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Medicine - Respi > Anti Asthmatic Drugs > Flashcards

Anti Asthmatic Drugs Flashcards

1
Q

Asthma symptoms

A
  • Wheezing
  • Dyspnoea
  • Cough
  • Chest tightness
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2
Q

Asthma Pathophysiology

A
  • Airway inflammation
  • Increased mucus secretion
  • Constriction of bronchial smooth muscles
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3
Q

Drug categories

A
  • Bronchodilators
  • Anti-inflammatory drugs
  • Monoclonal antibody
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4
Q

Bronchodilators types

A
  • β₂ agonists
  • Methyl xanthines
  • Anticholinergics
  • Leukotriene antagonists
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5
Q

Anti-inflammatory agents types

A
  • Mast cell stabilisers
  • Inhalational
  • Systemic
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6
Q

Monoclonal antibody type

A

Anti-IgE antibody

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7
Q

β₂ agonists examples

A

SABA: salbutamol, terbutaline
LABA: salmeterol, formeterol

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8
Q

Methyl xanthines examples

A
  • Theophylline

* Aminophylline

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9
Q

Anticholinergics examples

A
  • Ipratropium bromide

* Tiotropium bromide

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10
Q

Leukotriene antagonists examples

A
  • Montelukast
  • Zafirlukast
  • Sodium Cromoglicate
  • Nedocromil
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11
Q

Mast cell stabilisers examples

A
  • Sodium Cromoglicate

* Nedocromil

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12
Q

Inhalational anti-inflammatory agents examples

A
  • Beclomethasone
  • Budesonide
  • Fluticasone
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13
Q

Systemic anti-inflammatory agents examples

A
  • Hydrocortisone

* Prednisolone

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14
Q

Anti-IgE antibody example

A

Omalizumab

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15
Q

Salbutamol indication

A
  • Used to terminate attacks
  • Not suitable for prophylaxis
  • Less cardiac side effects
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16
Q

Salmeterol, formeterol indication

A

• Used for maintenance therapy and nocturnal asthma

17
Q

β₂ agonists side effects

A
  • Headache, palpitations, tremors
  • Repeated doses: cardiac arrythmia, death
  • Metabolic: hypokalaemia, increased insulin secretion
18
Q

Methyl xanthines MOA

A
  • Decrease cAMP degradation by inhibiting phosphodiesterase

* Slow and sustained bronchial smooth muscle relaxation

19
Q

Theophylline indication

A

Act as “controller agent” during asthma therapy

20
Q

Theophylline adverse effects

A
  • Overdose: hypertension, arrythmia, convulsion
  • CNS: tremor, nausea, insomnia, anxiety
  • CVS: palpitation, arrythmia, precordial pain
21
Q

Theophylline drug interaction

A
  • Increased plasma level with enzyme inhibitors (erythromycin)
  • Decreased plasma level with enzyme inducers (rifampicin)
22
Q

Ipratropium bromide MOA

A

• Blocks AcH muscarinic receptors and inhibits bronchoconstriction (M3)

23
Q

Ipratropium bromide indication

A
  • Used prophylactically
  • Used with β₂ agonists in acute attack
  • Main use in COPD
24
Q

Leukotriene antagonists MOA

A
  • Antagonise LT1 receptor mediated bronchoconstriction
  • Bronchodilation, reduced sputum eosinophil count, suppression of bronchial inflammation and hyper reactivity
  • Effective in aspirin induced asthma
25
Q

Leukotriene antagonists indication

A

Used for prophylactic therapy in mild to moderate asthma

26
Q

Mast cell stabilisers MOA

A

• Inhibits degranulation of mast cells and hence release of histamine, interleukins, PAF, LTs

27
Q

Mast cell stabilisers indication

A
  • For long term prophylactic use
  • Ineffective if given during an attack
  • Reduces the number of attacks
28
Q

Corticosteroids MOA

A

• Reduces bronchial hyper reactivity and mucosal edema

29
Q

Inhaled corticosteroids advantage

A

Produce very few side effects

30
Q

Inhaled steroid therapy indication

A
  • controller drug
  • No role in acute Attack
  • Commonly used with β₂ agonists in mild to moderate asthma
31
Q

Systemic steroid therapy indication

A
  • Severe chronic asthma

* In status asthmaticus not responding to bronchodilator therapy

32
Q

Inhalational steroid therapy adverse effects

A
  • Oropharyngeal candidiasis
  • Hoarseness of voice
  • Cough
33
Q

Systemic steroid therapy adverse effects

A
  • HPA axis suppression
  • Bone resorption
  • Cataracts
  • Glaucoma
  • Steroid myopathy
  • Skin thinning, purpura
  • Psychiatric changes
34
Q

Omalizumab MOA

A
  • Inhibits binding of IgE to high affinity receptors (receptors on mast cells, basophils, macrophages etc)
  • Thus reducing inflammatory response
35
Q

Omalizumab indication

A
  • To reduce steroid dependence
  • To decrease asthma attacks
  • For concomitant asthma and allergic rhinitis, nasal allergy, food allergy
36
Q

Management of asthma in adults

A

• Step 1: mild intermittent asthma: inhaled SABA as required
• Step 2: regular preventer therapy: add inhaled steroid
• Step 3: initial add-on therapy: LABA
Maximise inhaled steroid
Consider leukotriene antagonist or SR theophylline
• Step 4: persistent poor control: increase steroid
Add 4th drug: leukotriene receptor antagonist, SR theophylline or β agonist
• Step 5: continuous use of oral steroids: daily steroid tablet

37
Q

Management of status asthmaticus

A
  • Hydrocortisone hemisuccinate
  • Theophylline slow IV
  • Salbutamol + Ipratropium bromide - nebulisation with O2
  • High flow humidified O2
  • Intubation if needed
  • Correction of electrolyte imbalance and maintain hydration

Medicine - Respi (5 decks)

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