Drugs For Treating Asthma Flashcards
(43 cards)
1
Q
What is asthma?
A
- chronic inflammatory disease of the airway
- results in obstruction of the airways from bronchoconstriction, edema, and excessive mucus production
2
Q
Why are NSAIDs typically ineffective in treating inflammation in repiratory system, but corticosteroids are?
A
Asthma is caused by leukotrienes which is a separate branch off of arachidonic acid. Corticosteroids act on phospholipase A2, whereas NSAIDs inhibit later on in the process to COX.
3
Q
Name some factors that can precipitate an asthma exacerbation:
A
- pet allergens
- dust mites
- fungal spores
- infection
- tobacco smoke
- pollen
- chemical exposure
- comorbid conditions
- cold temperatures
- NSAIDs
- exercise
4
Q
What is EIB?
A
- exercise induced bronchospasm
- can be a symptom of asthma, but can have bronchospasm and no asthma
- if it only happens in exercise, it’s usually EIB
5
Q
What is NSAID induced asthma?
A
- NSAIDs or aspirin can trigger asthma in those that have severe asthma
- less likely in those with mild or moderate asthma
6
Q
What is bronchospasm?
A
- reversible airway obstruction caused by spasm of the smooth muscles of the bronchial walls
- non inflammatory, meaning an anti-inflammatory will not help.
7
Q
What are the 2 categories of asthma/EIB medications when categorized by therapeutic intention?
A
- quick-relief therapy: “rescue” medications, used for acute symptoms
- long-term therapy: decrease chronic inflammation, decrease frequency of acute attacks
8
Q
What are the 2 categories of asthma/EIB medications when categorized by pharmacological activity?
A
- bronchodilators: relax bronchial smooth muscle, open airways
- anti-inflammatory drugs: decrease chronic inflammation
9
Q
How are quick-relief drugs used?
A
- treat symptoms in an acute attack
- prevent an imminent attack
- taken when needed, not on a routine basis
- can also be taken prophylactically before exercise if EIB
- every asthma patient should have a quick-relief drug available
10
Q
Name 3 quick-relief drugs:
A
- short acting beta2 agonists (SABA)
- anticholinergics
- systemic corticosteroids
11
Q
What do Beta 1 and Beta 2 do?
A
- Beta 1: receptors found in heart and kidneys (can have impact on BP and blood volume). Can be considered a performance enhancing drug.
- Beta 2: dilating bronchioles
12
Q
Most SABA are made up of….
A
A mix of Beta 1 and Beta 2.
13
Q
How do short acting beta2 agonists work? What are some examples of it?
A
- rapid onset (5 min or less)
- short duration (up to 6 hours)
- results in broncodilation
- if needing quick-relief drugs daily, they are not being managed well and need long term medications. Tolerance can be developed to both.
- ex. Albuterol/Salbutamol - Albuterol (Ventilin) most common
14
Q
Side effects of short acting beta2 agonists (SABA):
A
Most effects are local because of inhalation, less risk of the side effects below:
- short term muscle tremor (can effect sport performance)
- hyperglycaemia
15
Q
How do anticholinergics work? Give an example.
A
- inhibit cholinergic receptors of the parasympathetic nervous system
- not commonly used in asthma treatment
- specifically blocks the action of neurotransmitter acetylcholine. Blocks mucus production and causes broncodilation
- Can be used for asthma (not as common) and EIB. Not nearly as effective as SABA
- ipratropium - often used in combination with SABA
16
Q
How does systemic corticosteroids for asthma work?
A
- typically oral administration
- most commonly prednisone
- short course
- risks/adverse effects
17
Q
Name 4 long-term therapies for asthma.
A
- inhaled corticosteroids
- long acting beta agonists (LABA)
- mast cell stabilizers
- leukotriene modifiers
18
Q
What are the purposes of long-term therapies for asthma?
A
- reduce the incidence of acute attacks
- scheduled medication therapy
19
Q
Inhaled corticosteroids are commonly utilized with ______ or ______. Why?
A
- SABA
- LABA
- SABA or LABA will open up bronchioles and allows corticosteroids to pass through and anti-inflammatory effect gets to where it needs to go.
20
Q
How do inhaled corticosteroids work?
A
- mainstay of long-term therapy
- reduces the frequency and severity of acute attacks
- improves control of nocturnal asthma
- decreases EIB
21
Q
How can inhaled corticosteroids be adjusted with increased asthma severity?
A
- increase dose
- add LABA
22
Q
Side effects of inhaled corticosteroids:
A
- local adverse effects. Side effects are limited due to inhaled nature.
- hoarseness, cough, thrush
- minimized by use of a spacer
- rinse mouth after each use
23
Q
What is thrush? How can it be avoided?
A
- yeast infection in mouth or pharynx
- can be common with corticosteroid inhaler
- rinse mouth with water after taking corticosteroid inhaler to avoid thrush
24
Q
How do long acting beta agonists (LABA) work?
A
- inhaled bronchodilators
- can also come in extended-release oral tablets (uses SABA in extended release pill form to make it LABA. More substantial side effects of SABA)
- slower onset than SABA
- beneficial effects include decreasing rescue inhaler use, decreasing nocturnal asthma
25
How should LABA be used?
- should not be used alone as the only long-term control medication
- can be added to inhaled corticosteroid regimen
- susceptible to developing tolerance to these.
26
Give an example of a LABA.
Salmeterol
27
How do mast cell stabilizers work?
- anti-inflammatory agents
- inhibit release of inflammatory mediators from mast cells
- not as effective as corticosteroids
- not preferred asthma treatment
28
Side effects of mast cell stabilizers:
- low incidence of adverse effects
- sometimes headaches, throat irritation, bad taste in mouth
29
Give an example of a mast cell stabilizer.
Cromolyn
30
How do leukotriene modifiers work?
- oral anti-inflammatory medication
- inhibit the synthesis or the activity of leukotrienes
- variable effectiveness
- often used in combination with inhaled corticosteroids
- not everyone will respond to this. It can be very effective, but is not commonly tried unless other therapies don’t work
- relatively few adverse effects
31
How do inhalers help with delivering medication?
- local delivery to site of action. Limits systemic side effects
- better pharmacokinetic parameters
- avoids GI absorption
- avoids first-pass effect
- avoids systemic distribution
32
Name the big issue with use of inhalers.
Proper technique is important to effective therapy
33
Name the advantages of using a metered dose inhaler.
- delivered directly to site of action
- fewer systemic adverse effects
- faster response
- cheapest form of medication
- can be used with a spacer
34
Disadvantages of using metered dose inhalers.
- requires proper technique
- low percentage of drug reaches the lung (even with best technique, only 20% makes it to end of bronchioles or alveoli)
- inconvenience
- cold weather impairs the propellant
- utilizes a propellant - environmental impact
35
Steps for using a metered dose inhaler:
1. Shake
2. Prime - puff out 1 or 2.
3. Time inhale while pushing down to get propellant to release medications.
Can be difficult in middle of exacerbation. Can be made easier with spacer.
36
How do breath-actuated metered dose inhalers work?
- does not use propellant
- mechanism not activated until patient inhales
- cannot use with a spacer
- more expensive than propellant based MDIs
37
How do dry powder inhalers work?
- drug contained in capsule or other package
- break package to allow drug to be inhaled
- patient inhales deeply and draws powdered drug into lungs
- no need to prime or shake
- substantially more expensive
- if moisture gets into the chamber, it can clog it up
38
Name some issues with inhalers:
- can cause coughing, which can cause medication to be coughed back out. Need to hold for a few seconds.
- must keep inhalers and spacers clean
- moisture can interfere with drug release from DPI
- cold temperatures decrease efficiency of propellant in MDIs
39
Goals of asthma therapy:
- prevent chronic and troublesome symptoms
- maintain normal lung function
- prevent exacerbation
- provide adequate pharmacotherapy with minimal adverse effects
40
How can we educate patients about asthma medications?
- quick-relief vs long-term therapies
- adherence
- use of inhalers, spacers, peak flow meters
- WADA/CCES - some of these can be banned substances. SABAs are not banned, but there is a certain level that you can have in your blood.
41
How can we monitor the use of asthma medication in our athletes?
- asthma symptom control
- EIB
- need to watch for athletes using inhalers without diagnosis of asthma (self managing). They may not be receiving optimal therapy
42
ATs need to have a specific plan for when ______ and _____ _____ are needed with asthma.
- caution
- medical action
43
How can ATs help in preventing asthma attacks?
- warmups in cold weather can be effective in preventing asthma or EIB
- dry > cold triggers
- don’t train or play if particularly high environmental triggers. Can take prophylactic measures.
