Obstructive and Restrictive Lung Disease Flashcards
What are the two general categories for drugs that treat obstructve airway conditions?
- Relievers - bronchodilators
- Preventers - anti-inflammatory
What is step 1 in asthma treatment?
SABA
Salbutamol
What is step 2 in asthma treatment?
SABA + ICS (200-800micrograms)
What is step 3 in asthma treatment?
SABA + LABA + ICS
What is step 4 in asthma treatment?
Increase ICS dose from step 3
Add fourth drug e.g. theophylline or a leukotriene receptor antagonist
What is step 5 in asthma treatment?
Use daily steroid tablet (prednisolone)
Maintain high dose ICS (2000micrograms)
Which immune cells are corticosteroid effcetive aginst in the mucose?
Eosinophils
What is a downside to corticosteroid use in asthma or COPD?
It weakens the immune system, and impairs the mucociliary escalator.
This increases chance of infection
In COPD chances of pneumonia infection are boosted
ICS have a ____ therapeutic ratio and are _______ due to being delivered directly to the organ of interest
High
Topical
Oral corticosteroids have a ___ therapeutic ratio
Low
Why is a spacer useful for administering asthma medication?
- Reduces oropharngeal and laryngeal side effects (gag reflex/nausea)
- Reduces systemic absorption (no swallowing)
- Acts as a holding chamber aiding inhalation
- Reduces particle size and velocity allowing the particle to embed deeper in the lungs increasing effectivity
What are cromones and what is their function?
Cromones are used in asthma and are propsed mast cell stabilisers
This means they can prevent pro-inflammatory mediator release
How are leukotrienes formed during asthma?
They are produced due to processes involving the lipids in the cell membrane
The enzyme phospholipase A2 detaches fatty acids from the second carbon group of the glycerol molecule that makes up a lipid
One of these acids is arachidonic fatty acids
When arachidonic acid is acted on by 5-lipoxygenase leukotienes are formed
What happens when cyclo-oxygenase acts on arachidonic acid?
Prostaglandins and thromboxanes are produced aiding inflammation and amplification
Which leukotriene is over produced in asthma?
LTD4
What is the effect of overproduction of leukotrienes in asthma?
- Trigger contraction and proliferation of smooth muscle
- Cause eosinophil influx (which release cationic proteins damaging epithelial cells)
- Increased mucus secretion, bu decreased transport
- Oedema
Lekotriene receptor antagonists are used in asthma, name one that is use dto bind to LTD4?
Montelukast
(taken orally)
What is anti-IgE and what is the name of one key form in relation to asthma called?
Monoclonal antibody
Omalizumab
Omalizumab has what effects?
Binds stongly to IgE inactivating it
Prevents pro-inflammatory mediators being released from basophils and mast cells
Boosted every 2-4 weeks via injection
Name two anti-IL5 drugs
- Mepolizumab
- Reslizumab
How does anti-IL5 therapy work?
TH2 cells produce IL-5 in the immune response aiding eosinophilic inflammation in asthma
The use of anti-IL5 therapy is that eosinophilic inflammation is much reduced
Name 2 LABAs
- Formeterol
- Salmeterol
What are the three different types of muscarinic receptors?
- M1 - enhance cholinergic reflex
- M2 - inhibit acetylcholine release
- M3 - mediate bronchoconstriction and mucus release
Muscarinic antagonists inhibit which type of muscarinic receptor?
M3
Name a SAMA
Ipratropium
Name two LAMAs
- Tiotropium
- Glycopyrronium
Methylxanthines act as ____________ and also ___________
Bronchodilators
Anti-inflammatory drugs
Name an example of a methylxanthine
Theophylline
What is the function of phosphodiesterase 4 enzymes?
Hydrolyse cAMP
What is the overall function of PDE4 inhibitors?
Prevent cAMP hydrolysis allowing high levels of cAMP in cells
Bronchial smooth muscle will become relaxed
PDE4 inhibitors are for use only in ____
COPD
Give an example of a PDE4 inhibitor
Roflumilast
Why are PDE4 inhibitors used infrequently?
Side effects suh as nausea, diarrhoea and headaches
What are mucolytics?
Drugs which reduce the viscocity of mucous and reduce inflammation
Give two examples of mucolytics?
- Carbocisteine
- Erdosteine
In an acute astha attack what treatment is given?
- Oral prednisolone (40mg)
- At least 60% oxygen aim for 94-98% SpO2
- Nebulised salbutamol
What are some treatment methods for COPD?
- Smoking cessation
- Immunisation
- Pharmacotherapy
- Oxygen
- Increase exercise
Name two LAMAs
- Titropium
- Aclidinium
Name two LABAs
- Olodaterol
- Formeterol
Name an ICS for COPD use
Beclometasone
Which antibiotic may be used for COPD?
Azithromycin
(also amoxicillin and doxycycline)
How is acute COPD treated?
- Nebulised high dose salbutamol and ipratropium
- Oral prednisolone
- Antibiotic (amoxicillin/doxycycline) if infection
- 24-28% O2
- Non-invasive ventilation
Which external factors can cause lung restriction?
- Skeletal causes (broken ribs, kyphoscoliosis)
- Muscle Weakness (intercostal/diaphragmatic)
- Obesity (due to compression)