Inhaled corticosteroids and LTRA Flashcards
How do inhaled corticosteroids improve symptoms in asthma and COPD?
They reduce muscosal inflammation, widen the airways and reduce mucus secretion
What reduces the effectiveness of inhaled corticosteroids
Current or previous smoking- therefore higher doses are needed in these patients
List 4 inhaled corticosteroids and state the brands they are commonly found in
1) Beclometasone dipropionate: Clenil, Qvar
↳(Qvar and clenil (200/250) unlicenced in under 12 years; Easyhaler® Beclometasone not for < 18 years)
2) Budesonide: Pulmicort
3) Ciclesonide: Alvesco
4) Fluticasone: Flixotide
(appear to all be as effective as each other)
Inhaled corticosteroids and LABAs are found in combination inhalers for the prophylaxis of asthma. what ingredients are found in the following brands of inhalers:
1) Symbicort, DuoResp
2) Fostair
3) What should be discontinued when these inhalers are used as relievers?
1) Symbicort and DuoResp: Budesonide with formoterol
2) Fostair: Beclometasone (particles are extra fine and more potent than traditional) with formoterol
3) These inhalers can be used as relievers (instead of a SABA), in addition to their regular use for prophylaxis of asthma (MART)
when are oral corticosteroids used in airway disease?
1) Severe infection
2) When airway obstruction or mucus prevent drug access to smaller airways
3) Acute asthma attack- Short course of oral steroids, starting with high dose provides good response.
Can the treatment of a short course of oral steroids be stopped abruptly?
yes, can usually be stopped abruptly without tapering off. As long as the patient receives an inhaled corticosteroid in an adequate dose
In whom might it be more useful to taper the corticosteroid dose gradually?
1) Patients who have needed several courses of oral corticosteroids
2) Those who the possibility of a period on maintenance therapy is being considered
when should oral corticosteroids be taken and why?
1) As a single dose in the morning with food
2) To reduce disturbance of circadian cortisol secretion
How can the dose of corticosteroids be optimised?
Regular peak-flow measurements. Dose should always be titrated to the lowest dose that controls symptoms
outline the use of oral corticosteroids in COPD, stating which drug is preferred and how long it should be continued for
1) Acute exacerbation of COPD- prednisolone should be given
2) Prolonged treatment is of no benefit and maintenance treatment is not recommended
Outline the MHRA alert regarding the use of inhaled corticosteroids
Rare risk of central serous chorioretinopathy (retinal disorder) with local as well as systemic administration. Patients should report any blurred vision or other visual disturbances with corticosteroid treatment given by any route
Describe the main side effects of inhaled corticosteroid treatment (4)
1) Oral candidiasis- reduced by using spacer, also rinse mouth after inhalation
2) Hoarse voice
3) Paradoxical bronchospasm- (Discontinue); If mild it can be prevented by using SABA beforehand or changind to DPI
4) May increase the risk of pneumonia (in COPD)
Very high doses of inhaled corticosteroids can lead to systemic absorption. List some of the side effects that may occur as a result of this. (3)
1) Adrenal suppression
2) Growth retardation (children)
3) Osteoporosis
Can inhaled corticosteroids be used during pregnancy and in those breastfeeding?
Inhaled drugs for asthma can be taken as normal during pregnancy and breastfeeding
what should be monitored in children who are prescribed prolonged treatment with inhaled corticosteroids and how often should this be done?
1) Height and weight
2) Annually- if growth is slowed, refer to pediatrician
Who should inhaled corticosteroids be used in caution with?
1) High dose, particularly fluticasone should be used in caution in COPD patients with a history of pneumonia
2) Children due to growth suppression
what is the difference between Clenil and Qvar and are these inhalers interchangeable?
1) Not interchangeable and should be prescribed by brand. (Clenil is also not interchangeable with generic)
2) Qvar has extra fine particles and is more potent
3) Qvar is 2x more potent than clenil
what should be issued with high doses of inhaled corticosteroids?
steroid card
1) Outline the MoA leukotriene receptor antagonists
2) Name two LTRAs
1) Reduce inflammation and bronchoconstriction in asthma by blocking cysteinyl leukotriene receptors in the airways and damping down the inflammatory cascade
2) Monteleukast and zafirlukast (12y+)
Who might LTRAs be of benefit in?
Those with exercise-induced asthma and in those with concomitant rhinitis. They are less effective in severe asthma
↳ (More effective than standard dose of ICS. Has additive effect when given concomitantly)
When would LTRAs be given in adults, Children 5-12 and children aged under 5 years of age?
1) Adults: Add-on therapy in asthma, if symptoms not controlled by ICS + LABAs
2) Children 5-12: Alternative to LABAs as an add-on therapy where ICS insufficient to control symptoms
3) Children < 5: First line preventative therapy in asthma when an ICS cannot be given
List the common side effects of LTRAs (5)
1) Headache
2) Abdominal pain, diarrhoea
3) Increased rate of URTI
4) Fever
5) Churg-Strauss: Eosinophilic autoimmune disorder rarely with the use of montelukast and zafirlukast. normally occurs after withdrawal of ICS.
↳ symptoms include: eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications.
Aside from Churg-Strauss what other rare side effect can occur with the use of zafirlukast?
Hepatic disorders- symptoms such as persistent nausea, vomiting, malaise or jaundice may develop and indicate the development of a liver disorder
State the does of montelukast in the following:
1) Child 6 months to 5 years
2) Child 6-14 years
3) Child 15-17 years
4) Adult
1) Child 6 months to 5 years: 4mg ON
2) Child 6-14 years: 5mg ON
3) Child 15-17 years: 10mg ON
4) Adult: 10mg ON
