ASTHMA 2

Question 1

The use of Glucocorticoids

Answer 1

This are anti-inflammatory drugs using mainstly to prevent acute attack
Not use as broncodilators
prevent progression of chronic asthma

Question 2

Glucocorticoids Mechanism of action for asthma

Answer 2

Restrain clonal proliferation of Th cells by reducing the transcription of the gene for IL 2 and reduce cytokines formation in particular the th2 cytokines that recruits and activates eosinophils and are responsible for production of IgE and IgE receptors
Inhibit the allergen-induced influx of eosinophils into the lung.
* Up-regulate β 2 adrenoceptors,
* Decrease microvascular permeability
* Indirectly reduce mediator release from eosinophils by inhibiting the
production of cytokines (e.g. IL-5 and granulocyte–macrophage
colony-stimulating factor) that activate eosinophils.
* Reduce synthesis of IL-3 (the cytokine that regulates mast cell
production) i.e. may explain why long-term steroid treatment
eventually reduces the number of mast cells in the respiratory
mucosa, and hence suppresses the early-phase response to allergens
and exercise.

Question 3

Explain different routes of administration of Glucocorticoids for asthama, aso writing down the drugs and the clinical indication

Answer 3

1. Inhaled corticosteriods (Buclemethasone, budesonide and fluticasone): use for chronic treatment of persistant asthma
2. Oral route: prednisole for exarcabation (attack) when asthma is uncontrolled
3. IV treatment: hydrocortisone when severe bronchospasm when unable to take oral

Question 4

Inhaled administration of Glucocorticoids, how many times?

Answer 4

Twice daily

Question 5

The glucocorticoids acts where? and quantity of drug deposited

Answer 5

Act topical of bronchial muscle and 15-20% of drugs is deposited in lungs

Question 6

What to do after using a drug

Answer 6

rinse mouth to prevent oral candida

Question 7

Significant improvement may take 5 weeks i.e. adherence is not
important for optimal effectiveness (educate on prophylactic use,
continue treatment even when symptom free)

TRUE OR FALSE

Answer 7

FALSE
Significant improvement may take 1-4 weeks i.e. adherence is
important for optimal effectiveness (educate on prophylactic use,
continue treatment even when symptom free)

Question 8

Adverse effects of inhaled glucocorticoids for asthma

Answer 8

Oral candidiasis
Hoarseness
Sore throats

Question 9

MOA of muscuranic receptor antagonist

Answer 9

1. Block airway contraction of bronchial smooth muscles
2. inhibits augementation of mucus secretion that occur via vagal stimulation
3. Increas mucociliary clearance of bronchial secretion

Question 10

MRA, response vary among individuals
what does this mean?

Answer 10

Only inhibit portion of bronchoconstrictive response mediated by parasympathetic pathways and more prone to COPD and eldery

Question 11

Ipratropium
1. Onset
2. Duration
3. Caution
4. Adverse effect

Answer 11

1. 30 min
2. 4 hours
3. Prostatic hyperplasia and narrow angled gluocoma
4. Bitter taste and dry mouth

Question 12

MOA of Xanthines

Answer 12

Unclear, relax smooth muscles via inhibition of phosphodiasterase isoenzyme. antagonise adenosine receptors

Question 13

we use theophylline when?

Answer 13

when other bronchodilators have fail

Question 14

Explain the pharmacokinetics of theophylline

Answer 14

Narrow therapeutic index
oral A good (Sustained release formulation, do not change formulation in patient already stabilised)
Metabolised in the liver
Half life variable: prolonged in infants and eldery, heart failure, hepatic disease and concurent infection
Shortened by smoking and drug interaction

Question 15

common side effects of theophylline

Answer 15

GI and CNS
GI irriation may be prevented by taking with food to prevent N and V, epigastric pain and intestinal bleeding
CNS effects: headache, irritability, nervousness, insomnia, convulsion and tremor

Question 16

Uncommon side effects of theophylline

Answer 16

Tachycardia
Depression
Arrythmias
Hypotension
Hyperglycemia
Palpiltation

Question 17

Caution of theophylline

Answer 17

IHD
Hx PUD
CCF
Hypertension
Hyperthrydosim
epilepsy
liver diseases
Older patients

Question 18

Drug interaction of theophylline

Answer 18

• Hepatic enzyme inhibitors: cimetidine, erythromycin, ciprofloxacin,
  ritonavir, etc.
• Hepatic enzyme inducers: smoking, alcohol, barbiturates rifampicin,
  phenytoin, carbamazepine
• Sympathomimetic agents: potentiate cardiac effects

Question 19

MOA of Leukotrines receptor antagonists

Answer 19

exhibits anti-inflammatory and bronchodilator effects by blocking activity cycTl in airways

Question 20

Indication of leukotrines receptor antagonists

Answer 20

prophylaxis and chronic treatment of atopic asthma (also treat allergic rhinitis), prevent exercise induced asthma

Question 21

Route of administration of Montelukast
and is not indicated for what?

Answer 21

Oral administration
Not indicated for acute attack (controller, take regullary)

Question 22

adverse effects of montelukast

Answer 22

Uncommon in general
hypersensitivity
Eosinophilia rarely
Neuropyschiatric events: agetation, aggregation, anxiousness, suciadial thinking and behavior, depression, hallucinations, insomnia irritability

Question 23

explain treatment procedure for midl and moderate acute asthma attacks

Answer 23

Salbutamol, inhalation using a metered-dose inhaler (MDI), 4–8 puffs, using a spacer.
* Inhale one puff at a time. Allow for 4 breaths through the spacer between puffs.
* If no relief, repeat every 20–30 minutes in the first hour.
* Thereafter, repeat every 2–4 hours if needed.
* Note: Administering salbutamol via a spacer is as effective as, and cheaper than, using a nebuliser.
* OR
* Salbutamol 0.5%, solution, nebulised, with oxygen.
* 1 mL (5 mg) salbutamol 0.5% solution, in 4 mL of sodium chloride 0.9%.
* If no relief, repeat every 20–30 minutes in the first hour.
* Thereafter, repeat every 2–4 hours if needed.
* AND
* Corticosteroids (intermediate-acting) e.g.: Prednisone, oral, 40 mg immediately
* Follow with prednisone, oral, 40 mg daily for 7 days.

Question 24

severe acute asthma attacks treatment procedures

Answer 24

Give oxygen with care (preferably by 24% or 28% facemask, if available). Observe patients
closely, as a small number of patients’ condition may deteriorate.
* AND
* Salbutamol 0.5%, solution, nebulised, with oxygen.
* 1 mL (5 mg) salbutamol 0.5% solution, in 4 mL of sodium chloride 0.9%.
* If no relief, repeat every 20–30 minutes until PEF > 60% of predicted.
* Once PEF > 60% of predicted, repeat every 2–4 hours if needed.
* AND
* Corticosteroids (intermediate-acting) e.g.:  Prednisone, oral, 40 mg immediately.
* Follow with prednisone, oral, 40 mg daily for 7 days.
* ADD (If poor response after first salbutamol nebulisation/inhalation):
* Ipratropium bromide solution, nebulised,
* 2 mL (0.5 mg) added to salbutamol solution every 20–30 minutes for 3 doses depending on clinical response.
OR using MDI, 80–160 mcg (2–4 puffs), using a spacer every 20–30 minutes as needed for up to 3 hours.
OR
Salbutamol, inhalation using a MDI, 4–8 puffs, up to 20
puffs, using a spacer.
o Inhale 1 puff at a time. Allow for 4 breaths through the spacer between
puffs.
o If no relief, repeat every 20–30 minutes until PEF > 60% of predicted.
o Once PEF > 60% of predicted, repeat every 2–4 hours if needed.
OR
If oral prednisone cannot be taken: Hydrocortisone IM/slow
IV, 100 mg as a single dose.
Follow with: Corticosteroids (intermediate-acting) e.g.:
Prednisone, oral, 40 mg daily for 7 days.

Question 25

explain non-pharamacological advice and education to patient about persistant asthma attacks

Answer 25

No smoking by an asthmatic or in the living area of an asthmatic.
* Avoid contact with household pets.
* Avoid exposure to known allergens and stimulants or irritants.
* Education on early recognition and management of acute attacks.
* Patient and caregiver education:
* emphasise the diagnosis and explain the nature and natural course of the condition;
* teach and monitor inhaler technique; and
* reassure parents and patients of the safety and efficacy of continuous regular
controller therapy.

Question 26

Medicine treatment is based on the ——— of the asthma and
consists of therapy to:
(1) prevent the inflammation leading to bronchospasm (controller)
name drug —————————–
(2) relieve bronchospasm (reliever)
name drug————————–

Answer 26

Medicine treatment is based on the severity of the asthma and
consists of therapy to:
(1) prevent the inflammation leading to bronchospasm (controller)
ICS: beclomethasone – use twice daily
(2) relieve bronchospasm (reliever)
SABA: salbutamol – use as needed

Question 27

treatment of Exercise induced asthma

Answer 27

Administer SABA: Salbutamol 30 minutes before exercise

Question 28

DRAW THE TABLES OF SEVERITY CLASSIFICATION OF ASTHMA AND MANANGEMENT OF CHRONIC ASTHMA