Asthma

Question 0

2nd generation histamine

Answer 0

Certirizine
Loratidine
Fexofenadine
Long QTc Syndrome (off market)
Astemizole
Terfenadine

Question 1

1st generation histamine

Answer 1

Diphenhydramine
Chlorpheniramine
Hydroxyzine
Meclizine
Cyclizine

Question 2

Effects of Leukotrienes

Answer 2

• BRONCHOCONSTRICTION
• EDEMA
• MUCUS PRODUCTION
• INHIBIT MUCOCILIARY TRANSPORT
• BRONCHIAL HYPERREACTIVITY

Question 3

Kallikreins and kinins

Answer 3

Pain – intense burning pain causing release of Substance P and Calcitonin gene-related peptide
Inflammation – including edema and vascular permeability
Bronchoconstriction
Increased renal blood flow
Stimulates tPA production

Question 4

Leukotrienes….

Answer 4

• 5-LIPOXYGENASE
• CHEMOATTRACTANT
• BRONCHOCONSTRICTION
• MUCUS SECRETION
• LT B4, LT C4, LT D4

Question 5

Properties of cytokines

Answer 5

Small PEPTIDES OR GLYCOPROTEINS
Picomolar CONCENTRATIONS
Increase 1000-FOLD
Many DIFFERENT CELL TYPES
Interleukin, INTERFERON, ETC

Question 6

Chemokins

Answer 6

• PEPTIDES (70-90 AMINO ACIDS)
• ALPHA (C-X-C) - NEUTROPHIL ACTIVATORS
• BETA (C-C) - ACTIVATORS OF MONOCYTES, LYMPHOCYTES, BASOPHILS AND EOSINOPHILS
• TARGETS OTHER CELLS

Question 7

Functions of Epithelial cells

Answer 7

• INVOLVED IN INFLAMMATORY PROCESS
• RELEASES MEDIATORS: NO, PGE2, 15-HETE, ARACHIDONIC ACID
• CYTOKINES: GMCSF, IL-8, RANTES (CCL-5), EOTAXIN (TH-2)

Question 8

Chemoattractants

Answer 8

• EOTAXIN - EOSINOPHILS
• C5a, LT-B4, PAF - NEUTROPHILS
• BETA-CHEMOKINES (RANTES, IL-8, MIP)

Question 9

Immune cell synthesis

Answer 9

• HGMCSF stimulates Granulocytes, Macrophages, RBCs, Eosinophils
• IFN & IL-2 stimulate Macrophages and B-cells (TH1)
• IL-4 & IL-5 stimulate B-cells and Eosinophils (TH2)
• IL-3 stimulates Mastocytes and increases their half-life; also increases IgE synthesis and expression

Question 10

Treatment for asthma

Answer 10

• BETA2 AGONISTS
• METHYLXANTHINES
• ANTI-CHOLINERGICS
• CORTICOSTEROIDS
• LEUKOTRIENE INHIBITORS
• MASTOCYTE STABILIZERS
• ANTI-IgE THERAPY

Question 11

Beta agonist

Answer 11

•ALBUTEROL
•METAPROTERENOL
•SALMETEROL
•FORMOTEROL
•ISOPROTERENOL
•PIRBUTEROL
•RITODRINE
•TERBUTALINE
•EPINEPHRINE
*Salmeterol and formoterol are long-acting ligand

Question 12

Methylxanthines

Answer 12

• AMINOPHYLLINE
• THEOPHYLLINE
• INCREASE cAMP by preventing breakdown
• INHIBIT ADENOSINE RECEPTORS
• Toxicity – can cause arrhythmias, tremors, tachypnea

Question 13

Anticholinergics

Answer 13

• IPRATROPIUM
• TIOTROPIUM
• BEST CHOICE FOR BETA-BLOCKER INDUCES ASTHMA
• SIDE EFFECTS: Dry mouth, Tachycardia, Increased IOP, Mydriasis, Constipation, etc.

Question 14

Corticosteroids

Answer 14

• INHIBITS INFLAMMATION
• INHIBITS PRODUCTION OF CYTOKINES, PGs, LTs
• POTENTIATES BETA AGONISTS
• LONG DURATION
• MANY SIDE EFFECTS

Question 15

Leukotriene inhibitors

Answer 15

• ZILEUTON - Inhibits Lipoxygenase. Metabolized by CYP3A4, 2C9, 1A2. Decreases clearance of propranolol, warfarin, theophylline, etc.
• ZAFIRLUKAST - Antagonist of LT D4 Receptor
• MONTELUKAST - Antagonist of LT D4 Receptor

Question 16

Mast cell stabilizer

Answer 16

• CROMOLYN
• NEDOCROMIL
• PROPHYLAXIS
• PREVENT ANTIGEN AND EXERCISE INDUCED ASTHMA
• INHIBITS CHLORIDE ION CHANNELS

Question 17

Omalizunab

Answer 17

Recombinant Humanized Monoclonal Antibody – IgG
Binds to IgE and prevents them from binding and activating mast cells and basophils
Decreases steroid use for asthma treatment
Elimination t½ = 26 days
Side Effects minimal

Question 18

COPD

Answer 18

Treatment includes bronchodialtors, steroids, anticholinergic agents
Chronic progressive disease