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Phoebe's Resp > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Where are cell bodies of the parasyympathetic preganglionic fibres located

A

Brainstem

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2
Q

Where are cell bodies of parasympathetic postganglionic fibres located

A

Bronchi and bronchiole walls

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3
Q

Stimulation of postganglionic cholinergenic fibres causes

A

Bronchial smooth muscle contraction (mediated by M3 ACH on ASM)
Increased mucus secretion (mediated by M3 ACH on goblet gland cells)

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4
Q

Stimulation of postganglionic noncholingergenic fibres causes

A

Bronchial smooth muscle relaxation (mediated by NO and VIP)

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5
Q

In the sympathetic division there is no innervation of

A

bronchial smooth muscle

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6
Q

Parasympathetic postganglionic fibres supply

A

Submucosal glands and smooth muscle of blood vessels

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7
Q

Stimulation of parasympathetic postganglionic fibres causes

A

Bronchial smooth muscle relaxation via B2- adrenoreceptors on ASM
Decreased mucus secretion mediated by B2-adrenoreceptors on goblet cells
Increased mucociliary clearance mediated by B2-adrenoreceptors on epithelial cells
Vascular smooth muscle contraction mediated by A1-adrenoreceptors on vascular smooth muscle cells

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8
Q

Contraction of smooth muscle caused by

A

Myosin light chain kinase phosphorylated

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9
Q

Relaxation of smooth muscle caused by

A

Dephosphorylation of Myosin phosphate

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10
Q

What causes the rate of phosphorylation to exceed rate of dephosphorylation

A

Presence of Ca2+

Relaxation requires Ca2+ to return to normal level

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11
Q

How does Ca2+ return to normal level

A

Active transport

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12
Q

Asthma

A

Recurrent, reversible obstruction of airways

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13
Q

Causes of asthma

A

Allergens
Exercise
Resp infection
Smoke, dust, environmental pollutants

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14
Q

Asthma patients present with

A

Tight chest
Wheeze
Cough
Difficulty breathing

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15
Q

Chronic asthma

A

Pathological changes that result from long standing inflammation:

  1. Increase mass of smooth muscle
  2. Accumulation of interstitial fluid
  3. Increased secretion of mucous
  4. Epithelial damage (exposing sensory nerve endings)
  5. Sub-epithelial fibrosis
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16
Q

Asthma caused FEV1 to

A

decrease

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17
Q

mild asthma displays

A

hypersensitivity

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18
Q

severe asthma displays

A

hypersensitivity

hyper-reactivity

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19
Q

FEV1

A

Forced expiratory volume in 1 second

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20
Q

In atopic individuals, stages of asthma immunity

A
  1. allergen
  2. phagocytosis
  3. Strong Th2 response, IgE
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21
Q

Development of allergic asthma

A
  1. Allergen in airway epithelium
  2. CD4+ express Th0 cells
  3. Th0 cells becomes Th2
  4. Th2 activates B cells
  5. B cells become IgE
  6. Th2 also release IL4 and IL13 causing mast cells to express IgE
  7. Stimulates Ca2+ entry, leukotriene release, contraction of smooth muscle
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22
Q

Stages in late phase of asthma

A
  1. Epithelial damage
  2. Airway hyper-responsiveness
  3. Bronchospasm, wheezing, cough, mucous over secretion
  4. Airway inflammation
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23
Q

2 categories of drugs used in treatment of asthma

A

Relievers (bronchodilators)

Controllers (Anti-inflammatory)

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24
Q

Relievers

A

SABA’s
LABA’s
CysLT1 receptors agonist

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25
Controllers
Glucocorticoids Cromoglicate Humanised IgE monoclonal antibodies
26
B2 - adrenoreceptors agoinsts
antagonist of all spasmogens | Bronchodilators
27
SABA's
Short Acting B2-adrenoreceptor Agonist Salbutamol Increase mucous clearance and decrease mediator release from mast cells and monocytes
28
LABA's
Long Acting B2-adrenoreceptor Agonist Salmeterol Formaterol Should not be used as monotherapy, should be used with gluticosteroids
29
used in nocturnal asthma
LABA
30
CysLT1
Cysteinyl Leukotriene Receptor Antagonists Act competitively at CysLT1 receptor stopping smooth muscle contraction Montelukast
31
Methylxanthines
Inhibits PDE3 Combine bronchodilator and anti-inflammatory actions Second line drugs used with B2-adrenoreceptor agonists and glucocorticoids
32
Corticosteroids
``` Glucocorticoids Anti-inflammatory Reduces immunological response Prevent inflammation Resolve established inflammation ```
33
Cromones
Mast cell stabilisers | Weak anti-inflammatory response
34
Sodium cromoglicate
Reduce phases of asthma attack | More effective in young children
35
Monoclonal antibodies against IgE
Binds to IgE to prevent it binding to cells
36
Asthma Treatment
1. SABA (salbutamol) 2. Inhaled corticosteroid (beclomethasone) 3. LABA + ICS (salmeterol) 4. Increase glucocorticoid dose, add 4th drug 5. Oral glucocorticoid (prednisolone)
37
Synthetic glucocorticoid used to prevent inflammation in chronic asthma
Inhaled beclometasone
38
Synthetic glucocorticoid used in severe or rapidly deteriorating asthma
Oral prednisolone
39
Weak anti-inflammatory used in allergic asthma
Inhaled Sodium Cromoglycate
40
volume of air breathed in and out per minute
pulmonary ventilation
41
volume of air exchanged between atmosphere and alveoli per minute
Alveolar ventilation
42
Major inspiratory muscle in a sheet, containing crura
Diaphragm
43
Palpable reference point used in BEC
Xiphoid process
44
Site of oblique fissure anteriorly
Rib 6
45
Most O2 is transported
bound to haemoglobin
46
Most Co2 is transported
as bicarbonate
47
A small proportion of O2 is transported
in solution
48
Carries deoxygenated blood, drains into superior vena cava and arches around right lung root
Azygous vein
49
Arise from anterior surface of descending aorta
Bronchial arteries
50
Surrounded by vessels and may appear black on dissection
Pulmonary lymph nodes
51
Palpable with jugular notch
Trachea
52
Level where lower respiratory tract begins
C6 vertebrae
53
Anatomical landmark for cardiopulmonary resuscitation
Xiphoid process
54
Site of horizontal fissure
Right 4th rib
55
Level of carina
Rib 2
56
Level of oblique fissure posteriorly
T3 vertebrae
57
Factor that most increases pulmonary ventilation
tidal volume
58
Methylxanthine used as add-on therapy in asthma. Serum levels must be monitored due to drug interaction
Oral theophyline
59
Anti-inflammatory that can trigger bronchospasm in sensitive individuals
Oral ibruprofen
60
A CysLT-1 receptor antagonist, used as an add-on therapy in asthma
Oral montelukast
61
Monoclonal antibody against IgE that reduces IgE receptor expression
Subcutaneous omalizumab
62
SABA used to relieve bronchospasm in mild to moderate asthma
inhaled salbutamol
63
Add on B-2 agonist that responds poorly to initial management
Inhaled salmeterol
64
B2 agonists end in
ol
65
B2 agonist examples
Salbutamol | Salmeratol
66
Inhaled corticosteroids
Beclomethasone | Fluticasone
67
Inhaled corticosteroids end in
One
68
CysLT-1 examples
Montelukast | Zafirlukast
69
CysLT-1 end in
lukast
70
Methylxanthines
Theophyline
71
Asthma immune response
1. IgE antibody attaches to mast cells 2. Degranulation occurs 3. Inflammatory mediators released causing bronchospasm, mucosal oedema and mucous formation
72
Pathophysiology of COPD
Inhalation of noxious gases/particles leads to inflammation, mucocilliary dysfunction and tissue damage
73
Cigarette smoking with COPD
1. Activates macrophages 2. Activates neutrophils 3. Proteases released causing alveolar wall dysfunction (emphysema) and mucous hypersecretion (bronchiectasis)
74
COPD Treatment
1. SABA 2. LAMA 3. LABA 4. LAMA/LABA combination inhaler 5. LABA/ICS combination inhaler 6. LABA/LAMA/ICS combination inhaler
75
LAMA
Long acting muscarinic receptor agonists Reduce bronchospasm caused by irritant Decrease mucous secretion
76
Treat acute exacerbation of asthma
``` Oxygen Salbutamol Hydrocortisone Ipratropium Theophylline Magnesium sulfate ANaethetist ```
77
Treat acute exacerbation of COPD
``` ipratropium Salbutamol Oxygen Amoxicillin Prednisolone ```
78
Aetiology of restrictive thoracic disease
Impaired alveolar gas exchange Fluid in alveolar spaces Consolidation of alveolar air spaces Inflammatory infiltrate of alveolar walls
79
LAMA example
Ipratropium
80
PDE4 inhibitors
COPD only Roflumilast Anti-inflammatory
81
Mucolytics
COPD only Oral carbocisteine Reduce sputum
82
D dimers
Fibrin degradation product | Increased = thrombosis, inflammation, malignancy, heart failure
83
COPD
Airflow reduction, partially reversible, progressively worsens
84
2 types of COPD
Chronic Bronchitis | Emphysema
85
Chronic Bronchitis
Inflammation of bronchi and bronchioles Cough Clear sputum Increasing breathlessness
86
Emphysema
Distension and damage to alveoli Destruction of acinal pouching in alveolar sacs Loss of elastic recoik
87
LAMA's end in
ium
88
Fexofenadine
Competitive H1 receptor antagonist used to treat allergic rhinitis
89
Ipratropium
A short acting drug that blocks acetylcholine non-selectively,
90
Rofumilast
PED4 inhibitor, given orally for COPD
91
Sodium cromoglicate
Mast cell stabiliser used in asthma
92
Rhinitis
Inflammation of nasal mucosa | May be allergic, non-allergic or mixed
93
Allergic Rhinitis
Seasonal Perennial Episodic
94
Non-allergic Rhinitis
``` Doesn't involve IgE Infection Hormonal Imbalance Vasomotor disturbances Medications ```
95
Anti-inflammatory treatment
Glucocorticoids
96
Mediator receptor blockade treatment
H1 receptor antagonist | CysLT receptor antagonist
97
Nasal blood flow treatment
Vasconstrictors
98
Anti-allergic
Sodium cromoglicate

Phoebe's Resp (23 decks)

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