Asthma and Eczema

Question 1

Ipratopium, tiotropium, glycopyrronium, aclidinium are all examples of what class of medications? Used to treat what?

Answer 1

• Anti-muscarinics

- used as bronchodilators to treat asthma or COPD

Question 2

MOA of anti-muscarinics e.g. Ipratopium, tiotropium

Answer 2

• 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

Question 3

Name 2 SEs of anti-muscarinics e.g. Ipratopium, tiotropium

as inhaled SEs are pretty minimal vs oral/IV preparations

Answer 3

• irritation of resp tract: nasopharyngitis, sinusitis and cough
• GI disturbance: dry mouth, constipation
• Urinary retention
• blurred vision
• headaches

Question 4

In what conditions/pts susceptible to what, should the use of anti-muscarinics like Ipratopium, tiotropium be prescribed with caution?

Answer 4

• angle-closure glaucoma (can precipitate a rise in ICP)
• pts at risk of arrhythmias
• pts in urinary retention

Question 5

Name one short acting anti-muscarinic and suggest dose and frequency vs
one long acting anti-muscarinic and frequency of administration?

Answer 5

• 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

Question 6

Name 3 examples of B2-agonists

used to treat asthma, COPD and which electrolyte disturbance?

Answer 6

• salbutamol, terbutaline, salmeterol, formoterol, indacaterol
• hyperkalaemia

Question 7

SABAs are used to relieve ___ in asthma, and LABAs are used as treatment for ___ asthma when inhaled ___ alone are insufficient.

Answer 7

• relieve SOB
• LABAs for chronic asthma
• when inhaled ICS alone..

Question 8

MOA of B2-agonists

Answer 8

-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)

Question 9

Of the following B2-agonists, which are short acting (SABAs) and which are long-acting (LABAs)?
-salbutamol, terbutaline, salmeterol, formoterol, indacaterol

Answer 9

SABAs: -salbutamol, terbutaline
LABAs: -salmeterol, formoterol, indacaterol

Question 10

B2-agonists, name 3 side effects of this medication class:

Answer 10

• ‘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

Question 11

LABAs should only be used in asthma alongside an ___ __ as part of therapy, because without this LABAs are associated with what?

Answer 11

• inhaled corticosteroid

- with increased asthma deaths

Question 12

Thinking about the fight/flight side effects of B2-agonists, what co-morbidity would you exercise caution in when prescribing?

Answer 12

-pts with CV disease (tachycardia may promote angina/arrhythmias)

Question 13

Common dose for adult asthma reliever B2-agonist is:

Answer 13

-Salbutamol 100-200 micrograms inhaled as required (PRN)

Question 14

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 ___ ____.

Answer 14

• by oxygen or air
• oxygen should be used in asthma
• medical air in COPD
• due to risk of CO2 retention

Question 15

Name 2 inhaled corticosteroids
Explain the indications in both
-asthma
-COPD

Answer 15

• 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

Question 16

What helpful effects do inhaled corticosteroids have in the airways of sufferers of asthma/COPD
(beclometasone, budesonide, fluticasone..)

Answer 16

• reduces mucosal inflamm
• widens airways
• reduced mucus secretion
• this improves symptoms and reduces exacerbations

Question 17

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:

Answer 17

-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)

Question 18

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?

Answer 18

-Children - may cause growth suppression

Question 19

Leukotriene receptor antagonists e.g. Monteleukast are indicated when in the following
adults:
children 5-12yrs
children <5yrs

Answer 19

• 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

Question 20

MOA of LTRAs e.g. monteleukast

Answer 20

• 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

Question 21

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?

Answer 21

• hyperactivity and reduced ability to concentrate

- Churg-Strauss Syndrome

Question 22

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?

Answer 22

-Acne vulgaris
-Folliculitis
(as they block pores and hair follicles)

Question 23

Latanoprost, bimatoprost are what class of medication? They are 1st line agents to lower intraocular pressure in what conditions?

Answer 23

• Prostaglandin analogue eye drops

- open-angle glaucoma, ocular hypertension (reduces progression of damage)

Question 24

-Prostaglandin analogue eye drops reduces progression of open-angle glaucoma, ocular hypertension. These analogues of prostaglandin F2a reduce intraocular pressure how?

Answer 24

-they increase the outflow of aqueous humour via the uveoscleral pathway

Question 25

What unusual SE can prostaglandin analogue eye drops have locally due to increasing the amount of melanin in stromal melanocytes of the iris?

Answer 25

-permanent change in eye colour (affects 1/3 esp if mixed eye colour)

Question 26

Advice for all pts using eye drops is they should gently compress where for 1minute immediately after instilling the drop to reduce drainage where? In order to lower ____ absorption of the drug.

Answer 26

• compress the medial canthus (nasal corner of eye)
• reduces drainage through lacrimal duct
• lowers systemic absorption of drug