Drugs For Bronchial Asthma

Question 1

What is asthma

Answer 1

Asthma is a COPD chxd by reversible bronchospasm and chronic inflammation in the respiratory tract. Symptoms generally include cough, wheezing, chest tightness and shortness of breath.

Question 2

Pathophysiology of bronchial asthma

Answer 2

The major pathophysiologic mechanism is release of chemical mediators by IgE sensitised mast cells and other cells involved in immune response. Allergens like pollen,dust act as an antigen and activate IgE which sensitive mast cells and lead to their degranulation and thus releasing prostaglandin, leukotrienes , cytokines etc. This would then lead to bronchospasm and increased mucus sectetion

Question 3

Bronchodilators include

Answer 3

B2 adrenergic agonists
Methylxanthines
Anticholinergics
BAM

Question 4

The B2 adrenergic agonists

Answer 4

Include the selective and non selective
Selective- INCLUDE
SABA- Salbutamol and terbutaline(salt)
LABA- Salmeterol and formoterol

Non selective- Adrenaline
However dangerous due to its action on B1

Question 5

Mechanism of action of b2aa

Answer 5

Activate B2 adrenergic receptors of the bronchial smooth muscles leading to an increase in cAMP production that would lead to bronchodilation and reduce release of chemical mediators. They are the mainstay of reversible airway obstruction.

Question 6

Adverse effects of B2AA

Answer 6

Palpitations
Tachycardia/tremor
Hypokalemia.

Question 7

SABA can be used in form of a metered dose inhaler T/F

Answer 7

T

Question 8

Methylxanthines include

Answer 8

Aminophylline
Theophylline
Doxophylline

Question 9

Mechanism of action of Methylxanthines

Answer 9

They are bronchodilators that act by inhibiting phosphodiesterases which break down cAMP to 5’AMP, thus leading to increased levels of cAMP and subsequent bronchodilation

Question 10

Adverse effects of mtx

Answer 10

The constant battle of the methylxanthines
Heart: palpitation,tachycardia,hypotension or even death due to cardiac arrythmias
Kidney:diuresis
Git: nausea vomiting gastritis or aggravation of pus
Cns: headache restlessness or even seizures.

Narrow therapeutic index

Question 11

Uses of Methylxanthines

Answer 11

Bronchial asthma and COPD however rarely used due to adverse effects
Premature apnea in infants- very low dose aminophylline

Question 12

Anticholinergic drugs include

Answer 12

Ipratropium and tiotropium bromide

Question 13

This Theophylline of a man😒🙄

Answer 13

Lazy- food delays it’s rate of absorption
Ajebutter- poorly water soluble, can only be taken orally
Amebo-drug interaction
Phenytoin/rifampicin/phenobarbital
Cimetidine/ciprofoxacin/erythromycin.

Question 14

Cross match of saba and laba

Answer 14

SABA- Acute attacks
Salmeterol- maintenance
Formoterol- prophylaxis

Question 15

MOA of anticholinergics

Answer 15

Act on muscarinic receptors to block effects of ach on bronchial smooth muscles and cause bronchodilation

Question 16

Anticholinergics are best effective when administered alone as inhalers. T/F

Answer 16

False, they have slow onset of action and have better effects when administered with b2 agonists

Question 17

Anti inflammatory agents in the treatment of bronchial asthma include

Answer 17

Corticosteroids
Mast cells stabilisers
The antibodies.
Leukotriene modifiers

Question 18

Leukotriene Antagonists ibclude

Answer 18

Zafirlukast
Minteleukast
Zileuton

Question 19

MOA of leukotriene Antagonists

Answer 19

Act by blocking the effects of cysteine leukotrienes
Zileuton exerts selective inhibition of 5-lipoxygenase.

Question 20

PK of leukotriene Antagonists

Answer 20

Reduce hyper activity
Well absorbed after oral administration
Highly bound to plasma proteins
Less side effects

Question 21

Mast cells stabilisers include

Answer 21

Sodium chromoglicate,
nedocromil sodium
ketotifen

Question 22

MOA of mast cell stabilisers

Answer 22

Stabilise mast cells membrane thereby preventing degranulation and release of chemical mediators.

Question 23

This Sodium chromoglicate is an actual babe 🔥💦

Answer 23

Poorly absorbed orally thus given by inhalation …just inhale her nice perfume
Used for prophylaxis not in acute asthma…no stress
Can also be used in allergic conjunctivitis,dermatitis,rhinitis etc..still an all rounder🔥🔥

Question 24

Which of the mast cell stabilisers have H1 blocking effect?

Answer 24

Ketotifen

Question 25

The glucocorticoids include

Answer 25

Inhalational- beclomethasone, budesonide and fluticasone
Systemic- hydrocortisone, prednisolone etc

Question 26

MOA of glucocorticoids

Answer 26

Secrete lipocortin which inhibits phospholipase A2 and thereby prevents formation of various mediators such as PGs and txas
Thus they have antiallergic, antiinflammatory and immunosuppressant effect

Question 27

The glucocorticoids do not have direct bronchodilatory effect and thus are given with bronchodilators. T/f

Answer 27

T.
Have synergistic effect when given with LABA asin fluticasone+salmeterol=seritide

Question 28

Adverse effects of glucocorticoids

Answer 28

Sodium and water retention, htn, muscle weakness,osteoporosis, gastric irritation due to inhibition of COX2

Question 29

The antiIgE antibody involved in bronchial asthma is known as?
MOA?

Answer 29

Omalizumab
Prevents IgE from binding to mast cells
Thus prophylactic

Question 30

In asthma, avoid

Answer 30

NBCS
NSAIDS
Badrenergic blockers like propanolol
Cholinergic agents
Sedatives

Question 31

Drugs for status asthmatics

Answer 31

O-oxygen

Salbutamol nebulised
Hydrocortisone 200mg IV
Ipratropium bromide nebulised
Theophylline