Asthma & COPD drugs Flashcards

1
Q

1 st line management of acute asthma exacerbation (3)

A
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2
Q

Is it better to give oral or IV prednisolone?

A

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

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3
Q

What are (3) other possible therapies in acute asthma exacerbation if the previous ones do not work?

A
  • Magnesium Sulphate (2 g IV over 20 minutes)

(inhibits smooth muscle contraction)

  • Aminophylline infusion (SNS stimulant)
  • Salbutamol IV
If patient is still deteriorating after the
above treatments (SAMA + SABA+ Magnesium and Aminophylline) -\> ICU needed
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4
Q

Steps in chronic asthma management

A
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5
Q

MoA of Xhantine

A

Inhibits phosphodiesterase -> increased cAMP

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6
Q

Side effects of Xhantine

A
  • significant - need to monitor levels

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

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7
Q

What’s the role of leukotrienes in athma?

A
  • leukotrienes = inflammatory mediators released by Mast cells
  • excess leukotrienes attract eosinophils
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8
Q

MoA and use of Montelukast (how much)

A

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)

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9
Q

Symptoms of long-term steroid use/ Cushing’s

A
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10
Q

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

A

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

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11
Q

What is possible specialist medical Rx in severe asthma?

A

Monoclonal antibodies

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12
Q

Management of COPD exacerbation

A
  • Salbutamol 5mg (nebuliser)
  • Iprapropium 500 mcg (nebuliser)
  • Corticosteroids: either Prednisolone 40mg oral or Hydrocortisone 200mg IV
  • antibiotics
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13
Q

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

A

Neb via air if at risk of type II resp failure

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14
Q

MRCP breathlessness scale

A
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15
Q

GOLD staging of COPD

A
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16
Q

Treatment for Group A patient with COPD

A

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

17
Q

Treatment for group B patient with COPD

A

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)

18
Q

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

A

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
19
Q

Treatment for group C patient with COPD

A

Group C (high exacerbations, low symptoms)

Either:

  • start with combined LAMA + LABA (straight away)

… or….

LABA + ICS

20
Q

Treatment of group D patient with COPD

A

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

21
Q

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

A

LAMA + LABA + ICS

(Triple therapy) -> maximal COPD therapy

It may be that all of three treatment in one inhaler

Examples: Trimbow

22
Q

Name 2 drugs /examples of LAMA

A

glycopyronium or tiotropium

23
Q

Non-therapeutic treatment of COPD

A

(STEP V)

S - stop smoking

T - treat exacerbations quickly

E - exercise

P - pulmonary rehabilitation

V - vaccinations

24
Q

Name (1) example of nicotine receptor blocker

A

Nicotine receptor blocker

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

released

25
Q

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

A

Dopamine releasing agents

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