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NUR1125 > Drugs for Asthma > Flashcards

Drugs for Asthma Flashcards

1
Q

salbutamol is use as a controller (true/false)

A

false, it is a reliever

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2
Q

list the a/e of mast cell stabilizer

A
  1. unpleasant taste
  2. cough
  3. nasal/throat irritation
  4. dry mouth
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3
Q

which class of bronchodilator is first line treatment of asthma

A

b2 agonist

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4
Q

briefly explain the MOA of anti-IgE monoclonal antibody

A
  1. deplete level of free IgE in serum
  2. decrease expression of FcεRI on mast cell (basophils)
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5
Q

what is the route & frequency of reslizumab

A

IV q4 weeks

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6
Q

list 1 drug example of mast cell stabiliser + explain the MOA

A
  • cromogrilic acid
  1. decrease mast cell degranulation induced by IgE mediated FcεRI crosslinking
  2. decrease inflammatory mediators secretion by eosinophils, neutrophils & macrophages
  3. control cl- channel to inhibit cellular activation
  4. increase annexin a1 secretion to inhibit PG & leukotrine production
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7
Q

what is the MOA of muscarinic receptor antagonist

A
  • inhibit m3 receptors, reducing bronchoconstriction
  • reverse vagal nerve, reducing bronchospasm & mucus secretion
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8
Q

for patient with aspirin induced asthma, which pharmacological class should be prescribed to him?

a) leukotriene pathway inhibitors
b) muscarinic receptor antagonist
3) mast cell stabiliser
4) anti-igE monoclonal antibodies

A

leukotriene pathway inhibitor eg. montelukast

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9
Q

what are some limitations of anti-IgE monoclonal antibody

A
  1. expensive
  2. small risk of MI, TIA, blood clots
  3. potential for anaphylaxis
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10
Q

which interleukin is contributed to eosinophilic asthma?

A

IL4, IL13, IL5

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11
Q

why is leukotriene pathway inhibitors helpful in NSAIDS exacerbated respiratory disease
A) NSAIDS activate endogenous cortisol release to trigger Cushing’s syndrome
B) antagonist at cysteinyl leukotriene receptors suppress prostaglandin synthesis
C) inhibition of COX leads to arachidonic acid overflow to the 5-LOX pathway

A

C

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12
Q

what is the route & frequency of anti-IgE monoclonal antibody

A

SC q2-4 weeks

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13
Q

what is the 3 criteria for selection of ICS

A
  1. high receptor binding affinity (very low dose required)
  2. extensive first pass metabolism (lesser systemic a/e)
  3. highly lipophilicity (easier absorption)
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14
Q

what is the 3 type of asthma, which is the most common?

A
  1. allergic asthma (more common) - type 1 inflammation IgE mediated
  2. eosinophilic asthma - type 2 inflammation cell mediated
  3. mix asthma
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15
Q

what is the route for mast cell stabilizer (eg. cromogrilic acid) administration

A

inhalation & intranasal

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16
Q

what is a soft steroid? + give 1 drug example

A) it can be administered oral to produce few side effects
B) it can cause adrenal suppression
C) it require esterase activation and so has less side effect

A

ciclesonide

C) soft steroid is a pro drug that require esterase activation in the lung, therefore bypassing systemic a/e

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17
Q

what are the a/e of b2 agonist, which is the most common & severe

A
  1. tremors (common) & muscle cramp
  2. palpitation & tachycardia
  3. hypokalaemia & hyperglycaemia
  4. flushing (peripheral vasodilation)
  5. b2 adrenoceptor downregulation (if LABA is use alone, it increase the risk of asthma related death)
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18
Q

pt read online that a single drug, omalizumab, can be use to control allergic asthma. is omalizumab suitable?
A) no, it only works for eosinophilic asthma
B) yes, it can effectively control allergic asthma injected every 2-4 weeks subq
C) no, it increase the risk of TIA
D) yes, but pt require to learn to self-administer daily injections

A

C

  • using omalizumab alone is not very effective
  • risk of MI, TIA & blood clots
  • potential for anaphylaxis
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19
Q

which of the following is belongs to the muscarinic receptor antagonist class
1. budesonide
2. cetirizine
3. ipratropium bromide
4. promethazine

A

ipratropium bromide (SAMA)

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20
Q

what are the administration route for magnesium sulphate

A
  1. IV
  2. nebulizer (efficacy is controversial)
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21
Q

what is the route of theophylline

A
  • oral-ER
  • IV
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22
Q

list some examples that trigger allergic asthma

A
  1. cold air
  2. dust mites
  3. pets
  4. smoke
  5. exercise
  6. pollen
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23
Q

what is the 3 symptoms of asthma

A
  1. cough
  2. wheezing
  3. SOB
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24
Q

what is the MOA of ICS

A
  1. does not directly relax airway smooth muscle
  2. possible prevention of airway wall remodelling
  3. decrease risk of asthma death
  4. decrease airway hyper-responsiveness in 4-6wks
  5. decrease freq of asthma exacerbation
  6. decrease need for b2 agonist
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25
Q

what does muscarinic antagonist block

A

acetylcholine to induce bronchodilation

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26
Q

what is the role of PDE

A

it convert cAMP to AMP, by inhibiting PDE, it increase cAMP, resulting in increase bronchodilation

27
Q

what is the onset & duration of action for formoterol

A

onset 2-3min
duration 12hrs

28
Q

what are the efficacy of cromogrilic acid

A
  • single dose therapy before antigen-challenge, cold/dry air, or exercised to prevent bronchospasm
  • reduce bronchial hyper-reactivity in 4 weeks
  • inter-individual variability
29
Q

what is the 2 other use of montelukast

A

as drug have a weak bronchodilator effect, it can be use
- as an adjunct therapy for mild-moderate asthma
- not to use alone as a reliever to rescue asthma attack

30
Q

what is the 2 use of ICS

A
  1. first line prophylactic treatment of asthma
  2. prevention of nocturnal asthma
31
Q

which of the following is not a steroid but can be an effective anti-inflammatory for mild asthma?
A) zileuton
B) fluticasone
C) theophylline
D) montelukast

A

A & D

leukotriene pathway inhibitors is an anti-inflammatory drug that can be use to treat mild-moderate asthma

32
Q

formoterol have a slow onset and long duration of action (true/false)

A

false, formoterol (LABA) have a fast onset of 2-3min, with duration of 12hrs

33
Q

what are the use & efficacy of muscarinic receptor antagonist

A
  1. adjunct therapy for b2 agonist & ICS
  2. for patient intolerant to b2 agonist
34
Q

salmeterol is use as a controller (true/false)

A

true

35
Q

long term therapy of fluticasone helps to improve adrenal function (true/false)

A

false, long term therapy of fluticasone can lead to adrenal suppression

36
Q

can ICS be given during an acute asthma attack

A

yes (through IV), however must be given early as onset of action is slow

37
Q

list 2 drug example of leukotriene pathway inhibitor

A
  1. montelukast (cysLT receptor antagonist)
  2. zileuton (5LOX inhibitor)
38
Q

patient present w recurrent episodes of bruising & throat infection, which of the following drugs could cause these a/e
1. zileuton
2. budesonide
3. formoterol
4. ipratropium bromide

A

budesonide (ICS)

39
Q

list one drug example of an anti-IgE monoclonal antibody, which pt is indicated?

A

drug: omalizumab

indication: pt w severe allergic asthma & elevated IgE level

40
Q

what are the a/e of ICS

A
  1. cataract
  2. easy bruising
  3. oropharyngeal candidiasis
  4. muscle wasted (enfeebled voice; dysphonia, thin arms/legs)
  5. osteoporosis
  6. buffalo hump
  7. increase abdominal fats
41
Q

what are the a/e of methylxanthine

A

CNS eg. tremors, insomnia, seizure

GI disturbance eg. diarrhoea, anorexia, nausea/vomiting

CVS: arrhythmia

42
Q

why does ICS have rare systemic a/e

A

drug is taken through inhalation, which has limited absorption in the systemic circulation, hence less systemic a/e

43
Q

pt complain of urinary retention, which of the drug is responsible for the a/e
A) montelukast
B) ipratropium bromide
C) formoterol
D) budesonide

A

B

  • a/e of ipratropium includes unpleasant taste, dry mouth & urinary retention
44
Q

can methylxanthine be use as an anti-inflammatory drug?

A

no, even though it have some anti-inflammatory effect on mast cell & T cells, & decrease micovascular leakiness

45
Q

patient on methylxanthine (eg. theophylline) asked if he is able to drink coffee, what will be your health education

A

advice patient to avoid coffee, tea or chocolate as it increase the risk of drug toxicity due to the narrow therapeutic window of methylxanthine (eg. theophylline)

46
Q

what is the use for mast cell stabilizer drug

A
  • prophylactic control of asthma (inhalation route only)
  • prophylactic control of allergic rhinitis & allergic conjunctivitis
47
Q

which interleukin is contributed to allergic asthma?

A

IL4 & IL13

48
Q

what is the administration route for anti-IL4/IL5 signalling monoclonal antibodies

A

intravenous

49
Q

pt forgot where he put his SABA reliever inhaler and so uses his LABA controller instead, will LABA controller help?

A) no, onset of action of LABA is too slow
B) no, LABA are not bronchodilators, they are use to control ongoing inflammatory disease
C) yes, prescription of a SABA is not necessary if the pt has a LABA
D) yes, but only if the LABA is a formeterol

A

D

  • formoterol have a fast onset of 2-3min and last for 12hrs
50
Q

what is the indication & MOA of magnesium sulphate

A

indication: adjunct therapy for severe acute asthma

MOA:
- relax airway smooth muscle
- modulate release of histamine & acetylcholine
- has anti-inflammatory effect

51
Q

list 2 drug from muscarinic receptor antagonist, what is the onset & duration of action for each?

A
  1. ipratropium bromide (SAMA, 5-30min onset, 6-8hrs duration)
  2. tiotropium bromide (LAMA, 30min onset, 24hrs duration)
52
Q

explain why LABA should not be given alone to treat asthma

A

long term therapy of LABA can cause the downregulation of b2 adrenoceptor & increase the risk of asthma related death, it should be combined with ICS to counter the effect

53
Q

list 3 drug example of ICS

A
  1. budesonide
  2. fluticasone
  3. ciclesonide
54
Q

what is an additional advantage of montelukast but not zileuton
A) montelukast has fewer a/e
B) montelukast is a bronchodilator (although a weak one)
C) montelukast is more effective in NSAID exacerbated respiratory disease

A

B

  • it is one third as effective as salbutamol
55
Q

what is the MOA of b2 agonist

A

it mimic the action endogenous adrenaline at b2 adrenoceptors site, resulting in
- airway smooth muscle relaxation (bronchodilation)
- mast cell stabilisation
- decrease microvascular leakiness
- increase mucociliary clearance

56
Q

give 1 drug example from the pharmacological class of methylxanthine, what is the MOA of it?

A
  • theophylline
  1. inhibit PDE
  2. block adenosine receptor
  3. increase release of adrenaline from adrenal medulla
  4. CNS stimulant action on respiration
57
Q

what are the 3 indication of leukotriene pathway inhibitor

A
  1. prophylaxis/chronic treatment of asthma
  2. nsaids/aspirin induced asthma
  3. exercised induced asthma
58
Q

what are some limitations & a/e of an anti-IL4/IL5 signalling monoclonal antibodies drug

A

limitations: expensive, potential for anaphylaxis

a/e: oropharyngeal pain

59
Q

montelukast have a strong bronchodilator effect (true/false)

A

false, it have a weak bronchodilator effect and therefore should not be given alone to rescue asthma attack

it is 1/3 as effective as salbutamol

60
Q

claus-straug syndrome is associated to which class of drug? how to avoid it?

A

leukotriene pathway inhibitor

titrate the dosage of ICS slowly before discontinuing

61
Q

give 1 drug example of anti-IL4/IL5 signalling monoclonal antibodies, and which patient is indicated

A

drug: reslizumab

indication: severe & persistent eosinophilic asthma in pt ≥18 y/o

62
Q

list 3 a/e of muscarinic receptor antagonist

A

limited systemic a/e as drug is taken via inhalation
1. unpleasant taste
2. dry mouth
3. urinary retention (esp in elderly)

63
Q

what are the use & efficacy of methylxanthine

A
  • IV administration for severe acute asthma
  • less effective bronchodilator than b2 agonist

NUR1125 (10 decks)

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