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28 Cards in this Set
- Front
- Back
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Why is it preferable to administer anti-asthmatic and anti-COPD medication by inhalation? |
Because the drug directly reaches the site where it is needed, which causes the onset of action to be quicker and fewer systemic side effects to occur. |
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What is the ideal particle size for drugs delivered by inhalation? |
1 µm |
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What are the indications for oral treatment of asthma and COPD?
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In severe cases where inhalatory treatment is insufficient. |
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Name the two most commonly used inhaler devices? |
Pressurized metered-dose inhaled (pMDI) and dry powder inhaler (DPI) |
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How does the pressurized metered-dose inhaled work?
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It contains the active drug dissolved in a liquefied gas propellant. When the inhaler is activated the pressurized propellant will be broken into an aerosol which is inhaled. |
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How does the dry powder inhaler work? |
The dry powder inhaler (DPI) contains the drug in powder form without a propellant. The force of the patient inhaling will entrain powder from the inhaler and break the powder into micron-sized particles which will reach the airways. |
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What are the long-term goals of asthma treatment?
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To decrease asthma-related death and exacerbations while also providing symptom control. |
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What are the two components of asthma treatment? |
The first component is a controller, which is an anti-inflammatory drug. They decrease the chronic inflammation of the airways and reduce the frequency and severerity of asthma attacks. The second component is a reliever, which is a bronchodilator. They're taken during asthma attacks to decrease their duration and severity. |
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What is new in the 2019 recommendations for asthma treatment? |
Previously people with mild asthma did not receive anti-inflammatory treatment. The new recommendations say that everyone with asthma, even those with mild asthma should receive anti-inflammatory treatment |
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What is the preferred controller for asthma? |
An inhaled corticosteroid like budesonide, often in combination with a long-acting β2-agonist like formeterol |
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What is the preferred reliever for asthma? |
Budesonide + formeterol or short-acting β2-agonists like salbutamol or terbutaline |
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Which bronchodilators are used in the treatment of asthma and COPD? |
Short-acting β2-agonists (SABA): Terbutaline and salbutamol/albuterol Long-acting β2-agonists (LABA): Formoterol and Salmeterol Ultra long-acting β2-agonists (ultra-LABA): Vilanterol Muscarinic antagonists: Tiotropium (long-acting) Ipratropium (short-acting) Theophylline |
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What are the indications of short-acting β2-agonists (SABAs)? |
SABAs are used as relievers in all steps of asthma treatment. |
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What are the indications of long-acting β2-agonists (LABAs) and ultra-loing-acting β2-agonists (ultra-LABAs)? |
LABAs and ultra-LABAs are used in combination with corticosteroids as controllers. |
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Which long-acting β2-agonist can not be used to relieve acute attacks and why? |
Salmeterol, because it has a slow onset of action |
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What are the indications for muscarinic antagonists? |
Muscarinic antagonists are used as add-on relievers in higher steps. |
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Why is theophylline rarely used anymore? |
It has a narrow margin of safety It cannot be given as inhalation to prevent systemic side effects Clearance differs considerably between persons It has multiple drug interactions It is cardiotoxic and neurotoxic |
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What is the mechanism of action of theophylline? |
Theophylline is a non-specific phosphodiesterase inhibitor and adenosine receptor antagonist. By inhibiting PDE theophylline increases intracellular cAMP and cGMP in bronchial smooth muscle, causing relaxation. However, theophylline doesn’t inhibit PDE at the therapeutic range of plasma concentrations so we’re not exactly sure how it works. |
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What are the side effects of β2-agonists? |
Tachycardia, tremor |
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What are the side effects of muscarinic antagonists? |
Dry mouth |
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What are the side effects of theophylline?
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Insomnia, nervousness, arrhythmia, seizures |
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Which anti-inflammatory drugs are used in the treatment of asthma and COPD? |
Inhaled corticosteroids: Budenoside, beclometasone, fluticasone Oral corticosteroids: Prednisone, prednisolone, methylprednisolone Leukotriene antagonists: Montelukast, zafirlukast Biological therapy: Anti-IgE – omalizumab Anti-IL4R – dupilumab Anti-IL5 – mepolizumab Anti-IL5R – benralizumab |
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What are the indications for anti-inflammatory treatment in asthma? |
All asthmatics should take an anti-inflammatory, either together with a reliever during attacks (step 1) or as a controller daily (steps 2 - 5). |
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What are the preferred anti-inflammatory drugs in the treatment of asthma and COPD? |
Inhaled corticosteroids |
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What is the mechanism of action of corticosteroids in relation to asthma?
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- They reduce the transcription of IL-2, which stimulates Th2 cells - They reduce the formation of cytokines which reqruit eosinophils and promote IgE production - They upregulate β2 receptors |
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What is the mechanism of action of leukotriene antagonists in relation to asthma? |
Montelukast and zafirlukast are leukotriene receptor antagonists. Leukotrienes cause bronchoconstriction, bronchial swelling and increased mucus secretion, so inhibiting their action will obviously have a beneficial effect on asthma. Leukotrienes also attract neutrophils, so inhibiting them will reduce inflammation as well. |
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What is the mechanism of action of the biological agents in relation to asthma? |
The biological agents bind to and inactivate various cytokines and receptors which are involved in the pathogenesis of asthma, like IgE, IL-4 and IL-5. |
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What are the side effects of inhalatory steroid treatment and how can they be prevented? |
Oral fungal infection is the most common side effect. It can be prevented by rinsing the mouth with water after inhalation |
