6.2: Asthma Pharmacology

Question 1

Asthma is characterised by infiltration of which T cells?

Answer 1

Th2 cells

Question 2

What are 2 examples of long acting beta agonists?

Answer 2

Salmeterol

Formoterol

Question 3

Which drugs are in a Symbicort inhaler?

Answer 3

Budenoside (steroid)

Formoterol (LABA)

Question 4

What is the pathophysiology of asthma in the bronchi?

Answer 4

1) bronchial smooth muscle contraction, due to stimuli
2) mucosal swelling caused by mast cell and basophils degranulation
3) increased mucus production that can cause mucus plugging

Question 5

What is the first step is treating mild intermittent asthma?

Answer 5

SABA inhaler PRN

Question 6

How does a SABA for asthma work?

Answer 6

Works on beta 2 receptors to reverse bronchoconstriction (activates Gas -> adenylyl cyclise -> cAMP -> PKA)

Question 7

What are 2 examples of SABAs?

Answer 7

Salbutamol

Terbutaline

Question 8

What are some side effects of beta 2 agonists?

Answer 8

Adrenergic so tachycardia
Palpitations
Tremor

Question 9

When should inhaled corticosteroids be added to asthma managerment?

Answer 9

When using SABA or have symptoms 3 or more times per week

Question 10

How do corticosteroids relive symptoms in asthma?

Answer 10

Bind to glucocorticoid receptor in the cell for transrepression of inflammatory mediators which reduces inflammation in the bronchi

Question 11

What is the first choice add on therapy for a px with symptomatic asthma already on SABA + ICS?

Answer 11

LABA

Question 12

What must a LABA always be prescribed in conjunction with?

Answer 12

Inhaled ICS

as LABA is not anti-inflammatory

Question 13

What are leukotreiene receptor antagonists and when are they indicated?

Answer 13

Leukotrienes induce bronchoconstriction, oedema and mucus so LRAs reduce these symptoms (but only work in approx 15% of px)

Question 14

What type of drug is tiotropium?

Answer 14

Long acting muscarinic antagonist

Question 15

What are some side effects of toptropium?

Answer 15

Dry mouth
Urinary retention
Glaucoma

Question 16

How do drugs such as theophylline and aminophylline exert their action?

Answer 16

Antagonise adenosine receptors and inhibit phosphodiesterase (which breaks down cAMP7

Question 17

What is the final step in asthma management?

Answer 17

Daily oral steroid e.g. prednisone

Deliver a higher and more efficacious dose when oral but more side effects as systemic effects

Question 18

What is the PEFR for someone with moderate asthma?

Answer 18

50-75% predicted

Question 19

What factors are typical of a diagnosis of severe acute asthma?

Answer 19

Unable to complete sentences
RR > 25
HR > 110
PEFR 33-50% predicted

Question 20

What treatments are needed in acute asthma attack?

Answer 20

High flow O2
Nebulised salbutamol 5mg (can repeat after 15 minutes)
Oral prednisolone 40mg for 5-7 days

Question 21

Which muscarinic receptor is tiotropium selective for?

Answer 21

M3

Question 22

What are features of life-threatening asthma?

Answer 22

PEFR <33% predicted
Cyanosis
Fatigued
Silent chest 
Hypotension
Low pH
Sats <92%

Question 23

What factor indicates near fatal asthma?

Answer 23

When CO2 is rising