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Pharmacology > Colds and Allergies (Chapter 10) + Bermon Paper on URTI + Bonus Lecture > Flashcards

Colds and Allergies (Chapter 10) + Bermon Paper on URTI + Bonus Lecture Flashcards

1
Q

What are the two main types of viruses?

A

rhinoviruses and coronaviruses

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2
Q

What are two diseases that colds are confused with often ?

A

Allergic rhinitis, or bacterial URTI

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3
Q

If someone has symptoms of a cold with a sore throat, what is it probably ?

A

Streptococcal infection (bacterial)

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4
Q

How are streptococcal infections spread ?

A

by airborne nasal discharge (sneezing), contact with hand

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5
Q

what are the complications of common cold ?

A

bacteria may appear in nose or ear because cavities are blocked

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6
Q

how many days does it take to get better from a cold ?

A

7-10

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7
Q

how long can viruses stay on inanimate objects for ? what happens to them ?

A

a few hours

oxygen can damage virus coating

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8
Q

how do viruses survive better ? what does this imply about the way they are usually transmitted ?

A

they usually survive better in liquids, therefore they need to contact the mucous membranes in order to more easily enter the body.

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9
Q

what is the difference between the way influenza and the common cold is transmitted ?

A

influenza is usually airborne

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10
Q

what drugs cure the common cold ?

A

none, they only alleviate the symptoms

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11
Q

what molecule is behind mucus production ? how ?

A

acetylcholine

released from cholinergic nerve, which increases mucus production

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12
Q

what effect does the common cold have on asthma ?

A

it may exacerbate asthma symptoms

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13
Q

is it ok to change asthma treatment if one is affected by a cold ?

A

yes, treatment may need to be increased to combat the increased symptoms

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14
Q

why do people have runny noses ?

A

mucus secretion trying to get rid of the virus

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15
Q

what is the symptom that may persist even after the end of the cold ?

A

cough

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16
Q

what is allergic rhinitis

A

a hypersensitivity reaction to an allergen which combines with an antibody, mainly IgE

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17
Q

explain the mechanism behind allergic rhinitis

A

antigen/allergen binds with antibody IgE
IgE then combines with mast cells at IgE receptors on the surface of the mast cell and basophils in mucosa of nasal passage. The granules which contain histamine and proteases are released into the outside.

when antigen present, cells degranulate, releasing histamine, prostaglandins, leukotrienes, platelet activating factor, bradykinin (inflammation)

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18
Q

what are the 5 things mast cells release in allergic rhinitis ?

A

histamine, prostaglandins, leukotrienes, platelet activating factor, bradykinin

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19
Q

why does inflammation occur in allergic rhinitis? what mechanism is behind it ?

A

tissues express H1 histamine receptor and receptors for leukotrienes, etc.

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20
Q

What do the proteases do in allergic rhinitis ?

A

The proteases directly kill tissues which release pain and inflammation mediators such as substance P, bradykinin, and arachidonic acid metabolites.

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21
Q

What are the immediate early phase symptoms of allergic rhinitis ?

A

rhinorrea (runny nose), vasodilation, sneezing, itching of nose and eyes

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22
Q

What are the late phase reactions of allergic rhinitis? What are they due to ?

A

Sneezing, congestion, enhanced responsiveness of other antibodies

Due to accumulation of the inflammatory cells (mast cells and basophils)

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23
Q

How do genes affect allergic rhinitis ?

A

If both parents have allergy, child has 50% change of getting allergies

If no parents have allergy, child has 10% chance

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24
Q

What is the counter-regulation theory?

A

That in developed countries, there are less parasites and infections, so the immune system is more sensitive than in under-developed countries in which the immune system becomes “harder to activate”

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25
Q

What are the three types of allergies ?

A

Seasonal, perennial, acute

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26
Q

Give examples of seasonal allergies (2)

A

Pollen: weeds, trees, grasses

Mold spores from decaying vegetation

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27
Q

How many people in the US do seasonal allergies affect ?

A

35 million

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28
Q

Give 3 examples of perennial allergies

A

mainly indoor

dust mites, pet dander, cockroaches

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29
Q

what is more common: seasonal or perennial allergies ?

A

seasonal

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30
Q

what are acute allergies ?

A

major reaction to allergens, may be deadly

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31
Q

What are heat cramps, heat exhaustion, heat stroke caused by ?

A

excessive loss of fluid and electrolytes

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32
Q

what is a medical emergency- heat cramps, exhaustion, or stroke?

A

heat stroke, may lead to coma

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33
Q

what is recommended to drink for an athlete ?

A

water

they won’t lose much electrolytes (dont need Gatorade) unless they are running a marathon

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34
Q

which drugs increases fluid loss or interferes with cooling mechanism, and therefore puts someone more at risk of heat related illnesses such as heat stroke ? (4)

A

beta blockers
alpha-agonists
anti-histamines
diuretics

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35
Q

how do beta-blockers increase fluid loss or interferes with cooling mechanism

A

prevent sweating, decrease blood supply to skin

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36
Q

how do alpha-agonists increase fluid loss or interferes with cooling mechanism

what are they used for

A

constrict blood flow

act as nasal decongestant

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37
Q

how do anti-histamines increase fluid loss or interferes with cooling mechanism

A

by decreasing sweating

anti-cholinergic

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38
Q

how do diuretics increase fluid loss or interferes with cooling mechanism

A

increase urine production (dehydration)

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39
Q

what are ways to prevent a cold ?

A

avoid crowded places

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40
Q

is it ok to stifle a sneeze ?

A

no

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41
Q

why is it bad to cough into one’s hand ?

A

because then the hand will touch stuff and the germs will spread

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42
Q

what should one consume if they have a cold

A

fluids like water or chicken soup

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43
Q

what sort of environment one should be in when they have a cold

A

moist, so that the humidity will help the mucus and throat deal with colds faster

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44
Q

what are two types of drugs that are used only for colds, not for allergies:

A

antitussive and expectorants

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45
Q

what is an expectorant ?

A

enhances the expulsion of mucus by air passages of the lungs

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46
Q

what are two types of drugs used for both colds and allergies ?

A

antihistamines, decongestants

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47
Q

what are three types of drugs used to treat only allergies, not colds:

A

corticosteroids, LT modifiers, mast cell stabilizers

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48
Q

what is the target tissue for allergic rhinitis ? what is the implication of this for the drugs used for administration of corticosteroids and mast cell stabilizers

A

nasal passage rather than bronchial tissue

this means that for allergies, nasal sprays are used rather than inhalers

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49
Q

what generation of antihistamines are desloratadine and loratadine ?

A

second

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50
Q

what do first generation antihistamines end with ?

A

-amine

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51
Q

what do second generation antihistamines end with?

A

-adine

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52
Q

what is histamine ?

A

a mediator released by mast cells and basophils

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53
Q

what are the receptors usually targeted by antihistamines for allergies ? what are their properties ? what kind of illnesses do drugs target ?

A

H1 receptor : respiratory tract and near peripheral blood vessels. drugs used as antihistamines
H2 receptor: on stomach cells. drugs used to treat ulcers

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54
Q

what is the H3 receptor ?

A

histamine receptor in brain, but no drug is known to work on it and we don’t know its purpose

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55
Q

what is the difference between antihistamine early and late second generation drugs

A

early: off the market
late: commonly used

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56
Q

what are the two main first generation antihistamine drugs ?

A

diphendramine and chlorphenamine

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57
Q

what are the main two side effects of the first generation antihistamines ?

A

sedation

anti-cholinergic symptoms

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58
Q

what are 6 anti-cholinergic symptoms?

A 
dry mouth 
less sweating 
tachycardia
urinary retention
blurred vision 
constipation
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59
Q

what are first generation antihistamines contraindicate

A

other depressants

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60
Q

how do first generation antihistamines affect athletic performance ?

A

negatively

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61
Q

how are second generation antihistamines different from first generation antihistamines in terms of structure?

A

second generation less lipophilic so less likely to cross blood-brain barrier

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62
Q

give two examples of second generation antihistamine drug

A

Allegra, Claritin

63
Q

when should anti-histamines be taken ?

A

before the allergy attack happens, as a preventative measure

64
Q

how are second generation antihistamines different from first generation antihistamines in terms of action?

A

less sedation and less anti-cholinergic effects

65
Q

why can anti-histamines be used in cold ?

A

because of anti-cholinergic effect of slowing down mucus production, which has the effect of minimizing sniffling.

66
Q

why are anti-histamines not ideal to take with a lower respiratory tract infection?

A

anti-histamines have anti-cholinergic effects, meaning they slow down mucus production. however, mucus production can be helpful in treating LRTI

67
Q

why are anti-histamines used in motion sickness products ?

A

because they prevent the feeling of vomiting

68
Q

how is dermatitis treated ?

A

with anti-histamines

69
Q

what are the two main active ingredients that are anti-histamine used in allergy and cold medication ?

A

chlorpheniramine (first generation)

diphehydramine (second generation)

70
Q

what are two distinguishing characteristics of poison ivy ?

A

leaves have a tear drop shape

3 leaves attached to stem

71
Q

what does poison ivy cause ?

A

dermatitis

72
Q

what is nasal congestion caused by ?

A

local vasodilation of nose blood vessels

73
Q

what is a fancy word for “stuffy nose”

A

nasal congestion

74
Q

what is a fancy word for “runny nose”

A

rhinorrhea

75
Q

what kind of drugs are used to treat stuffy noses ? why?

A

stuffy nose= local vasodilation of nose blood vessels

therefore, we need to cause vasoconstriction with drugs that activate the alpha-adrenergic receptor

sympatho-mimetic drugs

76
Q

what are the 2 active ingredients usually found in nasal decongestants ?

A

phenylephrine and pseudoephedrine

77
Q

what drug is used to make crystal meth, and therefore is kept behind the counter ? how does this affect the sale of other drugs ?

A

pseudoephedrine

therefore, companies usually sell phenylephrine

78
Q

what kind of 3 side effects does the nasal decongestant pseudoephedrine have ?

A

side effects related to adrenergic activation, therefore sleeplessness, tremor, agitation

79
Q

what is rebound congestion ?

A

when the cold is over, the nasal vessels dilate again as a result of using the spray, therefore congestion becomes worse

80
Q

what drug should decongestants not be used with

A

monoamino oxidase inhibitor

81
Q

what kind of effect does a decongestant have combined with caffeine ?

A

caffeine has similar effects on CNS as pseudoephedrine

these effects are additive when both drugs are used together, and therefore can be a hazardous combination

82
Q

why is phenylephrine preferred by companies instead of pseudoephedrine ?

A

because can’t be converted into crystal meth

83
Q

what are corticosteroids used for- allergic rhinitis or the common cold ?

A

topically for allergic rhinitis

84
Q

what do corticosteroids do ?

A

reduce all major symptoms (runny nose, itching, sneezing, nasal congestion)

85
Q

when is it best to use corticosteroids ?

A

before the anticipated exposure

86
Q

what are 3 side effects of corticosteroids ?

A

nasal irritation
headaches
local fungal infections

87
Q

what is the action of mast cell stabilizers ?

A

inhibit mast cell degranulation

88
Q

do you take mast cell stabilizers as a preventative measure or after the symptoms start ?

A

preventative

89
Q

how often do mast cells stabilizers have to be taken ?

A

frequently

90
Q

what is more effective, mast cell stabilizers or corticosteroids ?

A

corticosteroids

91
Q

what do leukotriene modifiers do ?

A

inhibit leukotriene receptors, or inhibit the synthesis of leukotrienes

92
Q

what is a side effect of leukotriene modifiers ?

A

ear infections

93
Q

if someone has a wet cough, do they need an expectorant ?

A

no

94
Q

what do expectorants do ?

A

lubricate the mucus

95
Q

why arent expectorants very useful ?

A

anti-cholinergics and anti-histamines oppose this effect, making this product not very useful

96
Q

what has the same effect as an expectorant ?

A

staying hydrated

97
Q

what is an active ingredient that is an expectorant ?

A

guaifenesin

98
Q

if someone has a dry cough, what are the three types of medication they need ?

A

expectorant
antitussive
analgesic

99
Q

what do antitussive agents act on ?

A

the CNS (cough center)

100
Q

when is coughing productive or not productive ?

A

productive when it is needed to clear mucus

not productive when it does not move the mucus

101
Q

what are opioids used as antitussives ? (2)

A

codeine, hydrocodone

102
Q

what is a non-opioid drug used an an antitussive

A

dextromorphan

103
Q

what are the main issues of taking opioids as antitussives ? (2)

A

constipation and abuse potential

104
Q

what are the 4 different types of analgesics used in medication ?

A
  • pillz: acetaminophen, ibuprofen, maybe aspirin
  • counter-irritants in lozenges, like menthol
  • benzocaine (topical anesthetic)
  • vapors (camphor and menthol)
105
Q

what drugs treat ocular inflammation ? (5)

A 
corticosteroids
antihistamines
decongestants
mast cell stabilizers
NSAIDs
106
Q

are antibiotics of any use to treat allergies or colds ?

A

not for allergies

not very effective against colds, usually used to treat complications

107
Q

what are some anti-viral medications

A

we don’t really have any

108
Q

what is a vaccine ?

A

a prophylactic measure whereby an inactivated or synthetic virus component is immunized into a person

109
Q

how do you know which vaccine to administer in the fall ?

A

it’s always a guess

110
Q

why is allergy to vaccines an issue ?

A

because vaccines are prepared in chicken eggs

111
Q

what are the effects of immune boosters such as Cold FX

A

nutritional supplements that could help the immune system fight the infection

112
Q

what are the three things that work best against a cold?

A

hydration, vitamins, balanced diet

113
Q

what is the three ways an AT can be involved in allergy/cold medication

A

1) adherence to the medication
2) be aware of side effects or complications
3) compliance with banned substance rules

114
Q

when should someone stop taking the medication ?

A

wait a bit after symptoms are gone

115
Q

what are the three kinds of medications that have banned substances ? which ones ?

A

1) nasal decongestants - sympathomimetic properties
2) antitussive agents - codeine, glucorticoids
3) herbal remedies- ephedrine

116
Q

with anti-cholinergic drugs what is the main concern for athletes in competition ?

A

heat exposure since will cause drowsiness and dizziness and blurred vision

117
Q

What are the three main viruses reported as causes of URTI?

A

rhinovirus, adenovirus and

para-influenza virus

118
Q

What is the percentage of URTI reported in studies ?

A

30% incidence of URTI

119
Q

What was the main conclusion of the Bermon Paper as to what causes symptoms of URTI in athletes ?

A

no identifiable pathogens were either reported or

studied

120
Q

what population has the highest incidence of reported URTI?

A

elite athletes

121
Q

explain the concept of inflammation without infection in elite athletes, as explained by Bermon et al

A

athletes have symptoms of URTI but in lab studies, it is shown that only 11 out of 37 illness
episodes overall had pathogenic origins, therefore the symptoms of inflammation are, 2/3 of the time, caused without infection

122
Q

so the Bermon paper shows that in URTI reported by athletes there aren’t always pathogens found in lab studies. what do these lab studies find that is there in resting conditions?

A

inflammation: increases in airway

neutrophils, eosinophils and lymphocytes

123
Q

what probably then causes the inflammation in athletes?

A

pollutants or chlorine-related compounds in swimmers.

124
Q

what is most frequent reason for consultation in sports medicine clinics, and is the most
common medical condition affecting athletes attending both summer and winter Olympics?

A

URTI

125
Q

what is symptomology?

A

using symptoms to deduce what the infection was

126
Q

what is pathogenic etiology

A

testing samples to see what causes the symptoms of the infection

127
Q

why would hockey players have inflammation without infection ?

A

carbon and nitrogen oxides, from ice resurfacing (Zamboni)

128
Q

elite athletes have more inflammatory cells in their lungs, but only when exercising. true or false ?

A

false

even at rest they have higher levels

129
Q

there is an increased quantity of this cell that is the most common and consistent feature across many sports. what is it?

A

neutrophils

130
Q

can athletes change the airway inflammation and asthmatic symptoms? with what lifestyle choices ?

A

yes, if they quit the sport the symptoms with decrease. otherwise they will get worse

131
Q

in sports-related inflammation of URT, what is the most likely mediator ?

A

The cytokine IL-6, a pro-inflammatory cytokine was the most likely ‘mediator’ of inflammation, this cytokine is part of the bodies danger signal

132
Q

elite swimmers demonstrated higher levels of what immune cell compared to sedentary control group ?

A

elite swimmers demonstrated higher levels of exhaled leukotriene B4 compared to sedentary control group

133
Q

so in a bunch of sports-related URTI cases, no pathogen was found. does that mean there is no pathogen?

A

no, perhaps cannot be detected like herpes

still higher likelihood that it’s due to environmental factors

134
Q

how does one ensure a uni-directional flow of lymph?

A

valves

135
Q

what are the two types of immunity?

A

innate and adaptive

136
Q

what are the 3 cells that are responsible for the 1st line of response (innate)?

A

macrophages, mast cells, neutrophils

137
Q

what are the 3 cells that are responsible for the 2nd line of response (adaptive)?

A

antibodies, B-cells, T-cells

138
Q

how do phagocytes “call” T-cells?

A

phagocytes eat and then present pathogen on surface, attracting T-helper cells and activating it

139
Q

T-cells require what cell to fully be activated ? what does this cause ?

A

co-stimulatory signal CD28

this causes proliferation and differentiation into subtypes

140
Q

what are cytokines ?

A

immune cells secrete cytokines attract more immune cells

141
Q

what cytokine does Th17 produce ?

A

IL-17

142
Q

what cell has been linked to autoimmune inflammatory diseases ?

A

IL-17

143
Q

how does one extract T-cells from blood ?

A 
centrifuge blood (top) and Ficoll (bottom)
then, goes into layers:

Plasma
White blood cells (natural killer cells, T-cells)
Ficoll
RBC

144
Q

what is the role of terbutaline ?

A

beta-2 agonist

145
Q

what is the role of ICI?

A

beta-2 antagonist

146
Q

what is ELISA ?

A

colorimetric assay that quantifies molecule of interest in sample (cytokines)
the darker the color, the more of the protein of interest we have

147
Q

what is flow cytometry?

A

laser based analysis of physical characteristics of single particles to determine what cell in sample

stain cells with markers for Th17 (CD3 and CCR6)

148
Q

what are two markers for Th17?

A

CD3 and CCR6

149
Q

what happens to IL-17 if you add terbutaline into a solution with activated Th17 ?

A

increase in IL-17

150
Q

what happens to IL-17 if you add ICI into a solution with activated Th17 ?

A

decrease in IL-17

151
Q

what happens to IFN-gamma if you add terbutaline into a solution with activated Th17 ?

A

decrease in IFN-gamma

152
Q

how are IFN-gamma and Th1 related?

A

IFN-gamma is a cytokine produced by Th1

153
Q

what happens to IFN-gamma if you add ICI into a solution with activated Th17 ?

A

increase in IFN-gamma

154
Q

what is the relationship between Th1 and Th17 called ?

A

reciprocal regulation

Pharmacology (15 decks)

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