therapeutics of ASTHMA and COPD Flashcards
1
Q
the asthma treatment pyramid
A
(Bottom of pyramid)
- reliever - short-acting B2-agonist PRN
- preventer 1st line - inhaled steroid
- add 2nd line controller - cromoglycate or LABA/LAMA
- oral steroid/biologies
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
3
Q
inhaled steroids in COPD
A
never use an inhaled steroid beginning with letter F, use one beginning with B
4
Q
what can pass through the trachea?
A
anything less than 5 microns
5
Q
what can get pass the smaller airways eg bronchioles (generation 8)?
A
anything less than 2 microns
6
Q
what does a spacer do?
A
- avoids coordination problems with pMDI
- reduces oropharyngeal and laryngeal side effects
- reduces systematic absorption from swallowed fraction
- acts a holding chamber for aerosol
- reduces particles size and velocity
- improves lung deposition
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
8
Q
is blocking LTD4 good for treating asthma?
A
yes
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
10
Q
montelukast
A
never use on it’s own
oral route
- once daily
- high therapeutic ratio
11
Q
anti-IgE
A
- anti-IgE monoclonal antibody: omalizumab
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
13
Q
anti- IL5
A
- mepolizumab
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
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