Management of Asthma and Chronic obstructive pulmonary disease Flashcards
How do you diagnose Asthma?
Upon demonstration of reversibility.
>12% increase in FEV1
200mL 15-20 min both following an 200-400mcg inhalation of salbutamol
20% improvement for PEF from the baseline
Define reliever
short-acting bronchodilators with rapid onset of action providing acute symptomatic
relief.
What are controllers?
Drugs with anti-inflammatory and/or sustained bronchodilator action
Give examples of short acting B2 agonist relievers.
Salbutamol
Fenoterol
Terbutaine
Give examples of Anti-cholinergic relievers.
Ipratroprium bromide
Give the class of controllers that can provide sustained bronchodilation action but has weak or unproven anti-inflammatory effects.
Long-acting B2 agonists
Theophylline.
Give examples of Long-acting B2 agonists.
Formoterol: Faster acting and long duration of action.
Salmeterol
What classes of controllers have anti-inflammatory action that prevents asthma attacks?
Inhaled Corticosteroids
Leukotriene modifiers
Oral Corticosteroids
Give examples of inhaled corticosteroids.
Beclomethasone
Budesonide
Fluticasone
Ciclesonide
Give examples of leukotriene modifiers.
Montelukast
Zafirlukast
Give examples of oral corticosteroids
Prednisone
Prenisolone
Methylprednisone
Methylprednisolone
Mode of actions for steroids.
It binds to glucocorticoid receptors
Alters gene expression
anti-inflammatory action
When can Short acting B2 agonist be used as the sole therapy?
Mild intermittent Asthma
Side effects of inhaled corticosteroids.
Oropharyngeal candidiasis
Hoarseness
Mode of actions for Long-acting B2 Agonists
Bind to beta 2 receptors → stimulate adenylyl cyclase → ↑ cAMP:
bronchodilation
Side effects of Long acting B2 agonist.
Tremor and Palpitations
Mode of action for Leukotriene modifiers.
Block effects of cysteinyl
leukotrines in airways
When are Leukotriene receptor antagonists useful as an add on therapy?
when still symptomatic despite already on
corticosteroids and long-acting β2-agonist or patient cannot tolerate longacting β2-agonist
Mode of action of Theophylline.
non-selective inhibition of Phosphodiesterases – may result in
bronchodilation and anti-inflammatory effect (inhibits release of
mediators
Side effects of theophylline.
gastrointestinal symptoms (nausea & vomiting), cardiac arrhythmias and
central nervous system symptoms (tremor, confusion, seizures)
Side effects of oral corticosteroids.
Suppress HPA axis-adrenal atrophy and
inadequate stress response.
Hypertension, fluid and electrolyte
disturbances, hyperglycaemia, inhibits inflammatory response, peptic
ulcer disease, muscle weakness, cataracts, osteoporosis, osteonecrosis,
growth retardation, Cushing’s syndrome, diabetogenic, dyslipidaemia.
Psychiatric-euphoria, behavioral changes, depression.
