Resp Pharm - Asthma

Question 1

What are aims of asthma control?

Answer 1

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

Question 2

What is step 1 of asthma control?

Answer 2

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

Used for symptom relief via bronchodilation
Used as required

Question 3

Why should β2 agonists not be used regularly?

Answer 3

Can lead to increased mast cell degranulation response to allergens

Question 4

What are some side effects of β2 agonists?

Answer 4

Tachyarrhythmias
Tremors
Hypokalaemia
Anxiety

Question 5

What is step 2 of asthma control?

Answer 5

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

Question 6

What is step 3 of asthma control?

Answer 6

Add on therapy

Long acting β2 agonists

Question 7

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

Answer 7

Check inhaler technique
Check pt compliance
Eliminate trigger factors

Question 8

What are the actions of LABA in asthma control?

Answer 8

Reduce asthma exacerbations
Improve symptoms
Improve lung function

Not anti-inflammatory, need to be given with ICS

Question 9

Why are LABA and ICS given in a single inhaler?

Answer 9

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

Question 10

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

Answer 10

High dose ICS
Leukotriene receptor antagonists
Methylxanthines
Long acting anticholinergics

Question 11

What is the MOA of leukotriene receptor antagonists?

Answer 11

Block effects of leukotrienes in the airways

Inhibit bronchoconstriction, mucus secretion and mucosal oedema

Question 12

What are some examples of leukotriene receptor antagonists?

Answer 12

Montelukast

Zafirlukast

Question 13

What are some side effects of leukotriene receptor antagonists?

Answer 13

Angioedema 
Dry mouth 
Anaphylaxis 
Arthralgia 
Fever 
GI upset 
Nightmares

Question 14

What is the MOA of methylxanthines?

Answer 14

Antagonise adenosine receptors

Increase cAMP

Question 15

What are some examples of methylxanthines?

Answer 15

Theophylline

Aminophylline

Question 16

What are some complications from methylxanthines?

Answer 16

Frequent side effects:
Nausea, headache, reflux

Life threatening:
Arrhythmias, fit

Drug interactions:
Levels increased by CYP P450 inhibitors

Question 17

What is an example of a long acting anticholinergic?

Answer 17

Tiotropium bromide

Question 18

What are long acting anticholinergics used for?

Answer 18

Exacerbations of asthma and COPD

Question 19

What are some side effects of long acting anticholinergics?

Answer 19

Dry mouth
Urinary retention
Glaucoma

Question 20

What is step 5 of asthma control?

Answer 20

Oral steroids

Biological therapies

Question 21

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

Answer 21

Prevent IgE binding to IgE receptor

IgE can’t cross link and therefore activate mast cells

Question 22

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

Answer 22

IL-5 is a growth factor for eosinophils

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

Question 23

When should stepping down of asthma control happen?

Answer 23

When asthma is controlled

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

Question 24

Describe delivery of drug particles via inhalers

Answer 24

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

Question 25

How should acute severe asthma be treated?

Answer 25

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

Question 26

What is the MOA of corticosteroids in treating asthma?

Answer 26

Decrease bronchial mucosal inflammation

Question 27

What is the MOA of theophylline?

Answer 27

Inhibit phosphodiesterase => increased cAMP levels => bronchodilatation

Requires ECG monitoring and measurements of serum levels if given IV