drug treatment for asthma

Question 1

What are the two main ways for treatment of asthma?

Answer 1

bronchodilators (relievers)
anti-inflammatory agents (preventers)

Question 2

What is the main bronchodilator?

Answer 2

β2-adrenoceptor agonists

Question 3

What is the main anti-inflammatory agent?

Answer 3

glucocorticoids

Question 4

What are the types of bronchodilators?

Answer 4

β2-adrenoceptor agonists
muscarinic receptor antagonists

Question 5

What are the anti-inflammatory agents?

Answer 5

glucocorticoids
leukotriene receptor antagonists
antibody to IgE
antibody to interleukin-5

Question 6

Why are β2-adrenoceptor agonist so useful?

Answer 6

fast acting + effective relievers
relax airway smooth muscle
reverse bronchoconstriction (excitatory mediators)
inhibit mediator release from mast cells
stimulate cilia beat frequency

Question 7

What is a short acting β2 agonist?

Answer 7

salbutamol

Question 8

What is an example of a long acting β2 agonist?

Answer 8

formoterol

Question 9

What is the main problem with β2-adrenoceptor agonists?

Answer 9

can mask inflammatory activity (bronchodilation without reversal of inflammation)

Question 10

What are some muscarinic antagonists used?

Answer 10

ipratropium
tiotropium

Question 11

How is glucocorticoids used for asthma therapy?

Answer 11

used prophylactically
used in combination with β2 agonists
administered via inhalation (fluticasone)
administered orally (prednisolone)

Question 12

What enzyme metabolise arachidonic acid (free)?

Answer 12

phospholipase A2

Question 13

How does glucocorticoids inhibit pro-inflammatory response?

Answer 13

stimulate lipocortin synthesis = inhibition of phospholipase A2
inhibit cyclooxygenase activity

Question 14

What occurs when phospholipase A2 is inhibited?

Answer 14

decrease in arachidonic acid
decreases synthesis of leukotrienes and prostaglandins

Question 15

What happens when cyclooxygenase activity is inhibited?

Answer 15

decrease prostaglandin
decrease influx of inflammatory cells
decrease mediator released from eosinophils
increase β2-adrenoceptors
decrease microvascular permeability

Question 16

What are some adverse effects of glucocorticoids?

Answer 16

oropharyngeal candidiasis
suppression of hypothalamic-pituitary adrenal axis
osteoporosis

Question 17

What is ciclesonide?

Answer 17

it is a glucocorticoid prodrug

Question 18

What is Ciclesonide converted to?

Answer 18

active metabolite M1 in the lung

Question 19

What is an anti-inflammatory and bronchodilator combination?

Answer 19

glucocorticoid (fluticasone) + long acting β2-agonist (formoterol)

Question 20

What are leukotriene receptor antagonists?

Answer 20

anti-inflammatory and bronchodilator drugs

Question 21

How are leukotriene receptor antagonists adminisitered?

Answer 21

orally

Question 22

Who is leukotriene receptor antagonists useful for?

Answer 22

elderly and young children

Question 23

What symptom reliefs does leukotriene receptor antagonists provide?

Answer 23

bronchodilation
reduce glucocorticoid dose in adults

Question 24

Why is antibody to IgE used in asthma therapy?

Answer 24

decrease glucocorticoid required
decrease incidence of asthma exacerbations
decrease hospitalisation

Question 25

Why is antibodies to interleukin-5 useful?

Answer 25

prevents interleukin-5 from binding to receptors
reduces eosinophil production and survival
reduces eosinophil numbers and mediator release

Question 26

Why is an example of antibody that binds to interleukin-5?

Answer 26

Reslizumab (Cinqair)