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Asthma Treatments Flashcards

0
Q

What illness has the symptoms of wheezing attacks/shortness of breath and a cough - both of which are worse at night?

A

Asthma

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1
Q

What condition is associated with airway hyper-responsiveness, reversible airflow limitation and bronchial inflammation?

A

Asthma

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2
Q

Name 6 triggers of asthma:

DEEP CD

A 
Exposure to allergen
Emotion
Diet (fruit and veg can fight oxidants that damage airway)
Cold air/exercise (dries out airways)
Pollutants (cig fumes etc)
Drugs (aspirin, beta-blockers)
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3
Q

The obvious long term aims of asthma therapy are to abolish symptoms and maintain optimal lung function.
What do we want therapy to prevent/avoid?

A

Prevent permanent lung damage, prevent death from acute attack and avoid unnecessary side effects

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4
Q

In asthma, an allergen activates T cells that release eosinophil into the airways. This activates B cells that form receptors which bind to mast cells in the airway.
Every time an asthmatic is exposed to the allergen, what do the mast cells do?

A

The mast cells are activated and produce histamine in the bronchioles

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5
Q

What do asthma relievers do?

A

Relax smooth muscle to widen the airways

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6
Q

What is a bronchodilator?

A

An asthma reliever - relaxing smooth muscle to widen the airways

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7
Q

What type of asthma treatment relaxes smooth muscle to widen the airways?

A

Bronchodilator

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8
Q

Name 4 bronchodilators:

SITS

A

Salbutamol (ventolin)
Ipratropium
Theophylline
Salmeterol

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9
Q

What is a long acting bronchodilator (begins with S)?

A

Salmeterol

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10
Q

What do asthma preventers do?

A

They are anti-inflammatory, stopping the response to allergens

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11
Q

What type of asthma treatment works as an anti-inflammatory, thereby stopping the response to allergens?

A

Preventer

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12
Q

What are Beclometasone, Sodium Cromoglicate and Montelukast examples of?

A

Asthma Preventer treatments

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13
Q

Name an asthma preventer treatment beginning with B and a asthma reliever treatment beginning with S (not salmeterol):

A

Beclometasone (a steroid that prevents inflammation)

Salbutamol

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14
Q

What receptors target the lungs, blood vessels and muscle spindles?

A

B2

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15
Q

What do B1 receptors target?

A

The heart

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16
Q

What do B2 receptors target?

A

Lungs, blood vessels and muscle spindles

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17
Q

What system do a receptors and b receptors affect?

A

THe SNS

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18
Q

What receptors would asthma treatments ideally target?

A

B2 - targets the lungs, blood vessels and muscle spindles

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19
Q

What chemical does salbutamol have a similar structure to?

A

Adrenaline

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20
Q

What do we use as a last resort for an asthma patient having a severe attack, who desperately needs oxygen?

A

Adrenaline.

Similar to salbutamol but adrenaline binds to everything whilst salbutamol is B2 selective

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21
Q

What do bronchodilators agonise?

A

B2 receptors

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22
Q

Are salbutamol and terbutaline short acting?

A

Yes

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23
Q

Are salemeterol and formoterol short acting?

A

NO, they are long-actings

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24
How can bronchodilators be administered?
Inhalation or oral
25
What are the side effects of bronchodilators?
Tremor Nervous tension Increased heart rate (binding to b1 receptors) Hypokalaemia = stimulates sodium/potassium exchange pump so muscle ache
26
Are inhaled or oral bronchodilators best?
Inhaler - goes straight to lungs, so less systemic effects
27
Bronchodilators are usually administered through a metered dose inhaler. What 2 devices can be used to assist its effectiveness?
``` A spacer (press then breathe - don't need coordination) Breath-activated inhaler (just breathe) ```
28
When using a metered dose inhaler, how much drug (%) actually makes it to the lung when used correctly?
10%
29
How much drug impacts in the mouth when using a metered dose inhaler correctly?
50%
30
How much drug is eventually swallowed when using a metered dose inhaler?
90%
31
What type of treatment results in only 10% of the drug reaching its target (the lungs)
A metered dose inhaler for asthma
32
What happens if a patient does not make an appropriate seal with their lips around a metered dose inhaler, and if they do not breathe at the same time as pushing it?
The drug will go into the atmosphere
33
What is an accuhaler?
A breath activated inhaler
34
What is a turbohaler?
A dry powder inhaler
35
What is a nebuliser? When is it used to treat asthma?
The patient wears a mask into which an air compressor sends a mist/aerosol of a drug. This is used for patients having an asthma attack when they can no longer use an inhaler. It would not be cost-effective to send these home so they are used in A&E
36
What are beclometasone, budesonide, fluticasone, mometasone and ciclesonide? What are they used for?
Glucocorticosteroids - one and ide Used for preventing asthma attacks
37
How long does it take beclometasone and other glucocorticosteroids to become effective to prevent asthma attacks?
Several days for relief of symptoms - budesonide is within 10 hours though. Must be used weeks before attack
38
What do combination inhalers contain?
Two drugs - a preventer and reliever
39
What are symbicort (budesonide/formoterol), SMART (symbicort maintenance and reliever therapy) and fluticasone/salmeterol combinations examples of?
Combination inhalers
40
Why can't combination inhalers be used for attacks?
The reliever in these have a long duration of action but a slow onset of action
41
What type of drug binds to DNA receptors in order to switch off the COX gene to reduce inflammatory mediators?
Glucocorticosteroids
42
How can you reduce Candida albicans and dysphonia in asthmatic patients?
Use a spacer device or rinse mouth after using inhaler
43
What drug do you use to treat acute asthma attacks, as a short course but in a high dose?
Oral Prenisolone | olone = acute
44
When would you use oral prednisolone alongside a high dose inhaled steroid?
Chronic severe asthma | olone = acute
45
What are patients on long-term steroid therapy advised to carry?
A card about their treatment
46
What may happen if you stop taking steroid treatment abruptly?
Addisonian crisis. The corticosteroids are regulated by CRH and acetylcholine in a negative feedback mechanism. If you come off quickly this can be life threatening as the body cannot produce adrenaline
47
What type of bronchodilator is short acting and works by blocking M receptors?
Antimuscarinic bronchodilators
48
Why are antimuscarinic bronchodilators used alongside high-dose inhaled corticosteroids?
Severe asthma
49
What is ipratropium an example of?
An antimuscarinic bronchodilator
50
Antimuscarinic bronchodilators are used instead of salbutamol alongside inhaled corticosteroids. Give an example of one and explain why it may cause dry mouth and precipitate glaucoma:
Ipratropium - it enhances the SNS as it blocks M receptors that narrow the airways whilst the steroid is a B2 agonist that widens the airways
51
What types of drug prevent bronchospasm by inhibiting the release of chemicals from mast cells and also reduce allergen-responses and bronchospasm during/after exercise?
Cromones
52
What are nedocromil sodium and sodium cromoglicate examples of?
Cromones - crom in the name
53
What are montelukast and zafirlukast examples of?
Leukotriene Receptor Antagonists - LUKAST LICKS UK ASTHMA
54
What type of asthma treatment reduces bronchoconstriction, stops the release of inflammatory cells and reduces secretions in the airways? Hint it antagonises leukotrienes that cause the above
Leukotriene Receptor Antagonists
55
What kind of disturbance can Leukotriene Receptor Antagonists cause?
GI disturbance
56
What asthma treatment works by blocking the PDE enzyme in airways causing muscles to relax, is often used with B-agonists and/or steroids for patients with persistent or severe symptoms and may also have anti-inflammatory effects? It also has a narrow therapeutic window and may increase heart-rate, palpitations, convulsions and headaches.
Theophylline
57
Theophylline is used for what kind of patient?
Patients with persistent/severe acute asthma
58
What is the name of an antibody that is administered subcutaneously every 2-4 weeks, that reduces the effects of allergen-reduced reactions? (used in asthmatic adults with severe asthma who do not respond to beta agonists or corticosteroids)
Omalizumab
59
What are 3 negatives of omalizumab?
May cause bruising, pain on injection and small risk of anaphylaxis
60
How does omalizumab work?
It stops B cells binding to mast cells so histamine is not produced
61
What is the most mild treatment strategy for asthma?
Inhaled short acting B2 agonist when needed
62
What is the most severe treatment method for asthma?
Continuous frequent use of oral steroids and immunosuppressants
63
Where inhaled short acting B2 agonists are not effective for asthma patients, we use inhaled steroids. We then graduate to inhaled long-acting B2 agonists combined with an increased dose of inhaled steroids. What is the next step up before continuous, frequent use of oral steroids?
Short AND long-acting B2 agonists with an inhaled steroid and another drug (such as LicksUKAsthma - LTR antagonist) Short - steroid - long and steroid - short and long and steroid and other drug - ORAL
64
Can we step down asthma treatment once it is controlled?
Yes
65
What % of arterial oxygen saturation makes asthma life threatening?
When it drops below 92%
66
If someone cannot complete a sentence, has a respiratory rate above 25, a pulse above 110, arterial oxygen saturation above 92% and a peak flow between 33-50% - what degree of asthma does a person have?
Severe
67
What is the first type of therapy choice given for an acute asthma attack?
Bronchodilator via a nebuliser
68
If an acute asthma attack is too severe for nebuliser bronchodilator therapy, what is the next treatment?
Corticosteroid - given orally (prednisolone) or via I.V. (hydrocortisone) depending on severity
69
When would we give an asthmatic oxygen therapy?
After severe attack and if O2 saturation is below 93%
70
What is the last resort treatment for an acute asthma attack?
Aminophylline injection

Pharmacology (13 decks)

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