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Drugs and Disease > Drugs in Asthma > Flashcards

Drugs in Asthma Flashcards

1
Q

What kind of condition is asthma?

A

An inflammatory condition

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2
Q

What are the symptoms of asthma

A

A recurrent obstruction of airflow in response to a non-noxious stimuli and bronchospasm

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3
Q

What is a non-noxious stimuli?

A

Stimuli that are too weak to affect non-asthmatic

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4
Q

Why do people get asthma?

A

Normally a combination of genetics and a trigger

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5
Q

Asthma is psychogenic; what is this?

A

It can be worse in different emotional situations i.e. it its worse in stress situation

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6
Q

Asthma is sometimes post-viral; what does this mean?

A

Can be brought out as the result of a viral infection

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7
Q

What is responsible for the onset of asthma in about 30% of cases?

A

A Trigger

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8
Q

What two ways can asthma be classified?

A

Atopic (extrinsic) and Non-atopic (intrinsic)

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9
Q

What does atopic mean?

A

Allergic

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10
Q

What does non-atompic mean?

A

Non-allergic

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11
Q

What is an antigen?

A

A foreign protein/modified protein that produces an antibody response

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12
Q

How do antigens cause the synthesis of antibodies?

A

Lymphocytes
Macrophage
Monocytes
and Mast cells

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13
Q

How are macrophages involved in antibody synthesis?

A

They present the antigen to be recognised by the lymphocytes

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14
Q

How are lymphocytes involved in antibody synthesis?

A

They recognise the antigen that the macrophage presents and they produce the antibodies

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15
Q

What are monocytes?

A

A type of white blood cell

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16
Q

How are monocytes involved in the immune system?

A

The differentiate into macrophages

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17
Q

What antibody do lymphocytes make that attach to mast cells?

A

IgE cells

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18
Q

What are mast cells?

A

Cells that contain histamine and can have a antibody attached to them that once it recognises the antigen it will release its contents

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19
Q

What are mast cells?

A

Contains granules and can have a antibody attached to them that once it recognises the antigen it will release its contents

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20
Q

What 3 important things do these mast cells release upon recognition of the antigen?

A
  1. Histamine
  2. Platelet activating factor (PAF)
  3. Leukotrienes
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21
Q

What do mast cells release?

A

Chemical mediators called cytokines

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22
Q

What are 3 other things sometimes released from mast cells?

A
  1. Prostaglandins
  2. Thromboxanes
  3. Interleukins
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23
Q

What is the effect of the cytokines the mast cells release and what symptoms do they produce?

A
  1. Oedema which leads to bronchial inflammation
  2. Smooth muscle contraction (broncial smooth muscle)
  3. Pain/itching
  4. Vasodilitation
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24
Q

What is the definition of an allergy?

A

An innappropriate immune response

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25
Q

In terms of allergy what varies depending on the tissue?

A

The form of the reaction and the mediators released

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26
Q

What are the symptoms of an allergic reaction involving the gut?

A

Vomiting

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27
Q

What are the symptoms of an allergic reaction involving the skin?

A

A rash or itchyness

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28
Q

What are the symptoms of an allergic reaction involving the eye or nose?

A

Hypersecretion

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29
Q

What are the two stages of asthma?

A

The intermediate and late phases

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30
Q

What is the intermediate stage of asthma?

A

The initial response to the allergen

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31
Q

What two things does the intermediate stage of asthma involve in terms of reaction?

A

Bronchoconstriction (bronchial smooth muscle contraction) causes the airways to contract and vasodilation

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32
Q

What happens to the force expiratory volume in one second (FEV1) during the intermediate phase of asthma when the trigger is applied?

A

It drops dramatically due to bronchoconstriction

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33
Q

What are the two stages of asthma?

A

The immediate and late phases

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34
Q

What is the immediate stage of asthma?

A

The immediate response to the allergen (up to an hour)

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35
Q

What two things does the immediate stage of asthma involve in terms of reaction?

A

Bronchoconstriction (bronchial smooth muscle contraction) causes the airways to contract and vasodilation

36
Q

What happens to the force expiratory volume in one second (FEV1) during the immediate phase of asthma when the trigger is applied?

A

It drops dramatically due to bronchoconstriction

37
Q

What is anaphalaxis?

A

When the allergic reaction is extreme and you can’t breathe rather than just become breathless

38
Q

What is the late stage of asthma?

A

occurs from 3 to 10 hours after the initial prolongs the asthma attack

39
Q

How does the late stage differ from the immediate?

A

More severe congestion and inflammation than seen in the immediate phase

40
Q

What happens to the FEV1 during the late stage?

A

It decreases

41
Q

What main things happen during the late stage?

A

Hypersecretion leads to mucus build up
Inflammatory response
Bronchoconstriction and hyperactivity

42
Q

What is status asthmaticus?

A

A sever condition in which asthma attackas follow each other without pause

43
Q

What nervous systems innvervate and contract the lungs?

A

The parasympathic and sympathic divisons of the nervous system
Non-adrenergic non-cholingergic excitory nervous system
Sensory part of the nervous system

44
Q

How could the sensory system affect the contractability of the lung?

A

Irritation of the sensory system leads to relflex constriction by the parasympathetic nervous system

45
Q

How does the parasympathetic (cholinergic) affect contracility?

A

causes contraction

46
Q

How does the sympathetic (adrenergic) affect contractility

A

causes relaxation

47
Q

What is the NANC system?

A

Part of the autonomic nervous system whose transmitters are not acetylcholine or adrenaline

48
Q

What system contracts the upper airways?

A

The parasympathetic

49
Q

What transmitter causes contraction of the upper airways and what receptor do they bind to?

A

Acetylcholine on the muscarinic (m3) receptor

50
Q

Which transmitters contract the lower airway muscles?

A

The excitatory NANC transmitters

51
Q

Which transmitters relax the lower airway muscles?

A

The inhibitory NANC transmitters

52
Q

What is an example of an inhibitory NANC transmitter?

A

Nitric oxide

53
Q

What other transmitter causes relaxation of the lower airway muscles and what receptor does it act on?

A

Adrenaline on the B2 receptor

54
Q

What is interesting about the relaxation of the lower airway muscles?

A

There is no sympathic nervous system innvervation it is only circulating adrenaline that causes relaxation

55
Q

What system vasoconstriction of blood vessel smooth muscle?

A

The sympathetic nervous system

56
Q

What transmitter and receptor of the sympathic nervous system are involved in contraction of blood vessel smooth muscle?

A

Through noradrenaline acts on the a-adrenoceptor1

57
Q

What other transmitter and receptor are involved in vasoconstriction of blood vessels that is not supplied by the sympathic nervous system?

A

circulating adrenaline acting on b2 recceptors

58
Q

Which systems act on the glands and control mucous secretion?

A

The sympathic and parasympathic nervous systems

59
Q

What affect does the parasympathic nervous system have on mucous secretion?

A

It increases mucous secretion

60
Q

What affect does the sympathetic nervous system have on the mucous secretion?

A

It decreases mucous secretion

61
Q

What other factors could cause mucous secretion from the glands to increase?

A

inflammatory mediators and chemical/physical stimuli

62
Q

What kind of drug therapy would be required during the immediate phase of asthma and why?

A

Smooth muscle relaxants to treat bronchospasm

63
Q

What kind of drug therapy would be required during the late phase of asthma?

A

Sterioids like corticosterioids to treat inflammation

64
Q

What 3 specific kinds of drugs would be used to treat the immediate phase?

A
  1. B2 receptor agonist
  2. Muscarinic antagonists
  3. Theophylline
65
Q

What 3 specific kinds of drugs would be used to treat the late phase?

A
  1. Antihistamines
  2. Leukotriene antagonists
  3. Glucocorticoids
66
Q

Name a Beta receptor agonist that could to treat asthma?

A

Salabutamol

67
Q

How is salabutamol administered?

A

Inhaled

68
Q

What transmitter does salabutamol mimic the action of?

A

Adrenaline

69
Q

What does salabutamol do to treat asthma?

A

It relaxes the bronchial smooth muscle which increases the FEV1

70
Q

Name a muscuranic receptor antagonist that can be used to treat asthma but is more useful in bronchitis?

A

Ipratropium

71
Q

Does ipatropium have good or poor absorption and why?

A

Poor as it is N+ (ionised)

72
Q

What is now the better replacement for ipatropium?

A

Tiotropium

73
Q

How is tiotropium used to treat asthma?

A

It is a selective m3 muscarinic receptor antagonist, block contraction by the parasympathetic nervous system

74
Q

How long does tiotropium last?

A

24 hours

75
Q

What does theophylline inhibit and why is this useful in the treatment of asthma?

A

It inhibit phosphodiesterase which breaks down cAMP and gGMP; raising these two will lead to relaxation of bronchial smooth muscle

76
Q

What is theophylline?

A

A bronchodilator

77
Q

Apart from inhibiting phosphodiesterase what else can theophylline do?

A

It can increase the production of adrenaline and noradrenaline

78
Q

What are some serious side effects of theophylline?

A

Heart arrythmias and convulsions

79
Q

What are antihistamines useful to treat? What do they treat indirectly?

A

Hayfever but can indirectly treat asthma

80
Q

What are leukotrienes?

A

Produced by mast cells are the main cause of inflammation in asthma

81
Q

Name a leukotriene receptor antagonist that could be used to treat inflammation?

A

Montelukast

82
Q

Glucocorticoids are good prophylactics. Why is this?

A

They reduce the permeability of blood vessels by blocking the leaky pores that lets lymphocytes out into site of infection

83
Q

Glucocorticoids turn off your immune system. Apart from blocking leaky pores name two ways how do they do this?

A

They inhibit production of immune mediators

They reduce lymphocyte and mast cell numbers

84
Q

Glucocorticoids are involved in the inhibition of which enzyme?

A

phospholipase A2

85
Q

Why is inhibition of phospholipase 2 by glucocorticoids important?

A

It means COX-2 is blocked and cannot make prostaglandins, leukotrienes etc

86
Q

What is the mechanism in which glucocorticoids inhibit phospholipase A2?

A

They bind a nuclear receptor which can regulate gene expression and produces more mRNA to synthesise the protein lipocortin (annexin-1) which inhibit phospholipase A2

Drugs and Disease (15 decks)

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