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Human Diseases > Asthma and Bronchodilators > Flashcards

Asthma and Bronchodilators Flashcards

1
Q

What is asthma?

A

Variable narrowing of the airways

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2
Q

What are the 2 features of pathophysiology of asthma?

A
  • Smooth muscle abnormalities: hyperresponsiveness and hypertrophy
  • Airway inflammation
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3
Q

How to diagnose asthma?

A

Spirometry
Peak expiratory flow

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4
Q

What does asthma eventually lead to?

A

Airflow obstruction

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5
Q

What factors can lead to variable airflow obstruction? (4 points)

A
  • Triggers such as exercise and irritants
  • Spontaneous diurnal variation
  • Response to treatment
  • Exposure to allergens
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6
Q

In people with asthma, lung function can be normal. True or false?

A

True

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7
Q

What are symptoms of asthma?

A

Wheeze, breathlessness, chest tightness
Variable symptoms usually worse at night or early morning; worse with exercise, irritant exposures, cold air etc
Cough, sputum

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8
Q

What are some non-pharmacological treatment options for asthma?

A

Stop smoking
Avoid triggers
Weight loss

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9
Q

What are the 2 types of pharmacological asthma treatment (inhalers)?

A

Bronchodilators (relievers)
Anti-inflammatory agents (preventers)

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10
Q

What drugs are classed under the bronchodilators “relievers”? (4 points)

A

Beta adrenergic agonists
Anticholinergics
Theophylline
Magnesium

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11
Q

What drugs are classed under anti-inflammatory agents “preventers”? (3 points)

A

Corticosteroids
Leukotriene antagonists
Anti IgE antibodies

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12
Q

What nerve supplies the parasympathetic nervous system of the airway smooth muscle (constriction)?

A

Vagus

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13
Q

What 1) receptor and 2) hormone stimulate the sympathetic nervous system of the airway smooth muscle (relaxation and dilatation)?

A

1) β2 adrenergic receptor
2) Circulating adrenergic hormones eg adrenaline

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14
Q

What 1) molecule and 2) ionic changes contribute to the constriction and dilatation of the airway smooth muscles?

A

1) cAMP
2) Changes in intracellular calcium

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15
Q

How do anticholinergics work to dilate the bronchus/airway?

A

They block off the vagus nerve, allowing the β2 receptor to take over

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16
Q

What can act on β2 receptors and lead to an increase in cAMP causing bronchodilation?

A

β2 agonists

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17
Q

How does theophylline work as a bronchodilator?

A

Blocks the break down of cAMP therefore causing an increase of intracellular calcium which increases smooth muscle relaxation

18
Q

How does magnesium work as a bronchodilator, usually for life-threatening asthma cases?

A

Displaces intracellular calcium causing potent and rapid airway smooth muscle dilation

19
Q

What are the different types of beta adrenergic agonists (asthma treatment) and examples?

A

Short acting ‘relievers’ eg Salbutamol/ventolin, Terbutaline (duration 2-4 hours)
Long acting eg Salmeterol, Formoterol (duration 12 hours)
Oral
Intravenous

20
Q

What colour is the salbutamol/ventolin inhaler?

A

Blue

21
Q

What is an example of a powder inhaler?

A

Terbutaline

22
Q

What are the effects of beta adrenergic agonists? (5 points)

A
  • Bronchodilation
  • Tachycardia
  • Hypokalaemia
  • Hyperglycaemia
  • Tachyphylaxis (if a drug is used repeatedly, receptors are worn out and drug no longer has an effect)
23
Q

What are examples of anticholinergics and how do they treat asthma?

A

Ipratropium and Tiotropium
Inhibit vagal tone

24
Q

What are the side effects of anticholinergics? (3 points)

A
  • Dry mouth
  • Glaucoma
  • Urinary retention
25
Q

Theophylline is a ________ derivative. It can be prepared __________ and intravenously. It has a _______ therapeutic window. The drug that it interacts with and is dangerous in overdose is _____________. Possible side effects include tachyarrthythmias, ventricular fibrillation and _____________.

A

Caffeine. Orally. Narrow. Erythromycin. Convulsions.

26
Q

How is magnesium usually administered?

A

Intravenously

27
Q

What are the three drug classes of anti-inflammatory agents “preventers” of asthma treatment?

A

Corticosteroids
Leukotriene antagonists
Anti-IgE antibodies

28
Q

What are the different types and examples of corticosteroids “preventers” asthma treatment?

A

Inhaled: beclomethasone, budesonide, fluticasone
Oral: prednisolone
Intravenous

29
Q

What are the possible side effects of corticosteroids “preventers”?

A

Inhaled: oropharyngeal candidiasis, dysphonia, bruising, cataracts
Oral: osteoporosis, skin thinning, hypertension, adrenal suppression, diabetes

30
Q

Leukotriene antagonists are _____ that are not very effective so not many people take it.

A

Tablets

31
Q

What do leukotriene antagonists and anti-IgE antibodies target when treating asthma?

A

Allergens (eg cat, house dust mite) + Specific IgE antibodies -> release of inflammatory mediators from mast and other cells

32
Q

In combination inhalers, what are the combined drugs?

A

Inhaled corticosteroid + long acting beta agonist

33
Q

What are some examples of combination inhalers?

A

Seretide: salmeterol + fluticasone
Symbicort: formoterol + budesonide

34
Q

What are the different devices used during asthma treatment that help get the drug into the patient’s lungs through the small airways?

A
  • Pressurised metered-dose inhalers
  • Spacer devices
  • Self-actuating devices
  • Dry powder inhalers
  • Nebulisers
35
Q

Pressurised metered-dose inhalers are convenient but they require ________ and high ________ _______ as they are breath actuated devices. They have ____________ ____________.

A

Coordination. Inspiratory flow. Oropharyngeal deposition

36
Q

Spacer devices (decrease/increase) the need for coordination. They (decrease/increase) oropharyngeal deposition and (decrease/increase) airway deposition.

A

Decrease
Decrease
Increase

37
Q

Dry powder devices usually require (higher/lower) inspiratory flow rate. (More/less) coordination is needed. They do not contain propellant.

A

Lower. Less.

38
Q

Nebulisers can administer very (high/low) doses but they are very inefficient. They may delay hospital admission.

A

High

39
Q

How to manage acute severe asthma?

A
  1. Assess the severity
  2. Summon help
  3. Support the patient to sit up
  4. Give high dose of bronchodilator (use nebuliser if avaible; improvise spacer device; salbutamol inhaler)
  5. Give corticosteroids/oxygen
40
Q

Assessing asthma severity

  • Moderate asthma exacerbation: increasing symptoms, PEF >__ - __% best or predicted, no features of acute severe asthma
  • Acute severe asthma: any one of PEF __ - __% best or predicted, respiratory rate >=25/min, heart rate >=110/min, inability to complete sentences in one breath
  • Life threatening asthma: any one of PEF < __% best or predicted, SpO2 < 92%, PaO2 < 8kPa, ‘normal’ PaCO2 4.6-6.0kPa, clincal signs of altered conscious level, exhaustion, arrhythmia, hypotension, cyanosis, silent chest, and poor respiratory effort.
  • Near-fatal asthma: raised PaCO2 and/or requiring mechanical ventilation with raised inflation pressures
A

> 50-75%
33-50%
<33%

Human Diseases (24 decks)

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