Drugs for Pulmonary Disorders

Question 1

what are the goals of asthma therapy?

Answer 1

• reduce intensity and frequency of asthma symptoms

- reduce the risk of adverse effects associated with asthma

Question 2

reduction of intensity and frequency of asthma symptoms include?

Answer 2

• reducing symptoms (cough, SOB)
• reducing need for short acting beta agonists
• reduce- night time awakenings due to asthma
• optimization of lung function
• participation in normal daily activities

Question 3

reduction of risk of adverse effects associated with asthma includes?

Answer 3

• prevention of recurrent exacerbations and need for emergency department or hospital care
• prevention of reduced lung growth in children, and loss of lung function in adults
• optimization of pharmacotherapy with minimal or no adverse effects

Question 4

what are the two main therapeutic strategies in asthma?

Answer 4

• relievers and controllers

Question 5

relievers include

Answer 5

• beta adrenergic agonists

- muscarinic antagonists

Question 6

controllers include

Answer 6

• glucocorticoids
• long acting beta adrenergic agonists
• leukotriene antagonists and lipoxygenase inhibitors
• methylxanthines
• IgE antibodies and mast cell stabalizers

Question 7

what two mediators induce bronchoconstriction?

Answer 7

• histamine and leukotrienes

Question 8

how does histamine induce bronchoconstriction?

Answer 8

• IP3 levels increase within the mast cell and cause calcium to be released from sarcoplasmic reticulum
• calcium causes mast cell degranulation and releases histamine

Question 9

how do leukotrienes induce bronchoconstriction?

Answer 9

• increase of calcium from sarcoplasmic reticulum also causes phospholipase A2 to be activated and causes formation of arachidonic acid
• AA causes leukotrienes to be created which cause immune cell recruitment and bronchoconstriction

Question 10

beta 2 adrenergic agonists

Answer 10

• bind to beta 2 receptor associated with Gs

Question 11

what are the routes of administration for beta 2 adrenergic agonists?

Answer 11

• severe asthma attack (nebulizer)
• inhaler (short and long acting)
• oral (long acting, paediatric cases, night time control)

Question 12

what are some adverse effects of beta 2 adrenergic agonists?

Answer 12

• tremors and tachycardia

Question 13

muscarinic antagonists

Answer 13

• blocks muscarinic receptors in the smooth muscle of the bronchi
• second line therapy (effective in 2/3 of clients with asthma, slower acting than SABA)

Question 14

when are muscarinic antagonists used?

Answer 14

• COPD, chronic bronchitis

Question 15

what are some adverse effects of muscarinic antagonists?

Answer 15

• dry mouth and sedation

Question 16

can muscarinic antagonists be combined with short acting beta agonists?

Answer 16

• yes

Question 17

how do allergens relate to asthma?

Answer 17

• induce transcription factors to induce formation of inflammatory cytokines which recruit immune cells to lungs
• immune cells produce cytotoxic compounds that will remodel air ways and cause bronchoconstriction

Question 18

what is the mechanism of action for glucocorticoids with asthma?

Answer 18

• act at a level of of transcription factor , terminating the ability to act at the level of DNA and causing no cytokines to be formed
• bind to receptor, the complex binds to response elements to cause down regulation of genes responsible for production of inflammatory cytokines, increased production of proteins that inhibit phospholipase A2

Question 19

what are the effects of daily administration of glucocorticoids?

Answer 19

• suppresion of airway inflammation, reduces airway hyper responsiveness sand airway obstruction to prevent asthma attacks

Question 20

what are the routes of administration for glucocorticoids?

Answer 20

• IV or oral for severe asthma

- inhalers for moderate to severe asthma

Question 21

what are some adverse effects of glucocorticoids?

Answer 21

• low does; throat irritation and oral candidiasis

- high dose; adrenal insufficiency and osteoporosis

Question 22

what is the mechanism of action for leukotrienes receptor antagonists?

Answer 22

• competitively bind to leukotriene receptors in bronchioles to induce bronchodilatory and immunodulatory effects
• weaker effects compared to beta 2 adrenergic agonists
• 2nd line therapy compared to glucocorticoids
• cam be used in combination with glucocorticoids

Question 23

what are the routes of administration for leukotriene receptor antagonists?

Answer 23

• oral (taken twice , available in chewable for paediatrics, taken at night

Question 24

what are some adverse effects of leukotrienes receptor antagonists ?

Answer 24

• nausea , headache

Question 25

when are mast cell stabalizers used?

Answer 25

- when someone is prone to asthma attacks when they are exposed predictably to a known allergen - prevent mast cells from releasing calcium in response to IgE receptor stimulation

Question 26

what is the mechanism of action of lipoxygenase inhibitors?

Answer 26

- inhibit formation of all leukotrienes | - used for prevention of asthma attacks

Question 27

what type of patients are lipoxygenase inhibitors contraindicated with?

Answer 27

- those with liver disease

Question 28

what is the mechanism of action of methylxanthines?

Answer 28

- inhibit phosphodiesterase which degrades CAMP | - slow release; for the control of nocturnal asthma

Question 29

what are some adverse effects of methylxanthines?

Answer 29

-GI distress, irritability, insomnia, headache, nausea and vomiting

Question 30

what is the mechanism of action of IgE antibodies?

Answer 30

- for allergic forms of asthma; reduces the production of IgE, down regulates IgE receptors, mast cell stabalizing effects

Question 31

when are IgE antibodies used and what type of patients?

Answer 31

- moderate to severe allergic asthma | - who have failed step 1 to 4 of therapy (do not respond to glucocorticoids)

Question 32

what are some adverse effects of IgE antibodies?

Answer 32

- pain, dizziness, fatigue, skin rash, anaphylaxis