Bronchodilators

Question 1

What are the SABAs, LABAs, SAMAs, LAMAs and leukotriene antagonists that we have to know?

Answer 1

Question 2

Explain the asthma management cycle?

Answer 2

Question 3

How do B2 agonists work? (smooth muscle and epithelial)

Answer 3

Question 4

What are the effect of SABAs (onset of action etc).

Answer 4

Question 5

Adverse drug reactions with SABAs?

Answer 5

Question 6

Beta blockers and asthma?

Answer 6

Question 7

What is the LABA that we have to know and how is it used?

Onset and length of activity?

Why can they not be used by themselves?

Answer 7

Not used as a reliever.

Higher rate of mortality if used alone without corticosteroid so must be used in combination

Question 8

Benefits of combined LABA glucocorticoid

Answer 8

Question 9

What is SMART therapy?

Answer 9

Question 10

Explain

Answer 10

Ach causes constriction by impacting on M2 and M3 receptors.

M3 causes the smooth muscle to contract directly and the M2 receptors counteracts the beta 2 action.

The Ach will feedback on itself and will switch off further release, this occurs through the M2 receptors.

Question 11

Why are SAMAs and LAMAs used in COPD but not asthma?

Answer 11

Question 12

Why are eosinophils important in ACh mediated asthma?

What does this mean for treatment?

Answer 12

Someone with very high levels of eosinophils which are activated by an antigen. The eosinophils will release compounds which turn off the muscarinic receptor on the nerve (the negative feedback loop) and it will keep releasing Ach. This is a lot of stuff that we don’t need to completely know about.

• These people may respond to a LAMA or SAMA

Question 13

What is the SAMA that we need to know?
Mechanism of action?

Indications?

Answer 13

Question 14

What is the methylxanthine that we need to know?

Mechanism of action?

Answer 14

Question 15

Theophylline pharmacokinetics?

Inhibitors vs inducers?

Answer 15

It is metabolised through CYP1A2, the problem with this is if someone is treated with certain drugs then it is broken down faster and you under treat the patient (cigarette smoking will also do it etc).

Question 16

What is the leukotriene pathway-modifying agent which we need to know?

How does it work?

What are the bad side effects?

Answer 16

Montelukast.

Blocks leukotriene inflammatory response including bronchoconstriction, mucous secretion, plasma exudate and eosinophil recruitment. Used in asthma.