Treatmment Bronchial Asthma

Question 1

Drug delivery

Answer 1

Topically to nasal mucosa
 Inhaled into lungs ( most effective)
 Orally
 Parenterally faster action
Local delivery methods preferred to minimize systemic side effects

Question 2

Most used drug for asthma

Answer 2

1-sympathomimetic agents (used as “relievers” or
bronchodilators)
2-inhaled corticosteroids (used as “controllers” or anti-
inflammatory agents)

Question 3

Anticholinergics

Answer 3

Ipratropium, tiotropium

Question 4

Methylxanthines

Answer 4

Theophylline, aminophylline

Question 5

Monoclonal antibodies

Answer 5

Omalizumab

Question 6

 Mast cell stabilizers

Answer 6

Sodium cromoglycate

Question 7

Leukotriene inhibitors

Answer 7

Zileuton, montelukast

Question 8

β2-adrenergic agonists

Answer 8

β2-adrenergic agonists relax airway smooth muscle,
quick relief

Question 9

β2 agonists have inflammatory effect true /false ¿

Answer 9

False • β2 agonists have no anti-inflammatory effects

Question 10

β2 agonists • not be used as monotherapy for patients with persistent asthma

Answer 10

True

Question 11

Short-acting β2 agonists:

Answer 11

a rapid onset of action (5-15min)

best delivered by inhalation

local effect on airway smooth muscle with least systemic
toxicity 80–90% of total dose of aerosol is deposited in the
mouth or pharynx

symptomatic treatment of bronchospasm

Question 12

Chronic use of β2-agonists - leads to tachyphylaxis
due to receptor down regulation

Answer 12

True

Question 13

Adverse effect of short b2 agonists

Answer 13

tachycardia, hyperglycemia, hypokalemia

Question 14

Example for short b2agnists

Answer 14

Salbutamol

Question 15

Example for Long-acting β2 agonists

Question 16

Duration of Long-acting β2 agonists

Answer 16

ong duration of action (12 hours)

Question 17

Long acting used for acute attack ¿

Answer 17

False  should NOT be used for acute attack

Question 18

Long acting used only in combination with an asthma controller
medication

Answer 18

ICS

Question 19

Example for Ultra LABA

Answer 19

vilanterol) has a 24-hour bronchodilator duration
of effect

Question 20

Vilanterol combian ……….for daily asthma

Answer 20

fluticasone

Question 21

Mechanism of Action Corticosteroids

Answer 21

inhibit arachidonic acid by phospholipase A2 inhibition
 producing anti-inflammatory effect

Question 22

Inhalational route ICS most commonly used ¿

Answer 22

True

Question 23

ICSs
Examples-

Answer 23

Beclomethasone, budesonide, fluticasone

Question 24

Systemic corticosteroids indicated in acute severe
asthma

Answer 24

prednisone/ prednisolone

Question 25

Adverse effects and cautions Corticosteroids

Answer 25

Sudden discontinuation of oral/parenteral therapy  acute adrenal insufficiency --- can be fatal

Question 26

When the Systemic adverse effects may occur Corticosteroids

Answer 26

high dose ICSs

Question 27

Where the ICS deposit

Answer 27

oral and laryngeal mucosa

Question 28

Corticosteroids  can cause candidiasis and dysphonia

Answer 28

True Prevented by rinsing mouth with water, use of spacer

Question 29

Ciclesonide associated with less frequent candidiasis

Answer 29

True

Question 30

Zafirlukast Food impairs absorptio

Answer 30

True

Question 31

Zileuton and its metabolites excreted in urine

Answer 31

True

Question 32

Zafirlukast, montelukast, and metabolites liver

Answer 32

False Zafirlukast, montelukast, and metabolites undergo biliary excretion

Question 33

Not useful in an acute asthma attack, because it is not a bronchodilator

Answer 33

Cromolyn sodium

Question 34

alternative therapy for mild persistent asthma prophylactic anti-inflammatory agent

Answer 34

Cromolyn sodium

Question 35

Ipratropium

Answer 35

nonselective M1, M2, and M3 antagonist  poorly absorbed, minimal systemic effects  adjunctive therapy in acute severe asthma not completely responsive to β2-agonists  not recommended for routine treatment of acute asthma  onset is much slower than inhaled SABAs  multiple-dose ipratropium bromide added to initial therapy in moderate to severe asthma

Question 36

Tiotropium

Answer 36

long-acting anticholinergic agent  can be used as an add-on treatment in severe asthma Adverse effects  Xerostomia

Question 37

Mechanism of Action Anticholinergics

Answer 37

Muscarinic antagonists reverse cholinergic bronchoconstriction  block vagally mediated contraction of airway smooth muscle and mucus secretion

Question 38

X use has declined  high risk of severe toxicity  drug interactions  less efficacy compared with ICSs and LABAs

Answer 38

Methyl Xanthines

Question 39

Nonselective phosphodiesterase inhibition  They also inhibit adenosine receptors ( adenosine contracts airways)

Answer 39

Theophylline

Question 40

Theophylline Toxicities include

Answer 40

nausea, vomiting  tachycardia, cardiac arrhythmias  Monitoring of serum concentrations essential for safe use • narrow therapeutic index • Dose of theophylline should be decreased if enzyme inhibitors like erythromycin and Ciprofloxacin are prescribed with it

Question 41

Binds selectively to (IgE)

Answer 41

Omalizumab

Question 42

Omalizumab monoclonal antibody

Answer 42

True

Question 43

Decreases binding of IgE to its receptor on mast cells and basophils.

Answer 43

Omalizumab

Question 44

 Is indicated for treatment of moderate to severe persistent asthma in poorly controlled patients

Answer 44

Omalizumab

Question 45

Route of administration (subcutaneous)

Answer 45

Omalizumab

Question 46

Drugs used in treatment COPD

Answer 46

1. Inhaled β2-agonists 2. Anticholinergic agents  ipratropium and tiotropium 3. Inhaled corticosteroids 4. Other agents  Roflumilast  Oral phosphodiesterase-4 inhibitor  Not indicated for relief of acute bronchospasm

Question 47

Two types of aerosols can be used.

Answer 47

• Aerosol using drugs in solution: These include metered dose inhaler(MDI) and nebulizers • Aerosols using drugs as dry powder (DPI)

Question 48

Spacers

Answer 48

large-volume chamber attached to an MDI more likely to reach the target airway tissue

Question 49

Delivers beta-adrenergic drugs directly to the lungs This is inhaled without having to coordinate dosing with breathing sound waves to create a continuous mist of drug

Answer 49

Nebulizer