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Pharmacology > Asthma Treatments > Flashcards

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
Q

How can bronchodilators be administered?

A

Inhalation or oral

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25
Q

What are the side effects of bronchodilators?

A

Tremor
Nervous tension
Increased heart rate (binding to b1 receptors)
Hypokalaemia = stimulates sodium/potassium exchange pump so muscle ache

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26
Q

Are inhaled or oral bronchodilators best?

A

Inhaler - goes straight to lungs, so less systemic effects

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27
Q

Bronchodilators are usually administered through a metered dose inhaler. What 2 devices can be used to assist its effectiveness?

A 
A spacer (press then breathe - don't need coordination)
Breath-activated inhaler (just breathe)
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28
Q

When using a metered dose inhaler, how much drug (%) actually makes it to the lung when used correctly?

A

10%

29
Q

How much drug impacts in the mouth when using a metered dose inhaler correctly?

A

50%

30
Q

How much drug is eventually swallowed when using a metered dose inhaler?

A

90%

31
Q

What type of treatment results in only 10% of the drug reaching its target (the lungs)

A

A metered dose inhaler for asthma

32
Q

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?

A

The drug will go into the atmosphere

33
Q

What is an accuhaler?

A

A breath activated inhaler

34
Q

What is a turbohaler?

A

A dry powder inhaler

35
Q

What is a nebuliser? When is it used to treat asthma?

A

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
Q

What are beclometasone, budesonide, fluticasone, mometasone and ciclesonide?
What are they used for?

A

Glucocorticosteroids - one and ide

Used for preventing asthma attacks

37
Q

How long does it take beclometasone and other glucocorticosteroids to become effective to prevent asthma attacks?

A

Several days for relief of symptoms - budesonide is within 10 hours though.
Must be used weeks before attack

38
Q

What do combination inhalers contain?

A

Two drugs - a preventer and reliever

39
Q

What are symbicort (budesonide/formoterol), SMART (symbicort maintenance and reliever therapy) and fluticasone/salmeterol combinations examples of?

A

Combination inhalers

40
Q

Why can’t combination inhalers be used for attacks?

A

The reliever in these have a long duration of action but a slow onset of action

41
Q

What type of drug binds to DNA receptors in order to switch off the COX gene to reduce inflammatory mediators?

A

Glucocorticosteroids

42
Q

How can you reduce Candida albicans and dysphonia in asthmatic patients?

A

Use a spacer device or rinse mouth after using inhaler

43
Q

What drug do you use to treat acute asthma attacks, as a short course but in a high dose?

A

Oral Prenisolone

olone = acute

44
Q

When would you use oral prednisolone alongside a high dose inhaled steroid?

A

Chronic severe asthma

olone = acute

45
Q

What are patients on long-term steroid therapy advised to carry?

A

A card about their treatment

46
Q

What may happen if you stop taking steroid treatment abruptly?

A

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
Q

What type of bronchodilator is short acting and works by blocking M receptors?

A

Antimuscarinic bronchodilators

48
Q

Why are antimuscarinic bronchodilators used alongside high-dose inhaled corticosteroids?

A

Severe asthma

49
Q

What is ipratropium an example of?

A

An antimuscarinic bronchodilator

50
Q

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:

A

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
Q

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?

A

Cromones

52
Q

What are nedocromil sodium and sodium cromoglicate examples of?

A

Cromones - crom in the name

53
Q

What are montelukast and zafirlukast examples of?

A

Leukotriene Receptor Antagonists - LUKAST

LICKS UK ASTHMA

54
Q

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

A

Leukotriene Receptor Antagonists

55
Q

What kind of disturbance can Leukotriene Receptor Antagonists cause?

A

GI disturbance

56
Q

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.

A

Theophylline

57
Q

Theophylline is used for what kind of patient?

A

Patients with persistent/severe acute asthma

58
Q

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)

A

Omalizumab

59
Q

What are 3 negatives of omalizumab?

A

May cause bruising, pain on injection and small risk of anaphylaxis

60
Q

How does omalizumab work?

A

It stops B cells binding to mast cells so histamine is not produced

61
Q

What is the most mild treatment strategy for asthma?

A

Inhaled short acting B2 agonist when needed

62
Q

What is the most severe treatment method for asthma?

A

Continuous frequent use of oral steroids and immunosuppressants

63
Q

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?

A

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
Q

Can we step down asthma treatment once it is controlled?

A

Yes

65
Q

What % of arterial oxygen saturation makes asthma life threatening?

A

When it drops below 92%

66
Q

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?

A

Severe

67
Q

What is the first type of therapy choice given for an acute asthma attack?

A

Bronchodilator via a nebuliser

68
Q

If an acute asthma attack is too severe for nebuliser bronchodilator therapy, what is the next treatment?

A

Corticosteroid - given orally (prednisolone) or via I.V. (hydrocortisone) depending on severity

69
Q

When would we give an asthmatic oxygen therapy?

A

After severe attack and if O2 saturation is below 93%

70
Q

What is the last resort treatment for an acute asthma attack?

A

Aminophylline injection

Pharmacology (13 decks)

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