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Respiratory > Pharmacology - Asthma > Flashcards

Pharmacology - Asthma Flashcards

1
Q

d: cholinergic

A

relating to or denoting nerve cells in which acetylcholine acts as a neurotransmitter

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2
Q

Where are the cell bodies of the preganglionic fibres located?

A

in the brainstem

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3
Q

where are the cell bodies of postganglionic fibres embedded in?

A

the walls of the bronchi and the bronchioles

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4
Q

Name the 2 things the stimulation of postganglionic cholinergic fibres cause

A

bronchial smooth muscle contraction

increased mucus secretion

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5
Q

what is bronchial smooth muscle contraction mediated by?

A

contraction mediated by M3 muscarinic ACh receptors on ASM cells

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6
Q

what does ASM stand for?

A

Airway Smooth Muscle

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7
Q

what is increased mucus secretion mediated by?

A

M3 muscarinic ACh receptors on gland (goblet) cells

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8
Q

Name the thing stimulation of postganglionic noncholinergic fibres cause and what is it mediated by?

A

bronchial smooth muscle relaxation mediated by nitric oxide (NO) and vasoactive intestinal peptide (VIP)

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9
Q

There’s no nerve supply of bronchial smooth muscle in humans so what supplies submucosal glands and smooth muscle of blood vessels instead?

A

post-ganglionic sympathetic fibres

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10
Q

Name 4 things stimulation of sympathetic nerves supply

A

bronchial smooth muscle relaxation
decreased mucus secretion
increased mucociliary clearance
vascular smooth muscle contraction

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11
Q

what is bronchial smooth muscle relaxation mediated by? and what are these activated by?

A

via beta2-adrenoceptors (β2-ADR) on ASM cells activated by adrenaline released from the adrenal gland

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12
Q

What is decreased mucus secretion mediated by?

A

mediated by beta 2-adrenoceptors on gland (goblet) cells

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13
Q

What is increased mucociliary clearance mediated by?

A

mediated by 2-adrenoceptors on epithelial cells (mucociliary escalator)

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14
Q

What is vascular smooth muscle contraction mediated by?

A

, mediated by α1-adrenoceptors on vascular smooth muscle cells

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15
Q

d: asthma

A

a respiratory condition marked by spasms in the bronchi of the lungs, causing difficulty in breathing. It usually results from an allergic reaction or other forms of hypersensitivity

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16
Q

give 4 causes of asthma

A

allergens (in atopic individuals)
exercise-cold, dry air
viral respiratory infections
smoke dust pollutants etc

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17
Q

What is asthmaticus?

Can it be Fatal?

A

acute severe asthma attacks can be fatal

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18
Q

give 4 symptoms of asthma

A

tight chest
wheezing
difficulty in breathing
cough

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19
Q

What is the cause of chronic asthma?

A

involves pathological changes to the bronchioles that result from long standing inflammation

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20
Q

Describe the process by which chronic asthma occurs

A

increased mass of smooth muscle (hyperplasia and hypertrophy)
accumulation of interstitial fluid (oedema)
increased secretion of mucus
epithelial damage (exposing sensory nerve endings)
Sub-epithelial fibrosis

21
Q

What is the effect of airway narrowing via inflammation and bronchoconstriction on, airway resistance, FEV1 and PEFR?

A

increase resistance

decreasing FEV1 + PEFR

22
Q

How do the bronchioles become hypersensitive in asthma?

A

epithelial damage, exposes sensory nerve endings, contributes to increased sensitivity of airways to bronchoconstrictor influences may cause neurogenic inflammation

23
Q

d: neurogenic inflammation

A

is inflammation arising from the local release by afferent neurons of inflammatory mediators

24
Q

name some sensory nerve endings that may be exposed during epithelial damage

A

C-fibres

irritant receptors

25
Q

name the tests and what spasmogens are used to reveal hyper-responsiveness

A

Provocation tests

histamine/ methacholine

26
Q

What 2 phases does an asthma attack occur of?

A

bronchospasm and delayed inflammatory response

27
Q

What is the main thing thought to cause asthma?

A

to be due to an immune imbalance between TH1 and TH2 lymphocyte-mediated responses

28
Q

What TH response dominates in mild to moderate asthma?

A

TH2

29
Q

What TH responses are involved in severe asthma?

A

TH2 +TH1

30
Q

What is TH1 response?

A

Cell-mediated immune
response involving IgG
and macrophages

31
Q

What is TH2 response?

A

Antibody-mediated immune
response
involving IgE

32
Q

How is TH2 lymphocyte activation caused?

A

: allergen through airway epithelium > CD4+ express to THO cells that mature to TH2 cells> these activate B cells that mature to IgE secreting B cells
Th2 cells also release IL4 & IL13 which cause mast cells to express IgE receptors

33
Q

How are IgE receptors activated?

A

are activated on mast cell > stimulates calcium entry > release of leukotrienes that cause airway smooth muscle contraction

34
Q

What do relievers act as and name some?

A

Act as bronchodilators
SABAs
LABAs
CysLT1 receptor antagonists

35
Q

What do controllers/preventors act as and name some?

A

Act as anti-inflammatory agents that reduce airway inflammation
Glucocorticoids
Cromoglicate
Humanised monoclonal IgE antibodies

36
Q

What drug is both a reliever and a controller?

A

methylxanthines

37
Q

What does SABA and LABA stand for?

A

short acting beta 2 adrenoreceptor agonists

long acting beta 2 adrenoceptor agonists

38
Q

Name a SABA and describe how fast react?

A

salbutamol rapid 5min

39
Q

Name 2 LABAs and how fast works and what always must be administered with?

A

salmeterol
formoterol
nocturnal lasts 8 hours
always be administered with glucocoticoid

40
Q

Name a CysLT1 Receptor Antagonists and what it does and what way administered?

A

Monteleukast

- blocks CysLT1 receptor for LTs from Mast Cells Bronchodilator (administered orally).

41
Q

Name 2 methylxanthines what they do and what it is nature

A

(Theophylline, Aminophylline) – Inhibits PDE3 – bronchodilator and anti-inflammatory actions

42
Q

what do glucocorticoids do?

A

decreases Th2 cytokines, Mast Cells, IgE antibodies) – prevent inflammation + resolve established inflammation

43
Q

what are the 2 roles of glucocorticoids in asthma?

A

prevent inflammation

resolve established inflammation

44
Q

name the 3 glucocorticoids and admin in mild/moderate asthma?

A

beclomethasone
budesonide
fluticasone
inhalation

45
Q

what are the most common side affects to glucocorticoids? why?

A

most common adverse effects (due to deposition of steroid in the oropharynx) are:
dysphonia (hoarse and weak voice)
oropharyngeal candidiasis (thrush)

46
Q

what glucocorticoid is used in chronic/severe asthma

A

Oral prednisolone may be used in combination with an inhaled steroid to reduce the oral dose required and minimise unwanted systemic effects. Bronchodilator drugs are co-administered

47
Q

name a Monoclonal antibodies directed against IgE

A

omalizumab

48
Q

why is Monoclonal antibodies directed against IgE not used regularly?

A

expensive

Respiratory (27 decks)

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