Asthma Medication

Question 1

What are the two main classes of Asthma Medications

Answer 1

1. Releivers
   * Bronchodilators for acute symptomatic releif (SABA/SAMA, aminophyline)
2. Preventers
   * Long-acting bronchodilators (LAMA, LABA, aminiphyline/theophyline)
   * Anti-inflammatories: corticosteroids, leukoterine receptor antagonist, mast cell stabalisers, monoclonal antibodies

Question 2

Bronchodilators - Selective B2 agonists

Answer 2

• MOA: Stimulates B2 receptors resulting in relaxation of bronchial smooth muscle. “opens the airways”
• Short acting B2 agonists (SABA) - reliever
• Salbutamol, Terbutaline
• Long acting B2 agonist (LABA) - preventor
• Formoterol, Salmeterol, Vilanterol

Side-effects: Tremor, Palpitastions, Headache, dry/irritation mouth/throat, hypokalemia

Contraindications: Hypokalemia causing drugs: corticosteroids, theophyline, aminophyline, digoxin

Question 3

Bronchodilators - Muscaranic antagonists

Answer 3

• MOA: inhibits Ach effect on M3 receptors resulting in ralaxation of bronchial smooth muscle
• Short acting muscuranic antagonists (SAMA) - Ipatropium
• Long acting muscuranic antagonists (LAMA) - Tiotropium, umeclidinium, glycoyrronium, aclidnium
• Side effects: dry mouth, constipation, nasal congestion, glaucoma (risk increased via nebuliser)
• Prostatic hyperplasia, CKD, glaucoma, arrhythmias
• Contraindications: Other anti-muscuranic/cholonergics: Amitryptiline, prochlorperazine

Question 4

Bronchodilators - Methylxanthines

Answer 4

• MOA: not known
• Oral: theophyline
• IV: Aminophyline
• Chronic Asthma

Question 5

Anti-inflammatories - corticosteroids

Asthma

Answer 5

• MOA:
• Decrease formation of cytokines
• Decrease Microvascular permeability
• Inhibit production of eosinophils into the lung, reducing overall inflammation
• reduce bronchial hyper-responsiveness

Oral - prednisolone
IV - hydrocortisone
Inhaled: Fluticasone, Beclometasone, Budesonide

ORAL C/I - active systematic infection
Caution: Hepatic impairment, psychiatric disturbances, wounds, heart failure, hypertension, diabetes, glaucoma, hypothyroidism, osteoporosis, obesity, peptic ulcers

INHALED no C/I
Side effects: Oral candidiasis (thrush), dysphonia
interactions: rare

Question 6

Anti-inflammatories - Leukoteriene receptor antagonists

Answer 6

MOA: Binds with high affinity to leukoteriene receptors inhibiting the action of cystenial leukoterienes, products of activated eosinophils and mast cells, which cause bronchoconstriction
Oral only
None cautions/ C/I
Side effects: fever, Gi symptoms, headache, skin reactions, upper GI infection
Interactions: Carbemazepine, Phenytoin, Phenobarbital, Rifampicin