Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

The Patient 20300 > Asthma (theraputics) > Flashcards

Asthma (theraputics) Flashcards

1
Q

What is asthma

A

Asthma is a chronic inflammatory disease of the airways based upon an allergic disorder mediated by IgE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the common symptoms of asthma

A

Wheezing

Shortness Of Breath (dyspnoea)
Coughing - particularly at night and on waking
Severe – cyanosis, difficulty speaking full sentences, drowsiness
Triggers from allergens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the key facts surrounding children and asthma

A

Commonly presents in children and will typically co-present with atopic disorders such as eczema
A night time cough is a key symptom

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the main difference between asthma and COPD

A

Reversibility! If we give certain agents (salbutamol, short acting beta agonist) the hyper-reactivity in the airway is reversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the aim for the tratment of patients with asthma

A

To control symptoms, including nocturnal & exercise-induced exacerbations, prevent patients’ having exacerbations. Reduce reliance on rescue therapy – indeed most effective control would be a patient that has no need for rescue medication (salbutamol inhalers).
Achieve best possible lung function (FEV1 &/or PEF > 80% predicted or best), minimising side effects of medication.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do we define controlled asthma

A

Control is defined as:
• No daytime symptoms
• No night-time symptoms
• No need for rescue medication
• No limitations on activity, including exercise
• No exacerbations
• Normal lung function (in practical terms FEV1 and/or PEF >80% predicted or best) with minimal side effects from treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What types of drug treatments are used for asthmatic patients

A

we use inhaled and oral routes of administration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the different types of inhalers

A

Reliever - Short-acting b-agonists (SABA) i.e. salbutamol
Produces quick symptom relief, normally prn (well controlled asthmatics shouldn’t need to use these)
Preventer - Inhaled corticosteroids i.e. beclomethasone
Act on underlying inflammation
Usually bd regardless of symptoms
Controller - Long-acting b-agonists (LABA) i.e. salmeterol
Slow onset, long acting
Usually bd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a nebuliser and when are they used

A

Nebulisers vaporise aqueous solution of drug (namely salbutamol and ipratropium) to a mist for inhalation through a mask or mouthpiece. They offer high dose delivery and are particularly useful in acute or chronic/ severe asthma since co-ordination is not needed. You will see these used a lot in the hospital setting. Used for ‘brittle asthma’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do β-2 Agonists work

A

Relax airway smooth muscle by stimulating beta2- adrenergic receptors, which increases cyclic AMP and produces functional antagonism to bronchoconstriction.
Cause bronchial smooth muscle relaxation and enhance mucociliary clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the two types of β-2 Agonists (give examples of the drugs)

A
  1. Short-acting (SABA):
    Salbutamol and terbutaline
    Onset 1-5 mins, duration 4-6 hours
    1st line relievers offer quick symptomatic relief
  2. Long-acting (LABA):
    Salmeterol: Onset 10-20mins, duration 12 h
    Formoterol: Onset 1-3 mins, duration 12 h (can be used in a MART reigime)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the ADRs of β-2 Agonists

A 
–	fine tremor in the extremities
–	nervous tension
–	headache
–	peripheral vasodilatation
–	tachycardia
–	hypokalaemia - low potassium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are corticosteroids and how are they administered

A

Anti-inflammatory reducing bronchial hyper-response to triggers.

Can be administered:
• Inhaled (ICS) for maintenance: e.g. beclomethasone, budesonide, ciclesonide
– Available in combination with LABA
- classed as either low, medium or high doses
• Oral: prednisolone (usually 40-50mg of 5/7 for acute attack) minimum effective dose in Step 5
• IV: hydrocortisone (in acute severe situations)
• Suppress inflammatory process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When are corticosteroids indicated (stepping up therapy)

A

• Indicated if:
– Exacerbation of asthma in last 2 years
– Using inhaled ß2-agonist >3 times per week
– Symptomatic >3 times per week
– Waking 1 night per week with symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the ADRs of corticosteroids (oral and inhaled

A

Inhaled:
Hoarseness or dysphonia - use spacer/dry powder
Oral candidiasis - Rinse mouth after use/spacer
Adrenal suppression – only in sustained doses >1500mcg beclomethasone daily

Oral
Hypertension, adrenal suppression, osteoporosis, skin thinning, hyperglycaemia, moon face, Acne

We must use the lowest dose that will control symptoms for shortest time possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are leukotrine antagonists and how do they work

A

Antagonise bronchoconstriction, airway oedema and mucous production.
Examples = Oral montelukast and zafirlukast

17
Q

What are the typical ADRs of leukotrine antagonists

A

Abdominal pain, Headache, Thirst (can lead to bedwetting in children), Rash, Sleep disturbance/CNS effects

18
Q

How do methylxanthines work

A

They are phosphodiesterase inhibitors that inhibit leukotriene synthesis and thus inflammation and bronchodilation
Examples: Oral: theophylline
IV/oral: aminophylline (salt of theophylline)

19
Q

What are the issues surrounding methylxanthines

A

Narrow Therapeutic Index
– SR preparations used to give more predictable effect
– brand must remain constant

20
Q

Give the effects of overdosing on methylxanthines

A
  • Therapeutic range: 10-20mg/L
  • <20mg/L: nausea, diarrhoea, nervousness, headache
  • > 20mg/L: vomiting, insomnia, arrhythmias
  • > 35mg/L: hyperglycaemia, arrhythmias, convulsions, death
21
Q

Clearance of methylxanthines (and therefore ADRs) is affected by CYP450 metabolism (hence they interact with many other drugs). Detail the effects of increased and decreased clearance and what causes it

A

• decreased clearance (increased plasma levels)
CCF, liver disease, obesity (dose by IBW)
- enzyme inhibition e.g. cimetidine, erythromycin, allopurinol, ciprofloxacin (interactions can lead to toxicity)
• increased clearance (decreased plasma levels)
Smoking, alcohol
- enzyme induction e.g. carbamazepine, rifampicin, phenytoin, smoking (interactions can lead to sub therapeutic doses)

22
Q

What are cromones and when are they used

A

Mast cell stabilisers. Inhibits mediator (histamine) release from mast cells

An example is Nedocromil: Preventer in 5-12 year olds

23
Q

What are the ADRs of cromones

A

N&V, bitter taste, dyspepsia

24
Q

What would we use to treat very brittle, uncontrolled asthma

A

Immunosuppressants such as methotrexate, ciclosporin, gold (amino-modulating drugs)
These are steroid-sparing agents - reduce the need for steroids
Specialist use - rarely used

25
Q

What are Anti IgE monoclonal antibodies used for. Give an example

A

Licensed as add-on therapy in adults and children > 12 for severe persistent allergic asthma
• S/C injection every 2 to 4 wks.
• Only initiated by specialist centres
• Patients must fulfil specific criteria (NICE)
• Discontinue after 16 wks. if inadequate response

An example is Omalizumab
Inhibits binding of IgE to mast cell receptors therefore preventing inflammatory response to trigger

26
Q

Give an example of a long acting antimuscarinic (LAMA)

A

Titotropium - licenced for asthma as an additional drug for patients with persistant poor control.
Also seen in the treatment of COPD

27
Q

How do we manage chronic adult asthma and which guidelines do we follow to do this

A

All patients should be offered inhaled short acting beta-2 agonist as required
Patients with infrequent, short-lived wheeze:
Regular preventer therapy
Add low dose inhaled steroid

We use BTS/SIGN guideline 2016. NICE guidelines are also used however the have differences. Which is used is based on local policy.

28
Q

What are the add on therapies we can offer to adults with cronic asthma when the condition isn’t improved by the initial interventions

A

Initial add-on therapy:
Add LABA to low dose ICS
Assess control & continue if good

Additional add-on therapies for persistent poor control
No response to LABA - stop & increase inhaled steroid dose
If benefit but inadequate response, continue LABA & increase inhaled steroid to medium dose

If control still inadequate, consider trials of:

  • leukotriene antagonist
  • SR theophylline
  • LAMA
29
Q

If contol is still not gained after the introduction of inhaled corticosteroids, a laba, leukotriene antagonists etc. what is the next step

A 
We move them onto High dose therapies: 
Increase ICS to high dose
Add a fourth drug:
LTRA (leukotrine antagonist)
SR theophylline
Beta-agonist tablet
LAMA
REFER TO SPECIALIST

We could also move to continuous or frequent use of oral steroids:
Daily oral steroid at the lowest dose to provide control
Maintain high dose ICS

REFER TO SPECIALIST

30
Q

What is the key concept used in the management of asthma

A

Management is step-wise in both directions and stepping down treatment is important.
Treatment is reviewed every 3-6 months with a view to stepping up/down

31
Q

What is PEF

A 
Peak Expiratory Flow rate(L/min)
Gives us an idea of lung function
Is effort dependent
Is a best of 3, patient records PEF “diary”. We can use this to monitor trends (if they're declining)
Is dependent on sex, age, height

Allows patient/HCP to monitor contro

32
Q

What is the aim for a PEF reading

A

Measured depending on the patients % predicted normal or best
Aim >70% or 0.7 (if FEV1/FEV)
“Normal” > 80% of their predicted best
<50% acute severe asthma (need care asap)

33
Q

What indicators do we use to tell if a patient has severe or life threatening severe acute asthma

A

Severe determined by four features:
PEF<50% normal/best, inability ability to talk full sentences, Respiratory Rate >25, HR>110

Life-threatening if:
the above PLUS: silent chest, cyanosis, bradycardia, confusion, exhaustion, coma, difficulty speaking full sentences. PEF<33% normal/best

Both cases require hospitalisation (life threatening needs icu)

34
Q

What drugs do we give if a patient is having a life threatening asthma attack

A

Immediate Rx
-oxygen: highest possible conc. 40-60%, aim for arterial oxygen saturation 94-98%
-beta-agonist: neb or multiple doses (10-20 puffs) via spacer
-Corticosteroid: prednisolone 40-50mg po or 100mg iv hydrocortisone (hold ICS)
Consider
-Ipratropium (short acting muscarinic) nebs
Single dose IV -magnesium sulphate (stabilises T-cells and mast cells)
-iv aminophylline/iv salbutamol

35
Q

How do we manage acute asthma

A

During hospitalisation

  • Stepdown treatment - iv => neb => inhaler
  • oral steroid at least 5/7
  • re-start steroid inhaler
  • discharge criteria (inc. reiterating asthma diary and recording PEF daily)
  • action plan
  • check inhaler technique

Transfer to ITU if

  • Deteriorating PEF
  • Persistent hypoxia
  • Hypercapnia (retaining CO2)– acidotic (blood pH rises ~ 7.4)
  • exhaustion, drowsiness
  • coma, resp. arrest
36
Q

What vitals do we monitor in acute asthma (9)

A
  • PEF
  • O2 saturation (Aim 94-98%)
  • arterial blood gases – inc. pH for acidosis
  • HR/RR (tachy-cardia/ponea)
  • theophylline levels if they’re on it (if cont >24h)
  • serum K+ as salbutamol causes hypokalemia (nebulised SABA)/glucose
  • Hydration
  • White cell count (asthma attack may have been caused by a chest infection)
  • C Reactive Protein (inflammatory marker)

The Patient 20300 (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions