Drugs And Asthma Flashcards
Muscarinic antagonists reduce the excessive mucus secretion which occurs in asthma and may increase clearance of bronchial secretions, true or false
True
True or false,status asthmaticus is another term for chronic asthma
False, it is another term for acute asthma
During an inflammatory reaction in the airways, mast cells release the following spasmogens
- Histamine. 4. Tumour necrosis factor-alpha
- Interleukins (IL-4, IL-5, IL-13). 5. Prostaglandin D2
- Leukotrienes (LTC4, LTD4)
Histamine, leukotrienes and prostaglandin D2
True or false, the problem with stopping steroid treatment abruptly is that the body over produces steroids
False
When treating asthma, the aim of drug treatment is to reduce inflammation and prevent bronchodilation, true or false
False
True or false, salbutamol has a longer duration of action than salmeterol
False
Oropharangeal thrush and dysphonia are adverse effects associated with the use of inhaled steroids, true or false
True
True or false, chronic asthma involves recurrent attacks of reversible airway obstruction
True
True or false, stimulating B2 adrenoceptors involves activation of a G protein coupled receptor, and increSe in cAMP and activation of protein kinase A
True
Match the following bronchodilators with their MOA
- Terbutaline. A. B2 adrenergic agonist
- Monteleukast. B. Leukotriene Rs antagonist
- Theophylline C. Muscarinic Rs antagonist
- Ipratropium. D. Leukotriene Rs antagonist
- Zafirleukast. E. Phosphodiesterase inhibitor
- Salmeterol. F. B2 adrenergic Rs agonist
1 - A 2 - B 3 - E 4 - C 5 - D 6 - F
Which type of asthma is not as susceptible to drugs; chronic or acute?
Acute
True or false, the aim of drug treatment in asthma is to reduce inflammation and prevent bronchoconstriction
True
Asthma that is classified as non-atopic is triggered by what?
Intrinsic trigger; exercise, respiratory infection, atmospheric pollutants
Asthma that is classified as atopic is triggered by what?
Allergic trigger, extrinsic trigger; pollen, dust mite proteins, animal dander
During the early phase of an asthma attack mast cells release the following inflammatory mediators
- Interleukins (IL-4, IL-5, IL-13)
- Histamine
- Macrophage inflammatory protein
- Tumour necrosis factor
- Prostaglandin D2
- Chemo taxing & chemokines
Interleukins
Macrophage inflammatory protein
Tumour necrosis factor
Chemotaxins and chemokines
What happens during the late phase of an asthma attack; bronchospasm or inflammation
Inflammation
Which of the following is not a type of bronchodilator B2 adrenergic receptor agonist Theophylline Muscarinic receptor agonist Leukotriene receptor antagonist
Muscarinic receptor agonist - it is a Muscarinic receptor antagonist
How do B2 adrenergic receptor agonists work?
Act on B2 adrenoceptors on bronchiole smooth muscle to relax muscle
Salbutamol, salmeterol and terbutaline are all types of what drug
B2 adrenergic receptor agonists - bronchodilators
How long does it take for salbutamol to have its maximum effect?
30mins
What is the duration of action if salbutamol and terbutaline
4-6 hours
How often would an individual with asthma take salbutamol
As and when needed
What duration of action does salmeterol have
12 hours
How often should a patient take salmeterol
Twice daily
Why are B2 agonists given by inhalation?
To decrease systemic effects
What is the most common unwanted effect of B2 agonists
Tremor
Some tolerance can be developed to B2 agonists, how can this be prevented
By using a glucocorticoid
True or false, theophylline is a phosphodiesterase inhibitor
True
When is theophylline used in the treatment of asthma?
As a second line treatment, when B2 agonists are not working
In acute asthma theophylline might be given, how would it be administered?
IV - severe bronchoconstriction so inhalation wouldn’t work
Ipratropium is used in asthma, what kind of drug is it
Muscarinic receptor antagonist
How long does it take for the maximum effect of ipratropium to be reChed
30mins
What is the duration if action of ipratropium
3-5 hours
How is the Muscarinic receptor antagonist ipratropium administered
Aerosol Inhalation
The drugs monteleukast and zafirlukast and what types of drugs used to prevent exercise induced and aspirin sensitive asthma
Leukotriene receptor antagonists
How are the Leukotriene receptor antagonists monteleukast and zafirlukast administered
Orally
Where do the Leukotriene receptor antagonists work.?
At cysteinyl-leukotriene receptors (on bronchiole smooth muscle cells)
Which glucocorticoids are only occasionally given to people with asthma Beclomethasone Prednisolone Budesonide Hydrocortisone Fluticasone
Prednisolone and hydrocortisone
How are glucocorticoids administered to people with asthma
Inhalation
True or false, the actions of glucocorticoids are immediate
False, it takes a few days for their full effect
Glucocorticoids work as anti inflammatory drugs because they reduce which of the following
- Cytokines
- Spasmogens (LT4, LTD4)
- Tumour necrosis factor
- Leucocyte Chemotaxins (LTB4, PAF)
1, 2 and 4
True or false, the actions of glucocorticoids in asthma reduces bronchospasm and increases recruitment and activation of inflammatory cells
False, reduces both
Which intracellular receptors do glucocorticoids bind to in cytoplasm
GR alpha
GR beta
What do glucocorticoids inhibit that blocks the entire bronchoconstriction pathway
Phospholipase A2
For patients with severe asthma, give inhaled steroid with which additional agent
B2 agonist or theophylline
For acute asthma attacks which two glucocorticoids would be given, and how would they be administered
Hydrocortisone - IV
Prednisolone - oral
How can the adverse effects of inhaled steroids, such as oropharyngeal thrush and dysphonia be minimised
Using a spacer device
Why can oral/regular large doses of glucocorticoids hVe serious effects
Adrenal suppression - stop natural production of glucocorticoids
Patients must carry a steroid card
Which drug can reduce both early (bronchoconstriction) and late (inflammation) phases of asthma attack
Cromoglicate
True or false, cromoglicate when used for the treatment of asthma is more effective in adults than children
No, children respond better than adults
The asthma drug cromoglicate is effective in asthma caused by what?
Antigen
Exercise
Irritants
Cromoglicate’s mechanisms are not understood. It is a mast cell stabiliser, it is thought it may;
- Reduce neuronal reflexes (desensitise to irritants)
- Increase release of T cell cytokines
- Affect inflammatory cells and mediators
1 & 3
It inhibits the release of T cell cytokines
What are the side effects of the asthma drug cromoglicate
Irritation of upper respiratory tract
Hypersensitivity reactions - rare
How is the drug cromoglicate administered
Inhalation
Is the asthma drug cromoglicate used as a prophylaxis or in treatment
Prophylaxis
True or false, the effects of the drug cromoglicate are seen immediately
False, they take weeks to develop
Which asthma drug is recombinant DNA-derived humanised IgG1 monoclonal antibody
Omalizumab
How is the asthma drug omalizumab administered
Sub cut injection, every 2-3 weeks
Omalizumab is sub cutaneously injected every 2-3 weeks and is slowly absorbed, when is the peak plasma concentration
7-8 days
What does the asthma drug omalizumab bind to
IgE, which inhibits the binding if IgE to IgE receptors on the surface if mast cells and basophils, inhibiting the IgE mediated cascade of asthma
What side effects may be seen from the drug omalizumab
Anaphylaxis
Malignancies
What drug treatment would be used with someone who had mild asthma with rare attacks
Inhaled B2 agonist prn
What drug therapy would be used with someone with mild asthma, with more frequent attacks
Glucocorticoid for prophylaxis
B2 agonist prn
What drug therapy would be given for someone with moderate to servers asthma
B2 agonist with glucorticoid in combined inhaler
