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ATTH 5100 > Drugs For Treating Asthma > Flashcards

Drugs For Treating Asthma Flashcards

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
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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.

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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
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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
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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
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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.
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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
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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
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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
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10
Q

Name 3 quick-relief drugs:

A
  • short acting beta2 agonists (SABA)
  • anticholinergics
  • systemic corticosteroids
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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
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12
Q

Most SABA are made up of….

A

A mix of Beta 1 and Beta 2.

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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
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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

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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
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16
Q

How does systemic corticosteroids for asthma work?

A
  • typically oral administration
  • most commonly prednisone
  • short course
  • risks/adverse effects
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17
Q

Name 4 long-term therapies for asthma.

A
  • inhaled corticosteroids
  • long acting beta agonists (LABA)
  • mast cell stabilizers
  • leukotriene modifiers
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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
Q

How should LABA be used?

A
  • 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
Q

Give an example of a LABA.

A

Salmeterol

27
Q

How do mast cell stabilizers work?

A
  • anti-inflammatory agents
  • inhibit release of inflammatory mediators from mast cells
  • not as effective as corticosteroids
  • not preferred asthma treatment
28
Q

Side effects of mast cell stabilizers:

A
  • low incidence of adverse effects
  • sometimes headaches, throat irritation, bad taste in mouth
29
Q

Give an example of a mast cell stabilizer.

A

Cromolyn

30
Q

How do leukotriene modifiers work?

A
  • 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
Q

How do inhalers help with delivering medication?

A
  • local delivery to site of action. Limits systemic side effects
  • better pharmacokinetic parameters
  • avoids GI absorption
  • avoids first-pass effect
  • avoids systemic distribution
32
Q

Name the big issue with use of inhalers.

A

Proper technique is important to effective therapy

33
Q

Name the advantages of using a metered dose inhaler.

A
  • delivered directly to site of action
  • fewer systemic adverse effects
  • faster response
  • cheapest form of medication
  • can be used with a spacer
34
Q

Disadvantages of using metered dose inhalers.

A
  • 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
Q

Steps for using a metered dose inhaler:

A
  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
Q

How do breath-actuated metered dose inhalers work?

A
  • does not use propellant
  • mechanism not activated until patient inhales
  • cannot use with a spacer
  • more expensive than propellant based MDIs
37
Q

How do dry powder inhalers work?

A
  • 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
Q

Name some issues with inhalers:

A
  • 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
Q

Goals of asthma therapy:

A
  • prevent chronic and troublesome symptoms
  • maintain normal lung function
  • prevent exacerbation
  • provide adequate pharmacotherapy with minimal adverse effects
40
Q

How can we educate patients about asthma medications?

A
  • 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
Q

How can we monitor the use of asthma medication in our athletes?

A
  • 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
Q

ATs need to have a specific plan for when ______ and _____ _____ are needed with asthma.

A
  • caution
  • medical action
43
Q

How can ATs help in preventing asthma attacks?

A
  • 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.

ATTH 5100 (13 decks)

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