Bronchodilators (not finished) Flashcards
Name 5 main classes of bronchodilators
B2 agonists muscarinic antagonists xanthines PDE-4 inhibitors leukotriene antagonists
What are 3 other anti-asthma drugs?
sodium cromoglycate
anti-inflammatory steroids
anti-igE - omalizubab
Describe neuro-humoral control in terms of:
- parasympathetics
- sympathetics
- NANC dilators
- sensory nerves
- inflammatory mediators
- M3 receptors –> constriction and secretion
M2 receptors –> inhibits relaxation - b2 receptors –> bronchodilation, decrease secretion and release from mast cells
- non-adrengergic, non-cholinergic dilators released from autonomic nerves. NT’s include NO and VIP
- C fibres and irratant receptors –> cough and constriction, axon reflexes, substance P and neurokinin A
- histamine, leukotrienes, platelet activating factor
B2 agonists (salbutatmol, terbutaline, salmeterol):
- main route of administration
- effects, 1 x certain, 1 x possible
- 4 x side effects, + explanations
- Explain how these may in fact worsen the disease process x2
- inhalation
- bronchodilation, anti-inflammatory (no evidence)
- tremor - B2 on skeletal muscle
headache - B2 on blood vessels
tachycardia - B2 in pacemaker region
anxiety - others are symptoms of anxiety - desensitisation –> normal emergency treatment stops working
airway hypereactivity, drugs open airways, allowing more irritants in —> inflammation
Muscarinic antagonists (ipratropium, oxitropium):
- route of administration
- what 2 conditions does it treat?
- How does the properties of quaternary nitrogen result in few systemic side effects?
- possible side effects when nebuliser treatment used
- inhalation always
- intractable asthma and COPD
- very poorly absorbed so high cons in lungs, low concs in systemic circulation
- dry mouth, increased intraocular pressure (problem in glaucoma)
Xanthines: (theophylline, aminophylline)
- What common beverage used to be used to treat asthma?
- What is the route of administration?
- What is one of the issues with these drugs and why patients on them must be monitored?
- What are the side effects? Think caffeine
- coffee because it contains caffeine
- orally for prophylaxis
- slow release with low therapeutic index
- nausea, headaches, insomnia, diuresis
PDE-4 inhibitors
- What is their mechanism of action?
- side effects
- route of administration
- PDE-4 is the main cAMP-PDE in inflammatory cells and other cells in lung. Increase cAMP in mast cells decreases degranulation It is therefore a bronchodilator and anti-inflammatory
- nausea and vomiting, headache, insomnia, suicidal ideation?
- oral
Leukotriene antagonists e.g. monteleukast
- route of administration
- when is it used?
- side effects
- oral
- adjunct in severe asthma or to prevent exercise induced asthma
- abdo pain, headache, RTI’s, suicidal behaviour
What are the three asthma drugs that are not bronchodilators?
sodium cromoglicate
glucocorticoids
omalizumab
When is sodium cromoglicate used?
What is its mechanism of action?
inhaled, prophylactically
stabilised mast cells
inhibits axon reflexes
When are glucocorticoids used?
What is their mechanism of action?
potent anti-inflammatory drugs
use limited by side effects
may help to reverse b2 agonist desensitization
What is omalizumab?
How does it work?
anti-IgE antibody
