Anti-asthmatics Flashcards
Characteristics of asthma:
- chronic airway inflammation
- hyper-responsiveness of airway
- wheezing, shortness of breath, cough
- recurrent reversible airway obstruction
List the anti-asthma controllers:
- Inhaled corticosteroids (ICS) (fluticasone)
- Leukotrienes receptor antagonist (LTRA) (montelukast)
- Inhaled Na Cromoglycate
- Anti-IgE mAb (omalizumab)
- Anti-IL-5 mAb/Anti-IL-5R mAb (mepolizumab/benralizumab)
- Anti-IL-4R mAb (dupilumab)
List the anti-asthma relievers:
- β2 agonists
- Methylxanthines (theophylline)
- Muscarinic antagonists
What is the difference between a anti-asthma controller n reliever?
Controller: anti-inflammatory, prevention of recurrent attack
Reliever: bronchodilators, reversal of airway constriction
What are the 2 major forms of asthma?
-
Allergic asthma
- driven by type 1 inflammation (IgE mediated)
- IL-4 & IL-13 play a role in IgE pdn -
Eosinophilic asthma
- driven by type 2 inflammation (cell mediated)
- IL-4 & IL-13 contribute to eosinophilic inflammation in the airway
LABAs (long-acting β2 agonists) ___________________ in asthma patients.
‘Cannot be used alone’, must be used w corticosteroid!
- controller
- use of LABAs alone makes asthma outcomes worse.
- it is contraindicated for asthma in patients of all ages without concomitant use of an asthma-preventer medication such as an inhaled corticosteroid.
Salbutamol is a (reliever/controller)
Salbutamol is a reliever!
- for relief of bronchoconstriction during acute asthma attacks
- fast-acting beta-2 agonist
Name the β2 agonist drugs.
Fast & Short acting, 4-6h: Salbutamol
- IV in emergencies
Fast & Long-acting, 12h: Formoterol, Salmeterol
Slow & Long-acting, 24h: Indacaterol
- usually thru inhalation
- long-term maintenance
What do the β2-adrenoceptor agonists do?
- airway smooth muscle relaxation (bronchodilation
- mast cell stabilisation
- decrease microvascular leakiness
- increase mucociliary clearance
Which form of asthma is more common?
Allergic asthma (usually starts as this then may develop into other forms of asthma)
If patient gets a asthma attack in the day (likely type 1 inflammatory), patient is actually susceptible to another asthma attack in the night (type 2 eosinophilic) which may be more dangerous cuz patient prolly sleeping.
What are the adverse effects of β2 agonist bronchodilators?
- Tremors and muscle cramps (most common)
- Peripheral vasodilatation (e.g. flushing)
- Palpitations & tachycardia (β1adrenoceptor effects)
- Hypokalemia/hyperglycemia
- usually transient/insignificant but beware of drug-drug interactions w other drugs causing hypokalemia/hyperglycemia - β2 adrenoceptor tolerance
Which drug is both a relieve and a controller?
Formoterol
- fast acting long acting
Must take______ whenever u take a β2agonist?
Inhaled corticosteroids must be taken whenever u take a β2 agonist.
What kind of drug is theophylline?
Methylxanthine, anti-asthma reliever
What kind of drug is aminophylline?
Methylxanthines.
- aminophylline is actually theophylline + ethylenediamine 2:1
When is magnesium sulphate (MgSO4) given?
- only given in emergency asthma treatment
- through IV or nebulized (but evidence of efficacy of nebulized mgso4 remains controversial)
What does magnesium sulphate do?
- relaxes airway smooth muscle (bronchodilation)
- modulates release of ACh n histamine
- anti-inflammatory effect
- improves pulmonary function when used as an adjunct to standard therapy in patients with very severe, acute asthma.
Name some ICS (inhaled corticosteroids)
Budenoside, Fluticasone, Ciclesonide
Uses of inhaled corticosteroids:
- First line prophylactic(prevent disease) for asthma treatment
- Preventing nocturnal asthma (high freq of attacks come at night)
Why must corticosteroids be prescribed with β2 agonists?
- increases expression of β2 receptors on airway smooth muscle (aids β2 agonist
- prevents airway wall remodeling-> reduces need for β2 agonist in long run
- decreases 1. Airway hyper-responsiveness 2. Frequency of acute asthma exacerbations -> reduces need for β2 agonists n thus, risk of death from asthma in long run
What are leukotriene receptor antagonists used for
- adjunct therapy for mild to moderate asthma
- not strong enough as a reliever during an acute asthma attack
- ‘addon’ drug: additive effects w β2 agonists
- 1/3rd efficiency of salbutamol
What class of drug is Fluticasone + what does it do?
Inhaled corticosteroid (ICS), anti-asthma controller
- reduces the symptoms of inflammatory conditions and allergic reactions such as swelling, redness and itching
- specifically: anti-inflammatory, prevents recurrent asthma attacks
What class of drug is Montelukast + what does it do?
Leukotrienes Receptor Antagonist (LTRA), anti-asthma controller
TLDR: blocks role of LTC4/LTD4 in asthma => bronchodilation, prevents airway hyper-responsiveness, prevent ASM hyperplasia
What class of drug is Omazulib + what does it do?
Anti-IgE mAb, anti-asthma controller
What it does:
1. Inhibit IgE-induced mast cell & basophil degranulation
2. Decrease expression of high affinity receptors on mast cell & basophil
3. Decrease mediator release=> decrease inflammation=> prevent asthma exacerbation
