Asthma Drugs

Question 0

Terbutaline

Answer 0

Short acting beta 2 agonist

Question 1

Salbutamol

Answer 1

Short acting beta 2 agonist

Question 2

Formoterol

Answer 2

Short acting beta 2 agonist

Question 3

Short acting beta 2 agonist action

Answer 3

Symptom relief through reversal of bronchoconstriction
Prevention of bronchoconstriction eg on exercise
Act on airway smooth muscle
Inhibit mast cell degranulation

Question 4

Short acting beta 2 agonist issues

Answer 4

Reduce asthma control if used regularly - increase mast cell degranulation in response to antigen

Question 5

Short acting beta 2 agonist ADRs

Answer 5

Adrenergic - tachycardia, palpitations, tremor

Question 6

Inhaled corticosteroid indications

Answer 6

Using beta 2 agonist >3x per week
Symptoms >3x per week
Waking >1x per week
Consider if exacerbation requiring oral corticosteroids in past 2 yrs
Eosinophilic asthma usually responds better

Question 7

Inhaled corticosteroid mechanism

Answer 7

Activate - beta 2 receptors, lipocortin, inhibitors of various inflammatory mediators
Repress - inflammatory mediators, adhesion molecules.

Question 8

Inhaled corticosteroid properties

Answer 8

High affinity for GCS receptor
High uptake and dwell time in tissue on local application
Rapidly inactivated in the liver

Question 9

Inhaled corticosteroids absorption

Answer 9

From mouth and pharynx to gut and lungs
From gut to liver, mostly inactivated
From lungs to systemic circulation.

Question 10

Budesonide

Answer 10

Inhaled corticosteroid

Question 11

Beclomethasone

Answer 11

Inhaled corticosteroid

Question 12

Fluticasone

Answer 12

Inhaled corticosteroid

Question 13

Long acting beta 2 agonist indications

Answer 13

Patient not controlled IV 400 mcg/day ICS

Question 14

Formeterol

Answer 14

LABA

Most efficacious

Question 15

Salmeterol

Answer 15

LABA

Least potent of the three

Question 16

Terbutaline

Answer 16

LABA

Question 17

Montelukast

Answer 17

Leukotriene receptor antagonist

Question 18

Zafirlukast

Answer 18

Leukotriene receptor antagonist

Question 19

Leukotriene receptor antagonist mechanism

Answer 19

LTC4 can cause bronchoconstriction, mucus secretion, mucosal oedema and promote inflammatory cell recruitment

Question 20

Leukotriene receptor antagonist ADRs

Answer 20

Angio oedema, dry mouth, anaphylaxis, arthralgia, fever, gastric disturbances

Question 21

Theophylline

Answer 21

Methylxanthine

Question 22

Aminophylline

Answer 22

Methylxanthine

Question 23

Methylxanthine mechanism

Answer 23

Antagonise adenosine receptors
Inhibit phosphodiesterase (increased cAMP)

Question 24

Methylxanthine ADRs

Answer 24

Narrow therapeutic window
Nausea
Headaches
Arrhythmia / tachycardia
Fits
Psychomotor agitation

Question 25

Theotroprium bromide

Answer 25

Anticholinergic

Question 26

Theotroprium bromide indications

Answer 26

COPD

Severe asthma

Question 27

Treatment of acute severe asthma

Answer 27

High flow O2 (aim for 94-98% sats)
Nebulised salbutamol 
Oral prednisolone 40 mg per day for 10-14 days
Can add nebulised ipratropium bromide
Consider IV MgSO4
Consider IV Aminophylline