Asthma & COPD drugs

Question 1

1 st line management of acute asthma exacerbation (3)

Answer 1

Question 2

Is it better to give oral or IV prednisolone?

Answer 2

Bioavailability of Prednisolone (oral) is the same (speed wise) to Hydrocortisone IV -> so give IV only if patient’s so short of breath that they cannot speak/swallow/ unconscious

Question 3

Tx of acute asthma exacerbation

Answer 3

Oxygen - give via nasal cannula/mask to get O2 sats between 94 and 98%

Salbutamol - 2.5 - 5mg nebulised

Hydrocortisone - 100mg IV or prednisolone 40mg oral

Ipratropium - 500mcg nebulised
(give these four IMMEDIATELY, use O2 driven nebs if possible)

Theophylline - IV

Magnesium sulphate - IV
(CONSULT A SENIOR PHYSICIAN)

Escalate care - if intubation and invasive ventilation are required

Question 4

Steps in chronic asthma management

Answer 4

Question 5

MoA of Xhantine

Answer 5

Inhibits phosphodiesterase -> increased cAMP

Question 6

Side effects of Xhantine

Answer 6

• significant - need to monitor levels

SEs: pain, nausea, cramping, vomiting, diarrhoea, arrhythmias

Question 7

What’s the role of leukotrienes in athma?

Answer 7

• leukotrienes = inflammatory mediators released by Mast cells
• excess leukotrienes attract eosinophils

Question 8

MoA and use of Montelukast (how much)

Answer 8

Montelukast 10mg once a day blocks the effect of leukotrienes *especially effective for people

with allergic type of asthma (ones that also suffer from hay fever etc)

Question 9

Symptoms of long-term steroid use/ Cushing’s

Answer 9

Question 10

What is the surgery that is possibly used in chronic management of severe asthma?

Answer 10

Bronchial Thermoplasty -> where bronchoscope is used to burn part of smooth muscle that is contracted in the airways

Question 11

What is possible specialist medical Rx in severe asthma?

Answer 11

Monoclonal antibodies

Question 12

Management of COPD exacerbation

Answer 12

• Salbutamol 5mg (nebuliser)
• Iprapropium 500 mcg (nebuliser)
• Corticosteroids: either Prednisolone 40mg oral or Hydrocortisone 200mg IV
• antibiotics

Question 13

How can be nebuliser administrated and why in a patient with COPD?

Answer 13

Neb via air if at risk of type II resp failure

Question 14

MRCP breathlessness scale

Answer 14

Question 15

GOLD staging of COPD

Answer 15

Question 16

Treatment for Group A patient with COPD

Answer 16

Start with a bronchodilator -> LAMA (glycopyronium or tiotropium)

Question 17

Treatment for group B patient with COPD

Answer 17

Group B (lots of symptoms, low number of

exacerbations)

Start with: LAMA or LABA (usually LAMA)

…if still have got symptoms…

LAMA + LABA (combined inhaler)

Question 18

What assessments (2) are needed to decide what group is patient in terms of management of COPD?

Answer 18

Four different groups and two based on the symptoms

• CAT (COPD Assessment Tool -

questionnaire) -> score (more or less than 10)

• mMRC (is a grading depending on how breathless patient is -> by asking them questions and then scoring it)

• CAT and mMRC decide if a patient is on LEFT or RIGHT side of the square (in the

algorithm above)

• Number of exacerbation -> whether patient is on UPPER or LOWER part

Question 19

Treatment for group C patient with COPD

Answer 19

Group C (high exacerbations, low symptoms)

Either:

• start with combined LAMA + LABA (straight away)

… or….

LABA + ICS

Question 20

Treatment of group D patient with COPD

Answer 20

Group D (highly symptomatic, high exacerbation

frequency)

LAMA + LABA + ICS

(Triple therapy) -> maximal COPD therapy

It may be that all of three treatment in one inhaler

Examples: Trimbow

Question 21

Example (1) of medication used as triple therapy in COPD

Answer 21

LAMA + LABA + ICS

(Triple therapy) -> maximal COPD therapy

It may be that all of three treatment in one inhaler

Examples: Trimbow

Question 22

Name 2 drugs /examples of LAMA

Answer 22

glycopyronium or tiotropium

Question 23

Non-therapeutic treatment of COPD

Answer 23

(STEP V)

S - stop smoking

T - treat exacerbations quickly

E - exercise

P - pulmonary rehabilitation

V - vaccinations

Question 24

Name (1) example of nicotine receptor blocker

Answer 24

Nicotine receptor blocker

Varenicline (Champix) -> they block and stimulate nicotinic receptor -> dopamine is

released

Question 25

(1) example of dopamine-releasing agent used in smoking cessation

Answer 25

Dopamine releasing agents

Bupropion (Zyban) -> release of dopamine (less cravings and break in the habit)

Question 26

Mech of action of LABA

Answer 26

Causes bronchodilation via smooth muscle relaxation due to agonistic action on the B2 adrenergic receptors

Question 27

Key side effects to be aware of with a beta-agonists

Answer 27

Headache

Tachycardia

Fine tremor

Hypokalaemia – excessive use drives K+ into cells through increased K+/NA ATPase stimulation. Move K inwards

Hypotension - vasodilation

Question 28

How does a LTRA work?

Answer 28

Inhibits the action of pro-inflammatory cytokine leukotriene

LTRA = leukotriene receptor antagonist

Question 29

How does a SR Theophylline work?

Answer 29

PDE inhibitor thus prevent the breakdown of cAMP. Leads to smooth muscle relaxation.

Question 30

How does a LAMA work?

Answer 30

Blocks acetylcholine binding to M3 receptors leading to smooth muscle relaxation

LAMA = long acting muscarinic antagonist

Question 31

Side effects of ICS use

Answer 31

Adrenal crisis or insufficiency – long term use

Cushing’s syndrome

Candidasis of the throat

Hyperglycaemia

Mood disturbance

Question 32

SAMA

Answer 32

Ipratroprium bromide

Question 33

LABA

Answer 33

sALMETEROL

Question 34

LAMA

Answer 34

Tiotropium

Question 35

ICS

Answer 35

Bundesonide

Question 36

ICS + LABA

Answer 36

Seretide

Question 37

Leukotrine receptor blocker

Answer 37

Montelukast