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RM - Resp Conditions Profiles > Asthma Pharmacology - Detailed > Flashcards

Asthma Pharmacology - Detailed Flashcards

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1
Q

What is the initial management for anyone presenting with asthma?

A

ICS and SABA

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2
Q

What is the indication to move from step 1 to step 2 of asthma management?

A

If the SABA is being used more than 3 times a week

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3
Q

What is the 2nd step of asthma management?

A

Add a LABA

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4
Q

Normally, how is the LABA administered?

A

In combination with an ICS

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5
Q

If a patient shows no responce to a LABA, what should be done?

A

Stop it and increase the ICS to medium dose

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6
Q

If a patient shows a responce to the LABA, what should be done if they still require further treatment?

A

Continue the LABA and increase the ICS dose to medium

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7
Q

What is another option in asthma management if a patient does have a responce to LABAs?
(but you dont want to increase the ICS dose)

A

Trail of a leukotriene receptor antagonist, SR theophylline or a LAMA

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8
Q

What are the 3 components of Step 4 asthma management?

A

High dose ICS
Add a 4th drug
Refferal

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9
Q

What are the 4 options of alternative asthma drugs that can be added as a 4th drug?

A

Leukotriene receptor antagonist
SR theophylline
Beta agonist tablet
LAMA

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10
Q

What is the final step of asthma management?

A

Daily oral prednisolone and refer

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11
Q

In the general management of asthma, any extrinsic causes/triggers should be ___ ____ __ _____ __ ____

A

Rapidly identified and removed if possible

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12
Q

Passive, and active _____ should always be avoided in asthma

A

Smoking

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13
Q

What are the 3 advantages of administering asthma meds through inhalation?

A

Direct delivery to the lungs
Avoids first-pass metabolism via the liver
Lowers dose needed and systemic effects

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14
Q

What is the general indication of asthma deterioration and therefore the need for more intensive management?

A

Increased reliever/bronchodilator usage

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15
Q

What should be done if asthma has been well controlled for 2/3 months?

A

The treatment reviewed and the steroid dose reduced

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16
Q

What beta agonists are selective to the resp tract?

A

Beta 2

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17
Q

Where are Beta 1 adrenoceptors?

A

The myocardium

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18
Q

What is the general effect of beta-agonists and what do they not do?

A

Relaxation of bronchial smooth muscle

Dont help with underlying airway inflammation

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19
Q

What kind of drug is Salbutamol?

A

SABA

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20
Q

What is the normal dose of SABA?

A

2 puffs when required

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21
Q

What are the 4 side effects of SABAs?

A

Fine tremor
Tachycardia
Arrhythmias
Hypokalaemia

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22
Q

What type of drug is terbutaline?

A

SABA

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23
Q

What time frame does a SABA work within, peak at and then last for?

A

5 mins
Peak - 30 mins
Lasts - 3-5 hrs

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24
Q

What type of drug is salmeterol?

A

LABA

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25
When are LABAs taken?
Everyday, regardless of symptoms
26
What type of drug is formoterol?
LABA
27
What is a fundamental to remember about LABA administration?
Should never be administered alone, always with an ICS
28
What are the 2 LABA/ICS combination inhalers
Salmeterol & fluticasone Formoterol & budesonide
29
What is seratide composed of?
Salmeterol and fluticasone
30
What type of drug is useful in noctural asthma?
LABAs
31
What type of muscarinic receptors are in the large airways?
M3
32
What type of muscarinic receptors are in the peripheral lung tissue?
M1 and M3
33
What type of drug is Ipratropium?
Anti-muscarinic bronchodilator
34
When are anti-muscarinic bronchodilators useful?
In exacerabtions
35
What are the 2 anti-muscarinics that are useful in severe exacerabtions?
Tiotropium or adidium
36
What type of drug is oxitropium bromide?
Antimuscarinic bronchodilators
37
What type of drug is sodium cromoglicate?
Mast cell stabliser
38
What type of drugs are sodium cromoglicate and nedocromil sodium?
Anti-inflammatories
39
What is the mechanism of action of asthma anti-inflammatory drugs?
Prevent activation of immune cells by blocking Ca2+ influx
40
What are the 3 immune cells that are blocked by asthma anti-inflammatories?
Mast cells Eosinophils Epithelial cells
41
When are anti-inflammatories used in asthma?
In milder asthma as a preventer (not a reliever)
42
What is the mechanism of action of ICS? (3)
Work by modifying genes - increase the transcription of anti-inflammatory genes, and decrease the inflammatory protein gene transcription
43
ICS's prevent the formation of Ig _
IgE
44
ICS's decrease ___ cytokine formation and cause ___
Th2 | Apoptosis
45
ICS's prevent allergen induced ___ influx into the lungs and cause __
Eosinophil | apoptosis
46
ICS's decrease the number of ___ __ and their IgE receptor expression
Mast cells
47
What are the 2 very general effects of ICSs?
Prevent inflammation | Reduce established inflammation
48
When are ICS's most effective?
In the long term - at preventing attacks
49
Why is the dose of ICSs metered?
To prevent unwanted, systemic side effects
50
How long does it take for ICSs to become active?
A few days
51
What are the 4 unwanted effects of ICSs?
Dysphonia (hoarse voice) Oral candidiasis Sup-capsular cataract formation (rare, but can occur in elderly) Stunted growth in children (final height not affected)
52
What 3 things must be included in good ICS technique?
Use of a spacer Mouth rinsing post-use Teeth cleaning post-use
53
What makes ICSs less effective?
Smoking
54
What are the 3 situations in which oral corticosteroids are used?
Chronic asthma Severe asthma Deteriorating asthma
55
What type of drug is methotrexate?
Oral corticosteroid
56
What type of drug is beclometasone dipropionate?
ICS
57
What type of drug is budesonide?
ICS
58
What type of drug is cicrolosporin?
Oral corticosteroid
59
What type of drug is fluticasone propionate and fluticasone furoate?
ICS
60
What type of drug is prednisolone?
Oral corticosteroid
61
What type of drug is montelukast?
Leukotriene receptor antagonist
62
Where are cysteinyl LT1 receptors?
Bronchial smooth muscle
63
What are the 3 effects of cysteinyl LT1 receptors?
Bronchial smooth muscle contraction Mucus secretion Oedema
64
What type of drug is zarfirlukast?
Leukotriene receptor antagonist
65
How are Leukotrine antagonists administered?
orally
66
What are leukotriene antagonists effective against?
The early and late bronchospasm in mild, persistent asthma
67
What are the 2 types of asthma are leukotriene antagonists used in?
Antigen-induced | Exersize-induced
68
Overall, leukotriene antagonists are well tolerated. What are the 2 potential adverse effects?
Headache | GI upset
69
What type of drug is theophylline?
Methylxanthine
70
What is the assumed mechanism of action of methylxanthines?
Inhibition of PDE (phosphodiesterase) stops cAMP break down, which therefore relaxes bronchial smooth muscle
71
What are the 2 general effects of methylxanthines?
Bronchodilatory | Anti-inflammatory
72
Methylxanthines increase ____ motility and reduce ___
Diaphragmatic | Fatigue
73
What drugs should methylxanthines be used in combination with?
Beta-agonists | Glucocorticosteroids
74
Methylxanthines have a __ __ therapeutic window
very narrow
75
What 4 things are affected in the side effects of methylxanthines?
CNS CVS GI tract Kidneys
76
What are the 3 main side effects of methylxanthines when dose is too great?
Arrhythmias seizures hypotension
77
In the theraputic range of methylxanthines, what are the 4 side effects that can occur?
Nausea Vomiting Abdo discomfort Headache
78
What kind of drugs can have adverse interactions with methylxanthines?
CYP450 drugs, especially antibiotics that inhibit CYP450 enzymes
79
What type of drug is omalizumab?
IgE monoclonal antibody
80
Describe the mechanism of action of omalizumab
They bind to IgE via the Fc receptor, preventing their attachment to mast cells, and therefore suppressing the allergen responce
81
When is omalizumab cost effective?
In patients that require frequent hospital admissions
82
Describe the administration of omalizumab
IV every 2-4 weeks
83
What 2 things does the dose of omalizumab depend on?
Body weight and total serum IgE
84
What type of drugs are mepolizumab and reslizumab?
Monoclonal antibodies against IL-5
85
When are IL-5 antibodies used in asthma?
Asthma associated with severe eosinophillia (steroid refractory)

RM - Resp Conditions Profiles (8 decks)

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