Asthma and Eczema Flashcards
Ipratopium, tiotropium, glycopyrronium, aclidinium are all examples of what class of medications? Used to treat what?
- Anti-muscarinics
- used as bronchodilators to treat asthma or COPD
MOA of anti-muscarinics e.g. Ipratopium, tiotropium
- bind to muscarinic receptor
- act as a competitive inhibitor of acetylcholine
- by blocking the ‘rest/digest’ enzymes they have effects of: increased HR and conduction, reduced SM tone, reduced secretions from resp and GI tract glands and pupil dilation
Name 2 SEs of anti-muscarinics e.g. Ipratopium, tiotropium
as inhaled SEs are pretty minimal vs oral/IV preparations
- irritation of resp tract: nasopharyngitis, sinusitis and cough
- GI disturbance: dry mouth, constipation
- Urinary retention
- blurred vision
- headaches
In what conditions/pts susceptible to what, should the use of anti-muscarinics like Ipratopium, tiotropium be prescribed with caution?
- angle-closure glaucoma (can precipitate a rise in ICP)
- pts at risk of arrhythmias
- pts in urinary retention
Name one short acting anti-muscarinic and suggest dose and frequency vs
one long acting anti-muscarinic and frequency of administration?
- short acting e.g. Ipratopium 4x daily/PRN when breathless e.g. 40micrograms (in an attack up to 500micrograms)
- long acting e.g. tiotropium, glycopyronium, aclidinium, prescribed once/twice daily
Name 3 examples of B2-agonists
used to treat asthma, COPD and which electrolyte disturbance?
- salbutamol, terbutaline, salmeterol, formoterol, indacaterol
- hyperkalaemia
SABAs are used to relieve ___ in asthma, and LABAs are used as treatment for ___ asthma when inhaled ___ alone are insufficient.
- relieve SOB
- LABAs for chronic asthma
- when inhaled ICS alone..
MOA of B2-agonists
-B2 receptors exist in: SM of bronchi, gut, uterus and vessels
-stimulation of these GPCRs activates a cascade –> SM relaxation
-this improves airflow in constricted airways, reducing SOB
(also stimulate Na+/K+ ATPase so shift K+ from extra to intracellular compartment)
Of the following B2-agonists, which are short acting (SABAs) and which are long-acting (LABAs)?
-salbutamol, terbutaline, salmeterol, formoterol, indacaterol
SABAs: -salbutamol, terbutaline
LABAs: -salmeterol, formoterol, indacaterol
B2-agonists, name 3 side effects of this medication class:
- ‘fight/flight’ SEs of:
- tachycardia
- palpitations
- anxiety
- tremor
- promote glycogenolysis so can increase blood glucose (at high levels serum lactate may rise)
- LABAs can cause muscle cramps
LABAs should only be used in asthma alongside an ___ __ as part of therapy, because without this LABAs are associated with what?
- inhaled corticosteroid
- with increased asthma deaths
Thinking about the fight/flight side effects of B2-agonists, what co-morbidity would you exercise caution in when prescribing?
-pts with CV disease (tachycardia may promote angina/arrhythmias)
Common dose for adult asthma reliever B2-agonist is:
-Salbutamol 100-200 micrograms inhaled as required (PRN)
When prescribing nebuliser therapy, you must always indicate if it should be driven by __ or by __.
In general, __ should be used in asthma whereas medical ___ should be used in COPD due to the risk of ___ ____.
- by oxygen or air
- oxygen should be used in asthma
- medical air in COPD
- due to risk of CO2 retention
Name 2 inhaled corticosteroids
Explain the indications in both
-asthma
-COPD
- beclometasone, budesonide, fluticasone
- asthma: treats airway inflamm/symptom control when SABA alone is inadequate
- COPD: to control sx and prevent exacerbations in pts with severe airflow obstruction and/or recurrent exacerbations
What helpful effects do inhaled corticosteroids have in the airways of sufferers of asthma/COPD
(beclometasone, budesonide, fluticasone..)
- reduces mucosal inflamm
- widens airways
- reduced mucus secretion
- this improves symptoms and reduces exacerbations
ICS e.g. beclometasone, budesonide, fluticasone SEs occur locally in airway, very little is absorbed into blood so there are few systemic SEs. Name 2 airway related SEs:
-their immunosuppressive effect can –> oral candidiasis
-can cause a hoarse voice
(so rinse mouth out and gargle after use)
-in COPD may increase risk of pneumonia (so caution use in pts with a history of pneumonia)
Other than evidence suggesting inhaled corticosteroids -in COPD may increase risk of pneumonia (so caution use in pts with a history of pnuemonia), who else would you caution ICS use in and why?
-Children - may cause growth suppression
Leukotriene receptor antagonists e.g. Monteleukast are indicated when in the following
adults:
children 5-12yrs
children <5yrs
- adults: add-on for asthma when ICS, and LABAs not enough
- children 5-12yrs: as alternative to LABAs if ICS isn’t enough to control asthma symptoms
- children <5yrs: as 1st line preventative therapy in young children unable to take an inhaled corticosteroid
MOA of LTRAs e.g. monteleukast
- in asthma, leukotrienes produces by mast cells and eosinophils activate GPCR (CysLT1) -> cascade -> inflammation and bronchoconstriction
- LTRAs reduce this by blocking the CysLT1 receptor so dampen down the inflamm cascade
LTRAs are well tolerated, mild SEs include headache and abdo pain + increased risk of upper respiratory tract infections, rarely what cognitive SE is reported? And what eosinophilic autoimmune disorder has been seen in association with LTRAs?
- hyperactivity and reduced ability to concentrate
- Churg-Strauss Syndrome
Emollients are topical and used for all dry/scaly skin disorders by containing oils to soften skin, reduce water loss etc. What 2 skin conditions can they worsen and why?
-Acne vulgaris
-Folliculitis
(as they block pores and hair follicles)
Latanoprost, bimatoprost are what class of medication? They are 1st line agents to lower intraocular pressure in what conditions?
- Prostaglandin analogue eye drops
- open-angle glaucoma, ocular hypertension (reduces progression of damage)
-Prostaglandin analogue eye drops reduces progression of open-angle glaucoma, ocular hypertension. These analogues of prostaglandin F2a reduce intraocular pressure how?
-they increase the outflow of aqueous humour via the uveoscleral pathway
