asthma Flashcards
whats the treatment for an acute attack
(OSHITMMAN)
oxygen = 100% non-rebreather mask Salbutamol (nebulised) Hydrocortisone IV or prednisalone (oral) Ipratropium (nebulised) Theophylline IV or aminophylline IV Magnesium IV Anaesthetist
is asthma restrictive or obstructive
obstructive
what is the main cell found in asthma
eosinophil
what would be found in a FBC
blood eosinophilia>4%
what would be heard when percussing
hyper-resonant
what would you expect from pulmonary function tests
decreased FEV1
decreased PEFR
normal FVC
describe FEV1
decreased
describe FVC
normal
describe PEFR
decreased
what investigations are used (6)
spirometry peak flow provocation testing exercise testing skin prick test FBC
what is the 1st line of treatment
SABA
what is the 2nd line of treatment
SABA + ICS
what is the 3rd line of treatment
LABA + ICS + SABA
what is the 4th line of treatment
add 4th drug e.g
methylxanthines
CysLT1 Receptor Antagonists
what is the 5th line of treatment
add oral steroid and refer to a specialist
what is the mechanism of action of SABA
Agonist binds to beta-2-adrenoceptor and initiates chain of reactions that causes ATP to be converted into cAMP leading to relaxation of airway smooth muscle
give examples of SABAs
salbutamol
terbutaline
what are the side effects of SABAs
fine tremor, tachycardia, hypokalaemia
what is the mechanism of action of LABAs
Agonist binds to beta-2-adrenoceptor which initiates chain of reactions that causes ATP to be converted into cAMP leading to relaxation of airway smooth muscle
what are the side effects of LABAs
may worsen asthma is given as a monotherapy
what should LABA be administered with
ICS
give examples of LABAs
salmeterol
formeterol
what is particularly useful in nocturnal asthma
LABA
what is the mechanism of action of ICS
anti-inflammatory effects. Act by mediating transcription of specific genes to alter mRNA levels + rate of synthesis of inflammatory/anti- inflammatory mediator proteins
give examples of ICS
beclometasone
budesonide
what is the mechanism of action of methylxanthines
anti-inflammatory and limited bronchodilator action. Uncertain mechanisms
give examples of methylxanthines
theophylline
aminphylline
when would methylxanthines be used
4th step
side effects of methylxanthines
many due to narrow therapeutic window
when would ICS be used
2nd step
when would SABA be used
1st step
when would LABA be used
3rd step
what is the mechanism of action of CysLT1 Receptor Antagonists
act competitively at the CysLT1 receptor cause smooth muscle
contraction, mucous secretion and oedema
what are CysLTs derived from?
mast cells and infiltrating
inflammatory cells
how are CysLTs administered
orally
give examples of CysLTs
montelukast
what Ig__ is present in asthma
IgE
give an example of a monoclonal antibody therapy in asthma
Omalizumab
what is the mechanism of action of Omalizumab
binds to IgE via Fc to prevent FCE receptor attachment
how is Omalizumab administered
IV
what type of hypersensitivity disease is asthma
type I
what is asthma
recurrent and reversible obstruction of the airways in response to a stimuli/substance