Asthma drugs

Question 1

Step 1 drugs

Answer 1

SABA:
Salbutamol
Formoterol

Question 2

Consequences of taking SABA regularly (>3 per week)

Answer 2

Increased mast cell degeneration in response to allergen

Question 3

Side effects of SABA

Answer 3

Tremor
Tachycardia
Palpitations 
Hypokalaemia
N&V
Headache

Question 4

Step 2 drugs and MoA

Answer 4

ICS

Inhibit inflammation and increase beta-2 adrenoreceptor expression

Question 5

When are step 2 drugs indicated

Answer 5

Using SABA at least 3 times per week
Symptoms at least 3 times per week
Nocturnal symptoms at least 1 time per week

Question 6

How are ICS drugs altered to decrease side effects

Answer 6

Added lipophilic side chain which:
Increases glucocorticoid receptor affinity
Increases time at site of action
Increased liver metabolism when enter systemic circulation

Question 7

Examples of step 3 and 4 drugs

Answer 7

LABA - salmeterol
High dose ICS 
Leukotriene antagonist 
Tiotropium bromide 
Theophylline

Question 8

Side effects of leukotriene antagonists

Answer 8

Angioedema and anaphylaxis
Dry mouth
Fever
Arthralgia

Question 9

MoA of methylxanthines

Answer 9

Increases cAMP which increases PKA causing smooth muscle relaxation

Question 10

Why are methylxanthines avoided

Answer 10

Lots of adverse drug reactions
Narrow therapeutic window
Life threatening complications
Many drug interactions

Question 11

What should be done before stepping up to 3

Answer 11

Check inhaler technique
Check compliance
Eliminate triggers

Question 12

Benefits of combination inhalers

Answer 12

Improves compliance

Safer

Question 13

Step 5 drugs

Answer 13

Oral steroids OD
Anti-IgE
Anti-IL5 to lower airway eosinophil count

Question 14

Treatment for acute severe asthma

Answer 14

High flow O2
Nebulised salbutamol
Oral prednisolone
Nebulised ipratropium bromide
IV aminophylline 
Mechanical ventilation if pCO2>6kPa

Question 15

Describe pressurised metered dose inhalers (4 points)

Answer 15

Evohalers
For quick relief in SOB
Blue if SABA, Green if LABA
Available as a spacer or with mask

Question 16

Describe breath activated inhalers (3 points)

Answer 16

Easibreathe
Not suitable in attack of SOB as they are activated by inspiration
Good for people with poor coordination

Question 17

What are the available dry powder inhalers

What drugs do each contain

Answer 17

Turbohalers - formoterol and budesonide (symbicort - red and white)
Accuhalers - salmeterol and fluticasone (seretide - purple disc)

Question 18

Describe inhalers with powder in hard capsule (4 points)

Answer 18

Handihalers
Contain tiotropium (a LAMA)
Require priming and repeat breathing
Risk of swallowing capsule or choking in children

Question 19

Dscribe soft mist inhalers (3 points)

Answer 19

Respimats
Give tiotropium
Spring action

Question 20

Advantages of respimats

Answer 20

Good if poor inspiration

Less cough as finer particles

Question 21

Contraindications of respimats

Answer 21

CVS pathology (or can try and monitor for CVS deterioration)

Question 22

What do drug classes do combo inhalers contain

Answer 22

LABA

ICS

Question 23

What do fostair inhalers contain

Answer 23

Formoterol

Beclomethasone

Question 24

Side effects of antimuscurinics

Answer 24

Dry mouth
Urine retention
Pharyngitis
Headaches
Cough

Question 25

Disadvantage of fostair inhalers

Answer 25

Expire after 1 month from first use

Need to be in fridge for at least 6 months before first use

Question 26

Side effects of immediate steroids

Answer 26

Cough
Oral candidiasis
Hoarseness

Question 27

Advice to prevent side effects from immediate ICS

Answer 27

Use spacer

Rinse mouth after use

Question 28

Side effects of prolonged ICS

Answer 28

Adrenal insufficiency
Glaucoma
Osteoporosis
Growth retardation in children