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Resp Pharm > Asthma > Flashcards

Asthma Flashcards

1
Q

What are the first line drugs for asthma?

A

Fast-acting B2 agonists SABA (Reliever)
Long-acting B2 agonists LABA (Controller)

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2
Q

What is the first line anti-inflammatory drug?

A

Glucocorticoid (Corticosteroids)

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3
Q

What is the MOA of B2-adrenoceptor agonists?

A

It promotes airway smooth muscle relaxation, mast cell stabilization which decrease microvascular leakiness and increase mucociliary clearance.

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4
Q

Name one SABA

A

Salbutamol

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5
Q

Name one LABA

A

Salmeterol

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6
Q

In the treatment of Asthma, Salbutamol is used as a ____ as it is fast/slow acting while _____ is used as a controller as it is fast/slow acting.

A

In the treatment of Asthma, Salbutamol is used as a reliever as it is fast-acting while Salmeterol is used as a controller as it is slow-acting.

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7
Q

What is one bronchodilator that can be used as both a reliever and controller?

A

Formoterol

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8
Q

What is the duration of action for Formoterol as a fast-acting agent?

A

2-3min

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9
Q

What is one medication used IV/SC in an emergency as a bronchodilator?

A

Adrenaline

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10
Q

What are the side effects of B2-adrenoceptor agonists?

A

Tremor
Muscle Cramps
Peripheral vasodilation
Palpitations
Tachycardia
Hypokalaemia
Hyperglycaemia

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11
Q

Why should LABA not be prescribed alone for asthma?

A

As LABA downregulates B2-adrenoceptor expression hence increasing the risk of asthma-related death.

Corticosteroids upregulate B2-adrenoceptor expressions, hence should be taken together with LABA

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12
Q

What medication should LABA always be used with?

A

Inhaled corticosteroid

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13
Q

When is SAMA / LAMA used for the treatment of Asthma?

A

When patient is intolerant of B2 agonists

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14
Q

What is the MOA of Muscarinic Receptor Antagonists?

A

It inhibits M3 receptor-mediated bronchoconstrictions and reverses vagal nerve mediated bronchospasm and mucus secretion.

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15
Q

What are the adverse effects of muscarinic receptor antagonists?

A

Dry Mouth
Urinary retention

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16
Q

Name one SAMA and one LAMA

A

SAMA: Ipratropium
LAMA: Tiotropium Bromide

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17
Q

What are some examples of Methylxanthines?

A

Theophylline
Aminophylline (Theophylline + Ethylenediamine 2:1)

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18
Q

Name one bronchodilator which can be used via the rectal route?

A

Aminophylline

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19
Q

What are the adverse effects of Methylxanthines?

A

Nausea and vomiting
Abdominal discomfort
Anorexia
Insomnia
Seizures
Arrhythmias
Tremor
Anxiety

20
Q

What is the adjunct treatment of severe acute asthma?

A

Magnesium Sulphate

21
Q

Name 3 examples of inhaled corticosteroids that are commonly used for the treatment of Asthma

A

Budesonide
Fluticasone
Ciclesonide
“BFC”

22
Q

Which corticosteroid is associated with greater risk of adrenal suppression?

A

Fluticasone

23
Q

What are some of the pro-inflammatory mediators that Corticosteroid reduces?

A

T cells, mast cells, eosinophils
Mucus secretion
Phospholipase A2
Cyclooxygenase -2
5-Lipooxygenase

24
Q

What are some of the anti-inflammatory mediators that Corticosteroid increases?

A

Annexin A1
B2 adrenoceptors

25
Q

What is the MOA of corticosteroid?

A

It decreases airway hyper-responsiveness in 4 to 6 weeks, decreases frequency of acute asthma exacerbations, possibly prevent airway wall remodelling, reduce need for B2 agonist and reduce risk of death from asthma.

26
Q

What is corticosteroid indicated for?

A

First line prophylactic for asthma treatment
Nocturnal asthma

27
Q

What are the adverse effects of corticosteroids?

A

Cough
Oropharyngeal candidiasis
Dysphonia
Easy bruising
Osteoporosis
Posterior subcapsular cataracts

28
Q

What are leukotriene pathway inhibitors indicated for?

A

Prophylaxis and chronic treatment of asthma
Aspirin-induced / NSAID exacerbated asthma
Exercise-induced asthma

29
Q

What are the 2 leukotriene pathway inhibitor?

A

Montelukast (Cysteinyl-leukotrine receptor antagonist)
Zileuton (5-Lipoxygenase Inhibitor)

30
Q

What syndrome is leukotriene pathway inhibitors associated with?

A

Churg-Straus Syndrome

Likely due to concomitant glucocorticoid withdrawal.

31
Q

Montelukast can be used as adjunct for ____ to ____ asthma

A

Mild to moderate asthma
(but cannot be used alone as reliver, is a weak bronchodialator at clinical dose)

32
Q

What medication is effective in aspirin-sensitive asthma and exercise-induced asthma?

A

Montelukast

33
Q

What group of drug does Cromoglicic acid belong to?

A

Mast Cell stabiliser

34
Q

What is cromoglicic acid indicated for in the treatment of asthma?

A

Prophylactic control of asthma
Prophylactic control of allergic rhinitis, allergic conjunctivitis and vernal keratoconjunctivitis

35
Q

Cromoglicic acid should be taken _____ before antigen-challenge or exercise to prevent bronchospasm

A

Single dose

36
Q

What are the adverse effect of cromoglicic acid?

A

Throat and nasal irritation
Mouth dryness
Cough
Unpleasant taste

37
Q

Omalizumab is a _____ monoclonal antibody

A

Anti-IgE

38
Q

In what cases of asthma is Omalizumab used?

A

Severe asthmatics with allergies and an elevated IgE level

39
Q

How often is Omalizumab given?

A

Subcutaneous injection every 2 to 4 weeks

40
Q

Omalizumab _____ levels of free ____ in serum and decreases FcER expression on _____.

A

Omalizumab depletes levels of free IgE in serum and decreases FcER expression on mast cells.

41
Q

What are some limitations or adverse effects of Omalizumab?

A

Expensive
Associated with small increase in risk of heart attack, transient ischemic attack and blood clot.

42
Q

What is one medication used for eosinophilic asthma?

A

Reslizumab

43
Q

Can a 10 year old patient with eosinophilic asthma be prescribed Reslizumab?

A

No. Reslizumab only approved for severe, persistent eosinophilic asthma in patient >18 years old.

44
Q

How often should Reslizumab be given?

A

IV once every 4 weeks

45
Q

What is one common adverse effect of reslizumab?

A

Oropharyngeal pain

46
Q

Seretide is the combination of ____ and _____

A

Salmeterol (LABA) + Fluticasone (Corticosteroid)

47
Q

Symbicort is the combination of ____ and _____

A

Formoterol (Fast acting LABA) + Budesonide (Corticosteroid)

Resp Pharm (3 decks)

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