Anti-asthma drugs

Question 1

List the asthma controllers (Prevention of recurrent attack via anti-inflammatory properties)

Answer 1

1. ICS: Fluticasone
2. Inhaled Na cromoglycate
3. Leukotriene receptor antagonist (LTRA): Montelukast
4. Anti-IgE mAb: Omalizumab
5. Anti-IL-5/5R mAb: Mepolizumab, Benralizumab
6. Anti-IL-4R mAb: Dupilumab

Question 2

List the asthma relievers (Reversal of airway constriction via bronchodilation)

Answer 2

1. SABA (4-6h): Salbutamol
2. LABA (12h): Salmerterol, Formoterol
3. LABA (24h) for COPD: Indacaterol
4. Theophylline
5. SAMA (3-5h): Ipratropium bromide
6. LAMA (24h): Tiotropium bromide

Question 3

Drugs for COPD?

Answer 3

1. Theophylline
2. Indacaterol
3. Tiotropium bromide

Question 4

What is the MOA of ICS?

Answer 4

Anti-inflammatory effects:

1. Decrease circulating T cells, mast cells, macrophages and eosinophils in the airways (chronic airway inflammation is highly eosinophilic)
2. Decrease shedding of epithelial cells (which irritates airways)
3. Decreases plasma exudation/mucus secretion
4. Decrease cytokines and proteases, leading to decrease inflammation and promotion of resolution
5. Increases B2 adrenoreceptors on airway smooth muscle; Promotes bronchodilation

Question 5

What is a danger of long term use of LABA?

Answer 5

Chronic use of LABA causes tolerance due to downregulation of B2 adrenoreceptors; Should be used in combination with ICS, which increases B2 adrenoreceptors on airway smooth muscle

Question 6

MOA of LTRA Montelukast?

Answer 6

Competitive antagonist against CysLT1 receptor; Binding of Montelukast to the receptor reduces the binding of leukotrienes to the receptor, leading to decrease risk of asthma

Question 7

MOA of Theophylline?

Answer 7

Theophylline competitively inhibits phosphodiesterase (PDE), the enzyme responsible for breaking down cyclic AMP in smooth muscle cells, possibly resulting in bronchodilation

Question 8

MOA of muscarinic antagonists?

Answer 8

Inhibit M3 receptor induced bronchoconstriction (it is still less effective as a bronchodilator than B2 agonists)

Question 9

MOA of muscarinic antagonists?

Answer 9

Inhibit M3 receptor induced bronchoconstriction (it is still less effective as a bronchodilator than B2 agonists)

Question 10

Which drug is used as 1st line prophylactic agent in asthma therapy?

Answer 10

Inhaled corticosteroids

Question 11

What drug is used for treatment of aspirin-induced asthma ?

Answer 11

Montelukast (LTRA)