Drugs And Asthma

Question 1

What are the 2 main types of drugs used for asthma treatment?

Answer 1

Bronchodilators
Anti-inflammatory drugs

Question 2

Name all the 5 additive sequence steps in treatment of drugs?

Answer 2

1.Short Acting Beta-Adrenoreceptor Agonists(SABA)—INHALED
2.Corticosteroids—INHALED
3.Long Acting Beta-adrenoreceptor Agonist—INHALED
4.Long Acting muscarinic cholinoreceptor antagonist(INHALED) + Theophylline(ORAL)
5.Corticosteroids tablets—ORAL

Question 3

Name the 3 SABA drugs;

Answer 3

1.SALBUTAMOL
2.TERBUTALINE
3.ISOPRENALINE—cons of using this:Tachycardia and it last for a short period-its a catecholamine hence metabolized by catechol-O-methyl transeferase(COMT)

1+2,lasts a bit longer since they aren’t catecholamines

Question 4

What are the adverse effects of using SABA drugs?

Answer 4

1.Tolerance due to Genetic polymorphism
2.NOCTURAL ASTHMA—due to lowered salbutamol response cause by mutation of CD16,arginine turned to glycine
3.HYPOKALAEMIA—more influx of K+,due to increased Na+/K+ATPase caused by mutation of Glutamine turned into glutamic acid..+salbutamol response
4.Tachycardia
5Tremor

Question 5

Name the 3 inhaled corticosteroids drugs(step2)

Answer 5

1.Beclomethasone
2.Budesonide
3.Fluticasone

Question 6

How does the inhaled corticosteroids help ease asthma symptoms?

Answer 6

*Have anti-inflammatory effects by changing DNA transcription
REDUCE: Vascular permeability
IL-2 transcription hence clinal expansion of N. lymphocytes

*not to be used for ACUTE RELIEF since it takes some time for the effects to kick in.

Question 7

What are the adverse effects of using inhaled corticosteroids?

Answer 7

*Immunosuppressive hence may cause: Oral Candidiasis and Pneumonia
*Adrenal suppression by Fluticasone prevented by metabolism on first pass by the liver

Question 8

What are the examples of LABA drugs(step3)

Answer 8

1.Salmeterol
2.Formoterol

*not for acute relief
*has to be taken with step 2 inhaled corticosteroids

Question 9

Mechanism and example of LEUKOTRIENE Receptor Antagonist(ORAL) STEP3

Answer 9

*MONTELUKAST
Mechanism-inhibits lung inflammation by decreasing mucus production,bronchoconstriction,airflow obstruction,inflammatory cell infiltration.

Question 10

What are the adverse effects of montelukast- leukotriene receptor antagonist?

Answer 10

Diarrhea
Gastrointestinal discomfort
Nausea
*NEUROPSYCHIATRIC reactions: speech impairment,OCD

Question 11

Example of Long Acting Muscarinic receptor Antagonist(LAMA)STEP4

Answer 11

Tiotropium- delivered by inhalation

Question 12

Mechanism of THEOPHYLLINE an Adenosine receptor Antagonist(STEP4)

Answer 12

• A bronchodilator ad respiratory stimulant
  *inhibits phosphodieterase- elevating cAMP
  (2 daily doses)

ADVERSE EFECTS:arrhythmia,convulsions,drug interactions.

Question 13

Example of corticosteroids tablet drug and its mechanism

Answer 13

*PREDNISOLONE
Stimulate anti-inflammatory proteins by affecting gene transcription
Decease IL-2 transcription,T cells clinal expansion,vascular permeability,mast cells
Increase beta-2-adrenoreceptor

Question 14

Adverse effects of glucocorticoids

Answer 14

Skin thinning
Abdominal fat deposition,hypertension,osteoporosis
Addisonian crisis

Question 15

Severe asthma and eosinophil degranulation links

Answer 15

The mast cell degranulation releases histamine and PGD2
*PD2 effects on eosinophils;1.Direct ACTIVATION
2.INDIRECT recruitment via IL-5 release from T cells causing chemotaxis

(IL5 can be inhibited by monoclonal antibodies MEPOLIZUMAB & RESLIZUMAB)