asthma pharmacology

Question 1

what is the first line drug for acute asthma ?

Answer 1

SABA

Question 2

what is the easy memorize slang of beta 2 adrenoreceptor agonist ?

Answer 2

OL

Question 3

what are the names of beta 2 adrenoreceptor agonist?

Answer 3

SABA - sabutamol

LABA - salmeterol and formeterol (long and fast)

Question 4

what is the mechanism for beta 2 adrenoreceptor agonist ?

Answer 4

relaxation of smooth muscle
bronchodilation and opening of airways
imitate the action of adrenaline triggering sympathetic response

Question 5

what are the extra notes to take for LABA ?

Answer 5

it downregulate the beta 2 receptor

MUST always take with corticosteroid

Question 6

what are the adverse effect of beta2 adrenoreceptor agonist ?

Answer 6

tremors (most common) 
muscle cramps 
peripheral vasodilation (flushing, palpitations,tachycardia)
hypokalemia 
hypertension

Question 7

what is the route of beta 2 adrenoreceptor agonist ?

Answer 7

usually by inhalation but oral when cannot use inhaler
IV in emergency

for epinephrine : IV/ SC in emergency

Question 8

what is the second line of drugs for acute asthma?

Answer 8

SAMA, add on if beta 2 agonist is not producing not enough bronchodilation or can completely replace it too if they cannot use beta 2

Question 9

what is the easy name for muscurinic receptor antagonist ?

Answer 9

tropium

Question 10

what are the medication names of muscarinic receptor agonist ?

Answer 10

SAMA ipratropium

LAMA tiotropium

Question 11

what is the mechenism of muscarinic receptor antagonist ?

Answer 11

inhibit ACH from causing vasoconstriction

inhibit m3 mediated bronchoconstriction

Question 12

what are the adverse effect of muscurinic receptor antagonist ?

Answer 12

unpleasant taste
parasympathetic effect like dry mouth and urinary retention (esp in elderly)

not well absorbed there fore little sideeffects

Question 13

what are the second class of bronchodilation medication for asthma?

Answer 13

methylxanthines

and leukotriene receptor antagonist , cyslt receptor antagonist (also anti inflammatory)

Question 14

what is the easy name for methylxanthines ?

Answer 14

phylline

Question 15

what are the uses of methylxanthines (phyllines) ?

Answer 15

as a add on bronchodilator

less effective than beta 2 agonist

Question 16

what is the mechanism of methylxanthines ? (phylline)

Answer 16

1. inhibit phosphodiesterase (PDE) for cyclic AMP to accumulate and cause bronchodilation
2. block adenosine receptor , block bronchodilation)
3. increase adrenaline release

has some anti inflammatory effects

Question 17

what are the adverse effect of methylxanthines ? (phylline)

Answer 17

1. narrow theraputic window
2. many drug drug interactions
3. gi discomfort
4. CNS nervousness, tremor anxiety
5. cns arrhythmia

Question 18

what is the easy name for leukotrine receptor antagonist (cyslt reecptor antagonist)

Answer 18

KAST

Question 19

what are the uses for leukotrine receptor antagonist (cyslt reecptor antagonist)?

Answer 19

add on for mild to moderate asthma 
weak bronchodilator 
mild asthma 
aspirin sensitive asthma 
exercise induced asthma

Question 20

what is the mechenism for leukotrine receptor antagonist (cyslt reecptor antagonist)?

Answer 20

prevent the formation of LTE which causes asthma

• decreases frequency of acute asthma
• reduce the need for beta 2 agonist
• decrease peripheral eosinophil level

Question 21

what is the adverse effect for leukotrine receptor antagonist (cyslt reecptor antagonist)?

Answer 21

upper respiratory infection

Question 22

what are the anti inflammatory medication used for?

Answer 22

preventer

Question 23

what is the first line drug for anti inflammatory?

Answer 23

glucocorticoid , corticosteroid

Question 24

what are the medication for glucocorticoid and corticosteroid?

Answer 24

budesonide
flutasone (can cause the body to stop producing corticosteroid)
ciclesonide (soft steroid,requires esterase actication and only work in the lungs )

Question 25

what are the mechenism of glucocorticoids ?

Answer 25

prevent asthma and nocturnal asthma 1. inhibit many inflammation associated molecules 2. anti inflammatory mediators are often upregulated 3. activate beta 2 receptors

Question 26

what are the adverse effect of glucocorticoids?

Answer 26

rare due to limited systemic absorption 1. oropharyngeal irritation 2. dysphonia (enfeebled voice due to msucle wasting) 3. cough 4. adrenosupression 5. easy bruising 6. cataracts 7. osteoporosis

Question 27

what is the route for glucocorticoid ?

Answer 27

via inhalation due to higher bidning affinity can be administered IV in acute asthma attack but must be early as onset of action is slow

Question 28

what are some extra notes of glucocorticoids ?

Answer 28

1. do not relax the smooth muscles 2. it ddecreases the airway hyper responsiveness in 4-6 weeks od using the drug 3. decrease frequency of asthma attacks 4. reduce the need for beta 2 agonist 5. reduce the death from asthma 6. improve lung fucntion

Question 29

what is the second line of drug for anti inflammatory ?

Answer 29

leukotrience pathway inhibitors 1. 5 lox inhibitor (zileuton) 2. montelukast ( cyst receptor antagonist), also a weak bronchodilator

Question 30

what are the uses of the anti inflammaotry drug leukotrine pathway inhibitor ?

Answer 30

``` second line ADD on if ICS is not enough or can be replaced in children or if asthma is mild can be replaced ``` for chronic treatment of asthma aspirin induced asthma exercise induced asthma

Question 31

what is the mechanism of leukotrine pathway inihbitor? (anti inflammatory)

Answer 31

1. inhibit bronchoconstriction 2. decrease frequency of asthma attack 3. decrease need for ICS and beta agonsit 4. decrease peripheral eosinophil level

Question 32

what are the adverse effect of leukotrine pathway inhibitors (anti imflammatory)?

Answer 32

churg straus syndrome (rapid withdrawal of glucocorticosteroid) suicidal thinking

Question 33

what is the route for leukotrine pathway inhibitors ?

Answer 33

oral only

Question 34

what medication is good for allergic asthma ?

Answer 34

mast cell stabilizer (cromoglicic acid) taken before allergic and exercise induced bronchospasm it decreases the need for beta agonist and need for bronchodilator therapy less effective than glucocorticoid response varies in patients

Question 35

what is the mechanism of mast cell stabilizer?

Answer 35

1. prevent lge mediated allergic granulation events 2. decrease release of histamine 3. decrease seecretion of inflammatory mediators 4. increase secretion of annexin A1 , anti inflammatory

Question 36

what are the adverse effect of mast cell stabalizer?

Answer 36

throat and nasal irritation mouth dryness cough unplesant tase

Question 37

what is the route of mast cell stabalizer

Answer 37

only inhalation

Question 38

what is the antibody medication used for allergic asthma/

Answer 38

anti -lgE monoclonal antibody for severe allergic asthma with an elevated LgE level (s/C route, every 2-4 weeks )

Question 39

what is the mechenism for anti LgE ?

Answer 39

- decreases the level of LgE in serum | - decreases mast cell degranulation

Question 40

what are the adverse effect of anti- lgE medication

Answer 40

small increase risk of heart attack blood clots body can make antibody against this expensive

Question 41

what is the antibody medication for eosinphilic asthma ?

Answer 41

anit iL 5 (reslizumab) | anti iL 4 for mixed asthma (dupilumaab)

Question 42

what is the use for antiiL 5 drug ?

Answer 42

only for eosinophilic asthma for people above 18 | L5 specific

Question 43

what are the adverse effect of anti iL 5 ?

Answer 43

oropharyngeal pain | potential for anaphylaxis

Question 44

what is the route for IL5 ?

Answer 44

IV once ever 4 weeks, expensive

Question 45

for severe acute asthma (emergency) what drug should be used?

Answer 45

magnesium sulfate (relaxes smooth muscle of the airway moderate release of acetylcholine and histamine anti inflammatory effect)