Asthma medication Flashcards
Describe what is meant by “good control” of asthma. (6)
Minimal symptoms during day and night Minimal need for reliever medication No exacerbation No limitations of physical activity Normal lung function - FEV1 of >80% predicted or best.
Describe the steps that should be taken before changing medications (3)
Check compliance with existing therapy.
Check inhaler techniques
Eliminate new trigger factors.
Describe the requirements for starting long term therapy. (4)
Exacerbation requiring oral steroids
Beta 2 agonist use over 3 times per week
Symptoms over 3 times per week
Waking more than once in a week.
Describe stage 1 of asthma control. (1)
Short acting beta 2 agonists.
Name two short acting beta 2 agonists. (2)
Salbutamol
Terbutaline.
Describe stage 2 of asthma control. (2)
Short acting beta 2 agonist.
Low dose ICS.
Describe stage 3a of asthma control. (3)
Short acting beta 2 agonist.
Inhaled LABA
Low dose ICS
Describe stage 3b of asthma control. (7)
Short acting beta 2 agonist.
Inhaled LABA
Low dose ICS
Then add in one of: Moderate dose ICS or LTRA or LAMA or S-R theophylline.
Describe stage 4 of asthma control. (8)
Short acting beta 2 agonist.
Inhaled LABA
Moderate dose ICS
Then add one of: high dose ICS, LAMA, LTRA, Beta agonist tablets, S-R theophylline.
Describe stage 4 of asthma control. (4)
Short acting beta 2 agonist.
Daily oral steroids at lowest possible dose.
High dose ICS.
Consider steroid sparing drugs.
Describe the MoA of short active beta 2 agonists. (2)
Symptomatic reversal of bronchocontriction, and inhibition of mast cell degranulation.
Explain why short acting beta 2 agonists can get less effective over time. (2)
Continues use can reduce control because mast cell degranulation increases.
Name one fast onset, long duration beta 2 agonists. (1)
Formoterol (12h)
Name one slow onset long duration beta 2 agonist. (1)
Salmeterol.
Describe the side effects of beta 2 agonists. (4)
Adrenergic - tachcardia, tremour, palpitations.
Describe the MoA of ICS. (4)
Upregulate anti-inflammatory things (transactivation) and downregulate pro-inflammatory things (transrepression).
Describe why ICS are used in asthma. (4)
Reduce inflammation which helps to: Improve symptoms Improve lung function Reduce exacerbation Prevent death
Which type of asthmatic has a higher response to corticosteriods? (1)
Eosinophilic
Describe why LABAs are the next choice if the patient is uncontrolled at 400mcg/day of ICS. (3)
Reduce exacerbation
Improve symtoms
Improve lung function.
Explain why LABAs are often combined with a low dose ICS in the same inhaler. (5)
LABAs are not efficacious on their own - need the ICS.
Normally prescribed in one inhaler because:
Easier - increased compliance
1 vs 2 inhalers to worry about
Cheaper to only get 1 prescription
Safer - no option to take LABA without ICS.
Name the four options for changing prescription in Stage 4. (4)
High dose ICS.
Leucotriene receptor antagonists
Methylxanthines
Long acting M3 selective anticholinergics.
Name one leucotriene receptor antagonist. (1)
Describe its MoA. (3)
Montelukast
Prevents the leukotrienes released by mast cells and eosinophils from causing bronchoconstriction, mucus secretion, and mucosal oedema.
Describe the side effects of a leucotriene receptor antagonists. (6)
Angioedema Dry mouth Anaphylaxis Fever Gastric disturbances Nightmares
Name two methylxanthines. Which is more commonly used in practice? (3)
Theophylline - most common
Aminophylline
Describe the disadvantages of methylxanthines. (4)
Narrow therapeutic window
Frequent side effects - nausea, headache, reflux
Toxic complications - fits, arrhythmias
Common DDIs.
Describe the MoA of methylxanthines. (1)
Adenosine receipt antagonists.
Name one long acting anticholinergic that is M3 selective. (1)
Tiotropium bromide
Explain why LAMAs are rarely prescribed in asthma. (1)
Often licenced only in COPD.
Describe the most common treatment for stage 5 asthma. (3)
Oral prednisone, often in a really high dose.
Name two biological therapies that can be used as steroid sparing agents in stage 5 asthma. State their main MoA. (4)
Omalizumab - anti-IgE
Mepolizumab - anti-IL-5
What characteristics need to be present in a patient to prescribe omalizumab? How does it’s action help? (4)
Needs atopy and specific IgE range.
Works because IgE cannot cross link to cause mast cell degeneration.
Describe how anti-IL-5 drugs are helpful. (1)
Reduces eosinophils.
Describe how size of particle in an inhaler affects effectiveness of a drug. (4)
Particles need to be 1-5microns big so they settle in the small airways.
If they’re too big, they settle in the mouth and oropharynx.
If they’re too small, they don’t settle anywhere, and are breathed out again.
Describe “acute severe asthma in adults”. (4)
Any one of: Unable to complete sentences Pulse > 110 Resp rate > 25 Peak flow 33%-50% of best
Describe “life-threatening asthma in adults”.
11
Any one of: Pulse > 110 Resp rate > 25 Peak flow < 33% best sp(O2) < 92% p(O2) < 8 kPa p(CO2) > 4.5 kPa Silent chest Cyanosis Feeble respiratory effort Hypotension, bradycardia, arrhythmia Exhaustion, confusion, coma.
Describe the criteria for comensing mechanical ventilation in asthma. (2)
p(CO2) of 6 kPa
Loss of consciousness
Describe the treatments for asthma attacks. (5)
High flow oxygen.
Nebulised salbutamol driven by high flow oxygen.
Oral prednisone - 10-14 days
If severe add nebulised ipratropium bromide.
If still severe add IV aminophylline.
Describe ipratropium bromide. (3)
An anticholinergic used in severe asthma for long lasting bronchodilation.
