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Year 1 HLB Respiratory > Asthma and COPD Management > Flashcards

Asthma and COPD Management Flashcards

1
Q

Where are B2 adrenergic receptors generally located in the lungs?

A
  • smooth muscle
  • trachea down to terminal bronchioles
  • ⬆️ noraadrenalin and adrenaline
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2
Q

What are the 5 different methods drugs can be given for asthma and COPD?

A

1 - inhaled (inhaler and nebuliser)

2 - oral

3 - intravenous

4 - intramuscular

5 - subcutaneous

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3
Q

What is the main benefit of use inhalers and nebulisers to deliver drugs to the lungs?

A
  • direct deposition into the lungs
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4
Q

What is the main disadvantage of use inhalers and nebulisers to deliver drugs to the lungs?

A
  • technique dependent
  • disease can reduce drug accessing lungs
  • 8-15% of drugs reaches lungs
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5
Q

What is the main benefit of taking asthma and COPD drugs orally?

A
  • not technique dependent
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6
Q

What is the main disadvantage of taking asthma and COPD drugs orally?

A
  • dependent on absorption in GIT
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7
Q

What are the 2 main benefits of taking asthma and COPD drugs intravenously?

A

1 - systemic effects

2 - not technique dependent

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8
Q

What are the main disadvantage of taking asthma and COPD drugs intravenously?

A
  • ⬆️ risk of side effects
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9
Q

Are inhales and nebulisers fast acting?

A
  • yes
  • directly into lungs
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10
Q

Why are inhalers and nebulisers associated with low risk of side effects?

A
  • majority of drugs remains in lungs
  • small amount may enter circulation
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11
Q

Does the whole drug dose of the inhaler reach the lungs, even with the best technique?

A
  • no
  • aprox 8-15% reaches lungs
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12
Q

Do all inhalers have the same size particles in the aerosol?

A
  • no
  • small, medium and large particles
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13
Q

Why is it important to know the particle size of drugs delivered as inhalers or nebulisers?

A
  • particle size affects where in the lungs drug reaches
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14
Q

How can we identify where in the lungs an inhaler or nebuliser reaches?

A
  • lung specific radio-labelling
  • radio-label appears on gamma camera
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15
Q

In addition to particle size, how does flow rate affect drug delivery in inhalers and nebbulisers?

A
  • ⬇️ flow rate = poor drug delivery
  • ⬆️ flow rate = good drug delivery
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16
Q

Do B2 agonists target adrenoreceptors or muscarinic receptors?

A
  • adrenergic receptors
  • Gas specifically
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17
Q

What is the basic pathway once an inhaler has bound to the Gas adrenergic receptor?

A
  • adenylyl cyclase converts ATP to cAMP
  • cyclic adenosine monophosphate (cAMP)
  • cAMP activates protein kinase A (pKA)
  • pKA activates intracellular phosphorylation
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18
Q

How does protein kinase A cause vasodilation and bronchodilation?

A
  • ⬇️ intracellular Ca2+
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19
Q

In addition to bronchodilation, what are the other 2 things that inhalers are able to induce in the lungs that can cause problems in obstructive lung disease?

A

1 - ⬆️ mucous clearance

2 - ⬇️ vascular permeability

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20
Q

Why is ⬇️ permeability following the use of an inhaler a good thing?

A
  • ⬇️ acute inflammation
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21
Q

What is the core drug used as a short term B2 agonist (SABA) for the treatment of asthma?

A
  • salbutamol
  • also known as ventolin
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22
Q

Salbutamol (ventolin) (SABA) is the core drug used as a short term B2 agonist for the treatment of asthma. What is another drug that can often be used?

A
  • terbutaline - also known as terbutaline
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23
Q

What is the core drug used as a long term B2 agonist (LABA) for the treatment of asthma?

A
  • salmeterol
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24
Q

Salmeterol is the core drug used as a long term B2 agonist (LABA) for the treatment of asthma. what is another drug that can often be used?

A
  • formoterol
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25
Q

How quickly can the short acting Salbutamol (ventolin) (SABA) take its affects?

A
  • generally <10 minutes
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26
Q

How long can the effects of the short acting Salbutamol (ventolin) (SABA) last?

A
  • 3-5 hours - max dose several times/day
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27
Q

What are the 3 most common side effects from B2 adrenergic agonists (SABA)?

A
  • tachycardia (B1 receptors in heart)
  • termor (B2 in skeletal muscle)
  • agitation
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28
Q

Would B2 adrenergic agonists used to treat asthma cause potential side effects on the sympathetic or para sympathetic nervous system?

A
  • sympathetic - adrenergic are only in sympathetics system
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29
Q

Are there likely to be more side effects in inhalers or when B2 adrenergic agonist are given intravenously?

A
  • intravenously - systemic distribution of drug
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30
Q

How quickly can the long acting Salmeterol (LABA) take its affects?

A
  • usually within 30 minutes
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31
Q

How long can the long acting Salmeterol (LABA) affects last?

A
  • 10-12 hours - max dose twice a day
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32
Q

How can the long acting Salmeterol (LABA) be administered?

A
  • inhaler only
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33
Q

Can the long acting Salmeterol (LABA) be administered in isolation like Salbutamol (Ventolin)?

A
  • no - ALWAYS administered with inhaled corticosteroids (ICS) and or LAMA
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34
Q

In addition to treating asthma, what can the combination of long acting Salmeterol (LABA) and inhaled corticosteroids (ICS) be used to treat?

A
  • COPD - common treatment
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35
Q

What is the common core drug used as a short term muscarinic antagonist (SAMA) in the treatment of asthma and COPD?

A
  • Ipratropium Bromide (SAMA) - also known as Atrovent
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36
Q

Ipratropium Bromide (Atrovent) is a short acting muscarinic antagonist (SAMA), which GPCR does it act on?

A
  • M3 muscarinic receptors - Gaq (M1, M3 and M5 are Gaq)
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37
Q

Ipratropium Bromide (Atrovent) is a short acting muscarinic antagonist (SAMA), acting on the Gaq GPCR receptors, how does it cause bronchodilation?

A
  • inhibits Ca2+ release - ⬇️ Ca2+ = brochodilation
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38
Q

What is the basic pathway for Gaq, which muscarinic antagonist act on?

A
  • phospholipase C cleavea PiP2
  • PiP2 cleaved into IP3 and DAG
  • IP3 binds to sarcoplasmic retculum and ⬆️ Ca2+
  • Ca2+ and DAG activate protein kinase C (pKC)
  • pKC activates phosphorylation
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39
Q

Ipratropium Bromide (Atrovent) is a short acting muscarinic antagonist (SAMA), how long does it take to have an effect on the patient?

A
  • 30 minutes
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40
Q

Ipratropium Bromide (Atrovent) is a short acting muscarinic antagonist (SAMA), how long do the effects last for?

A
  • 6 hours - can be used up to 4/day
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41
Q

Ipratropium Bromide (Atrovent) is a short acting muscarinic antagonist (SAMA) generally used to treat asthma, but what other obstructive lung disease can it be used to treat?

A
  • COPD - 20-40ug quantum dots (qds) nano carriers for drugs
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42
Q

If a patient has an acute exacerbation of asthma or COPD, why is Ipratropium Bromide (Atrovent), a short acting muscarinic antagonist (SAMA) given via a nebuliser?

A
  • higher dosage of the drug delivered - 250-500ug quantum dots (qds) nano carriers for drugs
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43
Q

Do short term B2 adrenoreceptor agonist (SABA) or short term muscarinic antagonists (SAMA) have a larger bronchodilator effect?

A
  • SABA - SABA and SAMA together are best
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44
Q

Ipratropium Bromide (Atrovent) is a short acting muscarinic antagonist (SAMA), in addition to bronchodilation, what else do they help with in obstructive lung diseases such as asthma and COPD?

A
  • ⬇️ mucus production
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45
Q

Does Ipratropium Bromide (Atrovent), a short acting muscarinic antagonist (SAMA) influence the parasympathetic nervous system?

A
  • minimal effects - muscarinic only in parasympathetic system
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46
Q

What is the common core drug used as a long term muscarinic antagonist (LAMA) in the treatment of asthma and COPD?

A
  • Tiotropium
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47
Q

Tiotropium is a long acting muscarinic antagonist (LAMA), in addition to bronchodilation, what else do they help with in obstructive lung diseases such as asthma and COPD?

A
  • ⬇️ bronchospasm - ⬇️ mucus production
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48
Q

Tiotropium is a long acting muscarinic antagonist (LAMA), how long does it generally last for?

A
  • 12-24 hours - max 2/day
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49
Q

Tiotropium is a long acting muscarinic antagonist (LAMA), how is it administered?

A
  • inhaler
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50
Q

What are some common side effects of long and short acting muscarinic antagomists?

A
  • dry mouth - blurred vision - urinary retention - cardiac arrhythmia’s - dizziness - epistaxis (nose bleeds) - closed angle glaucoma (iris bulges forward)
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51
Q

What are corticosteroids?

A
  • class of steroid hormones
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52
Q

Other than antibiotics, what is the most commonly prescribed drug for lung disease?

A
  • corticosteroids
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53
Q

What is the main purpose for the use of corticosteroids in lung disease?

A
  • anti-inflammation - they do have systemic effects
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54
Q

Where are corticosteroids receptors located in the body?

A
  • on most cells in the body
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55
Q

How do corticosteroids induce their effects in the body?

A
  • hormone so can cross plasma membrane
  • binds to glucocorticoid receptor in cytoplasm
  • receptor binds to nucleus and enters
  • specifically binds to nucleotides
  • ⬇️ inflammatory translation and transcription occur
  • ⬇️ inflammatory protein translation
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56
Q

What is the most common corticosteroids prescribed orally to patients with lung disease?

A
  • prednisolone
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57
Q

What is the most common corticosteroids prescribed as an inhaler to patients with lung disease?

A
  • beclomethasone
58
Q

What are the benefits of administering corticosteroids intravenously or orally?

A
  • stronger effects as higher doses available - not technique dependent - better route in the ill and in emergency
59
Q

What are the disadvantages of administering corticosteroids intravenously or orally?

A
  • ⬆️ risk of side effects - especially in long term treatment
60
Q

What are the benefits of administering corticosteroids using an inhaler?

A
  • localised action - ⬇️ side effects
61
Q

What are the disadvantages of administering corticosteroids through an inhaler?

A
  • disease may prevent penetration of drug
62
Q

Beclomethasone is a corticosteroid used to treat lung disease through inhalers. What are the 3 common side effects associated with them?

A

1 - immunocompromised, ⬇️ ability to fight infections

2 - oral candidiasis (fungal infection)

3 - dysphonia (croaky voice)

63
Q

Beclomethasone is a corticosteroid used to treat lung disease through inhalers. Immunocompromised, oral candidiasis (fungal infection) and dysphonia (croaky voice) are common side effects, what can be done to reduce them?

A
  • gargle prior to administration - use spacer for mdi - use turbohaler
64
Q

What are some short term (days) effects of steroids used in lung disease?

A
  • indigestion - skin bruising - insomnia - psychosis
65
Q

What are some medium term (weeks) effects of steroids used in lung disease?

A
  • gastric ulcers - skin bruising - insomnia - psychosis - weight gain
66
Q

What are some long term (months) effects of steroids used in lung disease?

A
  • osteoporosis - growth retardation - weight gain - cushingoid appearance (moon face) - adrenal suppression - hypertension - diabetes
67
Q

What are the 3 main types of inhaler devices?

A

1 - pressurised metered dose inhaler with spacer 2 - dry powder inhaler 3 - soft mist inhaler

68
Q

What are spacers?

A
  • volumetric device with one way valve - ⬆️ space between actuator and mouth - ⬇️ oropharyngeal drug deposition
69
Q

Why are spacers used with inhalers?

A
  • ⬆️ drug delivery to lungs
70
Q

What is combination therapy?

A
  • multiple drugs given together - work synergistically
71
Q

Does combination therapy improve anything other than respiratory symptoms?

A
  • improves patients quality of life
72
Q

Why is combination therapy used?

A
  • ⬆️ efficacy and max brochodilation - cost effective - ⬆️ compliance
73
Q

When considering the stepwise guide to treating asthma, is it better to increase a dose of a drug, or to use combination therapy and provide a second different drug?

A
  • combination therapy is best
74
Q

What is a nebuliser?

A
  • breathing device - able to deliver large dose of drugs as an aerosol
75
Q

In patients with exacerbations of asthma and COPD, what adrenergic and muscarinic drugs are given through a nebuliser?

A
  • short acting adrenergic agonists - short acting muscarinic antagonists
76
Q

In addition to providing a large dose of a drug as an aerosol, nebulisers be useful in asthma and COPD to distinguish what?

A
  • distinguish between asthma and COPD
  • if asthma symptoms improve rapidly (reversible)
  • if COPD symptoms do not improve (non-reversible)
77
Q

What are methylxanthines?

A
  • non selective phosphodiesterase inhibitors and bronchodilators
78
Q

Methylxanthines are phosphodiesterase inhibitors, what is the mechanism of action?

A
  • small molecules so can cross plasma membrane
  • inhibit breakdown of cAMP, so cAMP ⬆️ in cells
  • ⬆️ protein kinase A
  • ⬇️ Ca2+ = bronchodilation
79
Q

Which Methylxanthines is given orally to treat chronic asthma and COPD?

A
  • Theophylline
  • T - think Throat
80
Q

Which Methylxanthines is given intravenously to treat exacerbations of asthma and COPD?

A
  • Aminophylline
  • A - think given in the Arm
81
Q

Does methylxanthines have a large or narrow therapeutic window?

A
  • narrow window
82
Q

What is a common mucolytic drug?

A
  • drug that breaks down mucus - easier to cough up mucus in COPD
83
Q

What is the common drug administered as a mucolytic drug?

A
  • Carbocisteine
  • C think Cough up mucus
84
Q

What drug can be prescribed to treat exercise induced asthma that is able to inhibit leukotrienes?

A
  • Montelukast
85
Q

Oxygen as a drug is used to treat patients with type 1 respiratory failure (PaO2 <7.8 kPA or 60mmHg), what is the target SaO2?

A
  • 94-98%
86
Q

Oxygen as a drug is used to treat patients with type 2 respiratory failure (PaO2 <7.8 kPA or 60mmHg and PaCO2 >48mmHg or 6.5kPA), what is the target SaO2?

A
  • 88-92%
87
Q

What can inappropriate use of O2 cause?

A
  • iatrogenic (caused by medical treatment)
  • type 2 respiratory failure
  • death
  • CO2 retention
  • acidosis
88
Q

Is O2 used for patients with breathlessness?

A
  • no
89
Q

What are the main methods O2 can be delivered to patients?

A
  • nasal cannula
  • simple face masks
  • re-breathe mask (bag on mask)
  • controlled O2 via venturi mask
90
Q

When is a venturi mask recommended?

A
  • type 2 respiratory failure
91
Q

In type 2 respiratory failure why is a venturi mask useful when delivering O2 % and rates of flow?

A
  • various levels of O2 can be delivered - various flow rates of O2 can be delivered
92
Q

When using a venturi mask recommended what is the SaO2 target?

A
  • 88-92%
93
Q

What is long term O2 therapy?

A
  • O2 given in O2 canisters - patients transport this around with them
94
Q

Only when O2 drops below a certain level would long term O2 therapy be recommended, what is this level?

A
  • continuously <7.3 kPA or 55mmHg
95
Q

What respiratory diseases would long term O2 therapy be used in?

A
  • COPD - pulmonary fibrosis - pulmonary hypertension
96
Q

When treating patients with asthma and COPD with antibiotics, why is it important, where possible to check the sensitivity of the organism?

A
  • antibiotic resistance
97
Q

When treating patients with asthma and COPD with antibiotics, what must you always do?

A
  • check allergies - drug interactions - drug contradictions
98
Q

What are 2 of the most common bacteria that cause infection in asthma and COPD?

A
  • streptpcoccus pneumonia
  • staphylococcus aureus
99
Q

What are the common antibiotics prescribed to patients with asthma and COPD for streptococcus pneumonia?

A
  • amoxicillin (penicillin) - clarithromycin (macrolides)
100
Q

What are the 3 main guidelines set out by the British Thoracic Society and Scottish Intercollegiate Guidelines Network for common acute asthma management?

A
  • avoid allergens
  • smoking cessation
  • inhaled therapy personalised asthma plan (PAP)
  • regular review of PAP
101
Q

When consulting the stepwise guidelines to asthma management, what is generally the first treatment option?

A
  • low dose of inhaled corticosteroids
102
Q

If a patient does not respond to treatment, is it best to increase the dosage or the current treatment such as inhaled corticosteroids?

A
  • no - better to add another medication such as B2 agonist
103
Q

What is a preventer in the treatment of asthma and COPD?

A
  • inhaler to ⬇️ inflammation - blocks inflammation pathway
104
Q

If inhaled corticosteroids fails as the first line of treatment, what preventer would generally be recommended to combine with the inhaled corticosteroids?

A
  • long lasting B2 agonist - Salmeterol (long lasting B2 agonist)
105
Q

What is a reliever in the treatment of asthma and COPD?

A
  • used to treat acute exacerbations - inhaler to ⬆️ bronchodilation
106
Q

When should a reliever inhaler in the treatment of asthma and COPD be used?

A
  • when symptoms are exacerbated
107
Q

When should a preventer inhaler in the treatment of asthma and COPD be used?

A
  • every day - regardless of symptoms
108
Q

What drug is used most commonly as a reliever?

A
  • short acting B2 agonists - Salbutamol
109
Q

Why is a personalised action plan for asthma important?

A
  • ⬆️ asthma control - ⬇️ emergency contact with GP - ⬇️ hospital administrations
110
Q

What should be included in the annual check up with the GP about a patients asthma plan?

A
  • number of exacerbations - review of medication - compliance to medication - spirometry
111
Q

If a patients symptoms decline or their asthma management is poor, where would a GP refer the patient to?

A
  • secondary care specialist
112
Q

If a patient with asthma had an exacerbation and attended A+E what would be the first examination the medics would do?

A
  • assess pulse oximetry - SaO2 >92%
113
Q

If a patient with asthma has an exacerbation and attends A+E with a PaO2 <92%, what would be the first examination the medics would do?

A
  • check arterial blood gas - life threatening asthma
114
Q

What sort of scan is routinely carried out in patients with respiratory symptoms?

A
  • Chest X-ray
115
Q

If possible to attain, what 2 respiratory measures would be useful?

A
  • PEF - FEV1
116
Q

If a patient with asthma had an exacerbation and attended A+E what would be the first line of treatment the medics would administer?

A
  • high dose using a nebuliser - B2 agonist (salbutamol) + M3 inhibitor (ipratropium bromide)
117
Q

If a patient with asthma had an exacerbation and attended A+E a steroid may be given. Would this be through an inhaler or orally/intravenously?

A
  • orally or intravenously - provides systemic effect
118
Q

If a patient with asthma had an exacerbation and attended A+E a steroid may be given. What steroid would be given intravenously?

A
  • hydrocortisone
119
Q

If a patient with asthma had an exacerbation and attended A+E a steroid may be given. What steroid would be given orally?

A
  • prednisolone
120
Q

If a patient with asthma attended A+E with a severe asthma attack what mineral could be given intravenously?

A
  • magnesium
121
Q

Why is magnesium given in severe asthma attacks?

A
  • bronchodilator
  • stabilises T cells
  • ⬇️ inflammation
122
Q

Can aminophylline be given intravenously in acute asthma?

A
  • yes - acts a bronchodilator
123
Q

How long should a patient be on the medication they will continue to take once discharged, prior to being discharged?

A
  • 24 hours
124
Q

Prior to being discharged from hospital after an acute asthma attack, what should the patients PEF1 be?

A
  • >75% of best or predicted
125
Q

Prior to being discharged from hospital after an acute asthma attack, what should the patients diurnal variability be?

A
  • <25%
126
Q

Prior to being discharged from hospital, what must the patient be checked and advised for, which are similiar to the British Thoracic Soceity guidelines?

A
  • check inhaler technique
  • personalised asthma plan is understood
  • smoking cessation (support and guidance)
  • ⬇️ oral steroid dose slowly
  • review with doctor/nurse in 2 weeks
127
Q

In COPD, do patients lung function improve or gradually decline?

A
  • progressively decline
128
Q

Is COPD reversible?

A
  • largely irreversible
129
Q

Is type 1 or 2 respiratory failure likely in patients with COPD?

A
  • type 2 respiratory failure
130
Q

What is cor pulmonale?

A
  • right heart failure caused by respiratory disease
  • COPD patients are at risk of this
131
Q

What are some simple lifestyle advice that patients with COPD should recieve?

A
  • smoking cessation - ⬆️ activity - improved nutrition
132
Q

In COPD what are the normal pharmacological management plans?

A
  • inhaler therapy
  • manage exacerbations
  • long term O2 therapy
  • non-invasive ventilation
133
Q

In extreme cases what treatment could patients with COPD have?

A
  • lung transplant - lung resection
134
Q

In COPD what are the normal non pharmacological management plans?

A
  • pulmonary rehabilitation - counselling - palliative care
135
Q

In COPD what pharmaceuticals do patients take to manage their symptoms?

A
  • short acting B2 agonist
136
Q

In COPD what combinations of pharmaceuticals do patients take?

A
  • ICS + LABA + LAMA
137
Q

In COPD why are they administered with Theophylline?

A
  • bronchodilator - given orally
138
Q

Why are COPD patients given a carbocisteine?

A
  • mucolytic drug - helps thin mucus and open airways
139
Q

If patients with COPD have an acute exacerbation, what are the common pharmacological management options?

A
  • nebulised short acting B2 agonist
  • systemic steroids
  • controlled O2
  • intravenous aminophylline
  • non invasive ventilation
  • antibiotics
140
Q

What improves survival in COPD?

A
  • long term O2 therapy - non invasive ventilation - lung volume reduction therapy
141
Q

What are some basic points to consider when discharging a COPD patient?

A
  • nutrition - smoking cessation - appropriate inhaler and correct technique - pulmonary rehabilitation - palliative care - vaccinations - psychological support

Year 1 HLB Respiratory (25 decks)

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