BRONCHIAL ASTHMA Flashcards
astham is chronic inflammtion with cough particularly at what time of the day ?
night or early morning
how can we asses asthma control ?
by symptoms in the last 4 weeks :
day time asthma more than twice a week
night wakening due to asthma
reliver needed more than twice a week
activity limitation due to asthma
none of this = well controlled
1-2 of each - partially
3-4 of this = uncontrolled
what are the medications for asthma control ?
inhaled corticosteroids
LABA
leukotrine receptor antagonists
sustained release theophyline
what are the reliver rescue medications ?(short term immediate relief)
SABA inhaled
oral short acting SABA
inhaled muscarinin antagonist
short acting theophyline
what are the add on therapies for severe asthma even with high dse ICS and LABA?
anti-IgE
systemic corticosteroids
what are the inhaled corticosteroids ? and how long are they inhaled for ?
beclometasone
fluticasone
budesonide
every 12hours
what are the side effects of inhaled corticosteroids ?
oropharyngeal candiasis and dysphagia
systemic if high doses only = adrenal atrophy and osteoperosis
what are the long acting b2 agonists ?
and are they administeered as monotherapy ?
salmeterol and formeterol = LABA
nerver inhaled as a monotherapy because they have minimal effcet i the chronic inflammtion in asthma = effcetive when combines with ICS better than doubling the dose of ICS
which is more rapid acting of the LABA ?
formeterol
whata re the side effects of LABA ?
tremor
hypokalemia
tachycardia and tachyarrythmia
rarley systemic effect
what are the leukotrine receptor anatgonists ? and how are they administered
and what is their effect ?
montelucast = administered orally
reduces airway inflammtion and exacerbations , BUT SMALL BRONCHODILATOR EFFECT
montelucast is especially used in ?
esp in children
as an alternative to ICS with MILD ASTHMA
patients with aspirin sensitive asthma
add on therapy (but less effective than LABA)
what are the side effects of montelucast ?
rare : dyspepsia and diarrhea
what is the administration of sustained reease theophyline ?
and what is its main phsyiological effect ?
given orally twice a day
bronchodilator - by blockng phosphodiesterase and anagonist of adenosine
low dose = modest anti inflammatory
what are the side effects of theophyline ?
it has a SMALL THERAPUTIC INDEX and conc above 40mg/dl can lead to arrythmia and seizures
if 10mg/kg/ day or more
CNS - anxiety , insomnia
cardio - tachycardia , arrythmia
GI = vomitting , nausea
what are the drug to drug interactions we need to be carefull of in theophyline ?
metabolsim of theophyline increased in smokinh , rifampicin , phenobarbitural ,, carbemezapine = lower effect
metabolsim inhibited and toxicity leading to side effects by = ciprofloxacin (other fluroquinilones!) fluvoxamine , verapamil , diltizem , macrolides such as clarithro or erythromyccin
what are the inhaled SABA ?
and how is saba used ?
salbutamol
used only in need bases , and for pretreatmnet in excercise indused bronchoconstriction
what are the side effects of SABA ?
developments of tolerance
in the beginning thats why we see tremor and tacycardia but goes away
what are the oral SABA?
salbutamol , clenbuterol , hexoprenaline
what are the inhaled anticholinergic agents ?
ipratropium and tiotropium
what is the indication for inhaled anticholnergeric agents ?
used for patients who have strong adverse tacchycradia and tachyarrythmia to SABA= bronchodilators but not as good as SABA
what are the side effects of inhaled anti cholinergic agents ?
dry mouth
and bitter taste
what are the short acting theophyline called ?
aminophyline = theophyline and ethylenediamine
whata re the disadvantges of short acting theophyline ?
does not give additional bronchidilator effects over adeqeate doses of SABA
whata re the anti-IgE add on therapy ? and how is it adminitered ? and what are the indications?
omalizumab
subcutaneous injection
uncontrolled step 4
what are the systemic corticosteroids ?
how long does the oral therapy last?
prednisolone , prednisone and methyprednisolone
oral therapy lasts 5-7 das and then replaced with inhaled corticosteroids
what are the side effects of the systemic corticosteroids ?
short term = hyperglycemia
gastroinetsnal - vomitting and diarrhea
change in mood
long term therapy = osteoperosis hypertension , diabetes mellitus , adrenal suppression , cataracts
glaucoma
skin thinning cutaneous stria
muscle weakness
patients who recieve long term treatmnet of corticosteroids systemic should be additionally prescribed what ?
bisphosphonates for the bone
what ais the step wise approach to control asthma?
step 1 (mild asthma) reliever = as needed SABA controller = low dose ICS or muscarinic antagonist (anticholinergic) oral SABA short acting theophyline
step 2 (mild asthma) reliever = as needed SABA controller = low dose ICS or or LTRA / low dose theophyline
step 3 (moderate asthma ) reliever =as needed SABA / low dose ICS / formterol controller = low dose ICS and LABA or medium to high dose ICS low dose ICS and LTRA low dose ICS and sustained release of theophyline
step 4 (severe asthma ) reliever = SABA / low dose ics / formeterol controller = medium/ high dose ICS and LABA or high dose ICS and LTRA high dose ICS and sustained release of theophylline
step 5 (severe asthma) reliever = SABA /LOW DOSE ICS/FORMTEROL controller = anti IgE + LABA + MEDIUM TO HIGH DOSE ICS or add low dose CS
what ais reffered to as mild asthma by the symptoms ?
day time symptoms of less than twice a month and short duration of few hours
no night awakening
and normal lung function of FEV1
