Drugs for asthma

Question 1

What happens to the airway of an asthmatic patient? (3)

Answer 1

Tightened muscles constrict airway

Mucus filles channel

Inflamed/thickened airway wall

Question 2

What causes the mucosal inflammation seen in asthma patients?

Answer 2

activated eosinophils, mast cells and T lymphocytes within the context of a remodelled airway with mucous metaplasia

An increase in smooth muscle

fibrosis and angiogenesis

Question 3

What is the hallmark of COPD?

Answer 3

Airflow limitation

Question 4

How does COPD differ from asthma? (4)

Answer 4

Different in terms of etiology, cellular mediators, treatment, and prognosis

Question 5

Describe Forced Vital capacity

Answer 5

Determination of vital capacity from a maximally forced effort

Question 6

Define expiratory volume (FEV1)

Answer 6

Volume that has been exhaled at the end of the end of the first second of forced expiration

Question 7

What do asthma and COPD patients have in common regarding their respiration?

Answer 7

Decreased FEV relative to their FVC

Question 8

What does Omalizumab block?

Answer 8

IgE

Question 9

What does Mepolizumab and Reslizumab inhibit?

Answer 9

Interleuken 5

Question 10

How are inflammatory mediators released by mast cells?

Answer 10

Immunological stimuli activate IgE receptors

Question 11

What are the three therapeutic benefits of asthma/COPD and what are two* examples of each?

Answer 11

Decreased inflammation

• Glucocorticoids
• Antileukotrienes

Bronchodilation

• beta2 adrenergic receptor agonists
• Muscarinic receptor antagonists

Decreased inflammation and bronchodilation

• methylxanthines

Question 12

How do glucocorticoids decrease inflammation?

Answer 12

Suppression of gene expression

Question 13

How to antileukotrienes decrease inflammation?

Answer 13

Decrease of leukotriene synthesis

OR

antagonization of CysLTR

Question 14

How do beta adrenergic receptor agonists dilate brochi?

Answer 14

Increasing cAMP

Question 15

How do muscarinic receptor antagonists dilate broncholes?

Answer 15

By blocking activation of muscarinic receptors by endogenous acetylcholine

Question 16

How do methylxanthines decrease inflammation and dilate broncholes?

Answer 16

By inhibiting adenosine receptor and increasing cAMP

Question 17

Name a clucocorticoid

Answer 17

Budesonide

Question 18

What are all the effects of glucocorticoids?

Answer 18

local and systemic inhibition of inflammatory mediator synthesis, and phagocytosis

Question 19

What are the antiinflammatory actions of glucocorticoids?

Answer 19

Decreased production of prostaglandins, cytokines and interleukins

Decreased proliferation and migration of lymphocytes/macrophages

Question 20

What cells are decreased after the actions of glucocorticoids?

Answer 20

Airway immune mediators: eosinophils, Th2 lymphocytes, mast cells, macrophages, and dendritic cells

Also redutions in epithelial cell inflammation, endothelial cell permeability, and hyperreactivity of bronchiolar smooth muscle

Question 21

True/False? Corticosteroid therapy is of significant benefit to both asthma and COPD patients

Answer 21

True/False? Corticosteroid therapy is of significant benefit to both asthma and COPD patients

minimal benefit for COPD patients

Question 22

What is the mechanism of action of glucocorticoids?

Answer 22

They bind to the glucocorticoid receptors, activate histone deacetylase 2 (HDAC2) and inhibit histone acetyltransferases (HAT)

Question 23

How are (most) leukotrienes named?

Answer 23

Montelukast

zafirlukast

——lukast

Question 24

How to leukotrienes work?

Answer 24

Competitive antagonists of CysLTR1

Question 25

Are antileukotrienes work better to treat acute episdes of bronchoconstriction, or rather as a prophylactic?

Answer 25

Prophylactic

Question 26

Which autonomic nervous system causes bronchodilation?

Answer 26

Sympathetic

Question 27

How do beta adrenergic receptor agonists work?

Answer 27

Beta adrenergic receptors are found all over bronchial smooth muscle Activation of Beta2 receptors leads to smooth muscle relaxation and therefore bronchodilation Agonists sensetize these receptors

Question 28

How does Ma Huang (ephedrine) work to treat asthma?

Answer 28

Nonselectie adrenergic agonist

Question 29

What is the medication of choice for all types of asthma?

Answer 29

Salbutamol (albuterol)

Question 30

How does Salbutamol work?

Answer 30

Short acting beta2 receptor agonist Rapid onset of action (15 mins)

Question 31

Is salbutamol better prophylactically or acutely?

Answer 31

acute

Question 32

True/False? Albuterol is a racemix mixture, but R-albuterol is more effective

Answer 32

**True**/False? Albuterol is a racemix mixture, but R-albuterol is more effective

Question 33

Name a methylxanthine

Answer 33

Theophylline Caffeine

Question 34

How do methylxanthines work?

Answer 34

Phosphodiesterase inhibitor, leading to increased intracellular cAMP

Question 35

What are negative effects of Theyphylline?

Answer 35

Decreased number/activity of immune mediators,

Question 36

What is the principal autonomic influence in the normal regulation of bronchomotor tone?

Answer 36

Parasympathetic NS tone

Question 37

What is cholinergic control of airway smooth muscle dominated by?

Answer 37

Muscarinic receptor M3 subtype (but all are present)

Question 38

What is the bronchodilator of choice for the treatment of COPD?

Answer 38

Inhaled muscarinic receptor antagonists

Question 39

What drugs are used to prevent acute episodes of Asthma and COPD?

Answer 39

Inhaled glucocorticoids (in more serious cases, LABAs)

Question 40

What drug is used to treat an acute episode?

Answer 40

SABAs

Question 41

What are advantages of routine first-line therapies for asthma and COPD delivered by inhalation?

Answer 41

Convey drug directly to the site of patholoty Much lower doses Reduces side effects

Question 42

What is the typical treatment for asthma?

Answer 42

Multiple drugs with continuous evaluation and adjustment depending on patient responses

Question 43

What should adults with mild/intermittent asthma take?

Answer 43

Infrequent use of fast acting "rescue" bronchodilator (SABAs)

Question 44

What are signs of increasing asthma severity

Answer 44

Nocturnal symptoms, daytime symptoms more than twice a week, limited normal activity

Question 45

What is a risk of LABA monotherapy? How is this countered?

Answer 45

Death (yikes) take in combination with inhaled corticosteroids

Question 46

What happens if the medication doesn't help?

Answer 46

Larger dose

Question 47

What should you take for severe asthma?

Answer 47

Oral corticosteroids

Question 48

Stopping inhaled corticosteroid therapy altogether (is/is not) recommended for adults

Answer 48

Stopping inhaled corticosteroid therapy altogether (is/**is not**) recommended for adults due to increased risk of exacerbated

Question 49

What drugs treat COPD?

Answer 49

Salmeterol or Formoterol (LABAs)