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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
ICS ADR'S
rare ⦁ Oropharyngeal candidiasis ⦁ Dysphonia.
26
indication of short term systemic corticosteroids rx
early in the treatment of severe acute exacerbation for 5-7 days
27
systemic CS ADRS
⦁ 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
list Short acting β2 agonists:
⦁ Salbutamol (Ventolin) – spray 0,02 % 10 ml, ⦁ Fenoterole(Berotec) ⦁ Terbutaline – inhalation powder 250 and 500 µg
29
List Long acting β2 agonists:
⦁ Salmeterole (Serevent) – discus 50 µg pro doses ⦁ Formoterole – caps
30
effects of b2 agonists in astma
⦁ Directly relax airway smooth muscles (β2 effect)
31
effects of SABA
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
LABA
⦁safe for asthma when used in combination with ICS. without ICS in asthma is associated with increased risk of ADRs.
33
which can be used as both controller and reliever
⦁ Formoterol – rapid onset and long duration of action – 12 h
34
b2 agonist adr
⦁ 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
which drug interactions increase ADR of b2 agonists
TCA MAOI thyroid hormones
36
drug interxn reducing effect of b2 agonist
beta blockers
37
drug interxn potentiating effect of b2 agonist
⦁ Inhaled corticosteroids and antimuscarinic drugs
38
Methylxanthines (Phosphodiesterase inhibitors) effect
inhibit phosphodiesterase this increases CAMP
39
effects of increased cAMP
⦁ bronchodilation; ⦁ inhibition of the release of histamin from mast cells; ⦁ improve mucociliary clearance in respiratory tract.
40
⦁ Short acting methylxanthine
Aminophylline (Novphyllin) – tab. 100 mg
41
⦁ Long acting methylxanthine
Theophylline (Theotard) – tab. 300 mg
42
what are methylxanthines used for
⦁ Prophylaxis of night–time attacks.
43
absoprtion of methyl xanthines
circadian rhythms in the absorbtion. High oral bioavailability absorbtion is faster in the morning and slower in the evening
44
what causes increased clearance of methylxanthines
smoking ez inducers e.g. -rifampicin -phenytoin/phenobarbital
45
causes of decreased methylxanthine clearance
pt's over 50 ez inhibitors - cimetidine - macrolides - ciprpofloxacin
46
methyl xanthine adr
cns: restless, insomnia, convulsion cvs: tachy K, palpitation, arrythmia-death
47
antimuscarinics drug effects
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
short acting antimuscarinic for asthma
Ipratropium bromide (Atrovent) – spray 15 ml
49
⦁ Long acting antimuscarinic for asthma
Thiotropium (Spiriva) – caps. pro inh. 18 µg
50
why is ipratropium less effect at relieving than SABA's
slower onset of action less bronchodilating effect.
51
ipratropium indication
⦁ Short-term use in acute asthma added to SABA reduces risk of hospitalisation.
52
indication for thiptropium
add-on option at step 4 or 5 for adults whose asthma is uncontrolled by ICS±LABA.
53
antimuscarinic adrs
⦁ Dry mouth. ⦁ Increased intraocular pressure, mydriasis. ⦁ Tachycardia. ⦁ Obstipation. ⦁ Retention of urine. ⦁ Caution in patients with benign prostate gland hypertrophy, arrhythmias and glaucoma
54
leukotriene modifiers mech
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
classification of leukotriene modifiera
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
adr's of leukotriene modifiers
zileuton and zafirlukast increase liver function tests
57
Mast cell stabilizers
used for phyophylaxis by preventing release of allergic mediators from mast cells ⦁ Sodium chromoglucate – caps. pro inh. 20 mg ⦁ Nedocromil sodium
58
which drugs are used for prophylaxis in BA
methylxanthines mast cell stabilizers
59
mast cell stabiliser drugs
⦁ Sodium chromoglucate – caps. pro inh. 20 mg ⦁ Nedocromil sodium ketotifen tab 1mg
60
which mast cell stabilser has antihistaminic effect
KETOTIFEN
61
mast cell stabiler ADR
cough when inhaled
62
which drug is used for severe persistent asthma
Anti-IgE (Omalizumab): | when ICS and LABA fail to controll symptoms
63
how is omalizumab admin
subcutaneously
64
how to manage an acute asthm attack
⦁ 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
CI antiasthmatic drugs and pregnancy
ICS in first trimester cause low baby weight and malformation
66
recc drugs in pregnancy
beta aganosis theophylline ICS after first trimester

clinical pharm y5 (22 decks)

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