COPD and Rhinitis Treatment

Question 1

M1 location

Answer 1

Ganglia

Question 2

M2 location

Answer 2

Post-ganglionic neurone terminals

Question 3

M3 location

Answer 3

Smooth muscle

Question 4

M1 muscarinic ACh receptor function

Answer 4

Enhance cholingeric reflex

Question 5

M2 muscarinic ACh receptor function

Answer 5

Inhibit ACh release

Question 6

M3 muscarinic ACh receptor function

Answer 6

Mediate bronchoconstriction and mucus secretion (increase secretion)

Question 7

SAMA

Answer 7

ipatropium and oxitropium

Question 8

LAMA

Answer 8

tiotropium and aclidium

Question 9

SAMA and LAMA given by

Answer 9

Inhalation

Question 10

How are side effects avoided in SAMA and LAMA

Answer 10

Quaternary ammonium group reduces absorption and systemic exposure

Question 11

SAMA and LAMA effect

Answer 11

Decrease mucus secretion

Question 12

Mainly palliative effect?

Answer 12

Yes

Question 13

Non-selective SAMA

Answer 13

Ipatropium

Question 14

Selective LAMA

Answer 14

Tiotropium - selective for M3, achieved by longer half life.
Aclindium also selective for M3.

Question 15

ultra LABA

Answer 15

Indacaterol

Question 16

LABA and LAMA combination

Answer 16

Best at increasing FEV1

Recommended for moderate COPD

Question 17

MABA

Answer 17

LABA and LAMA in the same molecule.

Batefenterol

Question 18

PDE4 inhibitor

Answer 18

Rofimulast

Question 19

Rofimulast action

Answer 19

Anti-inflammatory, also suppresses emphysema

Add on to LABA/LAMA

Question 20

Rofimulast side effects

Answer 20

Nausea, diarrhoea, headache, weight loss

Question 21

Glucocorticoid unresponsiveness cause in COPD

Answer 21

oxidative/nitrative stress

HDAC2 is reduced in COPD

Question 22

Rhinitis definition

Answer 22

Acute/chronic inflammation of the nasal mucosa

Question 23

Rhinorrhoea definition

Answer 23

Runny nose

Question 24

allergic rhinorrhoea types

Answer 24

seasonal, perennial and episodic

Question 25

in rhinits, inhalation of allergen causes

Answer 25

Increase of specific IgE levels, IgE binds to receptors on mast cells and basophils. Re-exposure to allergen causes mast cell and basophil degranulation, and release of mediators, causing acute symptoms. Delayed response caused by recruitment of lymphocytes and eosinophils to nasal mucosa contributes to congestion and obstruction.

Question 26

Mediators released in rhinitis

Answer 26

histamine, cysLTs, tryptase, prostaglandins

Question 27

non-allergic rhinitis

Answer 27

doesn't involve IgE

Question 28

occupational rhinitis

Answer 28

may have allergic and non-allergic components

Question 29

both rhinitis and rhinorrhoea involve

Answer 29

Increased mucosal blood flow and/or increased blood vessel permeability - increase volume of nasal mucosa causing difficulty in breathing.

Question 30

Glucocorticoids in rhinitis mechanism

Answer 30

Reduce vascular permeability, recruitment and activity of inflammatory cells and release of cytokines and mediators.

Question 31

Glucocorticoids in rhinitis examples

Answer 31

Beclometasone Fluticasone Prednisolone

Question 32

Glucocorticoids in rhinitis

Answer 32

mono therapy suitable Reduce all symptoms Can be combined with antihistamines

Question 33

Glucocorticoids in rhinitis administration

Answer 33

Intranasal

Question 34

Anti-histamines (H1 receptor antagonists) in rhinitis mechanism

Answer 34

Competitive antagonists of H1 receptors reduce effects of mast cell derived histamine that include: - vasodilation and increased capillary permeability - increased mucus secretion - activation of sensory nerves

Question 35

Anti-histamines (H1 receptor antagonists) in rhinitis examples

Answer 35

Second generation examples: - Loratadine - Fexofenadine - Cetirizine

Question 36

Anti-histamines (H1 receptor antagonists) in rhinitis administration

Answer 36

Orally | Intranasal spray - azelastine

Question 37

Anti-histamines (H1 receptor antagonists) in rhinitis

Answer 37

Mono therapy suitable Less effect on congestion than others Effective in allergic rhinitis

Question 38

Anti-cholingeric drugs (muscarinic receptor antagonists) in rhinitis mechanism

Answer 38

Stops ACh activating M3 muscarinic receptor.

Question 39

Anti-cholingeric drugs (muscarinic receptor antagonists) in rhinitis administration

Answer 39

Nasal

Question 40

Anti-cholingeric drugs (muscarinic receptor antagonists) in rhinitis examples

Answer 40

Ipatropium

Question 41

Anti-cholingeric drugs (muscarinic receptor antagonists) in rhinitis

Answer 41

Reduce rhinorrhoea in PAR and SAR. | No effect on itching, sneezing, coughing

Question 42

Sodium Cromoglicate in rhinitis mechanism

Answer 42

Mast cell stabilisation? | Anti-allergic

Question 43

Sodium Cromoglicate in rhinitis adminsitation

Answer 43

Nasal

Question 44

Sodium Cromoglicate in rhinitis

Answer 44

Less effective than corticosteroids

Question 45

CysLT receptor antagonists in rhinitis mechanism

Answer 45

Reduce the effect of CysLTs on the nasal mucosa

Question 46

CysLT receptor antagonists in rhinitis

Answer 46

Equi-Effective with H1 receptor antagonists - additive effect

Question 47

CysLT receptor antagonists in rhinitis example

Answer 47

Montelukast

Question 48

Vasoconstrictors in rhinitis mechanism

Answer 48

Mimic effect of noradrenaline - vasoconstriction via activation of alpha1-adrenoreceptors to decrease swelling in nasal mucosa. Help nasal blood flow

Question 49

Vasoconstrictors in rhinitis examples

Answer 49

Oxymetazoline - intranasal - reduce congestion in allergic rhinitis - after a few days - rebound increase in nasal congestion (rhinitis medicamentosa) due to receptor desensitisation etc.