ASTHMA 2 Flashcards
The use of Glucocorticoids
This are anti-inflammatory drugs using mainstly to prevent acute attack
Not use as broncodilators
prevent progression of chronic asthma
Glucocorticoids Mechanism of action for asthma
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.
Explain different routes of administration of Glucocorticoids for asthama, aso writing down the drugs and the clinical indication
- Inhaled corticosteriods (Buclemethasone, budesonide and fluticasone): use for chronic treatment of persistant asthma
- Oral route: prednisole for exarcabation (attack) when asthma is uncontrolled
- IV treatment: hydrocortisone when severe bronchospasm when unable to take oral
Inhaled administration of Glucocorticoids, how many times?
Twice daily
The glucocorticoids acts where? and quantity of drug deposited
Act topical of bronchial muscle and 15-20% of drugs is deposited in lungs
What to do after using a drug
rinse mouth to prevent oral candida
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
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)
Adverse effects of inhaled glucocorticoids for asthma
Oral candidiasis
Hoarseness
Sore throats
MOA of muscuranic receptor antagonist
- Block airway contraction of bronchial smooth muscles
- inhibits augementation of mucus secretion that occur via vagal stimulation
- Increas mucociliary clearance of bronchial secretion
MRA, response vary among individuals
what does this mean?
Only inhibit portion of bronchoconstrictive response mediated by parasympathetic pathways and more prone to COPD and eldery
Ipratropium
1. Onset
2. Duration
3. Caution
4. Adverse effect
- 30 min
- 4 hours
- Prostatic hyperplasia and narrow angled gluocoma
- Bitter taste and dry mouth
MOA of Xanthines
Unclear, relax smooth muscles via inhibition of phosphodiasterase isoenzyme. antagonise adenosine receptors
we use theophylline when?
when other bronchodilators have fail
Explain the pharmacokinetics of theophylline
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
common side effects of theophylline
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
Uncommon side effects of theophylline
Tachycardia
Depression
Arrythmias
Hypotension
Hyperglycemia
Palpiltation
Caution of theophylline
IHD
Hx PUD
CCF
Hypertension
Hyperthrydosim
epilepsy
liver diseases
Older patients
Drug interaction of theophylline
- Hepatic enzyme inhibitors: cimetidine, erythromycin, ciprofloxacin,
ritonavir, etc. - Hepatic enzyme inducers: smoking, alcohol, barbiturates rifampicin,
phenytoin, carbamazepine - Sympathomimetic agents: potentiate cardiac effects
MOA of Leukotrines receptor antagonists
exhibits anti-inflammatory and bronchodilator effects by blocking activity cycTl in airways
Indication of leukotrines receptor antagonists
prophylaxis and chronic treatment of atopic asthma (also treat allergic rhinitis), prevent exercise induced asthma
Route of administration of Montelukast
and is not indicated for what?
Oral administration
Not indicated for acute attack (controller, take regullary)
adverse effects of montelukast
Uncommon in general
hypersensitivity
Eosinophilia rarely
Neuropyschiatric events: agetation, aggregation, anxiousness, suciadial thinking and behavior, depression, hallucinations, insomnia irritability
explain treatment procedure for midl and moderate acute asthma attacks
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.
severe acute asthma attacks treatment procedures
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.
explain non-pharamacological advice and education to patient about persistant asthma attacks
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.
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————————–
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
treatment of Exercise induced asthma
Administer SABA: Salbutamol 30 minutes before exercise
DRAW THE TABLES OF SEVERITY CLASSIFICATION OF ASTHMA AND MANANGEMENT OF CHRONIC ASTHMA
