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CPT > Resp Pharm - Asthma > Flashcards

Resp Pharm - Asthma Flashcards

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1
Q

What are aims of asthma control?

A 
Minimise symptoms during day and night 
Minimise need for reliever medication 
No exacerbations
No limitation on physical activity 
Normal lung function
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2
Q

What is step 1 of asthma control?

A

For mild intermittent asthma
Short acting β2 agonists - salbutamol, terbutaline

Used for symptom relief via bronchodilation
Used as required

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3
Q

Why should β2 agonists not be used regularly?

A

Can lead to increased mast cell degranulation response to allergens

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4
Q

What are some side effects of β2 agonists?

A

Tachyarrhythmias
Tremors
Hypokalaemia
Anxiety

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5
Q

What is step 2 of asthma control?

A

Regular prevention therapy - inhaled corticosteroids
Targets eosinophilic inflam
Inhibits translocation of transcription factors => decreased inflam mediators

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6
Q

What is step 3 of asthma control?

A

Add on therapy

Long acting β2 agonists

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7
Q

What needs to be checked before step 3 of asthma control?

A

Check inhaler technique
Check pt compliance
Eliminate trigger factors

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8
Q

What are the actions of LABA in asthma control?

A

Reduce asthma exacerbations
Improve symptoms
Improve lung function

Not anti-inflammatory, need to be given with ICS

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9
Q

Why are LABA and ICS given in a single inhaler?

A

Easier use
Better compliance
Only one prescription to worry about
Cheaper to use 1 inhaler

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10
Q

What are some alternative step 3 add-ons in asthma control?

A

High dose ICS
Leukotriene receptor antagonists
Methylxanthines
Long acting anticholinergics

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11
Q

What is the MOA of leukotriene receptor antagonists?

A

Block effects of leukotrienes in the airways

Inhibit bronchoconstriction, mucus secretion and mucosal oedema

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12
Q

What are some examples of leukotriene receptor antagonists?

A

Montelukast

Zafirlukast

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13
Q

What are some side effects of leukotriene receptor antagonists?

A 
Angioedema 
Dry mouth 
Anaphylaxis 
Arthralgia 
Fever 
GI upset 
Nightmares
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14
Q

What is the MOA of methylxanthines?

A

Antagonise adenosine receptors

Increase cAMP

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15
Q

What are some examples of methylxanthines?

A

Theophylline

Aminophylline

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16
Q

What are some complications from methylxanthines?

A

Frequent side effects:
Nausea, headache, reflux

Life threatening:
Arrhythmias, fit

Drug interactions:
Levels increased by CYP P450 inhibitors

17
Q

What is an example of a long acting anticholinergic?

A

Tiotropium bromide

18
Q

What are long acting anticholinergics used for?

A

Exacerbations of asthma and COPD

19
Q

What are some side effects of long acting anticholinergics?

A

Dry mouth
Urinary retention
Glaucoma

20
Q

What is step 5 of asthma control?

A

Oral steroids

Biological therapies

21
Q

What is anti-IgE (omalizumab) MOA in asthma?

A

Prevent IgE binding to IgE receptor

IgE can’t cross link and therefore activate mast cells

22
Q

What is the MOA for anti-IL5 (mepolizumab, reslizumb) therapy?

A

IL-5 is a growth factor for eosinophils

Therefore inhibiting it reduces the number of eosinophils in the airways and blood

23
Q

When should stepping down of asthma control happen?

A

When asthma is controlled

Pts should be maintained at the lowest possible dose of inhaled steroid

24
Q

Describe delivery of drug particles via inhalers

A

Large particles - deposited in mouth and oropharynx

Intermediate particles - settle in small airways tf most effective

Small particles - inhaled to alveoli and exhaled w/o being deposited in the lungs

25
Q

How should acute severe asthma be treated?

A

High flow oxygen - keep sats at 94-98%
Nebulised salbutamol - oxygen driven
40mg PO prednisolone/100mg IV hydrocortisone

If not responding add nebulised ipratropium bromide
IV aminophylline if no improvement

26
Q

What is the MOA of corticosteroids in treating asthma?

A

Decrease bronchial mucosal inflammation

27
Q

What is the MOA of theophylline?

A

Inhibit phosphodiesterase => increased cAMP levels => bronchodilatation

Requires ECG monitoring and measurements of serum levels if given IV

CPT (21 decks)

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