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Advanced Pharmacy Practice > Asthma > Flashcards

Flashcards in Asthma Deck (23)
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1
Q

What is asthma (definition)?

A

Chronic inflammatory disease characterised by recurrent attacks of breathlessness and wheezing.

2
Q

LABA work on which aspect of asthma pathophysiology?

A

The smooth muscle dysfunction.

3
Q

ICS work on which aspect of asthma pathophysiology?

A

The airway inflammation.

4
Q

Smooth muscle dysfunction in asthma consists of?

A

Bronchoconstriction
Bronchial hyper-reactivity
Hyperplasia
Inflammatory mediator release

5
Q

What does SIMPLE stand for?

A
Stop smoking. 
Inhaler technique 
Monitoring
Pharmacotherapy
Lifestyle 
Education
6
Q

What would a young teenager newly diagnosed with asthma typically be prescribed?

A

Salbutamol Inhaler

ICS (Spacer)

7
Q

What symptoms indicate a high probability of an asthma diagnosis?

A
Cough
Wheeze
Worse at night
Exercise induced
Family history
Widespread wheeze
Evidence of airway narrowing.
8
Q

What symptoms are likely to indicate a differential diagnosis to asthma?

A
Cough BUT NO wheeze or SOB. 
Dizzy & lightheaded. 
No airway narrowing
Voice disturbance 
Symptoms with cold only
Chronic productive cough
Cardiac disease
9
Q

Is the nitric oxide breath test useful? How does it work?

A

No. FeNO in the breath of people with asthma detects lung inflammation.

10
Q

What is the ACT?

A

Asthma Control Test.

Five Qs that refer to the last 4 weeks.

11
Q

What is salbutamol?

A

Short acting beta agonist (SABA)

12
Q

What is beclametasone?

A

It is an ICS.

13
Q

What is a typical low dose ICS?

A

Beclametasone 100microgram per puff. One puff twice a day: low dose.
Two puffs twice a day: medium dose.

14
Q

What is a LABA?

A
Either 
Formeterol 
or 
Salmeterol 
Long acting b2 agonists.
15
Q

What is the initial add on therapy to asthma treatment following SABA (sulbutamol) and low dose beclametasone (ICS)?

A

Inhaled LABA
Formeterol/Salmeterol
Consider using combined low dose ICS and LABA in combined inhaler.

16
Q

Following SABA, ICS (low dose) and LABA what can be added a an additional therapy to the management of asthma?

A

First of all should consider if no response to LABA - ? stopping it and increasing dose of ICS.

If LABA = benefitting, continue LABA and increase ICS to medium dose.

Can also consider trial of LTRA, LAMA etc.

17
Q

What are the licensing requirements for omalizumab?

A
Step4/5 asthma 
FEV1<80%
>2 severe exacerbations
\+ve skin prick test or +ve RAST to common aeroallergens. 
IgE >50 and <700iu/ml.
18
Q

What is step 1 asthma treatment?

A

SABA (blue) PRN

IF more than 3x week or 2x day, need to add in a trialed ICS low dose.

19
Q

What is step 2 of asthma management?

A

If SABA PRN and low dose ICS is not enough, check inhaler technique etc and then add in a LABA such as salmeterol or formeterol.

20
Q

What is step 3 in asthma management?

A

If SABA prn, low dose ICS and LABA are not managing patient, increase to a medium dose ICS if they have had some improvement from the low dose ICS. If no ICS benefit then a LAMA or LTRA can be considered instead at this stage.

21
Q

What is step 4 of asthma management?

A

Patient would be on:
SABA prn, medium dose ICS + LABA.

We can now move to high dose ICS/LABA combo plus SABA prn plus a 4th drug: LAMA, LTRA, Theophylline, B agonist tablet.

22
Q

What is step 5 of asthma management?

A

Oral corticosteroid.

23
Q

How is an acute asthma attack managed?

A
  1. Nebulised bronchodilators such as salbutamol and ipaptropium if severe, driven by OXYGEN. Mg Sulphate stat one dose IV.
  2. Oxygen sats of 94-98%.
  3. Hydrocortisone IV stat followed by prednisolone 50mg for 5 days post attack.
  4. VTE risk assessed.
  5. No antibiotics unless evidence of consolidation on chest x-ray or other signs of infection.