12.8 Drugs used in managing respiratory conditions

Question 1

Define asthma

Answer 1

A chronic inflammatory disorder in which many cells and cellular elements play a role, in particular mast cells, eosinophils, T lymphocytes, macrophages and epithelial cells. In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly in the early morning. These episodes are usually associated with widepread but variable airflow obstruction that is often reversible, either spontaneously or with treatment.

Question 2

What is the airway narrowing in asthma due to?

Answer 2

Smooth muscle hypertrophy and hyperplasia
Inflammatory cell infiltration
Oedema
Goblet cell and mucous gland hyperplasia
mucus hypersecretion
Protein deposition including collagen
Epithelial desquamation

Question 3

What defines COPD?

Answer 3

inflammation and airway limitation that is not fully reversible. It is a progressive, disabling disease with serious complication and exacerbations that are the major burdens for healthcare

Question 4

Where are B1 and B2 receptors located?

Answer 4

B1: heart (and brain)
B2: smooth muscle, brain and other tissues

Question 5

What G-protein do B1 and B2 activate?

Answer 5

Gs

Question 6

What is the signalling cascade for B1 and B2?

Answer 6

B1: increases adenylyl cyclase
B2: Adenylyl cyclase increases or increases/decrease

Question 7

What is the function of B1 and B2

Answer 7

B1: heart rate and force increased
B2: smooth muscle relaxation

Question 8

Where are B3 receptors?

Answer 8

fat tissue and heart

Question 9

What are examples of SABAs

Answer 9

salbutamol, terbutaline

Question 10

How do B2 agonists work?

Answer 10

They stimulate B2 receptors on airway smooth muscle which relaxes the muscle resulting in bronchodilation

Question 11

What are the adverse effects of B2 agonists?

Answer 11

tachycardia, tachyarrhythmias, tremor, headache, muscle cramps, insomnia, feeling of anxiety and nervousness
In high doses: hypokalaemia and hyperglycaemia

Question 12

Examples of LABAs

Answer 12

Salmeterol, eformoterol

Question 13

Examples of anticholinergic bronchodilators

Answer 13

Ipratopium bromide and tiotropium

Question 14

How do anticholinergic bronchodilators work?

Answer 14

prevents the stimulation of muscarinic receptors which lessens bronchoconstirction and mucous production

Question 15

Side effects of anticholinergic

Answer 15

Parasympathetic: vagal nerve stimulation, cholinergic 
dry mouth 
constipation 
depression 
angina 
urinary retention 
glaucoma

Question 16

What are the routes of administration for glucocorticoids

Answer 16

Inhalation
oral
IV
topical intra-articular

Question 17

What are the major metabolic side effects of glucocorticoids?

Answer 17

Hyperglycaemia
Protein catabolism (muscle atrophy and weakness, thinning of skin)
fat redistribution (moon face, buffalo hump, abdominal fat, muscle atrophy and thinning of limbs)

Question 18

What are the CNS side effects of glucocorticoids?

Answer 18

Euphoria
psychosis
depression

Question 19

Immune system side effects of glucocorticoids

Answer 19

Increased infections especially those dependent on lymphocyte driven
decreased healing from decreased migration of cells

Question 20

CV side effects of glucocorticoids

Answer 20

Hypertension