Asthma 1

Question 1

What are the agents of 1st choice

Answer 1

Short acting b2 adrenoceptor agonists (e.g. Salbutamol)

Question 2

Mode of action of short acting b2 adrenoceptor agonists

Answer 2

Act on b3 adrenoceptors on smooth muscle to increase cAMP which leads to relaxation.

Increases FEV1

Question 3

What else do b2 agonists do

Answer 3

Reduce parasympathetic activity

Question 4

Side effects of b2 agonists

Effect of long term use

Answer 4

Tremor
Tachycardia

Prolonged use may lead to receptor down regulation

Question 5

What is given for ling term prevention and long term control

Answer 5

Long acting beta agonists (e.g. salmeterol)

Question 6

What other drugs are used for prevention

Answer 6

Corticosteroids/glucorticoids (e.g. beclometasone or prednisolone)

Question 7

Mode of action of anti inflammatory agents

Answer 7

Anti inflammatory by activation of intracellular receptors, leading to altered gene transcription (decrease cytokine production) and production of lipocortin (annexin1)

Lipocortin/annexin A1 inhibits synthesis PLA2 which therefore inhibits arachidonic acid metabolism and therefore inhibits production of Leukotrienes and Prostaglandins (inflammatory)

Question 8

When are inhaled steroids used

Answer 8

Given with b2 agonists which reduce its receptor down regulation

Question 9

Side effects of inhaled steroid

How to reduce impact

Answer 9

Throat infections
Hoarseness

Use spacer
Wash mouth out

Question 10

When are oral corticosteroids used

Answer 10

In severe asthma

-Used for short periods of time

Question 11

side effects of oral corticosteroids

When should you be careful

Answer 11

Adrenal suppression
Diabetes
Osteoporosis

Ensure gradual withdrawal when used >3 weeks

Question 12

Mode of action of Leukotriene receptor antagonists

When are they used

Answer 12

Preventative and bronchodilators. Increased role as add on therapy

Antagonist actions of leukotrienes which are bronchodilators and inflammatory

Question 13

What is omalizumab and its mode of action

When is it used

Answer 13

Used in difficult to treat asthma

MAB which is recited against free IgE (but not bound IgE)

-Prevents IgE from binding to immune cells and which leads to allergen-induced mediator release in allergic asthma

Question 14

First line of treatment

Answer 14

Short acting b2 agonist
plus
Regular inhaled steroid

Question 15

Second line of treatment and when used

Answer 15

If pt needs 3 or more uses of b2 agonist per week

+ trial of LABA or LTRA

Question 16

Third line of treatment

Answer 16

Increased dose of inhaled steroid

Question 17

fourth line of treatment

Answer 17

Add oral steroid

Question 18

What should be used first

Bronchodilator or steroid

Answer 18

Bronchodilator

Question 19

What should be given in acute asthma pre-admission

Answer 19

Nebulised salbutamol

Question 20

What should be given in acute asthma on admission

Answer 20

O2 and salbutamol

Nebulised ipratropium if severe or poor response to salbutamol

Start oral steroids if they haven’t been started already and continue for 5+ days