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Pharmacology MD3001 > Treatment of Asthma and COPD > Flashcards

Treatment of Asthma and COPD Flashcards

1
Q

What is the pathogenesis and features of asthma?

A

Pathogenesis - Acute and Chronic inflammatory responses.

Features - Airway narrowing (reversible), airway hyper-responsiveness and airway inflammation

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2
Q

What are the goals of treatment?

A
  • No daytime symptoms,
  • No waking due to asthma,
  • No need for rescue meds,
  • No asthma attacks,
  • No limits on exercise,
  • Normal lung function,
  • Minimal side effects
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3
Q

Name some of the different inhaler devices?

A
  • MDI = metered dose inhaler.
  • Breath-actuated
  • Autohaler,
  • Accuhaler (dry powder)
  • Or via spacer/aerochamber
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4
Q

Describe features of nebulised route?

A

It uses O2, compressed air or unltrasonic powder to break up drug solutions into a fine mist. It therefore gives high doses of reliever meds in acute asthma to get fast responses. This means higher risk of side effects.

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5
Q

What are the 5 pharmacological steps in treating asthma?

A

1) Intermittent reliever therapy,
2) Regular preventer therapy,
3) Initial add-on therapy
4) Additional controller therapy,
5) Specialist therapies

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6
Q

What are the main drug groups used in the treatment and prevention of asthma and name an example.

A

1) Beta 2-adrenoceptor agonists (short acting eg, salbutamol. Long acting, salmeterol)
2) Glucocorticoids eg, Beclomethasone or Budesonide.
3) Cystienyl Leukotriene antagonists (LTRA) eg, Montelukast.
4) Methylxanthines eg, Theophylline
5) Monoclonal antibodies (anti-IgE treatment) eg, Omalizumab

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7
Q

Describe the mechanism of action of Beta 2-adrenoceptors

A
  • Stimulate bronchial smooth muscle beta receptors, relaxing muscle, dilating airways and reducing breathlessness.
  • They inhibit mediator release from mast cells and infiltrating leucocytes.
  • Increases ciliary action which aids mucus clearance
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8
Q

What medications would you give in step 1 and 3 of the treatment of asthma?

A

1) Short acting beta agonist (SABA) (these are fast acting, lasting up to 5 hours and are used as required for breathlessness)
3) Long acting beta agonist (LABA) These are given regularly with inhaled steroid. Used to prevent bronchospasm. Never used as fast acting reliever

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9
Q

What are some of the side effects of beta 2 agonists?

A

If given orally/I.V or high dose inhaled

  • Sympathomimetic effects,
  • Muscle pain/cramps,
  • Electrolyte disturbances (hypokalaemia).
  • Hyperglycaemia,
  • Paradoxical bronchospasm (rare)
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10
Q

What are the features of inhaled corticosteroids (ISC)? and what step are they used in?

A

Step 2. When patients are using SABA more than 3x weekly or symptomatic. eg, waking at night with wheeze, asthma attack in last 2 years. Disadvantages - Due to longer term effects (slow onset) over months the adherence is vital

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11
Q

Describe the mechanism of action of inhaled corticosteroids

A
  • Binds to glucocorticoid receptors which modifies the immune response.
  • Inhibition of formation of cytokines, the activation and and recruitment of inflammatory cells,
  • Reduces mucosal oedema due to inhibition of inflammatory prostaglandins and leukotrienes.
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12
Q

Name examples of corticosteroids used in asthma

A

Inhaled route (beclomethasone), Oral (prednisolone) and IV (hydrocortisone) but last 2 in acute severe attacks.

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13
Q

What are the side effects of corticosteroids

A
  • Oropharangeal candidiasis,
  • Dysphonia (horseness)
  • Systemic eg, osteoporosis, adrenal insufficiency and growth retardation)
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14
Q

What is the mechanism of action of leukotriene receptor antagonists and name some examples?

A

Montelukast.

  • Block the effects of bronchoconstricting cysteinyl leukotrienes in the airways.
  • Reduces eosinophil recruitment to airways
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15
Q

What are the side effects of LTRAa?

A

Abdominal pain, headaches and hyperkinesia in children (hyper active and unable to concentrate)

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16
Q

Describe examples and features of Methylxanthines (step 5)

A

Theophylline. They are phosphodiesterases inhibitors. It is implicated in inflammatory cells and therefore inhibition reduces inflammation and increases intracellular cAMP - bronchodilation, blocks adenosine receptors = bronchodilation and activates histone deacetylase.

17
Q

What are the side effects of methylxanthine?

A

GI upset, Arrhythmias, CNS stimulation and hypotension

18
Q

Describe examples and features of monoclonal antibodies (step 5, used in persistent allergic asthma)

A

Omalizumab. It is an antibody to IgE which inhibits mediator release of basophils and mast cells. It is expensive, only available via IV route and can cause anaphylaxis and increase the risk of strokes/heart disease

19
Q

What is the management of acute severe asthma (should be revision)

A

Immediate - Oxygen, SABA via nebuliser, IV or oral steroid with/without antibiotics or muscarinic antagonists.
If they are then still not improving then use - IV magnesium sulphate and witch to IV salbutamol or methylxanthine

20
Q

What is the recommendation for all COPD patients?

A
  • Smoking cessation,
  • Early use of bronchodilators,
  • Inhaled corticosteroids,
  • Immunise against pneumovax and flu
  • Pulmonary rehab,
  • Self management,
  • Optimise treatment for co-morbidities
21
Q

What are the features of muscarinic receptor antagonists?

A

They cause bronchodilation, decrease mucus secretion and may increase mucociliary clearance. Long acting muscarinic antagonists can improve outcomes

22
Q

Give an examples of a short acting muscarinic antagonists and a long acting muscarinic antagonists

A

SAMA - Ipratropium (non selective).

LAMA - Tiotropium (selective for M3 receptor)

23
Q

What are the side effects of muscarinic receptor antagonists

A

Uncommon, constipation, dry mouth, nausea, headache, cough, urinary retention, and can worsen angle closure glaucoma.

24
Q

Describe the overview of the NICE COPD guidelines if there is no suggestion of asthma/steroid responsiveness

A

Step one - If required then SABA or SAMA.

Step two - LABA and LAMA.

Step three - LABA, LAMA and ICS trial

25
Q

Describe the overview of the NICE COPD guidelines if there is suggestion of asthma/steroid responsiveness

A

Step one - If required SABA or SAMA.

Step two - LABA and ICS combination.

Step three - LAMA and LABA and ICS

26
Q

Describe features of inhaled corticosteroids in COPD?

A
  • Limited benefit
  • The inflammatory cells responsible for COPD are less responsive than eosinophils to the actions of corticosteroids.
  • High doses may increase risk of pneumonia and osteoporosis
27
Q

What are some other treatments for COPD?

A
  • Methylxanthines,
  • Mucolytics - If chronic productive cough, reduced sputum viscosity.
  • Phosphodiesterase Type-4 inhibitors,
  • Long term antibiotics,
  • Anti-IgE monoclonal antibody.
  • Long term oxygen
28
Q

Describe the assessment of COPD

A
  • Primarily based on patient symptoms,
  • Changes in lung function (spirometry)
  • Risk of exacerbation
29
Q

Describe features of asthma-COPD overlap syndrome

A
  • Higher eosinophil count
  • FEV1 swings,
  • Diurnal variation in PEFR
  • Respond better to steroids
  • More reversible to Beta 2 agonists.
30
Q

Describe the treatment of acute severe COPD exacerbations

A
  • Nebulise SABA/SAMA,
  • Add oral prednisolone,
  • Antibiotics if infected
  • Physio
  • 24-28% O2,
  • If extreme then NIV or intubation

Pharmacology MD3001 (14 decks)

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