Asthma Flashcards
What are the first line drugs for asthma?
Fast-acting B2 agonists SABA (Reliever)
Long-acting B2 agonists LABA (Controller)
What is the first line anti-inflammatory drug?
Glucocorticoid (Corticosteroids)
What is the MOA of B2-adrenoceptor agonists?
- Promotes airway smooth muscle relaxation
- Mast cell stabilization which decrease microvascular leakiness
- Increase mucociliary clearance.
Name one SABA
Salbutamol
Name one LABA
Salmeterol
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.
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.
What is one bronchodilator that can be used as both a reliever and controller?
Formoterol
What is the duration of action for Formoterol as a fast-acting agent?
2-3min
What is one medication used IV/SC in an emergency as a bronchodilator?
Adrenaline
What are the side effects of B2-adrenoceptor agonists?
Tremor
Muscle Cramps
Peripheral vasodilation
Palpitations
Tachycardia
Hypokalaemia
Hyperglycaemia
Why should LABA not be prescribed alone for asthma?
Downregulates B2-adrenoceptor expression hence increasing the risk of asthma-related death.
What medication should LABA always be used with?
Inhaled corticosteroid
When is SAMA / LAMA used for the treatment of Asthma?
When patient is intolerant of B2 agonists
What is the MOA of Muscarinic Receptor Antagonists?
It inhibits M3 receptor-mediated bronchoconstrictions and reverses vagal nerve mediated bronchospasm and mucus secretion.
What are the adverse effects of muscarinic receptor antagonists?
Dry Mouth
Urinary retention
Name one SAMA and one LAMA
SAMA: Ipratropium
LAMA: Tiotropium Bromide
What are some examples of Methylxanthines?
Theophylline
Aminophylline (Theophylline + Ethylenediamine 2:1)
Name one bronchodilator which can be used via the rectal route?
Aminophylline
What are the adverse effects of Methylxanthines?
Nausea and vomiting
Abdominal discomfort
Anorexia
Insomnia
Seizures
Arrhythmias
Tremor
Anxiety
What is the adjunct treatment of severe acute asthma?
Magnesium Sulphate
Name 3 examples of inhaled corticosteroids that are commonly used for the treatment of Asthma
Budesonide
Fluticasone
Ciclesonide
Which corticosteroid is associated with greater risk of adrenal suppression?
Fluticasone
What are some of the pro-inflammatory mediators that Corticosteroid reduces?
T cells, mast cells, eosinophils
Mucus secretion
Phospholipase A2
Cyclooxygenase-2
5-Lipooxygenase
What are some of the anti-inflammatory mediators that Corticosteroid increases?
Annexin A1
B2 adrenoceptors
What is the MOA of corticosteroid?
- 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.
What is corticosteroid indicated for?
First line prophylactic for asthma treatment
Nocturnal asthma
What are the adverse effects of corticosteroids?
Cough
Oropharyngeal candidiasis
Dysphonia
Easy bruising
Osteoporosis
Posterior sub-capsular cataracts
What are leukotriene pathway inhibitors indicated for?
Prophylaxis and chronic treatment of asthma
Aspirin-induced / NSAID exacerbated asthma
Exercise-induced asthma
What are the 2 leukotriene pathway inhibitor?
Montelukast (Cysteinyl-leukotrine receptor antagonist)
Zileuton (5-Lipoxygenase Inhibitor)
What syndrome is leukotriene pathway inhibitors associated with?
Churg-Straus Syndrome
Likely due to concomitant glucocorticoid withdrawal.
Montelukast can be used as adjunct for ____ to ____ asthma
Mild to moderate asthma(but cannot be used alone as reliver, is a weak bronchodialator at clinical dose)
What medication is effective in aspirin-sensitive asthma and exercise-induced asthma?
Montelukast
What group of drug does Cromoglicic acid belong to?
Mast Cell stabiliser
What is cromoglicic acid indicated for in the treatment of asthma?
Prophylactic control of asthma
Prophylactic control of allergic rhinitis, allergic conjunctivitis and vernal keratoconjunctivitis
Cromoglicic acid should be taken _____ before antigen-challenge or exercise to prevent bronchospasm
Single dose
What are the adverse effect of cromoglicic acid?
Throat and nasal irritation
Mouth dryness
Cough
Unpleasant taste
Omalizumab is a _____ monoclonal antibody
Anti-IgE
In what cases of asthma is Omalizumab used?
Severe asthmatics with allergies and an elevated IgE level
How often is Omalizumab given?
Subcutaneous injection every 2 to weeks
Omalizumab _____ levels of free ____ in serum and decreases FcER expression on _____.
Omalizumab depletes levels of free IgE in serum and decreases FcER expression on mast cells.
What are some limitations or adverse effects of Omalizumab?
Expensive
Associated with small increase in risk of heart attack, transient ischemic attack and blood clot.
What is one medication used for eosinophilic asthma?
Reslizumab
Can a 10 year old patient with eosinophilic asthma be prescribed Reslizumab?
No. Reslizumab only approved for severe, persistent eosinophilic asthma in patient >18 years old.
How often should Reslizumab be given?
IV once every 4 weeks
What is one common adverse effect of reslizumab?
Oropharyngeal pain
Seretide is the combination of ____ and _____
Salmeterol (LABA) + Fluticasone (Corticosteroid)
Symbicort is the combination of ____ and _____
Formoterol (Fast acting LABA) + Budesonide (Corticosteroid)
