Asthma

Question 1

B2 adrenoreceptor agonists

Answer 1

Albuterol (SABA)
Salbuterol (LABA)

MoA: ↓Ca2+ >↑AC >↑cAMP > relax SM > ❌ Mast cells, ↓permeability > ❌ Edema

ADR: Hypokalaemia* - Tachycardia* - Fine Tremor

DDIs: Theophylline (↑risk of *)

Question 2

Anti-cholinergics

Answer 2

Ipatromium (5-6hrs) [inhaler/nebuliser]
Tiotropium (18-24hrs)

MoA: ❌ M3 receptors > ❌ ACh > ❌ SM contraction & ❌ Mucus secretion

Uses: intolerance to B-agonists & Elderly

ADR:
Dry mouth - Cough
Headache - Dizziness
Nausea - Constipation

Question 3

Non-selective PDEIs

Answer 3

Theophylline (oral)
Aminophylline (IV)
[theophylline + ethylenediamine]

MoA:
❌ PDE >↑cAMP
❌ Adenosine receptor > bronchodilation

ADR: GI - esp. Nausea (10%) and
Toxicity w/ arrhythmias & seizures

DDIs: Atenolol (↑bronchospasm)
Amiodarone (↑hypokalaemia)

Narrow TI: 10-20 mg/L

Question 4

Corticosteroids

Answer 4

Beclomethasone
Budenoside (persistant asthma)
Prednisolone*

MoA: ✅ glucocorticoid receptor > ❌eosinophilia inflammation

ADR: Hoarse voice - Oral candidiasis - Adrenal suppression

use if possible & w/device
max anti-inflammation w/min systemic absorption

Question 5

Leukotriene antagonists

Answer 5

Zaferleukast (SA)
Monteleukast (LA)

MoA: ❌ LTD4
↓bronchial hyper-responsiveness & Edema
↓SMC proliferation & eosinophilic recruitment

Question 6

Asthma Management Step 1

Answer 6

SABA only

Question 7

Asthma Management Step 2

Answer 7

SABA + low-dose ICS

Question 8

Asthma Management Step 3

Answer 8

SABA + low-dose ICS + LTRA

Question 9

Asthma Management Step 4

Answer 9

SABA + low-dose ICS + LABA

Question 10

Asthma Management Step 5

Answer 10

SABA + low-dose MART (ICS + LABA)

or

SABA + LTRA + low-dose MART

Question 11

Asthma Management Step 6

Answer 11

SABA + medium- dose MART (ICS + LABA)

or

SABA + LTRA + medium-dose MART