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pharmacology 2 > Asthma > Flashcards

Asthma Flashcards

1
Q

asthma is worse at

A

night

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2
Q

airway narrowing in asmtha is due to

A

increased thickness of airway wall
increased mucus
increased constriction of airway smooth muscle

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3
Q

increased mucus is due to

A

activation of larger submucosal glands

more goblet cells

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4
Q

reliever/rescue medications

A

beta 2 adrenoceptor agonists

rapidly reverse/prevent bronchoconstriction

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5
Q

controller medications

A

inhaled corticosteroids

suppression of airway inflammation

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6
Q

substances released within the airway wall during an ASM

A

leukotrienes and histamine
acetylcholine
neuropeptides
endothelin-1

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7
Q

leukotrienes and histamines are released from

A

activated mast cells

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8
Q

salbutamol and efermoterol

A

given by aerosol
rapidly activate beta 2 adrenoceptors located on the surface of airway smooth muscle cells, causing relaxation irrespective of the substances causing bronchoconstriction

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9
Q

short acting beta 2 adrenoceptor agonists

A 
bind to and stimulate beta 2 adrenoceptors on airway smooth muscle inducing bronchodilation irrespective of the mediator causing bronchoconstriction 
do nto inhibit inflammation 
rapid onset of action 
salbutamol, terbutaline
SABAs
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10
Q

long acting beta 2 adrenoceptor agonists

A 
salmeterol and formoterol 
long-lasting bronchodilator actions 
structure is similar to salbutamol, but has an additional lipophilic tail that binds to a second binding site on beta 2 adrenoceptors 
salmeterol and femoterol 
LABAs
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11
Q

2 SABAs

A

salbutamol and terbatuline

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12
Q

2 LABAs

A

salmeterol and formooterol

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13
Q

difference between salmeterol and formoterol

A

salmeterol is delayed onset of action and not a useful reliever
formoterol is a rapid onset of action - can be used as a reliever

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14
Q

muscarinic cholinoceptor antagonists

A

not effective relievers
eg. ipratropium bromide, tiotropium
only reverse acetyl choline induced constriction
delayed onset of action

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15
Q

leukotriene receptor antagonists

A

not effective releievers
eg. m montelukast
only reverse leukotriene induced constriction
delayed onset of action due to being given orally

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16
Q

what are salmeterol (LABA), muscarinic cholinoceptor antagonists and leukotriene receptor antagonists used for

A

add-on therapy to Beta 2 adrenoceptor agonists and inhaled corticosteroids to improve asthma control

17
Q

controller medications

A

suppress airway inflammation and provide better long term control of asthma symptoms

18
Q

SABA only treatment

A

inhibit contraction of smooth muscle but not other factors contributing to airway narrowing
associated with increased risk of asthma

19
Q

inhaled corticosteroids

A

do not relieve acute bronchoconstriction
front line therapy
reduces expression of genes and proteins that drive driive Th2/eosinophilic inflammatory response often seen in asthma

20
Q

adverse effects of ICS

A

osteoporosis, hypertension, diabetes, airway and systemic infections caused by long term use
given by inhalation to avoid side effects

21
Q

ICS example

A

fluticasone

must be given prophylactically to be effective

22
Q

clinical benefits of ICS

A

decreased airway inflammation
decreased sputum and decreased exhaled NO (marker of inflammation)
less airway narrowing
improved lung function
more symptom free days
reduction in morbidity and mortality
less hospital drugs and reduced asthma medication usage

23
Q

why is asthma sub optimally controlled

A

irregular use of inhaler medications (poor or non adherence)
incorrect inhaler technique - most patients do not use effectively
inadequate treatment of comorbidities
asthma heterogeneity - different phenotypes, some respond less well to ICS
true glucocorticoid resistance - rare

24
Q

asthma phenotype responding poorly to inhaled corticosteroids

A

neutrophilic asthma

25
Q

combination inhalers

A

combines two Classes of medicine in one inhaler

- most commonly ICS and LABA

26
Q

advantages of combination inhalers over individual inhalers

A
  • improved adherence
  • reduce iver reliance on SABA only bronchodilators
  • reduced frequency of asthma attacks
27
Q

leukotrienes

A

potent mediators of inflammation, whose production by mast cells and eosinophils is unregulated in asthma

28
Q

cysteinyl leukotrienes

A

LTC4, LTD4, LTE4

all contain cycteine residue within their structure

29
Q

leukotrienes bind to

A

CysLT1 receptors in the airways and induce airway narrowing

30
Q

LT receptor antagonists

A

block interaction of cysteine leukotrienes with CusLT1 receptor
decrease airway narrowing

31
Q

LT receptor antagonists example

A

zafirlukast, montelukast, Singulair

32
Q

monoclonal antibodies

A

to target IgE
omalizumab
humanised monoclonal antibody that targets free IgE preventing binding to the IgE receptor
used to treat uncontrolled severe allergic asthma

33
Q

limitations of omalizumab

A

expensive and given by subcutaneous injection

34
Q

other biologicals

A

mepolizumab - targets free IL-5

benralizumab - targets IL-5 receptor on eosinophil

35
Q

IL-5 cytokine

A

key cytokine in proliferation, activation and survival of eosinophils and 50% of patients with severe asthma have elevated levels of blood/sputum eosinophils

36
Q

anti IL-5/IL-5R antibodies are useful for

A

asthmatics with high blood/sputum eosinophils that continue to have asthma attacks despite high doses of ICS

37
Q

in allergic asthma, air way narrowing is due to three things

A

increased thickness of the airway wall - Th2/eosinophillic inflammation
increased mucus due to activation of larger mucus glands and more goblet cells
increased airway smooth muscle constriction

pharmacology 2 (19 decks)

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