pharmacology of asthma Flashcards

1
Q

what are the four main pharmacological therapies for asthma

A

bronchodialators, inhaled corticosteroids, leukotriene receptor antagonists, monoclonal antibodies targeting eosinophillic inflammation

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2
Q

what are the main goals of asthma treatment

A

to reduce impairment to life, minimise risks e.g exacerbations

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3
Q

what is the difference between a reliever and controller in asthma treatment

A

reliver short term e.g broncho dialoator, controller long term e.g ics

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4
Q

outline how you treat asthma using stepwise management

A
  1. consider low dose controller. SABA
  2. low dose ics and saba
  3. low dose ICS/LABA, SABA or formoterol
  4. med or high dose ICS LABA and SABA/formeterol
  5. Refer for add on treatment anti ige e.g tiotropium, SABA/ics formetrol and low dose ocs of ics
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5
Q

how would you manage a patient with infrequent asthma symptoms of short duration, no risk factors for exacerbations and no night waking due to asthma

A

SABA

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6
Q

name some selective beta adrenoreceptor agonists

A

sahort term salbutamol, long acting formoterol, salmeterol, vitanterol. can be given iv

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7
Q

name anticholinergic/muscarinic antagonists

A

Inhaled
– Short-acting: Ipratropium
– Long-acting: Tiotropium, Umeclidinium

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8
Q

how long does salbutamol act for

A

Overall duration of action of salbutamol is 4-6 hours. takes 3-5 mins to kick in when inhaled

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9
Q

how do anticholinergic muscarinic antagonists work

A

Block effects of ACh released from cholinergic parasympathetic nerve
fibres to smooth muscle & mucus glands
– Prevents airway smooth muscle contraction
– Prevents mucus hypersecretion
• Less effective than β-2 adrenoceptor agonists

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10
Q

how does tiotropium work

A

long lasting, Tiotropium attenuates IL-13-induced goblet cell metaplasia and
potentially reduced mucus hypersecretion

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11
Q

what does ics therapy do for asthma patient outcomes

A

reduces symptoms, increase lung function, improves quality of life, reduces exacerbation risk.

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12
Q

how does ics work act on the body

A

Corticosteroids suppress Th2 / ‘Type 2’ airways inflammation
– reduce the infiltration and activation of eosinophils, Th2 cells, and
other inflammatory cells

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13
Q

what does having elevated blood eosinophil levels mean for asthma patients

A

more exacerbations and lower asthma control

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14
Q

What is fluticasone furoate

A

long acting ics fast association and slow disassociation. long duration of action and retained so can be used once daily. in severe asthma

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15
Q

what does ocs stand for

A

oral corticosteroids

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16
Q

what are the side effects of ocs

A

excellent at controlling the

inflammation of asthma, but can cause diabetes obesity,skin diesease, osteoporosis, reflux

17
Q

what is Leukotriene Receptor Antagonist (LTRA)

A

CysLT1 receptor mediates the bronchoconstrictive and
proinflammatory effects of cysteinyl-leukotrienes (LTC4, LTD4, and LTE4)
• Montelukast is a competitive antagonist of the CysLT1 receptor

18
Q

Anti IL-5 mAb’s Mepolizumab and Benralizumab: reduce

asthma exacerbations by >50%. HOW?

A

eosinophills essential to asthma, il5 contributes to eosinophills activation, maturation synthesis and honing, anti il5 mabs target il5 receptor reducing eosinophills and exacerbation and steroid exposure