B2 W2 - Pharmacology of Airway Disease Flashcards

1
Q

What is the immediate phase of asthma characterised by, and what causes it?

A

The immediate phase of asthma is characterised by episodes of bronchospasm, brought on by allergen triggers.

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2
Q

How can drugs target the immediate phase of asthma?

A

Drugs can alleviate the immediate phase by affecting lung smooth muscle function and targeting receptors on mast cells involved in allergen responses.

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3
Q

What characterises the late phase of asthma?

A

The late phase of asthma involves a more profound involvement of immune cells recruited to the lung due to chronic inflammation.

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4
Q

What types of drugs can alleviate the late phase of asthma?

A

Drugs that target the immediate phase can also help with the late phase, along with corticosteroids, which can modify immune system responses to reduce inflammation and bronchospasm.

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5
Q

What are the three main pharmacological strategies for managing chronic airway diseases?

A

The strategies involve
targeting
* nervous system control of airway constriction
* airway hyper-responsiveness,
* chronic inflammation in the lung.

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6
Q

What is the primary mechanism for promoting bronchodilation directly?

A

Bronchodilation can be directly promoted by targeting the smooth muscle cells that control airway diameter.

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7
Q

What are three ways drugs can target smooth muscle cells to promote bronchodilation?

A
  1. Activate beta-two adrenergic receptors (β2-Adrenergic Agonists)
  2. Target acetylcholine responses (Anti-muscarinic drugs)
  3. Affect adrenergic responses (Methylxanthines.)
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8
Q

How can drugs target the immunological aspects of airway diseases?

A

Drugs like corticosteroids and leukotriene receptor antagonists can reduce tissue inflammation and modulate inflammatory responses.

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9
Q

What acronym is useful for remembering the steps in emergency asthma care?

A

“OMG SHIT”

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10
Q

What does the “O” in “OMG SHIT” represent, and what is its purpose?

A

“O” stands for oxygen, which is the first step in emergency asthma care to address the patient’s immediate need for oxygen.

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11
Q

What does the “S” in “OMG SHIT” represent, and how is it administered?

A

“S” stands for salbutamol, a beta-two agonist drug often administered intravenously in emergencies to promote bronchodilation.

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12
Q

What does the “H” in “OMG SHIT” represent, and what is its function?

A

“H” stands for hydrocortisone, a corticosteroid drug used to reduce inflammation and help restore airway function.

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13
Q

What does the “I” in “OMG SHIT” represent, and what type of drug is it?

A

“I” stands for ipratropium, an anti-muscarinic drug that helps to relax the airways.

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14
Q

What does the “T” in “OMG SHIT” represent, and how is it considered in treatment?

A

“T” stands for theophylline, a methylxanthine drug that is a potent but last resort treatment for severe cases.

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15
Q

What additional treatment, not included in the acronym, can be used in emergency respiratory care?

A

Magnesium sulphate (Mg) can also be used, and its abbreviation conveniently fits into the acronym.

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16
Q

What distinguishes the different phases of asthma?

A

The severity of the pathology

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17
Q

What is the immediate phase of asthma characterised by?

A

The immediate phase involves episodes of bronchospasm caused by allergen triggers.

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18
Q

What types of drugs can target the immediate phase of asthma?

A

Drugs that affect lung smooth muscle function and target receptors on mast cells involved in allergen responses can target the immediate phase.

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19
Q

How is the late phase of asthma different from the immediate phase?

A

The late phase involves a more significant influx of immune cells to the lungs due to chronic inflammation and progressive lung changes.

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20
Q

What drugs can alleviate the late phase of asthma?

A

Drugs used for the immediate phase and corticosteroids, which modify immune system responses, can alleviate the late phase.

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21
Q

What is the role of glucocorticoids in treating airway diseases?

A

To modify immune system responses to reduce inflammation and bronchospasm in the lungs.

Often used interchangeably with corticosteroids

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22
Q

How do leukotriene receptor antagonists function in treating airway diseases?

A

Leukotriene receptor antagonists work by modulating some of the immunological and inflammatory responses in the lungs.

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23
Q

What does the acronym ‘SABA’ stand for, and what is an example of this drug class?

A
  • SABA stands for short-acting beta-agonist
  • E.g Salbutamol.
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24
Q

What is the mechanism of action of a SABA?

A

SABAs promote bronchodilation by activating beta-two adrenergic receptors on airway smooth muscle cells.

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25
Q

What is a potential side effect of SABAs?

A

Tremor

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26
Q

What does the acronym ‘LABA’ stand for?

A

LABA stands for** Long-Acting Beta-Agonist.**

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27
Q

Provide an example of a LABA.

A

Salmeterol

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28
Q

What is the mechanism of action of an anti-muscarinic drug for airway disease?

A

Anti-muscarinic drugs block acetylcholine receptors on airway smooth muscle, preventing bronchoconstriction.

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29
Q

What is a common example of an anti-muscarinic used for airway disease?

A

Ipratropium bromide

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30
Q

What is a potential side effect of ipratropium bromide?

A

Dry mouth.

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31
Q

What is the mechanism of action of methylxanthines in treating airway disease?

A

Methylxanthines affect the adrenergic responses in bronchial smooth muscle cells, leading to bronchodilation.

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32
Q

What is the main methylxanthine used in treating airway disease?

A

Theophylline

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33
Q

What are two potential side effects of theophylline?

A

Nausea and tachycardia.

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34
Q

What is the mechanism of action of corticosteroids in treating airway disease?

A

Reduce tissue inflammation in the airways.

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35
Q

Provide an example of a commonly used corticosteroid in airway disease.

A

Beclomethasone

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36
Q

What is a potential side effect of inhaled corticosteroids?

A

Oral thrush

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37
Q

What is the mechanism of action of leukotriene receptor antagonists?

A

Leukotriene receptor antagonists **block **the action of leukotrienes, which are inflammatory mediators.

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38
Q

Provide an example of a leukotriene receptor antagonist.

A

Montelukast

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39
Q

Which branch of the nervous system predominantly influences smooth muscle function in the lungs?

A

Sympathetic nervous system.

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40
Q

What is another name for the sympathetic nervous system?

A

The sympathetic nervous system is also known as the **“fight or flight” **system.

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41
Q

What are the nerve fibres associated with the sympathetic nervous system called?

A

Adrenergic nerve fibres.

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42
Q

What is the primary neurotransmitter involved in the sympathetic nervous system’s influence on the lungs?

A

Noradrenaline.

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43
Q

What is the primary effect of sympathetic responses in the lungs?

A

Sympathetic responses primarily cause bronchodilation, widening the airways to enhance airflow into the lungs.

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44
Q

What is the parasympathetic nervous system often associated with?

A

It is associated with “rest and digest” responses.

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45
Q

What is the primary neurotransmitter of the parasympathetic nervous system?

A

Acetylcholine is the primary neurotransmitter, acting through cholinergic nerve fibres.

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46
Q

What is the typical effect of parasympathetic responses on the airways?

A

Parasympathetic responses generally lead to bronchoconstriction, narrowing the airways.

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47
Q

Which neurotransmitter and type of nerve fibre primarily mediate parasympathetic responses in the lungs?

A

The parasympathetic nervous system primarily uses **acetylcholine **and cholinergic nerve fibres.

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48
Q

How do the sympathetic and parasympathetic nervous systems interact in regulating airway diameter?

A

The parasympathetic nervous system often works alongside and in opposition to the sympathetic nervous system, reversing the bronchodilation effect after a predominant sympathetic response.

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49
Q

What is the key component of Beta 2 agonist action in the lungs?

A

The key component is the Beta 2 adrenergic receptor found on lung smooth muscle cells.

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50
Q

What is the role of Beta 2 agonists in relation to the Beta 2 adrenergic receptor?

A

Beta 2 agonists, such as salbutamol or salmeterol, act as stimulants, activating the Beta 2 adrenergic receptor.

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51
Q

What are the natural agonists for the Beta 2 adrenergic receptor?

A

Noradrenaline and adrenaline

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52
Q

What is the purpose of introducing a pharmacological agent like salbutamol?

A

Introducing salbutamol enhances and drives the adrenergic response in the lungs.

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53
Q

What intracellular change occurs upon salbutamol binding to the Beta 2 adrenergic receptor?

A

It leads to an increase in the concentration of cyclic AMP (cAMP) inside the cell.

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54
Q

What is the function of cyclic AMP?

A

Cyclic AMP, a small intracellular mediator, acts to reduce cytoplasmic calcium levels and, consequently, smooth muscle contraction.

55
Q

What is the ultimate outcome of Beta 2 agonist action on smooth muscle?

A

It promotes smooth muscle relaxation, leading to enhanced airway dilation and improved airflow.

56
Q

What enzyme is activated by the rise in cyclic AMP concentration?

A

Protein kinase A

57
Q

How does protein kinase A contribute to smooth muscle relaxation?

A

It affects muscle physiology and calcium balance within the cell, favouring relaxation.

58
Q

How is cyclic AMP inactivated?

A

By phosphodiesterase enzyme

59
Q

What are the two main types of Beta 2 agonists and their duration of action?

A
  • Salbutamol is a short-acting Beta 2 agonist
  • Salmeterol is a longer-acting one.
60
Q

On which cells do Beta 2 agonists act?

A

They act on bronchial smooth muscle cells.

61
Q

What is the molecular target of Beta 2 agonists?

A

Their molecular target is the Beta 2 adrenergic receptor, which they stimulate.

62
Q

How do Beta 2 agonists affect calcium ions in smooth muscle cells?

A

Through protein kinase A activation, they drive calcium ions into storage vesicles, away from the contractile machinery of the muscle.

63
Q

What are two key side effects of Beta 2 agonists? Why might these side effects occur?

A
  • Tremor and tachycardia (increased heart rate)
  • These drugs promote a sympathetic (“fight or flight”) response, which can affect the cardiovascular system and muscle tone throughout the body.
64
Q

On what cell type do methylxanthines act?

A

Bronchial smooth muscle cells

Similar to beta-2 agonists.

65
Q

How do methylxanthines differ in their mechanism from beta-2 agonists?

A

Unlike beta-2 agonists, which stimulate the beta-2 adrenergic receptor, methylxanthines block the phosphodiesterase enzymes that break down cyclic AMP.

66
Q

What is the effect of methylxanthines on cyclic AMP levels?

A

Sustain cyclic AMP levels in smooth muscle cells, leading to prolonged muscle relaxation.

67
Q

What are the administration routes for methylxanthines?

A

Orally as tablets or intravenously in acute asthma cases.

68
Q

Why do methylxanthines have to be used with particular care intravenously?

A

Intravenous administration of methylxanthines carries a risk of serious side effects but can also be life-saving in emergency situations.

69
Q

What are the key side effects associated with methylxanthines? Why?

A

Due to their enhancement of the sympathetic response, methylxanthines can cause cardiac arrhythmias and, in severe cases, seizures.

70
Q

At what point in the adrenergic response pathway do methylxanthines act?

A

Methylxanthines inhibit the breakdown of cyclic AMP, sustaining the adrenergic response and promoting smooth muscle relaxation.

71
Q

What is the specific muscarinic receptor associated with lung smooth muscle cells?

A

The M3 muscarinic receptor is particularly associated with lung smooth muscle cells.

72
Q

Do lung smooth muscle cells express other receptors besides the M3 muscarinic receptor?

A
  • Yes
  • They also express beta-2 adrenergic receptors.
73
Q

What is the typical effect of acetylcholine on lung smooth muscle via the M3 muscarinic receptor?

A

Acetylcholine binding to the M3 receptor triggers events leading to an increase in inositol triphosphate (IP3), ultimately causing smooth muscle constriction and bronchial constriction.

74
Q

How do anti-muscarinic drugs affect the M3 muscarinic receptor?

A

Anti-muscarinic drugs, like tiotropium, act as antagonists, blocking and silencing the M3 receptor.

75
Q

What is the effect of anti-muscarinic drugs on IP3 production and calcium release?

A

By blocking the M3 receptor, anti-muscarinic drugs reduce the production of IP3 and the **release **of calcium into the cytoplasm, ultimately inhibiting bronchial constriction.

76
Q

What is the overall effect of anti-muscarinic drugs on bronchial smooth muscle?

A
  • promote bronchodilation
  • By inhibiting the pathways that would normally lead to bronchial constriction.
77
Q

Name examples of short-acting and long-acting anti-muscarinic drugs.

A
  • Ipratropium is a short-acting example
  • Iotropium and glycopyrronium are long-acting.
78
Q

What is the primary target cell for anti-muscarinic drugs in the context of airway disease?

A

The target cell is the bronchial smooth muscle cell.

79
Q

What is their specific molecular target?

A

They target the M3 muscarinic acetylcholine receptor.

80
Q

What is the most common side effect of anti-muscarinic drugs used in airway disease?

A

Dry mouth

81
Q

What is the impact of immune system dysfunction or the build-up of inflammatory responses in the lungs?

A

Damage and respiratory disease.

82
Q

In asthma, what kind of immune response is triggered by substances like allergens and pollen?

A

Abnormal hypersensitive immune responses

83
Q

Which cells are activated by allergens in conditions like asthma?

A

Mast cells and eosinophils

84
Q

What effect do mediators released from activated mast cells have on the airways?

A

They can cause bronchospasm and worsen immune reactions.

85
Q

What can infiltrates of lymphocytes (like T cells) lead to in chronic respiratory diseases?

A

A chronic inflammatory state in the lungs, potentially leading to tissue remodelling and destruction, and reduced lung function.

86
Q

Apart from bronchospasm, what other effect do mediators from mast cells have on immune reactions in conditions like late-phase asthma and COPD?

A

They augment (increase or worsen) further immune reactions.

87
Q

What is a key consequence of a chronic inflammatory state in the lungs, particularly in relation to lung tissue?

A

Can give rise to pathological tissue remodelling and destruction.

88
Q

What is the overall impact of chronic inflammation on lung function?

A

Reduction in overall lung function.

89
Q

What opportunity does the immune system’s involvement in airway disease provide from a pharmacological perspective?

A

It presents pharmacological targets that can be used to reduce the inflammatory burden and alleviate disease.

90
Q

What are leukotrienes?

A

Leukotrienes are lipid-based signalling molecules that have various effects throughout the body, particularly in the lungs.

91
Q

What is the function of leukotriene receptors (LTRs)?

A

LTRs are receptors found on immune and smooth muscle cells that transduce intracellular signals in response to the presence of leukotrienes.

92
Q

What effect do leukotriene receptors on bronchial smooth muscle cells have?

A

They stimulate an increase in IP3, leading to bronchial constriction.

93
Q

What is eosinophil chemotaxis, and how is it related to leukotriene receptors?

A
  • Eosinophil chemotaxis is the movement and recruitment of eosinophils to the site of an allergen.
  • Leukotriene receptors on eosinophils guide this process, increasing the inflammatory response.
94
Q

What is the overall effect of leukotrienes in the context of airway inflammation?

A

Leukotrienes are potent pro-inflammatory signalling molecules associated with bronchospasm and bronchial constriction.

95
Q

What is the mechanism of action of leukotriene receptor antagonists?

A

They block leukotriene receptors, thereby reducing the effects of leukotrienes.

96
Q

Name two common examples of leukotriene receptor antagonist drugs.

A

Montelukast and zafirlukast.

97
Q

What are the cellular targets of leukotriene receptor antagonists in the lungs?

A

Eosinophils and bronchial smooth muscle cells.

98
Q

What type of leukotriene receptor is typically targeted by these antagonists?

A

cysteinyl leukotriene receptors (cysLT)

99
Q

What is the impact of leukotriene receptor antagonists on inflammatory responses during asthma?

A

They reduce inflammatory responses in both early and late phases of asthma.

100
Q

Can leukotriene receptor antagonists be used with other asthma medications?

A
  • Yes,
  • They can be used alongside other medications, such as inhaled corticosteroids.
101
Q

Do leukotriene receptor antagonists have an effect on the chronic remodelling of lung tissue?

A
  • No
  • Unlike corticosteroids, they do not affect chronic tissue remodelling.
102
Q

What is the primary therapeutic use of leukotriene receptor antagonists in asthma management?

A

They are primarily used as preventer medications to help prevent asthma attacks and the associated bronchospasm.

103
Q

What are the most common side effects associated with leukotriene receptor antagonists?

A

Abdominal pain and headache.

104
Q

What is a key difference between the uses of corticosteroids and leukotriene receptor antagonists in medicine?

A

Corticosteroids have a broader range of uses in medicine compared to leukotriene receptor antagonists, which are mainly used for airway diseases.

105
Q

Apart from airway diseases, what are some other conditions that corticosteroids can be prescribed for?

A

Rheumatoid arthritis and Crohn’s disease.

106
Q

Name three common examples of corticosteroids used in the treatment of airway diseases.

A
  • Beclomethasone (inhaled)
  • Prednisolone (oral),
  • Hydrocortisone (IV).
107
Q

What are the primary cellular targets of corticosteroids in the context of airway disease?

A

Immune cells in the lungs such as macrophages, T lymphocytes, and eosinophils.

108
Q

What is the molecular target of corticosteroids within these immune cells?

A

The glucocorticoid receptor (GR), an intracellular protein.

109
Q

How does the glucocorticoid receptor differ from other receptors like beta-2 adrenergic, muscarinic, and leukotriene receptors?

A
  • The GR is an intracellular protein and acts as a transcription factor, directly influencing gene expression.
  • It does not use secondary messenger systems like G-protein coupled receptors.
110
Q

How does the mechanism of action of corticosteroids compare to that of aldosterone and its receptor?

A

Corticosteroids, like aldosterone, bind to intracellular receptors (GR for corticosteroids and mineralocorticoid receptor for aldosterone) that act as transcription factors, modulating the expression of numerous genes.

111
Q

What is the general effect of corticosteroids on gene expression in macrophages, T cells, and eosinophils?

A

They generally exert an anti-inflammatory effect.

112
Q

Give two examples of anti-inflammatory events triggered by corticosteroids.

A
  • Enhanced expression of anti-inflammatory products (like lipoprotein 1, SPI, and interleukin 10)
  • Suppression of pro-inflammatory mediators (like TNF-alpha and interleukin 8).
113
Q

Describe the process by which corticosteroids interact with the glucocorticoid receptor.

A
  • Corticosteroids, being hydrophobic, diffuse across the cell membrane and bind to the GR.
  • This binding displaces the chaperone protein Hsp90, allowing the activated GR to translocate to the nucleus and alter gene expression.
114
Q

How do corticosteroids affect the expression of beta-2 adrenergic receptors?

A

They upregulate beta-2 adrenergic receptors.

115
Q

What is the potential consequence of this upregulation of beta-2 adrenergic receptors for airway function?

A

It can potentiate the bronchodilatory effects of beta-2 agonists like salbutamol.

*Potentiate - Increase the power, effect, or likelihood (especially drug

116
Q

How do corticosteroids affect the number and activity of eosinophils?

A

They reduce eosinophil numbers and suppress their activity.

117
Q

What is the impact of corticosteroids on the production of pro-inflammatory cytokines by T lymphocytes?

A

They reduce the production of these cytokines.

118
Q

How are mast cell numbers and activity modulated by corticosteroids?

A

Corticosteroids generally reduce mast cell numbers and dampen their activity.

119
Q

What is the effect of corticosteroids on the production of pro-inflammatory cytokines by macrophages?

A

They decrease the production of pro-inflammatory cytokines by macrophages.

120
Q

How do corticosteroids influence dendritic cell numbers?

A

Corticosteroids reduce the numbers of dendritic cells.

121
Q

How do corticosteroids impact epithelial cells in the lungs?

A

They reduce the production of pro-inflammatory cytokines by epithelial cells.

122
Q

What effect do corticosteroids have on the permeability of endothelial cells in the lungs?

A

They make endothelial cells less permeable, reducing the leakage of inflammatory cells and mediators into lung tissue.

123
Q

What impact do corticosteroids have on mucus production by mucus gland cells in the lungs?

A

They decrease mucus production.

124
Q

What underlies the development of Cushingoid features in patients taking corticosteroids?

A

Corticosteroids mimic the effects of cortisol, and dysregulation of cortisol is implicated in Cushing’s disease, which is characterized by similar features.

125
Q

Why do corticosteroids increase the risk of infection?

A

Corticosteroids have immunosuppressive effects that can compromise the body’s ability to fight infections.

126
Q

What is the link between corticosteroid use and impaired wound healing?

A

Corticosteroids suppress immune responses that are essential for efficient wound healing.

127
Q

What is a hallmark side effect of corticosteroid use, especially in the context of long-term oral treatment?

A

A distinct facial appearance often referred to as “moon face” or Cushingoid features.

128
Q

What other condition shares this distinctive facial characteristic, and what is its relevance to corticosteroid action?

A
  • Cushing’s disease, a condition involving cortisol dysregulation, also presents with this facial appearance.
  • This is significant because corticosteroids mimic the actions of cortisol in the body.
129
Q

Besides the characteristic facial changes, what are two other common side effects associated with prolonged corticosteroid use?

A

Poor wound healing and increased susceptibility to infection.

130
Q

Why do patients on long-term corticosteroid therapy often experience poor wound healing?

A

Corticosteroids suppress the immune system, and a robust immune response is crucial for efficient wound healing.

131
Q

Why do patients on corticosteroids have an increased risk of infection?

A
  • Corticosteroids have an immunosuppressive effect
  • By suppressing the immune response, corticosteroids compromise the body’s ability to effectively fight off infections, making patients more vulnerable.
132
Q

Why is patient consultation, particularly for those prescribed oral corticosteroids, often extensive and significant?

A

Because corticosteroids influence the expression of multiple genes across various tissues, they can cause a wide range of side effects that require careful management and monitoring.

133
Q

What must be emphasised about the efficacy and potential risks of corticosteroids as a class of drugs?

A

While corticosteroids are potent and effective drugs that can be life-saving in certain situations, their use carries risks that must be carefully managed.