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The Patient > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A

An allergic disorder mediated by IgE in response to an allergen/trigger eg pollen, exercise

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2
Q

What causes bronchospasm in patients with asthma?

A

IgE causes an inflammatory response, histamine, prostaglandins, leukotrines and eosinophils enter the airway, goblet cells over produce mucous and T-lymphocytes release cytokines to potentiate the inflammatory response. This cascade causes bronchospasm.

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3
Q

How is asthma diagnosed?

A

There is no single test to diagnose asthma. Use lung function tests based on predicted values based on age, race, sex and height. Expect asthma patients to have a decreased PEFR and FEV1 but it should improve after a SABA or corticosteroid.

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4
Q

What does an FEV1/FVC ratio below 70% indicate?

A

Obstruction

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5
Q

How much should FEV1 improve by in asthma patients after they have taken salbutamol?

A

400ml

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6
Q

Give 3 examples of inhaled corticosteroids.

A

Beclomethasone, budesonide, ciclesonide.

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7
Q

List the ADRs for inhales corticosteroids.

A

Oral thrush, adrenal suppression and hoarseness

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8
Q

When are corticosteroids indicated in asthma patients?

A

If the patient has had an exacerbation in less than 2 years, is using their beta 2 agonist more than 3x a week, is waking 1 night a week and is symptomatic more than 3x a week.

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9
Q

When is IV hydrocortisone used in the treatment of asthma?

A

In acute severe situations

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10
Q

What is the dose and duration for prednisolone for an acute asthma attack?

A

40-50mg for 5 days

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11
Q

List the ADRs for prednisolone.

A

Hyperglycaemia, moon face, acne, skin thinning, osteoporosis, adrenal suppression, hypertension.

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12
Q

Give two examples of long acting beta 2 agonists.

A

Salmeterol and formoterol

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13
Q

What is the duration of action for a LABA?

A

12 hours

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14
Q

What is the onset and duration of action for a SABA?

A

1-5min onset, 4-6 hour duration

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15
Q

What is the mechanism of action for beta 2 agonists?

A

Relax airway smooth muscle by stimulating beta 2 receptors which increase cAMP and prevent bronchoconstriction.

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16
Q

What are the side effects of beta 2 agonists?

A

Tremor, nervous tension, hypokalaemia, headache, tachycardia, peripheral vasodilation.

17
Q

How is inhaled medication classified?

A

Relievers- quick symptomatic relief when required eg SABA
Preventers- act on underlying inflammation eg corticosteroids
Controllers- eg LABA

18
Q

Give an example of a leukotrine antagonist.

A

Montelukast

19
Q

What is the mechanism of action of leukotrine antagonists?

A

Antagonise bronchoconstriction, airway oedema and mucous production.

20
Q

Give 3 side effects of montelukast

A

Sleep disturbances, rash and thirst

21
Q

What are cromones?

A

Mast cell stabilisers

22
Q

Which patients are cromones used for?

A

5-12 year olds

23
Q

What is the mechanism of action of cromones?

A

Inhibit histamine release from mast cells

24
Q

What are methylxanthines?

A

Phosphodiesterase inhibitors that inhibit leukotrine synthesis and thus inflammation and bronchodilation.

25
Q

Give an example of a methylxanthine.

A

Theophylline

26
Q

Why do methylxanthines have many interactions and ADRs?

A

Because they are metabolised by CYP450

27
Q

Why must the brand of methylxanthines used in a specific patient remain constant?

A

Because they have a narrow therapeutic index.

28
Q

True or false, smoking and alcohol can lead to a sub therapeutic dose of theophylline?

A

True

29
Q

What are anti IgE monoclonal antibodies licensed for?

A

Adults and children over 12 for severe persistent allergic asthma

30
Q

How are ant IgE monoclonal antibodies administered?

A

By a subcutaneous injection every 2-4 weeks

31
Q

What is the mechanism of action of anti IgE monoclonal antibodies?

A

Inhibit binding of IgE to mast cell receptors to prevent the inflammatory response.

32
Q

How should you monitor a patient with asthma?

A

O2 sats (aim= 94-98%), PEF, CRP, WCC, blood pH (due to risk of acidosis), hydration, serum K+ (because hypokalaemia is a side effect of beta agonists), theophylline levels, tachycardia, arterial blood gasses.

33
Q

How do severe/life threatening exacerbation of asthma present?

A

With cyanosis, drowsiness, difficulty speaking, unconsciousness, tachycardia and severe dyspnoea.

34
Q

What can be given in acute asthma if the patient has a PEF of less than 50%?

A

A single dose of IV magnesium sulphate as it is a smooth muscle relaxant

35
Q

Define acute asthma

A

Respiratory rate of more than 25 breaths/minute, heart rate of more than 110bpm, O2 sats less than 92%

The Patient (5 decks)

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