Pathophysiology and Pharmacology of obstructive airway diseases

Question 1

What is asthma?

Answer 1

• Asthma is a chronic inflammatory disorder in susceptible individuals

Question 2

What are the features of asthma?

Answer 2

• bronchospasm

- Bronchial hyperresponsiveness

Question 3

What is bronchospams?

Answer 3

• It is reversible airflow obstruction caused by the constriction of the bronchi

Question 4

Bronchial hyperresponsiveness can be non specific i.e histamine, old air, sulphur or it can be specific i.e adenosine. TRUE OR FALSE?

Answer 4

TRUE

Question 5

Which cells produce IgE?

Answer 5

B cells

Question 6

What are dug targets for asthma?

Answer 6

B2 receptor agonits
CyaLT - antangonists
Theophyllines
Glucocorticosteriods

Question 7

what occurs in acute inflammation?

Answer 7

• Symptoms of bronchoconstriction

Question 8

What occurs in chronic inflammation?

Answer 8

• Exacerbations

- Non-specific hyperreactivity

Question 9

what occurs in airway remodelling?

Answer 9

-Persistent airflow obstruction

Question 10

what are the airway changes in chronic to severe asthma?

Answer 10

• Inflitration of inflammatory cells e.g eosinophiles
• Mast cells
• Thicked basement membrane
• Dilated blood vessels and oedema

Question 11

what are the goals for asthma treatment?

Answer 11

Relief
- relief bronchoconstriction 
in severe attacks:
- Reduce mucus production 
- Supress airway oedema 

Prevent:

• Inhibit bronchoconstriction
• Supress chronic inflammation
• Inhibit airway remodelling

Question 12

What is COPD and what are these patients likely to suffer from?

Answer 12

Chronic obstructive pulmonary disease

• It is an impairement in lung function and defence against infection
• People with COPD are at greater chances of obtaining lung infections e.g Bronchitis and pneumonia

Question 13

Inflammatory reaction in COPD leads to tissue destrcution i.e emphysema. TRUE OR FALSE?

Answer 13

• TRUE

Question 14

What are the goals of COPD therapy?

Answer 14

Relief

• Increasing airway patency
• Controlling reccurent infections

Prophylaxis

• Supress chronic inflammation
• Reduce mucuc secretion

Question 15

Name some drug classes for the treatment of asthma?

Answer 15

Relievers

• B2 adrenoceptor agonist
• Muscarinic receptor antangonists

Preventers

• Long acting bronchodilators
• Cromones
• Glucortiocoids (can be inhaled)
• Leukotriene receptor antangonists

Question 16

Provide an example of a bronchodilator drug and mechanism of action of bronchodilators?

Answer 16

• Salbutamol

- Bronchodilators work by relaxation of bronchiol smooth muscle usually cAMP mediated

Question 17

Salbutamol is a B2-adrenoceptor agonist. TRUE OR FALSE?

Answer 17

TRUE

Question 18

B2 adrenoceptors agonists have rapid onset of action when taken as inhaler, this also reduces side effects.

Duration of action is 5 minutes and lasts up to 6hrs . TRUE OR FALSE?

Answer 18

TRUE

Question 19

where are B2 adrenoceptors agonists metabolised?

Answer 19

In the liver of conjugate sulphate

Question 20

what is the oral half life of B2 adrenoceptors agonists?

Answer 20

4 hrs

Question 21

B2 adrenoceptors agonists have drug interactions with B2 adrenoceptor antangonist. TRUE OR FALSE?

Answer 21

TRUE

Question 22

Salbutamol has off target effects at the B1 receptors in the heart. TRUE OR FALSE?

Answer 22

TRUE

Question 23

B2 receptors causes relaxation of heart and skeletal smooth muscles, this leads to dilation of blood vessels, this drop in presure can lead to tachycardia. TRUE OR FALSE?

Answer 23

• TRUE

Question 24

Name a long acting adrenceptor agonist (LABA) drug?

Answer 24

Salmeterol and formoterol

Question 25

Salmeterol does not have the same mechanims of action as salbutamol. TRUE OR FALSE?

Answer 25

FALSE

Question 26

Name a muscarinic receptor antangonist drug?

Answer 26

Ipratriopium

Question 27

What is the mechanism of action of muscarinic receptor antangonist?

Answer 27

- relax bronchiol smooth muscle - inhibit bronchiol mucus secretion - Antagonist of the muscarinic receptors - They are speicif cto parasympathetic bronchoconstrction

Question 28

muscarinic receptor antangonist e.g ipratropium is activated by inhilation and 10-30% is deposited in the airway the rest is swallowed. TRUE OR FALSE?

Answer 28

TRUE

Question 29

Ipratropium has High pulmonary biolavailability but low oral bioavailability. TRUE OR FLASE?

Answer 29

TRUE

Question 30

Duration of action of ipratropoium is 3-5 hr for tiotropium is more than 24hr. true or false/

Answer 30

true

Question 31

Name a drug in the class of Methylxanthines?

Answer 31

e.g Theophyllines

Question 32

What sis the mechanims of action of Methylxanthines e.g theophyllines?

Answer 32

- Bronchiol smooth muscle relaxtaion - Inhibition of cyclic nucleotide PDE - Possible anti-inflammatory actions

Question 33

Theophyllines are non- selective PDE inhibitors. TRUE OR FALSE?

Answer 33

TRUE

Question 34

Name a glucocorticoid drug?

Answer 34

- Beclometasone

Question 35

What is the mechanism of action of glucocorticoids drugs?

Answer 35

- Reduce activation of inflammatory cells - Reduce IgE synthesis - Up regulate B2 adrenoceptor expression

Question 36

Glucocorticoids are activated by inhilation. TRUE OR FALSE?

Answer 36

TRUE

Question 37

glucocorticoid (Beclometasone) have low pulmonary biolavilability and oral bioavailability. TRUE OR FALSE?

Answer 37

TRUE

Question 38

Which glucocorticoid drug has a rapid first pass metabolism?

Answer 38

- Fluticasone

Question 39

Name a cromone drug?

Answer 39

- Sodium cromoglyate nedocromil

Question 40

What is the mechanism of action for cromones?

Answer 40

- Casue mast cell stabilization - Inhibit sensory nerves (blcoking cl- chanels) - Small effect in paediatricsmild asthma

Question 41

cromones have extremely low oral and pulmonary bioavailbility. They are excreted via coughing and throug faeces. TRUE OR FALSE?

Answer 41

TRUE

Question 42

Provide an example of a anti-leukotriene inhibitor?

Answer 42

- 5-lipoxygenase inhibitors (orally active with few adevrse reactions)

Question 43

Name an anti- IgE therapy drug?

Answer 43

- Omalizumab - humanised monoclonal antibody

Question 44

What does anti-IgE drugs do?

Answer 44

- get rid of circulating IgE | - Supress allergic reactions esapecially those underling from asthma

Question 45

List some drug therapies for COPD?

Answer 45

- LABA - Theophillines - Bronchodilators - antimuscarinic prefered - Glucocorticoids