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Anti-Asthamtics Flashcards

1
Q

Asthma is a (reversible or irreversible ?) (acute or chronic?) (obstructive or restrictive ?) disease of the _____ caused by _______ to various stimuli, characterized by episodic broncho______ and ________ of the airways.

A

reversible

chronic

obstructive

airway; hyperresponsiveness

constriction; inflammation

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2
Q

Upper Respiratory Tract consists of :

–______
–______

A

Nose

Pharynx

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3
Q

Pharynx:

___pharynx
___pharynx
_____pharynx

A

Naso
Oro
Laryngo

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4
Q

Components of Lower Respiratory Tract

–_______
–_________
————-
–______

A

Larynx

Trachea

Bronchus

Lungs

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5
Q

The Lungs consists of the

_______ and _______
• •

A

Bronchioles

Alveoli

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6
Q

ANATOMY: Tracheal

Also called _______

A ______ tube

Extends from the _____ to ______

Length of ______

Conduct air in and out of the respiratory tree

A

Windpipe

Cartilaginous

C6 to T4/T5

12cm

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7
Q

HISTOLOGY: Trachea

Made up of four layers of tissue

____,______,______,________

A

MUCOSA

SUBMUCOSA

CARTILAGE

MUSCLE

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8
Q

ANATOMY : Bronchus

______________ tube

Connects from the _____ to _______

Conduct air in and out of the respiratory tree

A

Musculo-cartilaginous

Trachea to Lungs

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9
Q

ANATOMY Bronchus

Divided into three parts

______ BRONCHUS
_______ BRONCHUS
_________ BRONCHUS

A

MAIN

LOBAR

SEGMENTAL

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10
Q

Histology: Bronchus

Made up of four layers of tissue

_____
_____
________
________

A

MUCOSA

SUBMUCOSA

CARTILAGE

MUSCLE

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11
Q

ANATOMY: LUNGS

Includes
______,________

Helps in the exchange of Oxygen and CO2

A

RIGHT LUNGS
LEFT LUNGS

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12
Q

HISTOLOGY Lungs

Composed of

_________
__________

A

BRONCHIOLES

ALVeoli

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13
Q

HISTOLOGY Lungs

Bronchioles is made up of

_______
_________
__________

A

MUCOSA
SUBMUCOSA
MUSCLE

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14
Q

HISTOLOGY Lungs

Alveoli is made up of _________

A

EPITHELIUM

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15
Q

REGULATORS OF RESPIRATION

_______ REGULATION

_________ REGULATION

A

NEURAL

CHEMICAL

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16
Q

ASTHMA

A (reversible or irreversible?) (acute or chronic?) ( obstructive or restrictive?) disease of the ________ caused by ______ to various stimuli, characterized by episodic _______ and ________ of the airways.

A

reversible

chronic

obstructive

tracheobronchial tree

hyperreactivity

bronchospasm and inflammation

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17
Q

Asthma result from a complex interaction between
–________ factors
–__________ factors

A

Genetic

Environmental

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18
Q

ASTHMA Aetiology: Genetic factor

– Many _______ or ______ have been
identified and this then to lead to
______________

– This involves abnormal ____________________ to wide range of environmental stimuli/allergens.

A

asthma genes or gene complexes

AIRWAY HYPER-REACTIVITY

sensitivity of the airways

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19
Q

Asthma: PATHOPHYSIOLOGY

Recurrent exposure of the airway to this Allergens triggers a ______________ reaction:

A

TYPE 1 HYPERSENSITIVITY

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20
Q

Asthma: PATHOPHYSIOLOGY

TYPE 1 HYPERSENSITIVITY reaction:
Allergens bind to _________ on Mast cell in the Airway

_________ ————

Release of —————- including ______,_______

A

IgE antibodies

Mast cell degranulates

inflammatory mediators

Histamine; Leukotriene

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21
Q

PATHOPHYSIOLOGY of Asthma

Histamine, leukotriene

These mediators target the ______ and ________ of the airway

Causing ________ and _______

A

Smooth muscle and Mucosa of the Airway

BRONCHOCONSTRICTION

INFLAMMATION

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22
Q

Asthma: Pathophysiology

Bronchoconstriction

–__________ of airway ________
– Airway ________
– Reduced (inspiration or expiration?) of air

A

Contraction

smooth muscles

narrowing

expiration of air

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23
Q

Asthma: Pathophysiology

Inflammation
– Vaso_________ of bronchial vessels
–____________ from vascular to interstitial space
– Mucosal _______
– Increase ____________________
– Airway _______
– Reduced expiration of air

A

dilatation

Extravasation of fluid

edema; mucus secretion and plugging

narrowing

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24
Q

Asthma: CLINICAL FEATURES

_________
Chest ________
_________
Rapid ________
_________

A

Shortness of breath

Tightness

Wheezing

respiration; Cough

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25
Q

Asthma: CLASSIFICATION

Based on Severity
–_________ or _________
–_________ Asthma

A

Acute Asthma or Status Asthmaticus

Chronic

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26
Q

CLASSIFICATION
Based on Severity

– Chronic Asthma
__________ Asthma
_____________ Asthma
____________ Asthma
______________ Asthma

A

Mild Intermittent

Mild Persistent

Moderate Persistent

Severe Persistent

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27
Q

Asthma: DIAGNOSIS

___________
___________

A

Peak-Flow meter

Spirometry

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28
Q

Asthma: management

Non-Pharmacological
–______________________________________

Pharmacological
–_____________

A

Identify and reduce exposure to Triggers

Anti-Asthmatics

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29
Q

The drugs used in the management of Asthma includes:
– ________________ AGENTS
–_______________

A

ANTI-INFLAMMATORY

BRONCHODILATORS

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30
Q

Anti-Asthmatics

ANTI- INFLAMMATORY AGENTS

__________
_________
____________
_________

A

Corticosteroids
Leukotriene antagonist
Mast cell stabilizers
Anti-IgE monoclonal antibody

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31
Q

Anti-Asthmatics

BRONCHODILATOR S
•_________
•_________
•_________

A

Beta 2 agonist

Anti-muscarinic

Methyl-Xanthine

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32
Q

Examples of short acting BETA 2 AGONIST

A

Albuterol
Salbutamol
Terbutaline
Levalbuterol
Pirbuterol
Epinephrine
Metoproterenol

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33
Q

Examples of long acting BETA 2 AGONIST

A

Formoterol
Clenbuterol
Arformoterol
Bambuterol
Salmeterol

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34
Q

MECHANISM OF ACTION of beta 2 agonist

Binds and stimulates BETA 2 ADRENERGIC RECEPTORS in the airway

Stimulation of βeta 2 receptors causes the activation of ____ and _______

This eventually results in ___________

A

Gs

increase in cAMP

BRONCHODILATION

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35
Q

ADVERSE EFFECTS of beta 2 agonists

Skeletal muscle _____.
_____ness
__________
__________ over dose

A

tremors

Nervous

Tolerance

Tachycardia

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36
Q

MUSCARINIC ANTAGONIST

EXAMPLES??

A

Tiotropium

Ipratropium

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37
Q

MUSCARINIC ANTAGONIST

MECHANISM OF ACTION
Binds and blocks MUSCARINIC CHOLINERGIC RECEPTORS in the airways

Blockade of Muscarinic receptors prevents the activity and effect of _____________

This inhibits Broncho_______ and _________
Thus leading to ____________

A

endogenous Acetylcholine

constriction

mucus secretion

BRONCHODILATION

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38
Q

MUSCARINIC ANTAGONIST

__________ skin
__________
_____________
______thermia
______cardia

A

Flushed skin

Constipation

Xerostomia

Hyper

Tachy

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39
Q

METHYL-XANTHINES

EXAMPLES??

A

Theophylline

Aminophylline

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40
Q

METHYL-XANTHINES : MECHANISM OF ACTION

Binds and blocks ________ ENZYME in the airway

This causes ________ and eventual accumulation of ______

This eventually results in __________

A

PHOSPHODIESTERASE

reduced breakdown ; cAMP

BRONCHODILATION

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41
Q

ANTI-INFLAMMATORY
Corticosteroids

EXAMPLE
Inhalational
– ________
–__________
–_____________

A

Budesonide

Fluticasone

Beclomethasone

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42
Q

ANTI-INFLAMMATORY
Corticosteroids

EXAMPLE
Oral
–________
–___________

A

Prednisone

Methyl prednisolone

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43
Q

ANTI-INFLAMMATORY
Corticosteroids

EXAMPLE
Intravenous
–_________
–____________

A

Hydrocortisone

Dexamethasone

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44
Q

CORTICOSTEROIDS

MECHANISM OF ACTION Binds and (blocks or stimulates?) __________

This (inhibits or stimulates?) the production of ___________

Lack of __________ leads to _________ of inflammatory mediators like ______ and ________

Thus eventually inhibiting _______

A

Blocks; PHOSPHOLIPASE A2

Inhibits; Arachidonic acid

Arachidonic acid ; reduced production

PROSTAGLANDIN; LEUKOTRIENE

INFLAMMATION

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45
Q

CORTICOSTEROIDS

Adverse effect: Inhaled Corticosteroids

______
Oropharyngeal ______ / Oral _____
_______/ Voice _________
_________ symptoms

A

Cough

candidiasis; Thrush

Dysphonia; hoarseness

Withdrawal

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46
Q

CORTICOSTEROIDS

ADVERSE EFFECT: Systemic Corticosteroids

Longgggggg

A

Cataract
Ulcers
Striae
Hypertension
Immunosuppression
Necrosis of the Head of Femur
Growth retardation
Obesity
Infection
Diabetes Mellitus
Myopathy
Adrenal suppression
Psychosis

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47
Q

LEUKOTRIENE MODIFIERS
Can be

___________ or _________

A

LEUKOTRIENE ANTAGONIST

LIPOXYGENASE INHIBITOR

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48
Q

Leukotriene Antagonist

List 3

A

Zafirlukast
Montelukast
Pranlukast

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49
Q

Lipo-oxygenase inhibitor

EXAMPLES

A

Zileuton

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50
Q

MECHANISM OF ACTION : Leukotriene Antagonist

(Reversibly or Irreversibly?) Binds and blocks LEUKOTRIENE
RECEPTORS (_______ receptors)

Prevent the action of Leukotrienes at its receptor site
Thus preventing ________

A

Reversibly

CysLT1

INFLAMMATION

51
Q

MECHANISM OF ACTION: Lipo-oxygenase Inhibitors

Binds and blocks __________

Prevent ____________ to _________
Thus preventing __________

A

5-LIPOXYGENASE

the conversion of Arachidonic acid to Leukotrienes

INFLAMMATION

52
Q

MAST CELL STABILIZERS

EXAMPLES
_________ / ________

____________

A

Cromolyn sodium

Cromoglycate

Nedocromil

53
Q

MAST CELL STABILIZERS: MECHANISM OF ACTION

Binds and ______ the MAST CELLS ______

Inhibits ________________

Thus prevents __________

A

stabilize; MEMBRANE

Mast cell degranulation

INFLAMMATION

54
Q

MAST CELL STABILIZERS: ADVERSE EFFECT

______ taste
_______ sensation
_________ congestion

A

Bitter

Burning

Nasal

55
Q

IGE MONOCLONAL ANTIBODY

EXAMPLES

A

Omalizumab

56
Q

IGE MONOCLONAL ANTIBODY: mechanism of action

Binds and blocks _________ on _____ cells

Prevents the _____________________

Thus prevents ______________ and ________

A

IGE ANTIBODY; Mast

crosslinking of Allergens to IgE

Mast cell degranulation

INFLAMMATION

57
Q

OBSTRUCTIVE PULMONARY DISEASE

Characterized by airway obstruction that is worse with ______.

A

expiration

58
Q

Most common obstructive diseases are ______,________, and _______

A

asthma, chronic bronchitis and emphysema.

59
Q

Many people have both _______ and ________ ( chronic obstructive pulmonary disease – COPD).

A

chronic bronchitis and emphysema

60
Q

Obstructive pulmonary disease

Major symptom of obstructive pulmonary disease is ______ and the unifying sign is ______.

A

dyspnoea

Wheezing

61
Q

Individuals with OPD have _____eased work of breathing, V/Q _________, and a _____eased forced expiratory volume.

A

incr

mismatching

decr

62
Q

ASTHMA

 Factor that sets it apart from COPD is its ___________.

A

reversibility

63
Q

ASTHMA

Occurs at _____ ages

approximately half of all cases develop during _______, and another 1/3 develop before age ______.

A

all

childhood

40

64
Q

ASTHMA

Morbidity and mortality still low

T/F

A

F

Morbidity and mortality still high despite increased no. and availability of antiasthma medications

65
Q

ASTHMA

 Vaso——— and increased capillary permeability.

 Chemotactic factors attract ____,______,______ to the area - _________

 Smooth muscle spasm in _____ due to ___ effect on autonomic neurons – ACh.

 Vascular _______

_______ formation

A

dilation

neutrophils, eosinophils and
lymphocytes ; bronchial infiltration.

bronchioles; IgE

congestion; Oedema

66
Q

ASTHMA
 Production of (thin or thick?) , tenacious mucus.
 Impaired ______ function.
 Thickening of _____
 _____eased bronchial responsiveness.

A

Thick

mucociliary

airway walls.

Incr

67
Q

ASTHMA

Untreated, this can lead to airway damage that is irreversible.

T/F

A

T

68
Q

SYMPTOMS OF ASTHMA
 During remission individual is ______ and pulmonary function tests are _____.
 Dyspnoea
 Severe cough
 Wheezing exhalation
 Attacks usually of _____ duration, but may be severe and continue for _______
 If bronchospasm is not reversed by usual measures, the individual is considered to have ________ or ___________ which can be life threatening.

A

asymptomatic; normal

1-2 h; days or weeks.

severe bronchospasm or status asthmaticus

69
Q

Lung function for :

Intermittent asthma
Mild persistent
Moderate persistent
Severe persistent

A

FEV1 >80%; FEV1/FVC is normal

FEV1 >80%; FEV1/FVC is normal

FEV1 60-80%%; FEV1/FVC is reduced by 5%

FEV1 <60 %; FEV1/FVC is reduced greater than 5%

70
Q

MANAGEMENT OF ASTHMA

 _____________

 Patient ___________

 Acute attacks - ________ and ________

A

Avoid triggers

education

corticosteroids and inhaled beta-agonists.

71
Q

MANAGEMENT OF ASTHMA

 Chronic management based on severity of asthma - regular use of inhaled anti-inflammatory drugs – _______,___________, or ____________

______ bronchodilators

 Immunotherapy - ————-, etc.

A

corticosteroids, chromolyn sodium or leukotriene inhibitors.

Inhaled

allergy shots

72
Q

MANAGEMENT OF ASTHMA

Bronchoconstriction may be a normal means of restricting airflow and intake of irritants and allergens.

T/F

A

T

73
Q

Long term use of antiasthmatics may actually increase exposure to these factors and cause more pronounced and chronic symptoms.

T/F

A

T

74
Q

MANAGEMENT OF ASTHMA

____________ agents have better long term effects.

A

Anti-inflammatory

75
Q

β2 AGONISTS

Examples:

List, and mention the exceptions

A

Albuterol, Bitolterol, Fenoterol,,, Procaterol, Formoterol, Salmeterol .

Metaproterenol
Isoetharine.
Ritodrine.
Salbutamol
Terbutaline

76
Q

β2 AGONISTS

Use with caution in patients with ___ disease (reduced by ____ administration)

minimal side effects → (short, long, or intermediate ?) acting.

A

CV

inhalational

intermediate

77
Q

β2 AGONISTS

PPAs:

______ of bronchial smooth muscle

________ of uterine SM

_______ of other ____ after _____ administration.

A

Relaxation

relaxation

activation; β2Rs

systemic

78
Q

β2 AGONISTS

PTUs:

_______ and __________

acute ______ (____________acting drugs)

premature labour ( _______)

prophylaxis (______ acting agents).

A

Asthma & chronic obstructive pulmonary disease

bronchospasm; short & intermediate

Ritodrine

long

79
Q

β2 AGONISTS

AEs:

______ stimulation, headache, anxiety, nausea, muscle _____, nervousness, palpitations etc.

A

Cardiac

tremors

80
Q

β2 AGONISTS

Cautious use in _____ and _____ disease.

Selective beta 2 agonists by ———- are drugs of choice.

____________ . in acute bronchoconstriction.

A

hypertension and cardiac

inhalation

Epinephrine subcutaneous

81
Q

β2 AGONISTS

 Rank order of potency:

β →______ >——. ≥ ____

α →_____ . ≥ ____ ≥ ________
.

A

Isoprenaline; Adr; NA

Adr; NA

Isoprenaline

82
Q

β2 AGONISTS

 Non-selective agonists:

Adr. (_________________)

NA (______________)

Isoprenaline (_________)

A

α1, α2, β1 , β2 , β3

α1, α2, β1&raquo_space; β2

β1 + β2

83
Q

Treatment of first choice to relieve acute asthma is ????

A

Use of beta 2 agonist short acting bronchodilator

84
Q

Formoterol and Salmeterol are long acting beta 2 adrenergic agonists used only for __________.

A

prophylaxis

85
Q

Salmeterol use in deteriorating asthma can be life- threatening.

T/F

A

T

86
Q

Metaproterenol is (short, intermediate , or long?) acting useful in _____ induced asthma and treatment of _______

A

Intermediate

exercise

acute bronchospasm.

87
Q

Indacaterol is ________-acting.

A

ultra-long

88
Q

Terbutaline - selective beta 2 adrenergic agonist that is a ____-acting bronchodilator.

A

long

89
Q

Terbutaline -

It loses selectivity when given __________.

A

subcutaneously

90
Q

________ is Also used to decrease premature uterine contractions during pregnancy besides ritodrine

A

Terbutaline

91
Q

MUSCARINIC ANTAGONISTS

________ administered via _______ for treatment of asthma and bronchitis.

A

Ipratropium

inhalation

92
Q

MUSCARINIC ANTAGONISTS

Ipratropium/salbutamol is a formulation containing _______ and _________(______) used in the management of ___________

A

ipratropium bromide

salbutamol sulphate (albuterol sulphate)

COPD and asthma.

93
Q

MUSCARINIC ANTAGONISTS

Ipratropium/salbutamol

Marketed as________ and _______

A

metered dose inhaler (MDI) and nebuliser preparations.

94
Q

Ipratropium should be used with caution in ________ and ————-

A

BPH and narrow- angle glaucoma.

95
Q

________ is another example.of a muscarinic antagonist besides ipratropoum

A

Tiotropium

96
Q

MUSCARINIC ANTAGONISTS

________________________ is the main reason for the relative lack of unwanted systemic effects.

A

Direct delivery of antimuscarinic drugs to the lung

97
Q

METHYLXANTHINES

Pharmacological actions include:

____ stimulation (including ———- stimulation)

diuresis

_________ of cardiac muscle

————- of smooth muscle especially ________ muscle.

A

CNS; respiratory

stimulation

relaxation; bronchial

98
Q

METHYLXANTHINES

Theophylline attenuate reversible airflow ______, airway ——— and airway ______.

A

obstruction

hyperresponsiveness

inflammation

99
Q

METHYLXANTHINES

 Doses that facilitate high serum levels (toxic side effects may manifest), produce ____________ effects.

A

direct bronchodilatory

100
Q

METHYLXANTHINES

Lower serum levels -

_________ effect but retains capacity as an _______________,______________,____________ drug.

A

weak bronchodilatory

immunomodulator, anti-inflammatory, and bronchoprotective

101
Q

METHYLXANTHINES

Predominant role in asthma treatment is as a controller medication for _______,__________ disease.

A

chronic, persistent

102
Q

METHYLXANTHINES

Administration - _____,______,_____,______ injection.

A

Oral, IV, inhalation and intramuscular

103
Q

METHYLXANTHINES

Inhalation has (poor or well?) bioavailability and is (well or not well?) tolerated.

Intramuscular injection is (painful or painless?) and (recommended or not recommended?) .

A

Poor

Not well

Painful ; not recommended

104
Q

METHYLXANTHINES

AEs: Have (wide or narrow?) therapeutic range, hence (low or high?) incidence of AEs.

A

Narrow

High

105
Q

METHYLXANTHINES

Mild AEs: Precautions necessary in patients with _______ disease,_______ , ______ impairment, _______thyroidism, acute ______, peptic ulcer disease, seizure disorder and _________.

A

cardiovascular

cystic fibrosis

hepatic
Hypo or hyper
Gastritis

pregnancy

106
Q

CORTICOSTEROIDS

Examples include

Mention 7

A

beclometasone dipropionate, budesonide, fluticasone propionate, hydrocortisone, prednisolone etc.

107
Q

CORTICOSTEROIDS

Inhalation: mention 5

Systemic: mention 3

A

beclomethasone, budesonide, flunisolide, fluticasone, triamcinolone.

Prednisone, methylprednisolone, and hydrocortisone.

108
Q

Most effective class of drug in the treatment of chronic asthma is ?????

A

CORTICOSTEROIDS

109
Q

CORTICOSTEROIDS

.
No ______ effect, hence of no benefit in the _____ stages of an acute attack of asthma.

A

bronchodilator

initial

110
Q

Corticosteroid are relatively ineffective in COPD.

T/F

A

T

111
Q

CORTICOSTEROIDS

Inhibit transcription of genes coding for the ______ involved in _______.

Activate _________ genes and genes linked to _______ effects (high does).

A

cytokines; inflammation

anti-inflammatory ; glucocorticoid unwanted

112
Q

CORTICOSTEROIDS

Reduce airway responsiveness to several bronchoconstrictor mediators

T/F

A

T

113
Q

CORTICOSTEROIDS

Inhibit _____________ reactions to allergen with chronic therapy.

A

both the early and late

114
Q

ANTI-INFLAMMATORY EFFECT OF CORTICOSTEROIDS

Reduced airway ______ and leucocyte recruitment by induction of ______ in vascular endothelial cells.

A

oedema

tight junctions

115
Q

ANTI-INFLAMMATORY EFFECT OF CORTICOSTEROIDS

Reduced inflammatory cell activation (including macrophages, T-lymphocytes, eosinophils and airway epithelial cells) with reduced inflammatory cytokine, chemokine, adhesion molecule and inflammatory enzyme expression.

T/F

A

T

116
Q

ANTI-INFLAMMATORY EFFECT OF CORTICOSTEROIDS

Reduced inflammatory cell recruitment to the airways (eosinophils, T-lymphocytes, mast cells etc.) through reduction in _______ and _______, and reduced cell survival (enhanced ________)

A

chemotactic mediators

adhesion molecules

apoptosis)

117
Q

ANTI-INFLAMMATORY EFFECT OF CORTICOSTEROIDS

Decreased local generation of inflammatory prostaglandins and leukotrienes due to inhibition of ___________ by _______ ( ________ ) which reduces mucosal oedema.

A

phospholipase A2 by annexin 1

lipocortin

118
Q

ANTI-INFLAMMATORY EFFECT OF CORTICOSTEROIDS

Suppression of the excess epithelial cell shedding and _______________ found in the bronchial epithelium in asthma etc.

A

goblet cell hyperplasia

119
Q

CORTICOSTEROIDS

Pharmacokinetics:Given by ______ of an aerosol or dry powder in order to minimise systemic unwanted effects.

Can be used ____ or ____ . in severe asthma.

A

inhalation

IV or p.o

120
Q

CORTICOSTEROIDS

Beclometasone dipropionate has (low or high?) rate of absorption across mucosal membranes but is (slowly or rapidly?) inactivated once it reaches the -_______ circulation.

A

IV or p.o

Low

Slowly

Systemic

121
Q

CORTICOSTEROIDS

_______ budesonide (inactivated by _____________ in the liver following _____ absorption) or fluticasone (very _______ absorbed from the gut) may be preferred if (low or high?) doses of inhaled drug are needed or for the treatment of children in whom the systemic effects can be more problematic.

A

Inhaled

extensive first-pass metabolism; oral

poorly; high

122
Q

CORTICOSTEROIDS

Unwanted effects: Inhaled corticosteroids

–________ ( ________ ), oral _______, unwanted effects with prolonged use - ____ suppression, osteoporosis and reduced ______ in children and increased risk of ______ in older people with COPD.

A

dysphonia; hoarseness

candidiasis

adrenal; growth velocity ; pneumonia

123
Q

Ketotifen is a ????

A

Mast cell stabilizer

House Pharmacology (50 decks)

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