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Resp > therapeutics of ASTHMA and COPD > Flashcards

therapeutics of ASTHMA and COPD Flashcards

1
Q

the asthma treatment pyramid

A

(Bottom of pyramid)

  1. reliever - short-acting B2-agonist PRN
  2. preventer 1st line - inhaled steroid
  3. add 2nd line controller - cromoglycate or LABA/LAMA
  4. oral steroid/biologies
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2
Q

corticosteroids

A
  • anti inflammatory
  • used in asthma and COPD
  • may cause pneumonia in COPD due to local immune suppression altered micro biome and MC clearance
  • very-fat soluble
  • low therapeutic ratio = not suitable long term
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3
Q

inhaled steroids in COPD

A

never use an inhaled steroid beginning with letter F, use one beginning with B

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4
Q

what can pass through the trachea?

A

anything less than 5 microns

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5
Q

what can get pass the smaller airways eg bronchioles (generation 8)?

A

anything less than 2 microns

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6
Q

what does a spacer do?

A
  1. avoids coordination problems with pMDI
  2. reduces oropharyngeal and laryngeal side effects
  3. reduces systematic absorption from swallowed fraction
  4. acts a holding chamber for aerosol
  5. reduces particles size and velocity
  6. improves lung deposition
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7
Q

cromones

A
  • anti inflammatory
  • only used in asthma eg cromoglycate
  • mast cell stabiliser - weak anti inflammatory of steroids
  • cromoglycate effective in atopic children
  • inhaled route only
  • not used much due to poor efficacy
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8
Q

is blocking LTD4 good for treating asthma?

A

yes

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9
Q

leukotriene receptor antagonists

A
  • anti inflammatory
  • only used in asthma
  • montelukast
  • less potent anti inflammatory than inhaled steroid
  • effective in allergic rhinitis with anti histamine
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10
Q

montelukast

A

never use on it’s own
oral route
- once daily
- high therapeutic ratio

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11
Q

anti-IgE

A
  • anti-IgE monoclonal antibody: omalizumab
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12
Q

omalizumab

A
  • inhibits the binding to the high affinity IgE receptor - inhibits TH2 response and assoc mediator release from basophils/mast cells
    0 injection every 2-4 weeks for asthma only
  • for patients with severe persistant . allergic asthma
  • very expensive
  • little effect on pulmonary function but reduces exacerbations and oral steroid sparing effect
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13
Q

anti- IL5

A
  • mepolizumab
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14
Q

what is mepolizumab?

A
  • blocks effect of TH2 cytokine IL-5 whichis responsible for eosinophilic iflammtion in asthma
  • injection every 4 weeks for asthma only
  • for patients with sever refractort eosinophili asthma
  • v expensive
  • Little effect on pulmonary function or symptoms but reduces exacerbations and oral steroid sparing effect
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15
Q

B2- angonists

A
  • stimulate bronchial smooth muscle B2 receptors
  • short-acting = sabutamol
  • long acting = salmeterol
  • combination inhalers = beclometasone
  • used in asthma and COPD
  • higher therapeutic ration when given by inhaled route
  • b2 down regulation and thacyphylacis with chronic LABA
  • systematic B2 effects when given systematically or at high inhaled doses
  • high nebulised doses (SABA) given in acute attack
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16
Q

are LABA every used on their own?

A

never, only in combination with an inhaled steroid for asthma

17
Q

what is used for high nebulised doses?

A

SABAs eg salbutamol

18
Q

what does acytylecholine do?

A

blocks the airway

19
Q

muscarinic antagonists

A
  • aka anticholinergics
  • block post junctional end plate M3 receptors
  • in COPD used with a LABA or as a triple inhaler
  • in asthma used as a triple therapy at step 4 with LABA
  • high nebulised doses of ipratropium used in acute COPD and in acute asthma
20
Q

methylxanthines

A
  • bromchodilator/anti inflammatory
  • oral for maintanence therapy
  • SR formulation usedful for nocturnal dips
  • used as add to inhaled steroid as complimentary non steroidal anti infalmmatory
  • IV for acute attacks
  • non selective phosphodiesterase inhibitor
  • aclso acs as adenosine antagonist
  • low therapeutic ratio
  • used in asthma and COPD
21
Q

treatment of chronic asthma

A
  • aims are to abolish symptoms, minimum use of B2, noamliise REV1, reduce PEf varibalitiy, reduce exac, prevent long term airway remodelling
  • Suppress inflammatory cascade with inh steroid
  • Stabilise smooth muscle with LABA/LAMA
  • Supress eosinophils with anti-IL5
  • Treat allergy with anti-IGE
22
Q

treatment of acute astham

A
  • oral prenisolone,

- nebulised high dose of salbutamol

23
Q

COPD management

A

non pharmacological

  • stop smoking or cessation
  • immunisation
  • pharamcotherapy
  • pulmonary rehan
  • oxygen

pharmacological

  • LABA/LAMA
  • ICS/LABA/LAMA combo (triple inhalers)
24
Q

treatment of acute COPD

A
  • neublised high dose of salbutamol plus ipratropium
  • oral predinisolone
  • antibiotic if infection
  • physio to get sputum up
  • non invasivel ventilation to allow FiO2

Resp (30 decks)

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