Asthma & COPD drugs Flashcards
1 st line management of acute asthma exacerbation (3)
Is it better to give oral or IV prednisolone?
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
What are (3) other possible therapies in acute asthma exacerbation if the previous ones do not work?
- 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
Steps in chronic asthma management
MoA of Xhantine
Inhibits phosphodiesterase -> increased cAMP
Side effects of Xhantine
- significant - need to monitor levels
SEs: pain, nausea, cramping, vomiting, diarrhoea, arrhythmias
What’s the role of leukotrienes in athma?
- leukotrienes = inflammatory mediators released by Mast cells
- excess leukotrienes attract eosinophils
MoA and use of Montelukast (how much)
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)
Symptoms of long-term steroid use/ Cushing’s
What is the surgery that is possibly used in chronic management of severe asthma?
Bronchial Thermoplasty -> where bronchoscope is used to burn part of smooth muscle that is contracted in the airways
What is possible specialist medical Rx in severe asthma?
Monoclonal antibodies
Management of COPD exacerbation
- Salbutamol 5mg (nebuliser)
- Iprapropium 500 mcg (nebuliser)
- Corticosteroids: either Prednisolone 40mg oral or Hydrocortisone 200mg IV
- antibiotics
How can be nebuliser administrated and why in a patient with COPD?
Neb via air if at risk of type II resp failure
MRCP breathlessness scale
GOLD staging of COPD
Treatment for Group A patient with COPD
Start with a bronchodilator -> LAMA (glycopyronium or tiotropium)
Treatment for group B patient with COPD
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)
What assessments (2) are needed to decide what group is patient in terms of management of COPD?
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
Treatment for group C patient with COPD
Group C (high exacerbations, low symptoms)
Either:
- start with combined LAMA + LABA (straight away)
… or….
LABA + ICS
Treatment of group D patient with COPD
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
Example (1) of medication used as triple therapy in COPD
LAMA + LABA + ICS
(Triple therapy) -> maximal COPD therapy
It may be that all of three treatment in one inhaler
Examples: Trimbow
Name 2 drugs /examples of LAMA
glycopyronium or tiotropium
Non-therapeutic treatment of COPD
(STEP V)
S - stop smoking
T - treat exacerbations quickly
E - exercise
P - pulmonary rehabilitation
V - vaccinations
Name (1) example of nicotine receptor blocker
Nicotine receptor blocker
Varenicline (Champix) -> they block and stimulate nicotinic receptor -> dopamine is
released
(1) example of dopamine-releasing agent used in smoking cessation
Dopamine releasing agents
Bupropion (Zyban) -> release of dopamine (less cravings and break in the habit)
