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Pharmacology > Asthma and COPD > Flashcards

Asthma and COPD Flashcards

Asthma and COPD features; Treatments of asthma and COPD; monitoring and diagnosis of COPD; inhalers; Bronchodilators; Beta 2 andernergic agonists; Muscaranic antagonists; Indirect brochodilators; ICS; Leukotreine antagonists; Cromylns; GINA guidelines; Mild-Severe COPD treatment; COPD exacerbation

1
Q

Diagnosis of asthma

onset age, presence of what

A

Childhood onset

Presence of trigger and respiratory wheeze

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2
Q

What 2 other features may be present with asthma?

A

Atopy

Cough at night

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3
Q

4 features of asthma
(obstruction reversible?, airway diameter, release of what hormone causes SOB, 2 meds for management of which two aspects of condition)

A

Obstruction is somewhat reversible
Airway lumen already narrowed
Release of histamine causes SOB
Use of bronchodilators for acute exacerbation, steroids for underlying inflammation

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4
Q

What is COPD?

term used for what, onset when, associated with what

A

Umbrella term for obstructive respiratory diseases, including emphysema and chronic bronchitis
Onset 40+
Associated with lifestyle factors such as smoking

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5
Q

6 features of COPD

decrease in lung … and …, airway diameter, assessment using what, obstruction reversible?, deterioration is …

A

Decrease in lung elasticity and surface area decreasing the surface for gaseous exchange leading to hypoxia
Narrowed airways leading to breathlessness
Assessment using spirometry
Obstruction to lungs is irreversible
Deterioration of COPD is progressive

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6
Q

What two requirements are there to be diagnosed with COPD?

A

Symptomatic

Altered spirometry scores

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7
Q

What does FEV1 stand for?

A

Forced Expiratory Volume over 1 second

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8
Q

What does FVC stand for?

A

Forced Vital Capacity

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9
Q

What two main inhaled medications are used for both asthma and COPD?

A

Direct bronchodilators

Indirect bronchodilators

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10
Q

Name 4 groups of direct bronchodilators

A

Short acting beta 2 antagonists
Long acting beta 2 antagonists
Short acting muscaranic antagonists
Long acting muscaranic antagonists

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11
Q

Name 3 classes of indirect bronchodilators

A

Inhaled corticosteroids
Leukotreine antagonists
Cromolyns

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12
Q

3 benefits of inhaled medication

A

Local to site of inflammation
Quick onset of action
Minimal side effects

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13
Q

What do bronchodilators do?

A

Open airways

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14
Q

Name 3 treatment uses of bronchodilators

asthma for what, COPD for what

A

Relief of symptomatic asthma
Acute and ongoing asthma and COPD management
Emergency relief of acute exacerbation of COPD/asthma attack

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15
Q

Name the 2 types of dosing of inhalers

A

Metered dose inhalers (MDI)

Non-MDI

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16
Q

How many puffs need to be taken to receive one dose from a MDI?

A

2 puffs

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17
Q

How many puffs from a non-MDI inhaler are needed to receive one dose?

A

1 puff

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18
Q

Name 2 classes of bronchodilators

A

Direct

Indirect

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19
Q

Explain mechanism of direct bronchodilators action

act on which nervous system, directly effect what to stimulate what

A

Act on autonomic nervous system

Directly acts on airways to dilate bronchioles

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20
Q

Name the 2 receptors for direct bronchodilators

A

Beta 2 andernergic agonists

Antimuscuranic agents aka muscaranic antagonists

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21
Q

Which nervous system do beta 2 andernergic agonists work on?

A

Autonomic

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22
Q

Which nervous system do muscaranic antagonists work on?

A

Parasympathetic

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23
Q

What are SABA inhalers used for?

?asthma ?COPD, what severity?, used in emergency treatment?

A

Used in both asthma and COPD
Used for mild-severe asthma
Only used in severe COPD
Used in acute exacerbation of COPD/ asthma attacks

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24
Q

What type of asthma are LABAs not used for?

A

Mild asthma

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25
Q

What are LABA inhalers used for?

what type of asthma, with what, type of COPD, with what, frequency of use, used in combination for acute…

A

Only used in moderate-severe asthma with direct bronchodilators
Used alone in mild-moderate COPD
Used in combination with LAMA for severe COPD
Frequency of use: OD/BD
Used in combination for acute exacerbation of COPD/asthma attack

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26
Q

What are SAMAs not used for, frequency of use and when are they used?

A

Not routinely used in asthma or COPD
Frequency of used multiple times a day
Used in emergency treatment of COPD and asthma

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27
Q

ADR of SAMA use

A

Tremour

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28
Q

Why do SAMAs cause tremour?

A

B2 agonist

29
Q

What are LAMAs not to be used for?

A

Asthma

30
Q

Why can LAMAs not be used for asthma?

A

Hide symptoms of inflammation, does not work as an anti-inflammatory, putting asthmatic pt at risk of attack.

31
Q

What are LAMAs used for and how frequently?

A

OD for mild-severe COPD

Acute exacerbation of COPD/asthma attack

32
Q

5 ADRs of LAMAs

A 
Dry mouth 
Constipation 
Urinary retention 
Dry eyes 
Blurred vision
33
Q

How do indirect bronchodilators work?

A

Work on process that causes inflammation, resulting in the end effect of opening airways.

34
Q

What severity of asthma are inhaled corticosteroids used for?

A

In mild-moderate asthma

35
Q

What severity of asthma and COPD are inhaled corticosteroids used in combination for?

A

Moderate to severe asthma and COPD

36
Q

What do inhaled corticosteroids do?

A

Control underlying inflammation

37
Q

For what severity of respiratory condition would an ICS and LABA be used for?

A

Moderate to severe asthma and COPD

38
Q

What severity of respiratory condition would an ICS, LABA and LAMA be used for?

A

Severe COPD

39
Q

What are the 3 doses of ICS?

A

Low
Medium
High

40
Q

What is the frequency of ICS dosing?

A

All BD apart from one OD

41
Q

2 types of ICS inhalers

A

Metered dose

Dry powder

42
Q

5 ADRs of ICS

A 
Oral canidiasis 
Hoarsness 
Cough 
Growth concerns 
Infection/pneumonia
43
Q

What is the minimum/maximum time for a review after ICS prescribed?

A

Minimum of 4 weeks

Max 3 months

44
Q

What does use of ICS increase the risk of in COPD and what should be checked for?

A

Pneumonia

Previous infections

45
Q

If ICS is improving asthma symptoms by the first review what should be done to the dose?

A

Reduced

46
Q

If asthma symptoms are worsening by first review after prescription of ICS what are the 3 incremental treatment steps that should be followed?
(dosing, inhalers added)

A

Increase dose of ICS
Add a LABA
Add a leukotreine receptor antagonist

47
Q

What should be taken or checked during a first asthma review having been prescribed ICS?

A

Inhaler technique
Asthma history
Potential anxiety/triggers

48
Q

What are leukotreine antagonists used for?

what condition, what line of intervention

A

In asthma as a second line intervention

49
Q

Explain the mechanism of action for how leukotreine antagonists work
(block … mediated broncho…, initiated by what, via oxidation of what, in what pathway)

A

Block leukotreine mediated bronchoconstriction, initiated by leukocytes via oxidation of arachidonic acid in the cyclooxygenase pathway.

50
Q

What is the only route that leukotreine antagonists can be given by?

A

Orally

51
Q

6 ADRs of leukotreine antagonists

A 
Hepatoxicity 
Headache 
GIT upset 
Flu like symptoms 
Rash 
Nasal congestion
52
Q

What age group requires alteration of the dose of leukotriene antagonists?

A

Children

53
Q

What respiratory condition are cromolyns used for?

what line of intervention

A

Asthma as a second line intervention

54
Q

How do cromolyns work for asthma?

stabilise which cell, preventing release of what

A

Stabilise mast cells preventing histamine release.

55
Q

What is the frequency of dosing for cromolyns?

A

QDS

56
Q

Why might a cough occur with a cromolyn inhaler?

A

Poor inhaler technique

57
Q

5 ADRs of cromolyns

A 
Unpleasant taste 
GIT symptoms 
Reflex bronchospasm 
Throat irritation 
Cough
58
Q

How many steps are there in the GINA guidelines for asthma?

A

5

59
Q

What is prescribed at step 1 and 2 of the GINA guidelines?

A

A low dose ICS

60
Q

At what step of the GINA guidelines for asthma is LABA added?

A

Step 3

61
Q

At what step of the GINA guidelines of asthma is the dose of ICS increased?

A

Step 4

62
Q

At what step of the GINA guidelines for asthma is help sought from specialist respiratory services?

A

Step 5

63
Q

What value for FEV1 classes as mild COPD?

(> what

A

> 60 <80

64
Q

What value for FEV1 classes as moderate COPD?

what

A

<60 >40

65
Q

What value for FEV1 classes as severe COPD?

(

A

<40

66
Q

What type of inhaler is given for mild COPD with what?

A

LABA or LAMA with rescue treatment

67
Q

What combination of inhalers are given for moderate COPD?

A 
LABA + ICS  
OR 
LAMA + ICS 
OR 
LAMA+LABA
68
Q

What combination of inhalers are given for severe COPD?

A

LABA + LAMA + ICS

69
Q

What are the 5 stages of treating exacerbation of COPD?

Which type of drug, prescribed what for what, Increase what, cause, association with

A

Systemic corticosteroids
Abx prescribed for increased sputum volume and viscosity
Increase BDs, oxygen, myolytics, physiotherapy
? reason for exacerbation- vaccinations?
Association with anxiety and depression

Pharmacology (10 decks)

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