BRONCHIAL ASTHMA

Question 1

astham is chronic inflammtion with cough particularly at what time of the day ?

Answer 1

night or early morning

Question 2

how can we asses asthma control ?

Answer 2

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

Question 3

what are the medications for asthma control ?

Answer 3

inhaled corticosteroids

LABA

leukotrine receptor antagonists

sustained release theophyline

Question 4

what are the reliver rescue medications ?(short term immediate relief)

Answer 4

SABA inhaled

oral short acting SABA

inhaled muscarinin antagonist

short acting theophyline

Question 5

what are the add on therapies for severe asthma even with high dse ICS and LABA?

Answer 5

anti-IgE

systemic corticosteroids

Question 6

what are the inhaled corticosteroids ? and how long are they inhaled for ?

Answer 6

beclometasone
fluticasone
budesonide

every 12hours

Question 7

what are the side effects of inhaled corticosteroids ?

Answer 7

oropharyngeal candiasis and dysphagia

systemic if high doses only = adrenal atrophy and osteoperosis

Question 8

what are the long acting b2 agonists ?

and are they administeered as monotherapy ?

Answer 8

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

Question 9

which is more rapid acting of the LABA ?

Answer 9

formeterol

Question 10

whata re the side effects of LABA ?

Answer 10

tremor
hypokalemia
tachycardia and tachyarrythmia

rarley systemic effect

Question 11

what are the leukotrine receptor anatgonists ? and how are they administered

and what is their effect ?

Answer 11

montelucast = administered orally

reduces airway inflammtion and exacerbations , BUT SMALL BRONCHODILATOR EFFECT

Question 12

montelucast is especially used in ?

Answer 12

esp in children
as an alternative to ICS with MILD ASTHMA
patients with aspirin sensitive asthma
add on therapy (but less effective than LABA)

Question 13

what are the side effects of montelucast ?

Answer 13

rare : dyspepsia and diarrhea

Question 14

what is the administration of sustained reease theophyline ?

and what is its main phsyiological effect ?

Answer 14

given orally twice a day

bronchodilator - by blockng phosphodiesterase and anagonist of adenosine

low dose = modest anti inflammatory

Question 15

what are the side effects of theophyline ?

Answer 15

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

Question 16

what are the drug to drug interactions we need to be carefull of in theophyline ?

Answer 16

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

Question 17

what are the inhaled SABA ?

and how is saba used ?

Answer 17

salbutamol

used only in need bases , and for pretreatmnet in excercise indused bronchoconstriction

Question 18

what are the side effects of SABA ?

Answer 18

developments of tolerance

in the beginning thats why we see tremor and tacycardia but goes away

Question 19

what are the oral SABA?

Answer 19

salbutamol , clenbuterol , hexoprenaline

Question 20

what are the inhaled anticholinergic agents ?

Answer 20

ipratropium and tiotropium

Question 21

what is the indication for inhaled anticholnergeric agents ?

Answer 21

used for patients who have strong adverse tacchycradia and tachyarrythmia to SABA= bronchodilators but not as good as SABA

Question 22

what are the side effects of inhaled anti cholinergic agents ?

Answer 22

dry mouth

and bitter taste

Question 23

what are the short acting theophyline called ?

Answer 23

aminophyline = theophyline and ethylenediamine

Question 24

whata re the disadvantges of short acting theophyline ?

Answer 24

does not give additional bronchidilator effects over adeqeate doses of SABA

Question 25

whata re the anti-IgE add on therapy ? and how is it adminitered ? and what are the indications?

Answer 25

omalizumab
subcutaneous injection
uncontrolled step 4

Question 26

what are the systemic corticosteroids ?

how long does the oral therapy last?

Answer 26

prednisolone , prednisone and methyprednisolone

oral therapy lasts 5-7 das and then replaced with inhaled corticosteroids

Question 27

what are the side effects of the systemic corticosteroids ?

Answer 27

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

Question 28

patients who recieve long term treatmnet of corticosteroids systemic should be additionally prescribed what ?

Answer 28

bisphosphonates for the bone

Question 29

what ais the step wise approach to control asthma?

Answer 29

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

Question 30

what ais reffered to as mild asthma by the symptoms ?

Answer 30

day time symptoms of less than twice a month and short duration of few hours
no night awakening
and normal lung function of FEV1