Asthma, Allergic Rhinitis, Anaphylaxis Flashcards
Asthma
Hyperresponsive airways (inflammatory condition) -wheezing -tight chest -cough -dyspnea (Worse early morning)
- constriction of smooth muscles
- chronic inflammation leading to narrowed airways
- overproduction of mucus
Controllers in asthma
Anti-inflammatory and/or sustained bronchodilator action
- Inhaled, oral and IV corticosteroids
- Leukotriene receptor antagonists
- Cromolyns
Beclomethasone
Inhaled corticosteroid
-controller
SE: dysphonia, oral candidiasis
Oral corticosteroid indications
- poorly controlled asthma at high doses of ICS and controller medication
- rescue medication (to regain control of Sx)
Leukotrine receptor antagonists
-Controller in asthma (oral agent)
-blocks receptor for cysteinyl leukotrines
(Leukotrines released from activated mast cells and eosinophils causing oedema, smooth muscle contraction and enhanced mucus secretion)
- prevent early and late bronchoconstrictor responses (allergens, aspirin sensitive asthma, exercise induced asthma)
- prevention of chronic asthma
Sodium chromoglycate
- controller in asthma
- prevents histamine release form mast cells
Long acting B2 agonists
-controllers: bronchodilators, but weak/unproven anti-inflammatory effect
Relievers
SABA
Ipratropium bromide - anticholinergic
Short acting B agonists mechanism
- stabilize mast cells (inhibit mediator release)
- enhance mucociliary clearance
- stimulate B2 receptors of airway smooth muscle
-may be used as sole therapy in mild intermittent asthma and exercise induced asthma
Salmeterol
Long acting B2 agonist
-sustained bronchodilator action but weak/unproven anti-inflammatory effect
Formoterol
Long acting B2 agonist
-sustained bronchodilator action but weak/unproven anti-inflammatory effect
Corticosteroid side effects
Inhaled: dysphonia, oropharyngeal candidiasis
Systemic with oral
Budenoside
Inhaled corticosteroid
-controller for asthma
Ciclesonide
Inhaled corticosteroid
-controller in asthma
Fluticasone
Inhaled corticosteroid (long acting!!) -controller in asthma
-T1/2 = 14h (others ICS only 3h)
Methylxanthines
Aka. Phosphodiesterase inhibitors
-Sustained release theophylline
-narrow therapeutic index NB
Salbutamol
Short acting B2 agonist
-reliever in asthma
Fenoterol
Short acting B2 agonist
-reliever in asthma
Terbutaline
Short acting beta 2 agonist
-reliever in asthma
B agonist side effects
- tachycardia
- irritability
- headaches
- tremor
- metabolic effects and hypokalemia in large systemic doses
Long acting B2 agonist indications
-bd use with low dose ICS (NEVER MONOTHERAPY)
- control Sx
- reduce frequency of exacerbations
-useful for nocturnal Sx and exercise induced asthma
Ipratropium bromide
Anticholinergic
-reliever in asthma
-used in pts who cannot tolerate B2 agonist SE (esp elderly)
- potent inhibitor of vagus-mediated bronchoconstriction
- not a preferred reliever, more useful in COPD
Anticholinergic SE
- dry mouth
- nausea
- constipation
- tiotropium - may cause urinary retention in prostatism
- arrhythmias
Theophylline
Phosphodiesterase inhibitor aka methylxanthine
-reliever in asthma
Aminophylline
Phosphodiesterase inhibitor (aka methylxanthines) -reliever in asthma
Phosphodiesterase inhibitors mechanism
- inhibit enzymes that degrades cAMP -> increased cAMP lvls -> bronchodilation
- narrow therapeutic index
GINA step 1
Controller: Consider low dose ICS
Reliever: SABA as needed
GINA step 2
Controller: low dose ICS
Other controller options: Leukotriene receptor antagonist or low dose theophylline
Reliever: SABA
GINA Step 3
Controller: Low dose ICS + LABA
Other controller options:
-med/high dose ICS
OR
-low dose ICS + leukotriene receptor antagonist / theophylline
Reliever:
-SABA as needed
OR
-low dose ICS/formoterol
GINA Step 4
Controller: med/high dose ICS + LABA
Other controller option:
-Triotropium bromide, High dose ICS + leukotriene receptor antagonist (or theophylline)
Reliever:
-SABA as needed
OR
-low dose ICS/formoterol
GINA step 5
Controller: refer for add-on Rx eg anti-IgE
Other controller options:
- add tiotropium bromide and low dose oral corticosteroids
Reliever:
-SABA as needed
OR
-low dose ICS/formoterol
Asthma Rx plan
All pts: 2 puffs SABA as needed
All pts: ICS as baseline Rx
If not well controlled: add LABA (preferred over raising the ICS dose, never use LABA alone)
Alternative: double ICS dose, or add LTRA (montelukast) or PDI (theophylline)
Oral steroids and IgE therapy only to be used as maintenance with extreme caution
1st Gen antihistamine SE
Dry mouth Urinary retention Tachycardia Sedation Weight gain Constipation
Antihistamine mechanism
Competitive antagonist at H1 receptor site
Chlorpheniramine
1st gen antihistamine
Fexofenadine
2nd gen antihistamine
Levocetirizine
2nd gen antihistamine
Promethazine
1st gen antihistamine
