Asthma

Question 1

Immune cells involved in immediate phase asthma

Answer 1

Mast cells which produce spasmogens (histamine PGD2 etc)

Question 2

Immune cells involved in late phase asthma

Answer 2

TH2 cells activate eosinophils

Question 3

Immediate phase asthma treatments

Answer 3

Bronchodilators (salbutamol, salmeterol)
CycLT1 receptor antagonists (zafirlukast, montelukast)
Cromoglicate
Nedocromil

Question 4

Late phase treatment

Answer 4

Inhaled glucocorticoids

Oral glucocorticoids

Question 5

Beta-2 agonists types

Answer 5

Long acting salmeterol

Short acting salbutamol/terbutaline

Question 6

Beta-2 agonist MOA

Answer 6

Binds to cause smooth muscle relaxation and bronchodilation

Question 7

beta-2 agonist SE

Answer 7

Tremor, nervous tension, tachycardia but all rare when given by inhalation

Question 8

Muscarinic antagonist MOA

Answer 8

Atropine/ipratropium inhibit ACh bronchoconstriction

Question 9

Xanthines MOA

Answer 9

Theophylline is an oral PDE-4 inhibitor, which breaks down cAMP which is needed for bronchodilation in smooth muscle

Question 10

Xanthines SE

Answer 10

Nausea, headache, insomnia, GI discomfort

Question 11

Why do NSAIDs cause asthma

Answer 11

Leukotrienes made instead of prostaglandins as arachidonate precursor in excess

Question 12

FLAP inhibitors MOA

Answer 12

Zileuton is 5-lipoxygenase inhibitor which blocks arachidinic acid conversion to LTA4

Question 13

Leukotriene receptor antagonist MOA

Answer 13

Zafirlukast, Montelukast block leukotriene receptor to reduce LT bronchoconstricor and inflammatory effects

Question 14

SAIDs used in

Answer 14

Main therapy for moderate-severe asthma, inhalation first then for more severe oral if necessary

Question 15

Inhaled SAIDs

Answer 15

Beclometasone/budesonide

Question 16

Oral SAIDs

Answer 16

dexamethasone, prednisonlone

Question 17

Cromoglicate/Nedocromil MOA

Answer 17

Inhaled mast cell stabiliser and T cell inhibitor, prophylactic only but less effective than inhaled corticosteroid prophylaxis

Question 18

Omalizumab MOA

Answer 18

Anti-IgE antibody, prevents cross-linking which leads to degranulation

Question 19

Omalizumab downsides

Answer 19

Expensive, variable results (works in limited number of patients)