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Pharmacology CP > ANS and Respiratory System > Flashcards

ANS and Respiratory System Flashcards

1
Q

What can be seen in a cross-section through airways?

A

(Inside out)

  • Lumen
  • Mucosal layer
  • Submucosa
  • Smooth muscle
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2
Q

What is the affect of cigarette smoke on the lumens of airways?

A
  • Allergens, irritants, chemicals may enter lumen

- Contraction of airways smooth muscle leads to narrowing and bronchoconstriction

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3
Q

What is asthma characterised by?

A
  • Intermittent brinchicinstriction caused by allergens or non-specific stimuli such as cold air
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4
Q

What is the risk of long-term exposure to irritants such as smoke, air pollution and isocyanates?

A

Chronic obstructive pulmonary disease

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5
Q

How is bronchial smooth muscle controlled?

A
  • Parasympathetic innervation

- Relaxed by actions of circulating adrenaline on β adrenoceptors

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6
Q

What types of drugs mimic the effects of adrenaline?

A
  • β-agonists
  • Relax smooth muscle regardless of contractile stimulus
  • Also muscarinic antagonists
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7
Q

What does noradrenaline stimulate?

A
  • Potent stimulus for α receptors

- Less effective against β-adrenoceptors

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8
Q

What does adrenaline stimulate?

A
  • Potent stimulus for both α and β adrenoceptors
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9
Q

What are the actions of adrenaline on the alpha-1 receptors?

A
  • Constriction of blood vessels in skin and gut

- Dilation of pupil

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10
Q

What are the actions of adrenaline on the alpha-2 receptors?

A
  • Increased renin secretion in the kidney
  • Glycogenolysis in the liver
  • Decreased GI motility
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11
Q

What are the actions of adrenaline on the β-1 adrenoceptors?

A
  • Increased heart rate and force of contraction
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12
Q

What are the actions of adrenaline on the β-2 adrenoceptors?

A
  • Dilation of blood vessels in skeletal muscle
  • Increased renin secretion in the kidney
  • Glycogenolysis in the liver
  • Decreased GI motility
  • Relaxation of bronchial smooth muscle
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13
Q

What are the uses of adrenaline?

A
  • Used to treat severe asthma for rapid reversal of bronchoconstriction is required
  • Also used in anaphylaxis where there is an explosive release of hits,ine
  • Adrenaline is metabolised relatively quickly
  • -> Wears off quickly in around 30 minutes-1hour
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14
Q

What autonomic innervation does the heart have?

A
  • Both sympathetic and parasympathetic innervation
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15
Q

What does stimulation of β-1 adrenoceptors in the heart lead to?

A
  • Increased force of contraction, increased heart rate and reduced cardiac efficiency
  • Oxygen consumption is increased more than cardiac work
  • Also helps restore automaticity of heart
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16
Q

What are the characteristics of an ideal drug for asthma?

A
  • Selective- no toxic side effects
  • Rapid onset of action
  • Appropriate route of administration
  • Appropriate duration of action
  • Cheap and easy to produce
17
Q

Describe the development of selective β agonists

A

1) noradrenaline α>β
2) adrenaline α=β
3) isoprenaline β>α
4) salbutamol β-2>β-1»α
- There is increasing sensitivity to β adrenoceptors

18
Q

What are the effects of β-2 adrenoceptor agonists?

A
  • Relax airway smooth muscle
  • Inhibit mediator release from mast cells
  • Inhibit release of TNF-α from macrophages
  • Increase mucus clearance via action on cilia
    • Muco-ciliary escalator
19
Q

What are the uses of β-adrenoceptor agonists?

A
  • Salbutamol is used to relieve symptoms of asthma
  • Rapid action
  • Relaxes smooth muscle regardless of stimulus
  • Βeta-2 adrenoreceptor agonists do not affect underlying airways inflammation and over-reliance on this form of therapy should be avoided
20
Q

How are β-2 agonists administrated?

A
  • Inhaled to reduce side effects
  • Can be given as an aerosol, powder or nebulised solution
  • Occasionally orally or via injection
21
Q

What is a nebulised solution?

A

Fine mist that can reach smaller airways (larger dose)

22
Q

What are the effects of excessive salbutamol?

A
  • Skeletal muscle tremor
  • Hyperglycaemia in diabetic patients
  • Cardiovascular effects- arrhythmias acutely and potentially myocardial ischaemia in long-term
  • Hypokalaemia-
  • Overuse may down-regulate β-adrenoceptor expression
  • No improvement in underlying airways inflammation
23
Q

Give an example of a longer-acting β-2 agonist

A
  • Salmeterol
  • Duration of action-12 hours
  • Patients that may constantly need Bronchodilation
  • Used twice daily to control symptoms
  • May be combined with steroid to reduce airway inflammation
24
Q

What is the issue with longer acting β-2 agonists?

A
  • High death rate linked to over-reliance on high dose, long-acting β-agonist
  • Once drug removed from market, death rate fell
25
Q

What are sympatholytics and what is their relationship with asthma?

A
  • Βeta blockers used to treat hypertension, angina and cardia arrhythmias
  • Not given to asthmatics because they antagonist β agonists severe broncho-constriction
26
Q

What muscarinic antagonists can be used to block bronchoconstriction?

A
  • Oxitropium
  • Ipratropium
    Relax airways
27
Q

What is the use of muscarinic antagonists in asthma?

A
  • Limited use in allergic asthma
  • Consistently failing
  • However inhibit mucous secretion
  • Takes 20-30 minutes to act and effects last 4-6 hours
  • More useful in COPD
28
Q

What is the use of muscarinic antagonists in COPD?

A
  • Patients with COPD are generally regarded as having irreversible airways obstruction
  • Declines x2-3 in smokers
  • However, many patients have a small amount of reversible airway obstruction- which may have an important effect on qol
  • Airway trapping
29
Q

What are the side effects of muscarinic antagonists?

A
  • Inhaled are not well-absorbed into systemic circulation so side effects are minimal
  • Care should be taken prescribing these to patients with glaucoma and prostate/bladder conditions
  • Constipation and more rarely, tachycardia and atrial fibrillation
30
Q

What are some other drugs used for asthma?

A
  • Xanthines
  • Steroids
  • Anti-leukotrienes
31
Q

What are some other drugs used for COPD?

A
  • Limited therapeutic options

Pharmacology CP (11 decks)

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