Pharmacology

Question 1

Effects of bronchodilators and anti-inflammatories (general)

Answer 1

Often effect both bronchodilation and inflammation

Question 2

Pathway of ß2 agonist

Answer 2

Increase cAMP: increase dilation, lower inflam. modulators, increase cilia work

Question 3

Pathway of Anti muscarinic and LTRA

Answer 3

decrease constriction

Question 4

SAßAs

Answer 4

Salbutamol and terbutaline

Question 5

LAßAs

Answer 5

Salmeterol, formoterol, indacaterol

Question 6

Good and bad effects of ß agonists

Answer 6

Good for ALL constriction

Bad: tremor, HR up, anxiety

Question 7

Anti-muscarinics

Answer 7

Ipratropium (short) and Tiotropium and glycopyrronium (longer)

Question 8

Side effects of Anti-musc

Answer 8

Dry mouth, nausea, constipation, headache

Question 9

LRTAs

Answer 9

Montelukast, zufirlukast

Question 10

Good and bad effects of LRTAs

Answer 10

“Good: for ASA-induced asthma.
NO effect for COPD
Bad: higher eosinophils? Churg something (rare); headaches, nausea

Question 11

Methylxanthines

Answer 11

Rare now.
Similar to caffeine.
Theophyllin - bronchodilator
-can cause seizure and fatal dysrhythmias at high dose!

Question 12

Why we need to treat inflammation in Asthma and COPD

Answer 12

Inflammation leads to remodelling, which is bad, so try to treat. Asthma is pretty responsive, COPD is not. Generally use ICS

Question 13

ICS function

Answer 13

Via gene regulation. Decrease cytokines and numbers of immune cells. Less edema from blood vessels around airways, less mucous.

Question 14

What changes do drug companies do to corticosteroids? Why?

Answer 14

To improve efficacy as corticosteroids, reduce CS side-effects and mineralocorticoid effects. But generally they all work about the same. Some have increased retention in the lungs but still unclear.

Question 15

Side effects of ICS

Answer 15

Inhibit genes for bone density and keratin (skin more wrinkly).
Oral candidiasis and dysphonia common
Growth retardation (but eventually catch up)
Increased risk of diabetes
Fat redistribution

Question 16

Why don’t ICS help COPD much?

Answer 16

In COPD pts, deacetylation is not working well, so genes stay activated despite ICS

Question 17

Mast cell stabilizers

Answer 17

Cromolyn and Nedocromil.

Make membrane inert so granules not released. Add on to therapy.

Question 18

Monoclonal Antibodies

Answer 18

Omalizumab.
Bind to IgE Antibodies so it can’t bind to mast cells. Expensive like 16k.
May increase chance of cancer a bit, otherwise well tolerated.