asthma pharmacology

Question 1

what is the first step in asthma treatment?

Answer 1

as needed saba

Question 2

what is second step in asthma treatment?

Answer 2

low dose inhaled corticosteroid and as needed saba

Question 3

what is the third step in asthma treatment?

Answer 3

low dose ics and laba

Question 4

what is the fourth step in asthma treatment?

Answer 4

med/high ics/laba
add tiotropium
add leukotrine receptor antagonist

Question 5

list some bronchodilating drugs

Answer 5

selective beta 2 adrenoceptor agonists
-salbutamol (short acting)
-formoterol, salmeterol (long acting)
inhaled but can be iv

anticholinergic/muscarinic receptor antagonists
-ipratropium (short acting)
- tiotropium (long acting)
inhaled

Question 6

how does salbutamol work?

Answer 6

stimulates b2 adrenergc receptors on smooth muscle
activation of adenyl cyclase
atp –>camp
high levels of camp relax bronchial smooth muscle and inhibits release of bronchoconstrictor mediators (eg histamine, leukotriene) from mast cells

Question 7

how long does salbutamol take to work?

Answer 7

inhaled:
3-5 mins
peaks at 15-20 mins

oral:
peak 2 hours after intake

overall: 4-6 hours total

Question 8

how do anticholinergic/muscarinic receptor antagonists work?

Answer 8

block ACh release from cholinergic parasympathetic nerve fibres
prevent bronchial smooth muscle contraction
prevent mucus hypersecretion

Question 9

which is more effective anticholinergic/muscarinic receptor antagonists of b2 andrenoceptor agonists?

Answer 9

b2 adrenoceptor agonists

Question 10

what are some side effects of anticholinergic/muscarinic receptor antagonists?

Answer 10

dry mouth
palpitations
headache
dizziness
blurred vision

Question 11

how do corticosteroids work?

Answer 11

reduce infiltration and activation of eosinophils, th2 cells and othe rinflammatory cells.

Question 12

what are the benefits of corticosteroids?

Answer 12

reduce asthma symptoms
increase lung function
reduce risk of exacerbation

Question 13

what are some side effects of long term corticosteroid use?

Answer 13

obesity, diabetes, cataracts, refluc, glaucoma, osteoporosis, skin disease, psychiatric

Question 14

give an example of an oral corticosteroid?

Answer 14

prednisolone

Question 15

higher eosinophil count = ______ risk of exacerbation

Answer 15

higher

Question 16

which cells are granulocutes, which degranulate in the lungs and release toxins, but also deal with parasitic infection?

Answer 16

eosinophils

Question 17

give an example of a long acting inhaled corticosteroid

Answer 17

fluticasone furoate

Question 18

why is fluticasone furoate suitable as a once dailly ics?

Answer 18

has enhanced affinity for glucocorticoid recptor
fast association and slow dissociation
longer duration of action , prolonged retention in lung

Question 19

what are leukotriene receptor antagonists?

Answer 19

eg montelukast
group of arachidonic acid derived inflammatory mediators
competetive antagonist of cyslt1 receptor, which mediates bronchocontstrictive and proinflam effects of cysteinyl leukotrienes

Question 20

which groups of patients are ltras used in?

Answer 20

paeds - contain no steroids

aspirin related exacerbatory disease (have increased cysteinyl leukotreine)

Question 21

what are side effects of ltras?

Answer 21

headache, gi disturbances

Question 22

what is the function of IL4?

Answer 22

tells B cells to produce IgE which cross links on mast cells

Question 23

What is the function of IL13?

Answer 23

airway hyperresponsiveness and mucus secretion

Question 24

what is the function of IL5?

Answer 24

causes production and release of eosinophils from the bone marrow

Question 25

how do dendetic cells work?

Answer 25

long protrusions between epithelial cells sample environment
present antigens to naive t cells in lymph glands
polarise to th2 cells and produce IL4, IL5 and IL13

Question 26

what is omalizumab?

Answer 26

anti IgE, effective in allergic patients. reduces allergen induced mast cells activation. decreases exacerbations, esp due to viruses. restores impaired interferon production.

Question 27

Which drug is anti-IL5 and thus reduces eosinophil production?

Answer 27

mepolizumab

Question 28

what does benralizumab do?

Answer 28

block IL5 receptors on eosinophils.

Question 29

which cytokines control viral infection?

Answer 29

interferons, esp type 1 and type 3

Question 30

what are some actions of interferons?

Answer 30

block viral entry into cells
control viral replication in cells
induce apoptosis
induce other cytokines