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Case 3 > Asthma > Flashcards

Asthma Flashcards

1
Q

what is acute asthma?

A

airway obstruction/constriction due to inflammation

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2
Q

2 phases of reaction of asthma ?

A

immediate phase and late phase

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3
Q

what happens in the immediate phase?

A

bronchospasm
increased mucus production
vasodilation
release of inflammatory mediators

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4
Q

what happens in the late phase?

A

recruitment of leukocytes and t cells
further release of inflammatory mediators

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5
Q

what is chronic asthma?

A

pathological change to bronchioles long standing inflammtion

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6
Q

drugs with adverse effects in patients with respiratory disease?

A

non-selective beta blockers (propranolol)
NSAIDs

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7
Q

what do the release of inflammatory mediators (MBP and cytokines) in the late phase cause?

A

eosinophil major basic protein MBP causes epithelial damage
cytokines - amplify inflammation

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8
Q

what cells are released in sensitisation to asthma (1st exposure)?

A

activated Th2 cells release cytokines IL-4,13,5

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9
Q

what does IL-4 stimulate in sensitisation?

A

stimulates IgE release from B cells, activates mast cells

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10
Q

what does IL-13 do in sensitisation?

A

stimulates IgE mucus secretion

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11
Q

what does IL-5 do in sensitisation?

A

activates locally recruited eosinophils

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12
Q

what is the immediate response when re-exposed to antigen?

A

antigen binds to IgE-IgE receptor complex
cross-links IgE receptor
stimulates Ca2+ entry into mast cells

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13
Q

what does the entry of Ca2+ cause?

A

release of secretory granules containing histamine
release of leukotrienes LTC4 LTD4 - muscle contraction
release of chemotaxins LTB4 causing inflammation

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14
Q

the airway remodelling in chronic asthma?

A

1- increased mass of smooth muscle
2 - accumulation of fluid (oedema)
3 - increased mucus secretion
4 - exposed sensory nerve endings casue bronchial hyperresponsiveness
5 - airway narrowing increases resistance

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15
Q

what can be tested in diagnosis of asthma?

A

demonstration of obstruction with spirometry and peak flow test
eosinophil count blood test
allergy test

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16
Q

Drugs to target immediate phase bronchospasm of asthma?

A

bronchodilators
- beta2 agonists
- muscarinic antagonists
- xanthines

17
Q

how do b2 agonists work?

A

act directly on beta2 adrenoreceptor (Gs) to increase cAMP and induce muscle relaxation
decreases mucus secretion

18
Q

types and examples of b2 agonists?

A

short acting (SABA) - salbutamol 4-6hr
long acting (LABA) salmeterol 12hr

19
Q

how do muscurinic antagonists work?

A

block M3 receptor, block Gq signalling, decrease Ca2+ to dilate bronchi
block M3 mucus secretion

20
Q

types and examples of muscarinic agonists?

A

short acting (SAMA) - ipratropium
long-acting (LAMA) - tiotropium

21
Q

how do xanthines work?

A

block phosphodiesterase enzymes to increase cAMP causing muscle relaxation and bronchodilation

22
Q

example of a xanthine?

A

theophylline

23
Q

what drugs target the late phase?

A

glucocorticoids

24
Q

how do glucocorticoids work in asthma?

A

inhibit transcription of phospholipase A2 to decrease production of inflammatory mediators

25
Q

example of glucocorticoids?

A

beclomethasone - inhaler
prednisolone - oral short term
hydrocortisone - injection

26
Q

drugs to target both phases?

A

chromolyn
cysteinil leukptrien1 receptor(cys-LT1) antagonist - montelukast

27
Q

how does cromolyn work?

A

mast cell stabiliser prevents release of histamine and mediators
depresses neuronal reflexes to inhibit hyper responsiveness

28
Q

how does CysLT1 antagonist work?

A

block leukotriene induced bronchospasm
effective for mild persistent asthma

29
Q

example of CysLT1 anatagonist?

A

montelukast

30
Q

what makes salmeterol longer acting?

A

2 binding sites
binds to active site and a specific exo-site that prolongs stimulation

31
Q

where are the 2 beta receptors found?

A

B1 - heart
B2 - bronchial smooth muscle

32
Q

difference between noradrenaline/adrenaline and isoprenaline binding?

A

adrenaline - non-selective
iso - only beta-adrenoreceptors

33
Q

which isomer of salbutamol is more active?

A

R isomer
S isomer associated with toxicity

Case 3 (10 decks)

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