asthma Flashcards
What are the first line drugs for asthma? (for bronchodilation)
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?
It promotes airway smooth muscle relaxation, mast cell stabilization which decrease microvascular leakiness and increase mucociliary clearance.
Name one SABA
Salbutamol
Name one LABA
Salmeterol/Formoterol
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
B2 adrenoreceptors tolerance
Why should LABA not be prescribed alone for asthma?
LABAs downregulate B2-adrenoreceptor expression hence increasing the risk of asthma-related death as responsiveness to B2-adrenoreceptor agonism decreases
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 and to prevent bronchoconstriction
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)
both can be administered via oral/IV
what is the MOA of methyxanthines
inhibits PDEs and blocks adenosine receptors
NOT a clinical anti-inflammatory but has effects
Name one bronchodilator which can be used via the rectal route?
Aminophylline
What are the adverse effects of Methylxanthines?
GIT, CNS, CVS effects
(CNS - tremor/anxiety
CVS - arrhythmias)
have to consider pt caffeine intake!!!!
What is the adjunct treatment of severe acute asthma?
Magnesium Sulphate
IV or Neb
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 the effects of corticosteroids
reduce pro inflammatory mediators
increase anti-inflammatory mediators
What is the MOA of corticosteroid?
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.
What is corticosteroid indicated for?
First line prophylactic for asthma treatment
Nocturnal asthma
What are the adverse effects of corticosteroids?
Cough
Oropharyngeal candidiasis
Dysphonia
(below are esp common in elderly)
Easy bruising
Osteoporosis
Posterior subcapsular cataracts
What are leukotriene pathway inhibitors indicated for?
Prophylaxis and chronic treatment of asthma
Exercise / Aspirin-induced / NSAID exacerbated asthma
What are the 2 leukotriene pathway inhibitor?
Montelukast (Cysteinyl-leukotrine receptor antagonist)
Zileuton (5-Lipoxygenase Inhibitor)
How can leukotriene pathway inhibitors be administered
Oral only
What syndrome is leukotriene pathway inhibitors associated with?
Churg-Straus Syndrome
Likely due to concomitant glucocorticoid withdrawal
what are CysLT (Cysteinyl-Leukotriene) Receptors also known as
weak bronchodilators, mainly prevent bronchoconstriction pathway
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 the MOA of cromoglicic acid (cromolyn)?
decreeases mast cell degranulation and inflammatory mediators secretion
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 4 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
what type of antibody is reslizumab
Anti- IL-5/IL-4
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)
