Asthma/COPD

Question 1

How does Asmol work?

Answer 1

Short acting Beta 2 agonists (SABAs) - RELIEVER

2. Binds to B2 in lungs
   - induces cAMP release
   - increases Ca levels
   - Smooth muscle relaxation
3. inhibit Mast cell release →
   - prevents histamine release
   - prevents TNF-a from monocytes

Question 2

How do you take an Asmol puffer?

Answer 2

works within minutes

Question 3

Salmeterol
MOA,
Similar drugs in this class
use

Answer 3

Long acting Beta 2 agonists (LABAs)
-same action as SABA
everything ends in 'rol'
eg formoterol, indacterol, vilanterol 
-preventer - BUT only used with ICS other wise it can actually cause a acute attack

Question 4

What has coffee got to do with asthma?

Answer 4

Theophylline (Neulin) is a Xanthine drug that is pretty much coffee.

MOA

• bronchodilator
• may stimulate CNS to cause diaphram contraction
• may inhibit phosdiesterase to increase cAMP

Question 5

Montelukast

• MOA
• Why is it used?

Answer 5

Cysteinyl leukotriene receptor antagonists

• prevents these potent mediators of inflammation
• allows bronchodilation and stops mucus secretion

1st line for children UNDER 6 yrs - so they dont have to take ICS
4mg daily

Question 6

Ipratopium

Answer 6

SAMA (short acting Muscarinic agents)

• competitive antagonist of acetylcholine
• causes bronchodilation and decrease mucus production

-bitter taste, dry mouth, blurred vision, urinary retention

DO not take SAMA and LAMA together

Question 7

Aclidinium
Glycopyrronium
Tiotropium
Umclidinium

Answer 7

LAMA (Long acting Muscarinic agents)

• competitive antagonist of acetylcholine
• causes bronchodilation and decrease mucus production

-bitter taste, dry mouth, blurred vision, urinary retention

DO not take SAMA and LAMA together

Question 8

How is asthma difference to COPD

Answer 8

Asthma

• caused by an allergen
• reversible

COPD

• chronic injury
• irreversible damage

Question 9

Describe the details of emphysema

Answer 9

damage to elasticity of cells
-no recoil, cants expire air - it gets trapped = barrel chest, no new air can get into lungs
loss of structure - floppy airways, muscles have to work harder to remove air = strain
-loos of alveoli - hyperinflated lungs = too much Co2 - hyeprcapnia = respiratory acidosis

Question 10

Describe the details of Bronchitis

Answer 10

damage to cells = causing hyperplasia/hypertrophy, impairing mucus removal and making an environment for infection

Question 11

What are the genetic factors involved in COPD?

Answer 11

May have a a1-antitrypsin deficiency

-it normally inhibits elastase - without it elastin is broken down causing lung tissue damage

Question 12

What is FEV1

Answer 12

Forced Expiration volume in 1 second

normal = 90%

Question 13

Alvesco
Pulmicort
Flixotide

Answer 13

ciclesonide (80 micro)
budnesonide (100)
fluticasone (100)

All ICS

Question 14

seretide

symbicort

Answer 14

fluticasone and salmeterol
ics and LABA

budesonide and fermoterol

Question 15

Atrovent

Answer 15

ipratropium 21mcg/dose

SAMA

Question 16

Bretaris

Answer 16

Aclidinium

Question 17

Why are ICS a last resort in COPD patients?

Answer 17

immunosuppressant = increase risk of infection - pneumonia = death

Question 18

Spiriva

Answer 18

tiotroprum -LAMA

Question 19

spiolto

Answer 19

Olodaterol (LABA) and tiotroprum (LAMA)

Question 20

adverse and contraindications for SABA

Answer 20

adverse
-tremors, headaches, insomnia, tachycardia, hyperglycaeia

contra

• cardiac disease
• arrythmia
• diabetes (mask hypers)
• hyperthyroidism

Question 21

Adverse and Contraindications for LAMA

Answer 21

adverse:
-bitter taste, dry mouth, throat irritation, blurred vision, urinary retention

caution
-Recent MI, HF, renal impairment (<50ml/min CrCl)