Respiration: Pharmacotherapy of airflow obstruction

Question 1

How can the drugs for the treatment of airflow obstructions be divided?

Answer 1

Preventers

Relievers

Question 2

Why are oral steroids generally avoided in the treatment of airflow obstructions?

Answer 2

Poor therapeutic Window

Adverse side effects

Question 3

What drugs are used when the symptoms of airflow obstruction are not controlled by an inhaled steroid?

Answer 3

Anti-IgE
LABA
LAMA
Theoph
Leukotriene receptor anatagonist

Question 4

What medication is given to act as anti -inflammatories?

Answer 4

Corticosteroids

Question 5

What are corticosteroids used in the treatment of, in terms of airway obstruction diseases?

Answer 5

Asthma

COPD

Question 6

What corticosteroids is used generally for asthma and COPD?

Answer 6

Prednisolone

Question 7

What is the disadvantage of Prednisolone?

Answer 7

Low therapeutic ratio. The amount you need for efficacy is the same amount that causes adverse side effects

Question 8

When are corticosteroid administered?

Answer 8

 only used for acute exacerbations (i.e. short amounts of time such as 2 weeks)

Question 9

What are the side effects of corticosteroids?

Answer 9

Weight Gain 
Fat deposits
Break down of skin collagen 
Osteoporosis 
Cataracts
Hypertension
Glucose Intolerance

Question 10

What inhaled steroids are used for maintenance therapy?

Answer 10

Beclomethasone

Question 11

What is the problem with topical inhaled route of drug delivery?

Answer 11

There will be systemic absorption directly into the lungs

Question 12

What are the actions of the spacer device?

Answer 12

• It makes the drug particles smaller and slower as they bounce around the spacer
• Avoids coordination problems with pMDI (pressurised metered dose inhalers)
• Reduces oropharyngeal and laryngeal side effects (e.g. laryngeal atrophy)
• Reduces systemic absorption from swallowed fraction
• It acts as a holding chamber so patient doesn’t need to worry about technique to the same extent
• Larger particles also get stuck, this reduces the chance of infection due to the local immunosuppression that comes with steroids (e.g. oral thrush)
• Improves lung deposition (drug distribution improves)

Question 13

What anti-inflammatory is used in asthma as they work on the allergic response mechanism?

Answer 13

Cromones (e.g. cromoglycate)

Question 14

How do Cromones work?

Answer 14

Mast cell stabiliser

Weak anti-inflammatory

Question 15

What type of patient is cromoglycate effective for?

Answer 15

Atopic asthma in children

Question 16

What are Leukotrine receptor anatagonists used for?

Answer 16

Used for asthma

Act as an anti-inflammatory

Question 17

What Leukotriene receptor antagonist is generally used in asthma?

Answer 17

Montelukast

Question 18

What are Leukotriene receptor anatgonists effect against?

Answer 18

Bronchospasm

Allergic rhinitis

Question 19

How is allergic rhinitis treated?

Answer 19

LTRA

Anti-histamine

Question 20

What type of antagonists are antihistamines?

Answer 20

 H1 (Histamine-1) receptor antagonists

Question 21

How are antihistamines administered?

Answer 21

Oral route

Question 22

What does the anti-IgE monoclonal antibody do?

Answer 22

 Omalizumab inhibits the binding to the high-affinity IgE receptor and inhibit mediator release from basophils and mast cells

Question 23

What are the types of bronchodilators?

Answer 23

Short acting (SABA)
Long acting (LABA)

Question 24

What receptor do bronchodilators work on?

Answer 24

Beta 2 receptor

Question 25

What does stimulation of Beta 2 receptor cause?

Answer 25

- Stimulate bronchial smooth muscle B2-receptors: increases cAMP

Question 26

What is the purpose of the M1 receptors?

Answer 26

M1-receptors enhance the cholinergic reflex

Question 27

What is the purpose of the M2 receptors?

Answer 27

M2-receptors inhibit acetylcholine release

Question 28

What is the purpose of the M3 receptors?

Answer 28

M3-receptors mediate bronchoconstriction and mucus secretion

Question 29

What anti-cholinergic drugs are there what do they affect?

Answer 29

- Block post junctional end plate M3 receptors Ipratropium - SAMA Tiotropium - LAMA

Question 30

What are anticholinergic drugs mainly used for?

Answer 30

Used in the treatment of COPD to reduce exacerbations in a LAMA/LABA combo or on its own. Used in triple therapy for Asthma

Question 31

What is done for the treatment of chronic asthma?

Answer 31

- AIMS: Abolish symptoms, min β2-use, normalise FEV1, reduce PEF variability, reduce exacerbations, prevent long term airway remodelling - Avoid triggers - Suppress inflammatory cascade with inhaled steroid - +/- Non-steroidal anti-inflammatory therapy –e.g. theophylline ,anti-leukotriene, cromoglycate - Stabilise smooth muscle with LABA/LAMA –only once optimal anti-inflammatory therapy in place

Question 32

What is done for the treatment of acute asthma?

Answer 32

- Oral prednisolone (or iv hydrocortisone ) - Nebulised high dose salbutamol, ± Neb ipratropium, ± iv aminophylline/magnesium - 60% O2 - ITU Assisted mechanical intubated ventilation if falling PaO2 and rising PaCO2  never use respiratory stimulant

Question 33

What are the non-pharmacological treatments for COPD?

Answer 33

```  Smoking cessation o +/- nicotine/bupoprion  Immunisation-Influenza/Pneumococcal  Physical activity  Oxygen –Domiciliary  Venesection  Lung volume reduction surgery  Stenting ```

Question 34

What is the treatment of acute COPD?

Answer 34

- Nebulised high dose salbutamol + ipratropium - Oral prednisolone - Antibiotic (amoxycillin/doxycycline) if infection - 24-28% O2 titrated against PaO2/PaCO2 - Physiotherapist to aide sputum expectoration - Non-invasive ventilation to allow higher FiO2 - ITU Intubated assisted ventilation only if reversible component (e.g . pneumonia)

Question 35

What are the Pharmacological treatments for COPD?

Answer 35

 LAMA: Tiotropium/Aclidinium  LABA: Salmeterol/Formoterol  LAMA-LABA combo: Aclidinium/Formoterol  LABA-ICS combo: Beclometasone-Formoterol  PDE4I-Roflumilast  Mucolytic – Carbocisteine  Antibiotics-Azithromycin – frequently given over winter months