - ⬆️ mucous clearance
2 - ⬇️ vascular permeability
20
Q
Why is ⬇️ permeability following the use of an inhaler a good thing?
A
- ⬇️ acute inflammation
21
Q
What is the core drug used as a short term B2 agonist (SABA) for the treatment of asthma?
A
- salbutamol
- also known as ventolin
22
Q
Salbutamol (ventolin) (SABA) is the core drug used as a short term B2 agonist for the treatment of asthma. What is another drug that can often be used?
A
- terbutaline - also known as terbutaline
23
Q
What is the core drug used as a long term B2 agonist (LABA) for the treatment of asthma?
A
- salmeterol
24
Q
Salmeterol is the core drug used as a long term B2 agonist (LABA) for the treatment of asthma. what is another drug that can often be used?
A
- formoterol
25
How quickly can the short acting Salbutamol (ventolin) (SABA) take its affects?
- generally \<10 minutes
26
How long can the effects of the short acting Salbutamol (ventolin) (SABA) last?
- 3-5 hours - max dose several times/day
27
What are the 3 most common side effects from B2 adrenergic agonists (SABA)?
- tachycardia (B1 receptors in heart)
- termor (B2 in skeletal muscle)
- agitation
28
Would B2 adrenergic agonists used to treat asthma cause potential side effects on the sympathetic or para sympathetic nervous system?
- sympathetic - adrenergic are only in sympathetics system
29
Are there likely to be more side effects in inhalers or when B2 adrenergic agonist are given intravenously?
- intravenously - systemic distribution of drug
30
How quickly can the long acting Salmeterol (LABA) take its affects?
- usually within 30 minutes
31
How long can the long acting Salmeterol (LABA) affects last?
- 10-12 hours - max dose twice a day
32
How can the long acting Salmeterol (LABA) be administered?
- inhaler only
33
Can the long acting Salmeterol (LABA) be administered in isolation like Salbutamol (Ventolin)?
- no - ALWAYS administered with inhaled corticosteroids (ICS) and or LAMA
34
In addition to treating asthma, what can the combination of long acting Salmeterol (LABA) and inhaled corticosteroids (ICS) be used to treat?
- COPD - common treatment
35
What is the common core drug used as a short term muscarinic antagonist (SAMA) in the treatment of asthma and COPD?
- Ipratropium Bromide (SAMA) - also known as Atrovent
36
Ipratropium Bromide (Atrovent) is a short acting muscarinic antagonist (SAMA), which GPCR does it act on?
- M3 muscarinic receptors - Gaq (M1, M3 and M5 are Gaq)
37
Ipratropium Bromide (Atrovent) is a short acting muscarinic antagonist (SAMA), acting on the Gaq GPCR receptors, how does it cause bronchodilation?
- inhibits Ca2+ release - ⬇️ Ca2+ = brochodilation
38
What is the basic pathway for Gaq, which muscarinic antagonist act on?
- phospholipase C cleavea PiP2
- PiP2 cleaved into IP3 and DAG
- IP3 binds to sarcoplasmic retculum and ⬆️ Ca2+
- Ca2+ and DAG activate protein kinase C (pKC)
- pKC activates phosphorylation
39
Ipratropium Bromide (Atrovent) is a short acting muscarinic antagonist (SAMA), how long does it take to have an effect on the patient?
- 30 minutes
40
Ipratropium Bromide (Atrovent) is a short acting muscarinic antagonist (SAMA), how long do the effects last for?
- 6 hours - can be used up to 4/day
41
Ipratropium Bromide (Atrovent) is a short acting muscarinic antagonist (SAMA) generally used to treat asthma, but what other obstructive lung disease can it be used to treat?
- COPD - 20-40ug quantum dots (qds) nano carriers for drugs
42
If a patient has an acute exacerbation of asthma or COPD, why is Ipratropium Bromide (Atrovent), a short acting muscarinic antagonist (SAMA) given via a nebuliser?
- higher dosage of the drug delivered - 250-500ug quantum dots (qds) nano carriers for drugs
43
Do short term B2 adrenoreceptor agonist (SABA) or short term muscarinic antagonists (SAMA) have a larger bronchodilator effect?
- SABA - SABA and SAMA together are best
44
Ipratropium Bromide (Atrovent) is a short acting muscarinic antagonist (SAMA), in addition to bronchodilation, what else do they help with in obstructive lung diseases such as asthma and COPD?
- ⬇️ mucus production
45
Does Ipratropium Bromide (Atrovent), a short acting muscarinic antagonist (SAMA) influence the parasympathetic nervous system?
- minimal effects - muscarinic only in parasympathetic system
46
What is the common core drug used as a long term muscarinic antagonist (LAMA) in the treatment of asthma and COPD?
- Tiotropium
47
Tiotropium is a long acting muscarinic antagonist (LAMA), in addition to bronchodilation, what else do they help with in obstructive lung diseases such as asthma and COPD?
- ⬇️ bronchospasm - ⬇️ mucus production
48
Tiotropium is a long acting muscarinic antagonist (LAMA), how long does it generally last for?
- 12-24 hours - max 2/day
49
Tiotropium is a long acting muscarinic antagonist (LAMA), how is it administered?
- inhaler
50
What are some common side effects of long and short acting muscarinic antagomists?
- dry mouth - blurred vision - urinary retention - cardiac arrhythmia's - dizziness - epistaxis (nose bleeds) - closed angle glaucoma (iris bulges forward)
51
What are corticosteroids?
- class of steroid hormones
52
Other than antibiotics, what is the most commonly prescribed drug for lung disease?
- corticosteroids
53
What is the main purpose for the use of corticosteroids in lung disease?
- anti-inflammation - they do have systemic effects
54
Where are corticosteroids receptors located in the body?
- on most cells in the body
55
How do corticosteroids induce their effects in the body?
- hormone so can cross plasma membrane
- binds to glucocorticoid receptor in cytoplasm
- receptor binds to nucleus and enters
- specifically binds to nucleotides
- ⬇️ inflammatory translation and transcription occur
- ⬇️ inflammatory protein translation
56
What is the most common corticosteroids prescribed orally to patients with lung disease?
- prednisolone
57
What is the most common corticosteroids prescribed as an inhaler to patients with lung disease?
- beclomethasone
58
What are the benefits of administering corticosteroids intravenously or orally?
- stronger effects as higher doses available - not technique dependent - better route in the ill and in emergency
59
What are the disadvantages of administering corticosteroids intravenously or orally?
- ⬆️ risk of side effects - especially in long term treatment
60
What are the benefits of administering corticosteroids using an inhaler?
- localised action - ⬇️ side effects
61
What are the disadvantages of administering corticosteroids through an inhaler?
- disease may prevent penetration of drug
62
Beclomethasone is a corticosteroid used to treat lung disease through inhalers. What are the 3 common side effects associated with them?
1 - immunocompromised, ⬇️ ability to fight infections
2 - oral candidiasis (fungal infection)
3 - dysphonia (croaky voice)
63
Beclomethasone is a corticosteroid used to treat lung disease through inhalers. Immunocompromised, oral candidiasis (fungal infection) and dysphonia (croaky voice) are common side effects, what can be done to reduce them?
- gargle prior to administration - use spacer for mdi - use turbohaler
64
What are some short term (days) effects of steroids used in lung disease?
- indigestion - skin bruising - insomnia - psychosis
65
What are some medium term (weeks) effects of steroids used in lung disease?
- gastric ulcers - skin bruising - insomnia - psychosis - weight gain
66
What are some long term (months) effects of steroids used in lung disease?
- osteoporosis - growth retardation - weight gain - cushingoid appearance (moon face) - adrenal suppression - hypertension - diabetes
67
What are the 3 main types of inhaler devices?
1 - pressurised metered dose inhaler with spacer 2 - dry powder inhaler 3 - soft mist inhaler
68
What are spacers?
- volumetric device with one way valve - ⬆️ space between actuator and mouth - ⬇️ oropharyngeal drug deposition
69
Why are spacers used with inhalers?
- ⬆️ drug delivery to lungs
70
What is combination therapy?
- multiple drugs given together - work synergistically
71
Does combination therapy improve anything other than respiratory symptoms?
- improves patients quality of life
72
Why is combination therapy used?
- ⬆️ efficacy and max brochodilation - cost effective - ⬆️ compliance
73
When considering the stepwise guide to treating asthma, is it better to increase a dose of a drug, or to use combination therapy and provide a second different drug?
- combination therapy is best
74
What is a nebuliser?
- breathing device - able to deliver large dose of drugs as an aerosol
75
In patients with exacerbations of asthma and COPD, what adrenergic and muscarinic drugs are given through a nebuliser?
- short acting adrenergic agonists - short acting muscarinic antagonists
76
In addition to providing a large dose of a drug as an aerosol, nebulisers be useful in asthma and COPD to distinguish what?
- distinguish between asthma and COPD
- if asthma symptoms improve rapidly (reversible)
- if COPD symptoms do not improve (non-reversible)
77
What are methylxanthines?
- non selective phosphodiesterase inhibitors and bronchodilators
78
Methylxanthines are phosphodiesterase inhibitors, what is the mechanism of action?
- small molecules so can cross plasma membrane
- inhibit breakdown of cAMP, so cAMP ⬆️ in cells
- ⬆️ protein kinase A
- ⬇️ Ca2+ = bronchodilation
79
Which Methylxanthines is given orally to treat chronic asthma and COPD?
- Theophylline
- T - think Throat
80
Which Methylxanthines is given intravenously to treat exacerbations of asthma and COPD?
- Aminophylline
- A - think given in the Arm
81
Does methylxanthines have a large or narrow therapeutic window?
- narrow window
82
What is a common mucolytic drug?
- drug that breaks down mucus - easier to cough up mucus in COPD
83
What is the common drug administered as a mucolytic drug?
- Carbocisteine
- C think Cough up mucus
84
What drug can be prescribed to treat exercise induced asthma that is able to inhibit leukotrienes?
- Montelukast
85
Oxygen as a drug is used to treat patients with type 1 respiratory failure (PaO2 \<7.8 kPA or 60mmHg), what is the target SaO2?
- 94-98%
86
Oxygen as a drug is used to treat patients with type 2 respiratory failure (PaO2 \<7.8 kPA or 60mmHg and PaCO2 \>48mmHg or 6.5kPA), what is the target SaO2?
- 88-92%
87
What can inappropriate use of O2 cause?
- iatrogenic (caused by medical treatment)
- type 2 respiratory failure
- death
- CO2 retention
- acidosis
88
Is O2 used for patients with breathlessness?
- no
89
What are the main methods O2 can be delivered to patients?
- nasal cannula
- simple face masks
- re-breathe mask (bag on mask)
- controlled O2 via venturi mask
90
When is a venturi mask recommended?
- type 2 respiratory failure
91
In type 2 respiratory failure why is a venturi mask useful when delivering O2 % and rates of flow?
- various levels of O2 can be delivered - various flow rates of O2 can be delivered
92
When using a venturi mask recommended what is the SaO2 target?
- 88-92%
93
What is long term O2 therapy?
- O2 given in O2 canisters - patients transport this around with them
94
Only when O2 drops below a certain level would long term O2 therapy be recommended, what is this level?
- continuously \<7.3 kPA or 55mmHg
95
What respiratory diseases would long term O2 therapy be used in?
- COPD - pulmonary fibrosis - pulmonary hypertension
96
When treating patients with asthma and COPD with antibiotics, why is it important, where possible to check the sensitivity of the organism?
- antibiotic resistance
97
When treating patients with asthma and COPD with antibiotics, what must you always do?
- check allergies - drug interactions - drug contradictions
98
What are 2 of the most common bacteria that cause infection in asthma and COPD?
- streptpcoccus pneumonia
- staphylococcus aureus
99
What are the common antibiotics prescribed to patients with asthma and COPD for streptococcus pneumonia?
- amoxicillin (penicillin) - clarithromycin (macrolides)
100
What are the 3 main guidelines set out by the British Thoracic Society and Scottish Intercollegiate Guidelines Network for common acute asthma management?
- avoid allergens
- smoking cessation
- inhaled therapy personalised asthma plan (PAP)
- regular review of PAP
101
When consulting the stepwise guidelines to asthma management, what is generally the first treatment option?
- low dose of inhaled corticosteroids
102
If a patient does not respond to treatment, is it best to increase the dosage or the current treatment such as inhaled corticosteroids?
- no - better to add another medication such as B2 agonist
103
What is a preventer in the treatment of asthma and COPD?
- inhaler to ⬇️ inflammation - blocks inflammation pathway
104
If inhaled corticosteroids fails as the first line of treatment, what preventer would generally be recommended to combine with the inhaled corticosteroids?
- long lasting B2 agonist - Salmeterol (long lasting B2 agonist)
105
What is a reliever in the treatment of asthma and COPD?
- used to treat acute exacerbations - inhaler to ⬆️ bronchodilation
106
When should a reliever inhaler in the treatment of asthma and COPD be used?
- when symptoms are exacerbated
107
When should a preventer inhaler in the treatment of asthma and COPD be used?
- every day - regardless of symptoms
108
What drug is used most commonly as a reliever?
- short acting B2 agonists - Salbutamol
109
Why is a personalised action plan for asthma important?
- ⬆️ asthma control - ⬇️ emergency contact with GP - ⬇️ hospital administrations
110
What should be included in the annual check up with the GP about a patients asthma plan?
- number of exacerbations - review of medication - compliance to medication - spirometry
111
If a patients symptoms decline or their asthma management is poor, where would a GP refer the patient to?
- secondary care specialist
112
If a patient with asthma had an exacerbation and attended A+E what would be the first examination the medics would do?
- assess pulse oximetry - SaO2 \>92%
113
If a patient with asthma has an exacerbation and attends A+E with a PaO2 \<92%, what would be the first examination the medics would do?
- check arterial blood gas - life threatening asthma
114
What sort of scan is routinely carried out in patients with respiratory symptoms?
- Chest X-ray
115
If possible to attain, what 2 respiratory measures would be useful?
- PEF - FEV1
116
If a patient with asthma had an exacerbation and attended A+E what would be the first line of treatment the medics would administer?
- high dose using a nebuliser - B2 agonist (salbutamol) + M3 inhibitor (ipratropium bromide)
117
If a patient with asthma had an exacerbation and attended A+E a steroid may be given. Would this be through an inhaler or orally/intravenously?
- orally or intravenously - provides systemic effect
118
If a patient with asthma had an exacerbation and attended A+E a steroid may be given. What steroid would be given intravenously?
- hydrocortisone
119
If a patient with asthma had an exacerbation and attended A+E a steroid may be given. What steroid would be given orally?
- prednisolone
120
If a patient with asthma attended A+E with a severe asthma attack what mineral could be given intravenously?
- magnesium
121
Why is magnesium given in severe asthma attacks?
- bronchodilator
- stabilises T cells
- ⬇️ inflammation
122
Can aminophylline be given intravenously in acute asthma?
- yes - acts a bronchodilator
123
How long should a patient be on the medication they will continue to take once discharged, prior to being discharged?
- 24 hours
124
Prior to being discharged from hospital after an acute asthma attack, what should the patients PEF1 be?
- \>75% of best or predicted
125
Prior to being discharged from hospital after an acute asthma attack, what should the patients diurnal variability be?
- \<25%
126
Prior to being discharged from hospital, what must the patient be checked and advised for, which are similiar to the British Thoracic Soceity guidelines?
- check inhaler technique
- personalised asthma plan is understood
- smoking cessation (support and guidance)
- ⬇️ oral steroid dose slowly
- review with doctor/nurse in 2 weeks
127
In COPD, do patients lung function improve or gradually decline?
- progressively decline
128
Is COPD reversible?
- largely irreversible
129
Is type 1 or 2 respiratory failure likely in patients with COPD?
- type 2 respiratory failure
130
What is cor pulmonale?
- right heart failure caused by respiratory disease
- COPD patients are at risk of this
131
What are some simple lifestyle advice that patients with COPD should recieve?
- smoking cessation - ⬆️ activity - improved nutrition
132
In COPD what are the normal pharmacological management plans?
- inhaler therapy
- manage exacerbations
- long term O2 therapy
- non-invasive ventilation
133
In extreme cases what treatment could patients with COPD have?
- lung transplant - lung resection
134
In COPD what are the normal non pharmacological management plans?
- pulmonary rehabilitation - counselling - palliative care
135
In COPD what pharmaceuticals do patients take to manage their symptoms?
- short acting B2 agonist
136
In COPD what combinations of pharmaceuticals do patients take?
- ICS + LABA + LAMA
137
In COPD why are they administered with Theophylline?
- bronchodilator - given orally
138
Why are COPD patients given a carbocisteine?
- mucolytic drug - helps thin mucus and open airways
139
If patients with COPD have an acute exacerbation, what are the common pharmacological management options?
- nebulised short acting B2 agonist
- systemic steroids
- controlled O2
- intravenous aminophylline
- non invasive ventilation
- antibiotics
140
What improves survival in COPD?
- long term O2 therapy - non invasive ventilation - lung volume reduction therapy
141
What are some basic points to consider when discharging a COPD patient?
- nutrition - smoking cessation - appropriate inhaler and correct technique - pulmonary rehabilitation - palliative care - vaccinations - psychological support
