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Pharmacology > ASTHMA > Flashcards

ASTHMA Flashcards

1
Q

What is the rationale for drug use in Asthma?

A
  • Symptom control and relief
  • Prevention of exacerbations, acute asthma and death.
  • Improve and maintain lung function and quality of life.
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2
Q

Explain the pathophysiology of Asthma.

A
  • Chronic inflammatory disorder of the airways
  • Inflammation is associated with bronchial hyper-reactivity
  • Asthma is reversible
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2
Q

How is asthma diagnosed?

A
  • combination of medical history, physical examination, and lung function tests
  • Lung function tests, such as spirometry and peak flow measurements
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2
Q

What are the clinical characteristics of asthma?

A
  • Early onset
  • Recurrent episodes of wheezing
  • Breathlessness
  • Coughing
  • Chest tightness
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2
Q

What is the underlying pathophysiology of asthma?

A
  • Asthma is characterized by chronic inflammation of the airways
  • leading to bronchoconstriction and hyperresponsiveness.
  • This inflammation involves immune cells, such as mast cells, eosinophils,
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2
Q

What are some common risk factors for developing asthma?

A
  • genetic predisposition (family history of asthma or allergies)
  • exposure to allergens (pollen, dust mites, pet dander)
  • respiratory infections in early childhood, exposure to tobacco smoke, and a history of atopy (a genetic tendency to develop allergic reactions).
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2
Q

How do short-acting beta-agonists (SABAs) work in asthma treatment?

A
  • SABAs relax and widen the airways by targeting beta receptors on airway smooth muscles, providing rapid relief of acute symptoms.
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2
Q

What are common triggers that can exacerbate asthma symptoms?

A
  • allergens (pollen, mould, animal dander)
  • respiratory infections, cold air, exercise, smoke (tobacco or wood),
  • strong odours, air pollution, and irritants like perfumes or cleaning products.
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2
Q

What is the role of inhaled corticosteroids (ICS) in asthma management?

A
  • ICS reduce airway inflammation
  • preventing exacerbations and
  • controlling chronic symptoms.
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2
Q

What are long-acting beta-agonists (LABAs) used for in asthma treatment?

A
  • LABAs provide sustained bronchodilation and are used as adjunct therapy for long-term control of asthma symptoms.
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3
Q

What is the main inflammatory mediator of Asthma?

A
  • Eosinophils
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4
Q

What are the drugs that may trigger Asthma?

A
  • Aspirin
  • NSAIDs
  • Beta-blockers
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5
Q

What are the drug choice for Asthma?

A

Inhaled corticosteroids (ICS), Short-acting beta 2 agonists (SABAs), Long-acting beta 2 agonists (LABAs) if using LABA for Asthma, always use with an ICS, Montelukast, Long-acting anticholinergics aka long-acting muscarinic antagonists or LAMAs, Monoclonal antibodies

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6
Q

What is the purpose of combination inhalers in asthma treatment?

A
  • Combination inhalers contain both ICS and a LABA
  • addressing both inflammation and bronchodilation in one inhaler.
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7
Q

What is the main purpose of SABAs in asthma treatment?

A
  • SABAs like Salbutamol and terbutaline provide rapid relief by relaxing airway muscles, helping to relieve acute bronchoconstriction.
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8
Q

When are SABAs typically used?

A
  • SABAs are used as rescue inhalers during acute asthma symptoms or before exercise to prevent exercise-induced bronchoconstriction.
9
Q

How do LABAs differ from SABAs in asthma management?

A
  • LABAs such as Formoterol and salmeterol provide prolonged bronchodilation and are used as part of long-term control therapy.
10
Q

Are LABAs meant to be used as monotherapy in asthma treatment?

A
  • No, LABAs are generally used in combination with inhaled corticosteroids (ICS) for better control of asthma symptoms.
11
Q

What is the primary role of ICS in asthma management?

A
  • ICS, like Budesonide and Fluticasone, reduce airway inflammation, prevent exacerbations, and help control chronic asthma symptoms.
12
Q

Are ICS used for immediate relief during acute asthma attacks?

A
  • No, ICS are not fast-acting and are mainly used for long-term control of asthma.
13
Q

How do Leukotriene Receptor Antagonists, such as Montelukast, work in asthma therapy?

A

LTRAs block the action of leukotrienes, which are inflammatory molecules, helping to reduce inflammation and bronchoconstriction.

14
Q

What is the primary function of SAMAs and LAMAs in managing respiratory diseases?

A
  • SAMAs like Ipratropium and LAMAs like Tiotropium act as bronchodilators by blocking muscarinic receptors in the airways.
15
Q

If asthma control is not achieved, what should be considered?

A
  • Check inhaler technique, address adherence issues, identify triggers, and assess comorbid conditions. Consider stepping up treatment.
16
Q

What step-up options are available if control is not achieved with current treatment?

A
  • Increase ICS dose, add a long-acting beta-agonist (LABA) if not already included, or consider other add-on therapies like leukotriene receptor antagonists (LTRAs).
17
Q

What are 2 medications that may trigger Asthma?

A

Aspirin & NSAIDs – bronchospasm +/- rhinitis

18
Q

How does an asthma flare up occur?

A
  • Muscles squeezing and narrowing the airway causing mucosal obstruction
19
Q

What are three differences between treatment of asthma and COPD?

A
  • In asthma, you can step up or down wheras in COPD you only go up
  • In asthma, you use LABAS ONLY with an ICS whereas COPD, you use LABAS on their own
  • LAMAs are the main treatment for COPD whereas with asthma, it is ICS
  • LTRAs are used in step 5 of asthma wheras you don’t use it at all in COPD
  • SAMAs are better with COPD
20
Q

What are two similarities between asthma and COPD treatment?

A
  • Step wise and based on severity
  • All patients should have a fast acting bronchodilator
21
Q

What is the general approach to adjusting asthma treatment?

A
  • Depends on symptom frequency, severity/impact of symptoms and history of flare ups
  • Good control is daytime symptoms for less than 2 days a week, the need for a SABA less than 2 times a week and no limit on daily activities
22
Q

What should you check before you step up asthma treatment? (4 marks)

A
  • Check symptoms
  • Check technique is correct
  • Check adherence to treatment
  • Check modifiable risk factors
23
Q

What are the four steps of treatment in asthma for adults?

A
  • 1st step- daily ICS and SABA reliever or budesonide-formoterol (low dose as needed)
  • 2nd step- daily ICS and LABA (low dose) add SABA if needed
  • 3rd step- daily ICS and LABA (medium to high dose) add SABA if needed
  • Specialist treatment
23
Q

What are two differences in asthma treatment for adults vs children?

A
  • A LABA is a better add on than ICS as age increases
  • A LTRA is more appropriate for younger patients
24
Q

What are the four steps of treatment for asthma in children (Remember: treatment at stage 3 is different for 1-5 yr olds and 6-11 yr olds)

A
  • 1st step- SABA reliever
  • 2nd step- regular preventer (ICS or montelukast) and reliever
  • 3rd step
    • 1-5: stepped up regular preventer (low dose ICS and montelukast or high dose ICS) and reliever as needed
    • 6-11: ICS (high dose), ICS/LABA combination (low dose) or ICS (low dose) and montelukast
25
Q

What is an example of a SABA and two adverse effects?

A
  • Salbutamol and terbutaline
  • AEs- tremor, palpitations and headache
26
Q

What is an example of a ICS and two adverse effects?

A
  • Budesonide and ciclysonide
  • AEs- Sore mouth, hoarse voice, adrenal suppression, osteoporosis and oral candestasis
27
Q

What is an example of a LABA and two adverse effects?

A
  • Eformoterol and salmeterol
  • AEs- tremor, palpitations and headache
28
Q

What is an example of a LTRA and two adverse effects?

A
  • Montelukast
  • AEs: headache, ab pain and diarrhoea
29
Q

What should you monitor with asthma and COPD treatment?

A
  • Inhaler technique
  • Exacerbations
  • Respiratory distress

Pharmacology (23 decks)

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