ALS Lecture 7 - Pharmacology of Airways Obstruction DONE Flashcards

1
Q

classic asthma starts in

A

childhood

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2
Q

classic asthma gives

A

bronchoconstriction

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3
Q

classic asthma has a

A

double reaction

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4
Q

1st asthma response

A

starts after 15mins of allergen, ends in ~15mins without treatment

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5
Q

2nd asthma response

A

75% is late reaction, more difficult to treat

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6
Q

asthma is characterised by

A

eosinophils

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7
Q

label the diagram of asthma pathophysiology

A

done

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8
Q

asthma pathophysiology (5 steps)

A
  1. IgE directed against allergen
  2. IgE produced by B lymphocyte, sticks onto mast cells
  3. degranulation of mast cells and inflammatory mediators
    4, bronchospasm, vasodilation, mucus secretion, oedema
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9
Q

asthma inflammation causes

A

mucus plugs to block airways

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10
Q

asthma histology of airway

A

filled with mucus, nuclei of inflammatory cells

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11
Q

eosinophils stain and how up

A

pink, stained with eosin

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12
Q

asthma medication types (5)

A

SABA, LABA, corticosteroids (inhaled), leukotriene receptor antagonist, combination inhalers

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13
Q

bronchoconstriction is mediated by

A

smooth muscle contraction, beta agonists reverse this

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14
Q

action of beta receptors on smooth muscle (3 steps)

A
  1. stimulated
  2. release cAMP
  3. relax smooth muscle
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15
Q

label the diagram of montelukast combined with a steroid affects the dual pathways of inflammation

A

done

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16
Q

short acting beta agonist (SABA) example

A

Salbutamol, 4-5hrs

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17
Q

long acting beta agonist (LABA) example

A

Salmetrol, Formoterol, 12-24hrs

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18
Q

leukotriene receptor antagonist MOA (2 steps)

A
  1. block leukotriene receptors

2. stop eosinophil recruitment

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19
Q

leukotriene receptor antagonist example

A

Montelukast

20
Q

antimuscarinics MOA (3 steps)

A
  1. blocks activity of muscarinic ACh receptor

2. bronchial dilation, decreased secretions

21
Q

long-acting muscarinic antagonist example

A

tiotropium

22
Q

methylxanthines act as

A

bronchodilators, relax smooth muscle

23
Q

methylxanthines are used in

A

asthma, COPD

24
Q

methylxanthines MOA (5 steps)

A
  1. inhibits phosphodiesterase which usually degrades cAMP
  2. increased cAMP
  3. activates PKA
  4. inhibits TNF-alpha, leukotriene synthesis
  5. reduces inflammation and innate immunity
25
Q

methylxanthine example

A

theophylline

26
Q

label the diagram of MOA of steroids

A

done

27
Q

steroids are very effective at getting rid of _______ as they ____ ______

A

eosinophils, cause apoptosis

28
Q

corticosteroids MOA (5 steps)

A
  1. attaches to and activates receptor
  2. receptor forms dimer
  3. dimer acts on DNA
  4. up regulates beta-receptor gene = more beta receptors
  5. down regulating cytokine genes = less inflammation
29
Q

only ____ inflammation responds to _____

A

eosinophilic, steroids

30
Q

oral steroids used to be given but

A

give lots of side effects

31
Q

side effects of oral steroids

A

cushing’s syndrome

32
Q

50-70% of inhaled steroids end up

A

in stomach

33
Q

inhaled steroids don’t give side effects as they are

A

metabolised on first pass through liver so don’t get into systemic circulation

34
Q

if patient is non-responsive to steroids, this may be due to (3)

A

poor compliance, poor technique, misdiagnosis

35
Q

label the diagram of omalizumab

A

done

36
Q

omalizumab blocks

A

IgE

37
Q

IL-5 from innate lymphocyte also calls in

A

eosinophils

38
Q

IL-5 blockers are injectable treatments used in _____ _____ with _____ _____

A

severe asthmatics, eosinophilic reaction

39
Q

label the diagram of IL-5 blockers

A

done

40
Q

label the triangle

A

done

41
Q

copd includes

A

emphysema, chronic bronchitis

42
Q

2 phenotypes of COPD patients

A
  • pink puffers, mostly emphysema

- blue bloaters, mostly chronic bronchitis, neutrophilic inflammation so no steroid respsonse

43
Q

eosinophilic bronchitis responds to

A

steroids

44
Q

label the spirometry graph

A

done

45
Q

to differentiate between eosinophilic and neutrophilic airway inflammation, look at the

A

full blood count

46
Q

blood eosinophils above ___ indicate ______ ______ ______

A

0.3, steroid responsive disease