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Pharmacology > Asthma > Flashcards

Asthma Flashcards

1
Q

Common asthma triggers

A 
5 majour indoor triggers 
Molds 
Dust mites 
Cockroaches 
Animal dander 
Second hand smoking
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2
Q

What are the acute symptoms of asthma

A

Bronchospasm and wheezing

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3
Q

How are acute symptoms of asthma reversed

A

With bronchodilators

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4
Q

How is asthma inflammation and exacerbations controlled

A

By anti inflammatory drugs

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5
Q

How can we treat airway remodelling

A

No treatment

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6
Q

What are the advantages of inhaled therapy

A

Direct delivery of the drug to the site of action
Rapid onset of action
Lower dose to produce desired effects
Minimise systemic adverse effects

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7
Q

What are the inhalation devices

A

Devices used to make an aerosol out of the drug solution

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8
Q

What are the types of inhalation devices

A

Inhaler - generate aerosols of solid particles

Nebulizer - generate aerosols of liquid particles in gas cloud

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9
Q

What to avoid deposition of solid particles from an inhaler in the mouth

A

By using a spacer

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10
Q

How is the drug absorbed from a dry powder inhaler

A

Drug is absorbed on a lactose carrier

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11
Q

What’s the preferred deliver in asthma treatment (rescue medication)

A

Low dose ICS + formoterol

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12
Q

What is the optimal route of administration for corticosteroids in inflammatory lung disease

A

Inhaled

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13
Q

What are inhaled corticosteroids used for

A

Used in asthma prophylactic therapy not to reverse acute asthma attack symptoms

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14
Q

What’s the best combination of corticosteroids in asthma

A

ICS + formoterol

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15
Q

List of ICS used in asthma

A

All are prodrugs
Beclomthasone
Dipropionate
Ciclesonide

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16
Q

How are the prodrugs of ICS activated

A

They admire metabolised in to active form by esterases in the lung

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17
Q

Which ICS is metabolised in the liver

A

Prednisone-> prednisilone

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18
Q

What are the characteristics that enhance the efficacy of inhaled ICS

A

Lung pulmonary residence time due to

  • lipophilicity
  • lipid conjugation
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19
Q

What are the ICS with the best lipophilicty

A

Ciclesonide

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20
Q

What are the ICS with the worst lipophilicty

A

Budesonide

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21
Q

What are the ICS with the best lipid conjugation

A

Budesonide

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22
Q

What are the ICS with the worst lipid conjugation

A

Ciclesonide

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23
Q

What are the topical adverse effects of Inhaled ICS

A

Dry mouth
Pharyngeal irritation
Increase frequency of oral condidiasis

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24
Q

How to reduce the topical adverse effects of ICS

A

Proper technique, using spacer and rinsing mouth after inhalation

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25
Q

What ICS is used in long term treatment of asthma

A

Inhaled ICS

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26
Q

What ics is used in acute asthma exacerbations and chronic severe asthma

A

Oral corticosteroids like
Prednisone
Prednisilone
Methyprednisolone

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27
Q

What ICS is used in severe acute asthma

A

I.V corticosteroids like
Hydrocrotisone
Methylprednisilone

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28
Q

Mode of administration of leukotrienes modifying drugs - what’s their effect on CYP450

A

Oral - they inhibit CYP450

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29
Q

What are leukotrienes

A

Receptor antagonists

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30
Q

What is montelukast and zafirlukast and what’s their drug interactions

A

Leukotrienes synthesis inhibitors

Interaction with warfarin

31
Q

Zileuton mechanism of action and drug interactions

A

Inhibit 5-LOX

Interacts with theophylline and warfarin

32
Q

What is leukotrienes treatment ineffective in

A

Acute bronchospasm

33
Q

What is leukotrienes treatment effective in

A

In aspirin and excercise asthma

34
Q

What can leukotrienes do to B2 agonists effect

A

Enhances the effect

35
Q

What type of asthma are leukotrienes used for

A

Mild to severe asthma

36
Q

What leukotrienes is approved in children over 6 months

A

Montelukast

37
Q

What leukotrienes is used in children over 5 years

A

Zafirlukast

38
Q

What does corticosteroids inhibit

A

Phospholipase A2

39
Q

Mechanism of action of zafirlukast and montelukast

A

Bind to leukotriene receptors

40
Q

Zileuton mechanism of action

A

Inhibits 5 lipooxygenase

41
Q

What are the similarities between leukotrienes and corticosteroids uses

A

They can both be used as a controller but not for acute bronchospasm

42
Q

What is the B2 receptors agonists actions

A

Relaxation of bronchi smooth muscle and decrease airway resistance

43
Q

List SABA

A

Short acting B agonist
Albuterol
Fenoterol

44
Q

What are SABA used for

A

active inhalation treatment of bronchospasm ( with low dose ICS - budesonide)

45
Q

SABA onset and duration of action

A

1-5 mins quick

Lasts for 2-6 hours short

46
Q

What are SABA most effective in

A

Most effective drugs in relaxing airway smooth muscles

47
Q

LABA

A

Long acting B agonist
Formoterol
Slameterol

48
Q

What are formoterol and salmeterol used for

A

Both are used for prevention of asthmatic attacks since they are long acting
BUT.
Formoterol can be used for relief from asthma attacks

49
Q

How often is LABA given

A

It’s given twice daily by inhalation for long treatment of asthma

50
Q

What are LABA USED FOR

A

Useful in

  • preventing nocturnal asthmatic attacks
  • prevent Late phase of allergen induced bronchoconstriction
51
Q

Why shouldn’t LABA be used alone

A

Masks the symptoms and lacks anti inflammatory action

52
Q

What should LABA be used with

A

ICS

53
Q

LABA adverse effects

A

Tremors and tachycardia

54
Q

What’s the corticosteroids and B2 agonist drug interactions

A

Corticosteroids prevent the desensitisation of B2 receptors and increase synthesis of B2 receptors

55
Q

What’s the rescue dose of LABA + ICS

A

4,5 ug , 160 ug or 4.5 ug, 80ug

E.g-> formoterol + budesonide

56
Q

Other name for methylxanthines

A

Theophylline

57
Q

Theophylline mode of administration

A

Oral

58
Q

Theophylline mechanism of action

A

Inhibits phosphodiesterase -> causing an increase in CAMP with in the cell leading to smooth muscle relaxation

59
Q

What’s wrong with theophylline therapeutic index

A

Has a narrow therapeutic index 5-15 mg/ml

60
Q

Theophylline indications

A

Bronchodilator in COPD

61
Q

Theophylline metabolism

A

Metabolised in the liver

62
Q

How do anticholinergic agents prevent contraction

A

Antagonist of M3 receptors in the bronchial smooth muscles

63
Q

Where are parasympathetic pathways more important

A

In bronchospasm than in some asthmatics

64
Q

What are anticholinergic agents used with

A

Used with ICS and LABA

CANT REPLACE LABA

65
Q

Anticholinergic agent effect on COPD AND ASTHMA

A

COPD&raquo_space; Asthma

66
Q

Can ipratropium work alone

A

It is ineffective in reversing bronchospasm on its own

67
Q

Ipratropium onset and duration of action

A

15 mins

6 hours

68
Q

Tiotropium onset and duration of action

A

30 mins

More than 24 hours

69
Q

What’s a good combination with ipratropium

A

Ipratropium with a SABA usually with FENOTEROL

Instead of either alone

70
Q

Mechanism of action of omalizumab

A

Antibody against IGE. Blocks it from binding to mast cells

71
Q

Omalizumab is used in which patients

A

Patients with sensitisation to perinnial aeroallergens - frequent asthma exacerbation

72
Q

IL 5 antagonists suffix

A

Zumabs but not omalizumab

73
Q

What does IL 5 do

A

Recruitment of eosinophils

74
Q

What are IL5 antagonists indicated for

A

Given for eosinophilic asthma as it decreases the production and survival of eosinophils

Pharmacology (33 decks)

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