Itches, scratches and sneezes / Prostaglandins and leukotrienes Flashcards
What is the allergic response (to pollen)?
1.) pollen
2.) White blood cells
3.) Memory cells
4.Engulf and digest (re-exposure)
5.) Release inflammatory mediators
What happens when mast cells are stimulated?
- Mast cells stimulated by the binding of pathogens/ allergens?
- Mast cell degranulates and releases its components into cells
- Releases histamines, prostaglandins and leuukotrienes , cytokines
What are some of the functions of mast cells?
- Epithelian permeability secretion (histamine LTC4, PGD2)
- Blood flow vascular permeability coagulation (histamine LTC4)
- Neuroimmune interactions, perisatalsis, bronchoconstrictio, pain (histamine proteases PGD2)
What are some pharmacological strategies for allergy prevention?
- Immunotherapy
- Prevent the release of mediators from mast cells
- Block actions of mediators (receptor antagonist)
- Inhibit synthesis of mediators
What is an example of a drug used to prevent the release of mediators from mast cells?
- Ammi visnaga = toothpick plant
- Khellin = active ingredient
- Cromoglicate stabilises mast cells which inhibits degranulation
- dry powder inhaler
Used in : - eye drops
- nasal spray
- asthma
What are eicosanoids?
What are some other inhibitors of mast cell release?
- Tyrosine kinase inhibitors:
- Imatinib (Gilvec)
- used in GI tumors but not for inflammation
What are actions of histamine?
- epithelial permeability secretion and blood flow vascular permeability coagulation can lead to runny nose, wheezing and flare and wheal
**- H1 receptor subtype **: contraction of smooth muscle (ileum, bronchi, uterus) , vasodilation, plasma exudation
H2 receptor subtype- increase gastric acid secretion and mucus secretion
H3 receptor subtype - inhibit release of neurotransmitters
What are 1st generation antihistamines?
- Histamine receptor antagonist
-
Cyclizine : anti-emetic in space-sickness
- Diphenhydramine, dimenhydrinate : cross blood brain barrier, have other non- histamine actions - prevent motion sickness
- **Chlorpherniramine (Piriton) **- crosses BBB sedation, effective allergy treatment
- Promethazine - sedation
What are 2 and 3rd generation antihistamines?
- Terfenadine : non-sedating antihistamine
- can cause arrhythmias (withdrawn)
- Fexofenadine, cetirizine, loratadine ( non-sedating)
How are prostaglandins and leukotrienes synthesised?
- Membrane phospholipids - phospholipase A2- arachidonic acid :
- FOR PROSTAGLANDINS:
- cyclooxygenase COX
- Prostaglandins
- prostacyclin (PGI2), PGF 2a, PGD2, PGE2, thromboxane (TXA2)
- Lipoxyhenase - (leukotrienes, LTC4, LTD4, LTE4)
What are analgesics?
- Anti-inflammatory drugs such as aspirin, ibruprofen, diclofenac, naproxen
- Cyclooxygenase inhibitors = NSAIDS (NON-STEROIDAL ANTIINFLAMMATORY DRUGS)
- Antipyretic anlgesics (e.g. Paracetamol)
What is the action of PGI2 (prostacyclin)?
- generating cell: endothelium
-IP receptor: - vasodilator
- pain
- cough
- inhibits platelet aggregation ( blood clots forming)
prostaglandin
What is the action of PGF2A?
FP receptor
- Broncho-constrictor
- myometrial contraction
- cough
What is the action of PGD2?
- generating cell = Mast cells
DP receptor - vasodilator
- broncho-constriction / allergic asthma (DP1)
- chemotaxis (DP2)
- inhibits platelet aggregation
What is the action of PGE2?
Generatign cell(s) : many cells
-EP receptor
- vasodilator
- pain (EP1 , neurons)
- fever ( EP3 neurons)
- cough
- Bone resporption ( EP4)
- mucus secretion (EP1)
What is the action of TXA2?
- generating cell: platelets
- TP receptor
- Vasoconstrictor
- Increases platelet aggregation
How do COX inhibitors work?
- Inhibit COX production from arachidonic acid
- Therefore no prostaglandinds secreted
- Anti-inflammatory : vasodilation, plasma exudation
- analgesics
- COX inhibition
- inflammed tissue contains prostaglandins whixh increases the pain signal
- antipyretic - inhibition of prostaglanding production in hypothalamus
- Paracetamol - not very anti-inflammatory
- Indomethacin/ piroxicam - not very antipyretic
How is leukotirene secretion inhibited?
- Inhibited by antagonists :
- Zarifirlukast (accolate)
- montelukast (Singulair)
- Lipoxygenase secretion inhibited (promotes inflammatory response)
What are the actions of LTC4, LTD4 and LTE4?
- bronchoconstriction, increased microvascular permeability
What is the action of LTB4?
- chemoattractant for neutrophils
- stimulates release of lysosmal enzymes from macrophages
What are some effects of glucorticoids ?
- Decrease inflammatory response ( adverse = increase susceptibility to infection)
- Decrease immunological response ( adverse: increase susceptibility to infection)
- increase gluconeogenesus and glucosse output from liver. Decreases utilisation ( could lead to diabetes)
- Increased protein catabolism (neg = muscle wasting)
- Increased bone catabolism ( neg - osteoporosis)
- Increased gastric acid and pepsin ( neg = peptic ulcer)
- Increase Na reabsorption, K, H excretion ( neg = hypertension, hypokalaemia, muscle weakness)
Why is the route of synthetic glucocoticoids adminstration varied?
- To limit adverse effects
- eg asthma — as aerosol — beclomethasone, budenoside
- eg eczema — topical
- eg rheumatoid arthritis — intra-articular injection of
- triamcinolone
eg enema in ulcerative colitis
sometimes get rebound after withdrawal
What are eicosanoids?
- 20 carbon fatty acids (i.e. Prostaglandins, Thromboxane’s, Leukotrienes, Lipoxins (LX)
- Not stored and very unstable - get broken down quickly
- Synthesised and act locally
Play an important role in everyday housekeeping physiology and inflammation
Where do eicosanoids come from?
- Membrane phospholipids : arachidonic acid
- Arachidonate is released by specialised phospholipase A2
Then production of eicosanoids
- Arachidonate is released by specialised phospholipase A2
What are the types of COX?
- COX 1
- Physiological roles
- Stomach
- Kidney
- Constitutive
-COX 2 : - inflammatory roles
- Induces during inflammation
What happens when Aspirin binds to COX?
-irreversible binding to COX
-Platelets :
- Express COX-1 , produce TXA2. Non nuclei
-TP receptors on vascular smooth muscle
Endothelial cells :
- Express COX-2 upon inflammation
- Produce PGi2
- Have nuclei
- IP receptors on vascular smooth muscle - vasodilation
- IP receptors on platelets = platelet disaggregation