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Resp JL > Airway Therapeutics Overview > Flashcards

Airway Therapeutics Overview Flashcards

1
Q

What are the 4 steps in teh asthma treatment pyramid, starting with least severe?

A
  1. Short acting B2 agonist PRN
  2. Inhaled steroid (cromoglycate)
  3. Theophylline, Leukotriene antagonist, long-acting B-agonist/LAMA, Anti-IgE
  4. Oral steroid
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2
Q

What are the BTS general guidelines for asthma?

A
  1. Short-acting B2 agonists PRN
  2. Inhaled sterroids
  3. Add on LABA/LAMA
  4. Add on LTRA/Theo/Anti-IgE
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3
Q

Name an oral steroid?

A

Prednisolone

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4
Q

What is prednisolone only used for and what is its therapeutic ratio like?

A

Low therapeutic ratio

Only used for acute exacerbations

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5
Q

Name an inhaled steroid?

A

Beclomethasone

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6
Q

What is the therapeutic ratio of beclamethasone like and what is it used for?

A

Higher therapetutic ration

Used for maintenance therapy

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7
Q

What can you use to maximise the lung delivery for corticosteroids?

A

Large volume spacer

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8
Q

What can be used to reduce oropharyngeal and laryngeal side effects of corticosteroids?

A

Spacer device

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9
Q

What are anti-inflammatory cromones only used in?

A

Asthma

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10
Q

What drugs are mast cell stabilisers?

A

Cromones

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11
Q

What patients is cromoglycate effective in?

A

Atopic children (exercise asthma)

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12
Q

How are cromones delivered?

A

Inhaled route only

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13
Q

What are the three cysteinyl LTs?

A

LTC4
LTD4
LTE4

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14
Q

Which leukotriene causes oedema, increased mucus secretion, decreased mucus transport, eosinophil influx, epithelial cell damage and contraction and proliferation?

A

LTD4

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15
Q

Which drugs are only used in asthma, are bronchodilators and anti-inflammatory drugs?

A

Leukotriene receptor antagonists

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16
Q

What can be said about the route of administration, dose and therapeutic ratio for Montelukast?

A

Oral route
Once daily
High therapeutic ratio

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17
Q

Are leukotriene receptor antagonists (Montelukast), more potent thant inhlaed steroids?

A

No

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18
Q

What line of treatment is Montelukast for asthma?

A

2nd line: complimentary non-steroidal anti-inflammatory additive to inhaled steroid

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19
Q

What kind of induced asthma is Montelukast effective in?

A

Exercise

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20
Q

Alongside an anti-histamine, what can leukotriene receptor antagonists be effective for?

A

Allergic rhinitis

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21
Q

When are anti-histamines of value?

A

When known allergic trigger (i.e. in atopic asthma)

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22
Q

How are anti-histamines deivered?

A

Oral route

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23
Q

What drugs are HI receptor antagonists?

A

Anti-histamines

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24
Q

Name a first generation anti-histamine?

A

Chlorpheniramine-sedative

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25
Q

Name a 2nd generation anti-histamine?

A

Cetirizine, Loratadine - non sedative

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26
Q

Name a 3rd generation anti-histamine?

A

Levocetirizine, Desloratadine - non sedative

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27
Q

What are anti-histamines more effective in than asthma?

A

Allergic rhinitis

28
Q

What combination with anti-histamines cause additive effects?

A

Leukotriene antagonist

29
Q

Name an anti-IgE monoclonal antibody?

A

Omalizumab

30
Q

How does Omalizumab work?

A

Inhibits the binding to the high-affinity IgE receptor and inhibit mediator release from basophils and mast cells

31
Q

How is omalizumab administered?

A

Injection every 2-4 wekks

32
Q

What kind of patients are Anti-IgE monoclonal antibody Omalizumab used for?

A

Patients with severe persistent allergic asthma despite maximum therapy

33
Q

What one thing does Omalizumab not have an effect on, and what two things does it reduce?

A

No effect on pulmonary function but reduces exacerbations and steroid sparing

34
Q

Name three long-acting B2 agonists?

A

Salmeterol
Formoterol
Indacaterol

35
Q

Name three combination B2 agonist inhalers?

A

Fluticasone/salmeterol
Budesonide/formoterol
Beclometasone/formoterol

36
Q

What does down regulation and tachyphylaxis occur with?

37
Q

What drugs are given in high nebulised doses given in acute attacks?

A

B2 agonists

38
Q

What do M1 receptors enhance?

A

The cholinergic reflex

39
Q

What do M2 receptors inhibit?

A

Acetylcholine release

40
Q

What do M3 receptors mediate?

A

Bronchoconstriction and mucus secretion

41
Q

What type of bronchodilators block post junctional end plate M3 receptors?

A

Anticholinergics

42
Q

Name 4 anticholinergics?

A

Short acting ipratropium qid

Long acting tioropium od, aclinidium bid, Glycopyrronium od

43
Q

How are anticholinergics adminsitered?

A

Inhaled route only

44
Q

What condition are anticholinergics used mostly in?

A

COPD - reduce exacerbations

45
Q

What is a high nebulised dose of ipratroipum used in?

A

Acue COPD and in acute asthma

46
Q

Name an oral methylxanthine?

A

Theophylline

47
Q

Are methylxanthines anti-inflammatory?

48
Q

What is the slow release formulation of theophylline (methylxanthine) useful for?

A

Nocturnal dips

49
Q

What is theophylline added to in the asthma treatment steps?

A

Added to inhaled steroid as complimentary non steroidal anti-inflammatory

50
Q

Name an IV methylxanthine used for acute attacks?

A

Aminophylline

51
Q

Name an adenosine antagonist?

A

Methylxanthine aminophylline

52
Q

Name a non-selective phosphodieterase inhibitor (increased cAMP)

A

Methylxanthine - aminophylline or theophyilline

53
Q

What can be said about the therapeutic ration for methylxanthines?

54
Q

Name a PDE4 inhibitor?

A

Roflumilast - oral tablet od

55
Q

What is Roflumilast indicated for only?

56
Q

Which drug reduces exacerbations and is an additive to LABA or LAMA?

A

Roflumilast

57
Q

Give four adverse effects of Roflumilast (PDE4 inhibitor)?

A

Nausea
Diarrhoea
Headache
Weight loss

58
Q

Name two oral mucolytics?

A

Oral carbocisteine and erdosteine

59
Q

What are mucolytics used for in COPD?

A

To reduce sputum viscosity and aide sputum expectoration [and reduce exacerbations]

60
Q

In COPD, what type of infections are more common than alveolar infections (i.e. pneumonia)?

A

Endobronchial (infective bronchitis)

61
Q

What disease treatment aims are these: abolish symptoms, minimise B2 use, normalise FEV1, reduce PEF variability, reduce exacerbations, prevent long term airway remodelling?

A

Chronic asthma

62
Q

In chronic asthma, what is used to supress the inflamamtory cascade?

A

Inhaled steroid

63
Q

In chronic asthma, give three types of drugs used as non-steroidal anti-inflammatories?

A

Theophylline, anti-leukotirene, anti-histamine

64
Q

In chronic asthma treatment, what can be used to stabilise smooth muscle, only once optimal anti-inflamm therapy in place?

65
Q

What are the 4 steps of treatment in acute asthma?

A
  1. Oral prednisolone (or IV hydrocortisone)
  2. Nebulised high dose salbutamol, +/- ipratropium, =/- IV aminophylline/magnesium
  3. 60% O2
  4. ITU assisted mechanical intubated ventilation if falling PaO2 and rising PaCO2
66
Q

What two classes of drugs can be used for airflow obstruction drug therapy?

A

Preventers (anti-inflammatory)

Relievers (bronchodilators)

67
Q

What are the 7 steps of treatment in acute COPD?

A
  1. Nebulised high dose salbutamol + ipratropium
  2. Oral prednisolone
  3. Antibiotic (amoxycillin/deoxycyline) if infection
  4. 24-28% O2 titrated against PsO2, PaCO2
  5. Physio to aide sputum expectoration
  6. Non invasive ventilation to allow higher FiO2
  7. ITU intubated assisted ventilation only if reversible component (e.g. pneumonia)

Resp JL (27 decks)

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