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Respiratory Pharmacology > Bronchial Asthma > Flashcards

Bronchial Asthma Flashcards

1
Q

Mention non-pharmacological treatment of asthma

A

Smoking cessation
Physical activity
Avoid NSAIDs

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2
Q

Mention as-needed reliever in all steps of BA & its alternative

A

Low dose ICS may be given ICS/formoterol as formaterol has rapid onset with rapid relief
A: SABA

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3
Q

Mention initial treatment in all 5 steps of BA

A 
Step 1: Low dose ICS-formoterol
Step 2: Low dose ICS or as-needed low dose ICS - Formoterol
Step 3: Low dose ICS - LABA
Step 4: Medium dose ICS + LABA
Step 5: High dose ICS + LABA
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4
Q

Describe mechanism of selective beta2 agonist

A

Increase intracellular cAMP:

  1. Bronchodilatation
  2. Mast cell stabilization
  3. Increased bronchial mucocilirat clearnace
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5
Q

Mention examples of SABA & routes of administration

A

Salbutamol (albuterol) , terbutaline

Inhalation, oral, IV

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6
Q

Describe indications of action of SABA

A

-Rapid onset & short acting (4hrs) used as short-term reliever in Asthma & COPD, prophylactic in exercise induced asthma (10 min before).

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7
Q

Mention examples & routes of administration of LABA

A

Salmeterol - formeterol

Inhalation

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8
Q

Mention adverse effects of Selective beta2 agonists

A

Tremors, tachycardia, tolerance, hypokalemia, hypoxemia.

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9
Q

GR: Selective beta2 agonists cause tolerance & hypoxemia

A

T: down rehulation of beta receptor with regular use.
H: V/Q ratio worsens (b2 stimulation, vasodilation mora than BD, insufficient oxygenation)

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10
Q

Unlike other LABA, formeterol can be used as ….. + …..

A

Rescue medication (rapid onset) + ICS

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11
Q

GR: LABA should never be administered alone.

A

As their anti-inflammatory effect is insignificant & their bronchodilator effect masks the progression in asthma severity so inc risk of mortlaity.

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12
Q

GR: Epinephrine is rarely used in asthma

A

It is replaced by selective b2 agonists due to shorter action, non-selectivity leading to tachycardia, arrhythmia & inc BP.

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13
Q

Uses of epinephrine

A

Bronchospasm esp in anaphylaxis

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14
Q

GR: Ephedrine is rarely used

A

CNS side effects & availability of more effective agents

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15
Q

Route of administration of antimuscurinic drugs.

A

Inhalation alone or w/ b2 agonists

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16
Q

Mechanism of action of antimuscarinic drugs

A

M3 receptors in bronchial musculature, blockade of vagally-mediated bronchospasm and mucus secretion.

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17
Q

Indications of ipratropium

A
  1. Bronchodilator in BB-induced asthma, that due to psychogenic stimuli & patients intolerant to b2 agonists/ theophylline esp cardiac, elderly & thyrotoxic patients.
  2. Adujant to b2 agonists
  3. COPD
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18
Q

Disadvantages of ipratropium

A
  1. Tolerance: due to acting on M2 as well as M3

2. Delayed onset of action & less effective than b2 agonists in asthma

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19
Q

Use & advantage of tiotropium

A

Maintenance therapy in COPD

It is not associated with tolerance

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20
Q

Caffeine is more selective on ………, while theophylline is more selective on …….. .

A

CNS & cerebral vessels

Smooth muscles

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21
Q

Mechansim of action of methylxathines

A
  1. Inhibit phosphodiesterase, inc cAMP:
    a. Direct BD
    b. Anti-inflammatory, dec mast cell mediators & cytokines.
  2. Block adenosine receptors, BD
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22
Q

Methylxanthines are metabolized in …. By ….

A

Liver, CYP450

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23
Q

Factors increasing theophylline serum level

A

Neonates & elderly, hepatoc disease, heart failure, viral infections, enzyme inhibitors (erythromycin, OC, cipro, zileuron, zafirlukast)

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24
Q

Factors decreasing theophylline serum level

A

Children, heavy smokers & drinkers, enzyme inducers (rifampicin, phenobarbital, phenytoin, carbamazepine)

25
Describe the anti-asthma & skeletal muscle effects of theophylline
1. Bronchodilation (for acute) , anti-inflammatory (for chronic) 2. Inc contractility & reverse fatigue of diaphragm in COPD
26
Mention CNS pharmacological & adverse effects of theophylline
P: alertness, respiratory stimulant A: insomnia, anxiety, headache, convulsions, tremors.
27
Describe CVS pharmacological & adverse effects
P: VC of cerebral blood vessels A: +ve inotropic & chronotropic, sinus tachycardia & arrythmia, VD & hypotension, cardiac arrest.
28
Mention adverse effects of theophylline on GIT
Anorexia, nausea, vomitting (CI: peptic ulcer) | Proctitis
29
Effect of theophylline on kidney
Weak diuretic action
30
GR: Increased risk of toxicity with theophylline (disadvatages of theophylline
Narrow safety margin Saturation kinetics requiring drug monitoring High Risk of drug interactions
31
Indications of theophylline
1. 2nd or 3rd line of treatment in BA, for relief of acute bronchospasm, long-term control esp nocturnal asthma (SR), acute severse asthma. 2. COPD 3. Neonatal apnea
32
Aminophylline is
Theophylline & ethylenediamine to increase solubility
33
Indication of SR theophylline
Control medication & in nocturnal dyspnea, as it is long acting
34
Advantages of low dose theophylline
Full anti-inflammatory effect | No need to monitor level
35
What is the goal of asthma treatment?
To achieve and maintain clinical control (by suppressing inflammation using long term controller medication)
36
What is the mechanism of action of glucocorticoids in asthma?
Immunosuppresive & anti-inflammatory: inhibit phosphodiesterase, dec influx of inflammmatory cell/mediators, dec bronchial inflammation & hyper-responsiveness. -Potentiate beta2 agonists: downregulate b2 receptors
37
Indications of corticosteroids in asthma
1. Control medication 2. Rescue medication in acute exacerbations not responding to b2 agonists 3. Acute severe asthma
38
GR: Oral corticosteroids should be given in the early morning.
To coincide with circadian rhythm of CS to dec adrenal suppression.
39
Ciclesonide is a prodrug activated by ……
Bronchial esterases
40
Advantages of Ciclesonide over other ICS
High 1st pass metabolism & tight plasma protein binding, less systemic side effects Less frequent candidiasis
41
Adverse effects of glucocorticoids
1. Oropharyngeal candidiasis 2. Hoarseness of voice 3. Cataract - glaucoma 4. Osteoporosis 5. Retardation of growth 6. Hypertension 7. Diabetes 8. Cushing syndrome 9. Adrenal suppression
42
Side effects of glucocorticoids are minimized by
- Gargling & spitting following inflammation | - Use of spacer device
43
Mention limitations of zileuton
Liver toxicity & frequent dosing
44
Describe the mechanism of Zafirlukast-Montelukast.
LTs receptor anatgonists, bronchodilation & anti-inflammatory
45
Mention indications of Montelukast
1. Control medications in persistent asthma: - Alternatives to inhaled steroids in mild persistent asthma (for patients intolerant to steroids or cannot use inhalers) - Added in moderate to severe cases 2. Aspirin induced asthma 3. Exercise-induced asthma (prophylactic)
46
Advantages of Motelukast
1. Oral therapy (easier than inhalation) 2. Long duration of action 3. Well-tolerated (minimal side effects)
47
Adverse effects of Leukotriene pathway inhibitors
1. Headache & dyspepsia 2. Elevated livers enzymes (zileutin, zafirlukast) 3. Enzyme inhibition (zafirlukast)
48
Mechanism of action of cromolyn & nedocromil
1. Inhibit mast cells degranulation, inhibit release of mediators, inhibit early response. 2. Inhibit eosinophil activation, inhibit late inflammatory response to antigen.
49
Route of administration of cromolyn & nedocromil
Aerosol & microfine powder
50
Uses of cromolyn & nedocromil
Prophylaxis of antigen & exercise-induced asthma . Chronic use for mild persistent asthma , dec bronchial hyper-responsiveness. Allergic rhinoconjunctivitis
51
Adverse effects of cromolyn & nedocromil Na
1. Throat irritation, cough, bronchospasm. | 2. Stinging in the eye (with eye drops).
52
Mechanism of action of Ketotifen
Mast cell stabilization & antihistamine
53
Mechanism, usage, adverse effects of omalizumab
Anti-IgE monoclonal antibody Add-on therapy in severe uncontrolled allergic asthma Inc risk of anaphylaxis & reaction at the site of injection
54
Anti IL5 uses & adverse effects
Add-on therapy in severe uncontrolled allergic asthma | Headache & reaction at site
55
Anti IL4 uses & adverse effects
-Add-on therapy in severe uncontrolled allergic asthma on high dise ICS/LABA -Atopic dermatitis +injection site reaction, blood eosinophilia
56
Management of mild to moderate acute exacerbations
Give inhaled SABA Prednisolone Controlled oxygen
57
GR: Severe acute asthma is refractory to the usual lines of treatment.
Due to down regulation of beta receptors, mucus plug & acidosis.
58
Management of severe acute asthma
1. Endotracheal intubation & suction of bronchial secretion 2. Humidified oxygen inhalation 3. IV fluids, correction of acid-base balance, electrolytes, dehydration. 4. Drug therapy
59
Drug therapy of severe acute asthma
``` A. SABA +/- ipratropium B. Systemic glucocorticoids C. Aminophylline D. Artificial respiration E. Antibiotics/avoid sedatives ```

Respiratory Pharmacology (3 decks)

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