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M2 Pharm > Asthma > Flashcards

Asthma Flashcards

1
Q

Controllers

A

CLAS: ICS, Na cromoglycate, Leukotriene-receptor antagonist, mAb (Anti-IgE, anti-IL5, anti-IL4R)

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2
Q

Reliever

A

BMT: SABA, LABA, COPD LABA, Theophylline, SAMA, LAMA

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3
Q

Example of ICS

A

Fluticasone

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4
Q

MoA of ICS

A

Anti-inflammatory:
Decreased inflammatory cells in airways — T cells, mast cells, macrophages and especially eosinophils for allergic asthma but no effect on neutrophils
Increased Annexin-1 but decreased COX 2, 5-LOX, PLA2 expression
Decrease cytokines

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5
Q

Use of ICS

A

1st line prophylactic therapy, decrease nocturnal asthma

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6
Q

Efficacy of ICS

A

Do not relax airway directly
Decreased risk of death from asthma
Decrease airway hyperresponsiveness in a few weeks
Decreased frequency of asthma

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7
Q

SE of ICS

A

Oropharyngeal candidiasis, cough, throat irritation
Some systemic effects (easy bruising in elderly, osteoproosis, adrenal suppression for fluticasone) present but lower risk of these

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8
Q

MoA of Na Cromoglycate

A

Mast cell stabilizer —prevents degranulation of mast cells –> prevent histamine, PG, leukotriene release
Promotes annexin-A1 secretion –> blocks histamine release
Blocks inflammatory mediators release

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9
Q

SE of Na Cromoglycate

A

Thorat irritation, dry mouth, cough, unpleasant taste

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10
Q

MoA of LTRA

A

Montelukast: competitive antagonist of cysteinyl leukotriene (CysLT1) receptor

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11
Q

Use of LTRA

A

Exercise and aspirin-induced asthma

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12
Q

SE of LTRA

A

Rarely get psychological reactions such as agitation, depression, hallucination

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13
Q

Efficacy of LTRA

A

Less effective than ICS but reduces use of ICS, decrease frequency of asthma exacerbation

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14
Q

Use of Na cromoglycate

A

Controller of asthma, control allergic rhinitis/conjunctivitis

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15
Q

Omalizumab

A

Anti-IgE mAb —effective for allergic asthma & rhinitis

SQ injection every 2-4w, $$$

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16
Q

MoA of omalizumab/IgE mAb

A

Bind to free IgE, decreases cell-bound IgE
Decrease expression of FcERI receptors, decrease mediator release
Decrease allergic inflammation
Prevent exacerbation of asthma

17
Q

Anti-IL-5(R) mAb

A

Inhibit eosinophil function by binding and neutralizing IL-5 or targets & blocks IL-5R
Expensive treatment

18
Q

Examples of B2 agonist

A

Non-selective: Epinephrine
SABA: salbutamol
LABA: salmeterol, formoterol
LABA for COPD: indacaterol

19
Q

Duration of action

A

SABA 4-6h
LABA: 12h
LABA COPD: 24h

20
Q

Use of ICS-LABA

A

ICS-Formoterol as preferred reliever for Px not on ICS-maintenance
If on ICS-maintenance, use SABA salbutamol as reliever on PRN basis
ICS-LABA for LT maintenance of asthma including nocturnal asthma

21
Q

SE of B2 agonist

A

FIne tremor of skeletal muscle, muscle cramps
Palpitations, tachycardia
HypoK/Hyperglycaemia
*** Black box warning for LABA: asthma-related death due to tolerance

22
Q

MoA of Theophylline

A

Inhibit PDE, block adenosine receptor

Increased epinephrine release –> BD effect

23
Q

Use of theophylline

A

Add=on therapy to B2 agonist and ICS
Slow-release for nocturnal bronchospasm
Improve COPD lung function

24
Q

SE of theophylline

A

Narrow therapeutic range — caution for potential DDI
GI: N&V, anorexia
CNS: nervousness, headache, anxiety
CV: arrhythmias

25
Q

Muscarinic antagonist

A

SAMA: ipratropium bromide
LAMA: tiotropium bromide

26
Q

MoA of SAMA/LAMA

A

Inhibit M3 receptor activated bronchoconstriction

reverse vagal-induced bronchospasm and mucus secretion

27
Q

Uses of SAMA/LAMA

A

Add-on to B2 agonist, ICS
Patients intolerant of B2 agonist
Greater BD effect in COPD — tiotropium > ipratropium

28
Q

SE of SAMA/LAMA

A

Unpleasant taste
Dry mouth, urinary retention in elderly —muscarinic antagonism effect
Paradoxical bronchospasm

M2 Pharm (13 decks)

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