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clinical pharm y5 > Clinical and pharmacological approaches for treatment of bronchial asthma: > Flashcards

Clinical and pharmacological approaches for treatment of bronchial asthma: Flashcards

1
Q

define bronchial asthma

A

chronic, inflammatory disease of the respiratory tract, which is characterized by bronchial hyperreactivity and respiratory obstruction.

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2
Q

what causes intermittent airway narrowing in asthma

A

⦁ bronchoconstriction,
⦁ congestion or edema of bronchial mucosa,
⦁ mucus,
⦁ or a combination of these

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3
Q

classification of asthma

A

extrinsic- atopic

intrinsic-non atopic

specific - occupatio/ aspirin

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4
Q

symptomatic classification

A

intermittent

mild persistant

moderate persistant

severe persistent

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5
Q

intermittent asthma

A

one day attack a week

one night attack per month

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6
Q

mild persistent

A

more than one day attack a week but less than one attack per day

night attacks 2x / month

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7
Q

moderate persistent

A

everyday attacks

night attack 1x a week

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8
Q

severe persistent

A

everyday frequent excacerbations

frequent night attacks

limited physical activity

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9
Q

what is GINA

A

GLOBAL INITIATIVE for ASTHMA maNAGEment

stepwise approach to the management of bronchial asthma

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10
Q

goals in rx of asthma

A

⦁ Avoid troublesome symptoms during day and night;
⦁ Need little or no reliever medication;
⦁ Have productive, physically active lives;
⦁ Have normal or near normal lung function;
⦁ Avoid serious asthma flare-ups (exacerbations, or attacks);

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11
Q

drug classificatino for asthma

A

Relievers – used for the treatment of the asthmatic attack:

Controllers – used to control the symptoms:

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12
Q

list the relievers

A

⦁ Short-acting β2 agonists (SABA).
⦁ Short-acting antimuscarinics.
⦁ Short-acting phosphodiesterase inhibitors.
⦁ Systemic corticosteroids

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13
Q

Controllers

A 
⦁	Long-acting β2 agonists (LABA)
⦁	Inhaled corticosteroids
⦁	L-acting antimuscarinics 
⦁	L-acting phosphodiesterase inhibitors
⦁	Leucotrien modifiers and mast cell stabilizers
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14
Q

devices used in asthma

A

Metered Dose Inhaler (MDI) : Spacers can help patients who have difficulty with inhaler use and can reduce potential for adverse effects from medication.
Nebulizer : Machine produces a mist of the medication/ Used for small children or for severe asthma episodes
Dry powder inhalers (DPI) : Single dose/ Multiple doses
Inhaled

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15
Q

step waise approach to bronchial asthma guidline

A

step 1: intermittent

step2: mild persistent
step3: moderate persistent

step 4: severe persistent

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16
Q

step 1

A

daily therapy : none

supplementary therapy: none

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17
Q

step 2

A

daily therapy; Low dose ICS

supplementary therapy:
leukotriene antagonise/ slow release theophyline

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18
Q

step 3;

A

daily therapy;
MOD ICS + LABA

supplementary therapy:
mod ICS + slow release thophyline

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19
Q

step 4

A

daily therapy;
high dose ICS + LABA

supplementary therapy:
more than one 
slow release theophyline
leukkotriene antagonist 
ige antibodies
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20
Q

effects of CS on asthma

A

⦁ Suppress inflammatory response to Ag-Ab reaction

Reduced bronchial hyperreactivity

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21
Q

effects of ICS on bronchi

A

Do Not have direct bronchodilating effect but potentiates the effects of β2-adrenergic agonists.

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22
Q

effects of CS on PT

A

⦁ Ιncrease lung function;/
reduce symptoms;/ improve quality of life;/ reduce the risk of exacerbations;/
reduce asthma-related hospitalizations and death.

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23
Q

how often must CS be taken

A

every day to controll inflammation even if symptoms are absent

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24
Q

list the inhaled corticosteroids

A

⦁ Beclomethasone (Becotide) – spray 50 µg

⦁ Fluticasone (Flixotide) -spray 25 µg

⦁ Budesonide (Pulmicort) - inhalation powder - 100 µg

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25
Q

ICS ADR’S

A

rare
⦁ Oropharyngeal candidiasis
⦁ Dysphonia.

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26
Q

indication of short term systemic corticosteroids rx

A

early in the treatment of severe acute exacerbation for 5-7 days

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27
Q

systemic CS ADRS

A

⦁ Adrenal supression – should be stopped gradually
⦁ Retention of sodium and water, peripheral edema./ Hypertension.
⦁ Thinning of the skin, striae.
⦁ Increased risk of infections.
⦁ Impaired wound healing.
⦁ Mood changes e.g. depression/ Increased intraocular pressure - risk of glaucoma./ Cataract/ Gastric ulcer/ Hyperglycemia/ Osteoporosis

28
Q

list Short acting β2 agonists:

A

⦁ Salbutamol (Ventolin) – spray 0,02 % 10 ml,

⦁ Fenoterole(Berotec)

⦁ Terbutaline – inhalation powder 250 and 500 µg

29
Q

List Long acting β2 agonists:

A

⦁ Salmeterole (Serevent) – discus 50 µg pro doses

⦁ Formoterole – caps

30
Q

effects of b2 agonists in astma

A

⦁ Directly relax airway smooth muscles (β2 effect)

31
Q

effects of SABA

A

relievers”

⦁ Onset of action within 1 to 5 minutes.

⦁ Bronchodilatation lasts for 2 to 6 hours.

⦁ used only as-needed at the lowest dose and frequency required.

32
Q

LABA

A

⦁safe for asthma when used in combination with ICS.

without ICS in asthma is associated with increased risk of ADRs.

33
Q

which can be used as both controller and reliever

A

⦁ Formoterol – rapid onset and long duration of action – 12 h

34
Q

b2 agonist adr

A

⦁ Tachycardia – with high doses selectivity is lost.
⦁ Hyperglycemia, hypokaliemia.
⦁ Headache, agitation.
⦁ Finger tremor.
⦁ Tolerance!!! Development of tolerance to long-term used LABA decreases the efficacy of SABA in the treatment of acute asthmatic attack.

35
Q

which drug interactions increase ADR of b2 agonists

A

TCA

MAOI

thyroid hormones

36
Q

drug interxn reducing effect of b2 agonist

A

beta blockers

37
Q

drug interxn potentiating effect of b2 agonist

A

⦁ Inhaled corticosteroids and antimuscarinic drugs

38
Q

Methylxanthines (Phosphodiesterase inhibitors) effect

A

inhibit phosphodiesterase

this increases CAMP

39
Q

effects of increased cAMP

A

⦁ bronchodilation;
⦁ inhibition of the release of histamin from mast cells;
⦁ improve mucociliary clearance in respiratory tract.

40
Q

⦁ Short acting methylxanthine

A

Aminophylline (Novphyllin) – tab. 100 mg

41
Q

⦁ Long acting methylxanthine

A

Theophylline (Theotard) – tab. 300 mg

42
Q

what are methylxanthines used for

A

⦁ Prophylaxis of night–time attacks.

43
Q

absoprtion of methyl xanthines

A

circadian rhythms in the absorbtion.

High oral bioavailability absorbtion is faster in the morning and slower in the evening

44
Q

what causes increased clearance of methylxanthines

A

smoking
ez inducers e.g.
-rifampicin
-phenytoin/phenobarbital

45
Q

causes of decreased methylxanthine clearance

A

pt’s over 50

ez inhibitors

  • cimetidine
  • macrolides
  • ciprpofloxacin
46
Q

methyl xanthine adr

A

cns: restless, insomnia, convulsion
cvs: tachy K, palpitation, arrythmia-death

47
Q

antimuscarinics drug effects

A

bronchodilation (slower than b2 agonists

reduce mucosal secretion
- more effective in COPD

-elderly w/ less b2 receptors

additive effect when combo w/ b2 agonists

48
Q

short acting antimuscarinic for asthma

A

Ipratropium bromide (Atrovent) – spray 15 ml

49
Q

⦁ Long acting antimuscarinic for asthma

A

Thiotropium (Spiriva) – caps. pro inh. 18 µg

50
Q

why is ipratropium less effect at relieving than SABA’s

A

slower onset of action

less bronchodilating effect.

51
Q

ipratropium indication

A

⦁ Short-term use in acute asthma added to SABA reduces risk of hospitalisation.

52
Q

indication for thiptropium

A

add-on option at step 4 or 5 for adults whose asthma is uncontrolled by ICS±LABA.

53
Q

antimuscarinic adrs

A

⦁ Dry mouth.
⦁ Increased intraocular pressure, mydriasis.
⦁ Tachycardia.
⦁ Obstipation.
⦁ Retention of urine.
⦁ Caution in patients with benign prostate gland hypertrophy, arrhythmias and glaucoma

54
Q

leukotriene modifiers

mech

A

Target leucotriene inflammatory pathway of asthma

⦁suppress bronchial inflammation on long term, decrease bronchial hyper-reactivity.
⦁ Used as controller therapy.
⦁ Preferred in children.
⦁ Less effective than low dose ICS.
⦁ Added to ICS – less effective than combination ICS/LABA.

55
Q

classification of leukotriene modifiera

A

Leucotriene receptor antagonists (lukasts)
suppress asthmatic response to allergens

⦁ Montelukasr (Singulair) – tab. 10 mg

Lipoxygenase inhibitors:

block leukotriene synthesis
⦁ Zileuton (Zyflo) – tab. 600 mg

⦁ Zafirlukast (Accolate) – tab. 20 mg

56
Q

adr’s of leukotriene modifiers

A

zileuton and zafirlukast increase liver function tests

57
Q

Mast cell stabilizers

A

used for phyophylaxis
by preventing release of allergic mediators from mast cells

⦁ Sodium chromoglucate – caps. pro inh. 20 mg
⦁ Nedocromil sodium

58
Q

which drugs are used for prophylaxis in BA

A

methylxanthines

mast cell stabilizers

59
Q

mast cell stabiliser drugs

A

⦁ Sodium chromoglucate – caps. pro inh. 20 mg
⦁ Nedocromil sodium

ketotifen tab 1mg

60
Q

which mast cell stabilser has antihistaminic effect

A

KETOTIFEN

61
Q

mast cell stabiler ADR

A

cough when inhaled

62
Q

which drug is used for severe persistent asthma

A

Anti-IgE (Omalizumab):

when ICS and LABA fail to controll symptoms

63
Q

how is omalizumab admin

A

subcutaneously

64
Q

how to manage an acute asthm attack

A

⦁ Inhaled SABA – repeat every 20 minutes for 1 hour.
⦁ Sort-acting antimuscarinic drug – Ipratropium (Atrovent).
⦁ Oral corticosteroids 1 mg/kg bw – no more than 50 mg for adults.
⦁ Oxygen.

65
Q

CI antiasthmatic drugs and pregnancy

A

ICS in first trimester

cause low baby weight and malformation

66
Q

recc drugs in pregnancy

A

beta aganosis
theophylline
ICS after first trimester

clinical pharm y5 (22 decks)

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