Pharmacotherapy of airflow obstruction

Question 1

What are the 2 main drug categories for airway obstruction?

Answer 1

Preventers - Anti-inflammatory
Relievers - Bronchodilators

Question 2

How do eosinophils and neutrophils react to corticosteroids?

Answer 2

Eosinophils are highly sensitive to corticosteroids, while neutrophils are insensitive to them

Question 3

What are some types of monoclonal antibodies against Th2 cytokines?

Answer 3

Anti-IgE
Anti-interleukin 5
Anti-interleukin 5 receptor
Anti-interleukin 4 receptor
Anti-TSLP

Question 4

When are monoclonal antibodies used in the treatment of asthma?

Answer 4

They are used in refractory management that cannot be controlled by earlier measures

Question 5

What is given as a reliever for type II high asthma?

Answer 5

SABA - Short Acting ß-adrenoceptor agonist when required (e.g. salbutamol)

Question 6

What are some examples of Short Acting ß Agonists (SABAs)?

Answer 6

Salbutamol
Terbutaline

Question 7

What is the 1st line controller given in type II high asthma?

Answer 7

Inhaled glucocorticosteroid (e.g. beclometasone)

Question 8

What are some examples of Inhaled CorticoSteroids (ICS)?

Answer 8

Beclometasone
Budesonide
Fluticasone
Mometasone

Question 9

What are some 2nd line controllers that can be given in type II high asthma?

Answer 9

Long Acting ß Agonist (ICS + LABA)
Long Acting Muscarinic Antagonist (ICS + LABA + LAMA)
Cysteinyl leukotriene receptor antagonists
Xanthines

Question 10

What are some examples of Long Acting ß Agonists?

Answer 10

Formoterol
Salmeterol

Question 11

What are some examples of Long Acting Muscarinic Antagonists?

Answer 11

Glycopyrronium
Tiotropium
Umeclidinium

Question 12

What is an example of a Cysteinyl leukotriene 1 receptor antagonist?

Answer 12

Montelukast

Question 13

What are some examples of Xanthines?

Answer 13

Theophylline
IV Aminophylline

Question 14

What drugs are used as in refractory asthma?

Answer 14

5 days oral corticosteroids 40mg per day
Biologics

Question 15

What are some examples of an anti-IgE drug?

Answer 15

Omilizumab

Question 16

What is an example of an anti-IL5 drug?

Answer 16

Mepolizumab

Question 17

What is an example of an anti-IL5 receptor drug?

Answer 17

Benralizumab

Question 18

What is an example of an anti-IL4 receptor drug?

Answer 18

Dopilumab

Question 19

What is an example of an anti-TSLP drug?

Answer 19

Tezepelumab

Question 20

What colour is a SABA (Salbutamol inhaler)?

Answer 20

Blue

Question 21

What colour is an ICS (Beclometasone) inhaler?

Answer 21

Brown

Question 22

What colour is an ICS/LABA (Beclometasone/Formoterol) inhaler?

Answer 22

Purple

Question 23

How long does a SABA give relief for?

Answer 23

3-5 hours

Question 24

How long does a LABA give relief for?

Answer 24

~12hours

Question 25

What is the risk of inhaled corticosteroids?

Answer 25

They can cause pneumonia in COPD due to local immune suppression

Question 26

What are some examples of oral glucocorticosteroids?

Answer 26

Prednisolone Beclometasone

Question 27

Why are oral corticosteroids only given for short periods of time?

Answer 27

They have a very small therapeutic window and can cause very large side effects if given chronically

Question 28

What diseases are ICSs used as first line controller therapy?

Answer 28

Asthma Eosinophilic COPD (ACO syndrome)

Question 29

What is the use of spacers on inhalers?

Answer 29

They decrease particle velocity and particle size and so allow the powder to move further into the lungs This is by allowing larger particles to get trapped in the chamber instead of the mouth, which also decreases the risk of oral thrush

Question 30

How are cell membrane phospholipids converted to cysteine leukotrienes?

Answer 30

Cell membrane phospholipids are converted to arachidonic acid by Phospholipase A2 Arachidonic acid is converted to Leukotriene A4 by 5-lipoxygenase LTA4 is then converted to LTC4, then LTD4 then LTE4

Question 31

What are the functions of Leukotrienes in asthma?

Answer 31

Leukotrienes stimulate increased mucus secretion Cause oedema Cause contraction and proliferation of airway smooth muscle via sensory nerves (C-fibres) Cause eosinophil influx and thus epithelial cell damage

Question 32

Which condition are leukotriene receptor antagonists used in?

Answer 32

Asthma, not COPD (Useful in allergic rhinitis)

Question 33

What comorbidities can anti-IgE drugs be useful in?

Answer 33

CSU - Chronic Spontaneous Urticaria CRSwNP - Chronic RhinoSinusitis with Nasal Polyps

Question 34

What do anti-IgE drugs do?

Answer 34

inhibit the binding of IgE to the high-affinity IgE receptor, which inhibits Th2 response and thus mediator release from basophils and mast cells

Question 35

What do anti-IL5 or anti-IL5 receptor drugs do?

Answer 35

Blocks the effects of the TH2 cytokine IL-5 which is responsible for eosinophilic inflammation in asthma. Anti-IL5 suppresses eosinophils Anti-IL5 receptors depleted eosinophils

Question 36

How do anti-IL4 receptor drugs work?

Answer 36

Blocks IL4/13 signaling

Question 37

What comorbidities can anti-IL4 receptor drugs work?

Answer 37

Allergic Dermatitis (AD) Eosinophilic Esophagitis (EE) Chronic RhinoSinusitis with Nasal Polyps (CRSwNP)

Question 38

What do anti-TSLP drugs do?

Answer 38

Blocks upstream epithelial alarmin TSLP and hence inhibiting downstream T2 cytokines IL4/5/13 –ie broad spectrum

Question 39

What is TSLP?

Answer 39

Thymus Stromal LymphoPoietin, an epithelial alarming that is released by damaged epithelial cells

Question 40

What is meant by maintenance and reliever therapy (MART)?

Answer 40

Therapy that uses a LABA ICS combination inhaler as a reliever, twice per day

Question 41

What is the risk of ß agonist overuse?

Answer 41

ß2 receptors can be down regulated and internalised, meaning the drug becomes tolerated, which can cause tachyphylaxis

Question 42

What is the effect of stimulation of M1 receptors in the lungs?

Answer 42

Enhancement of the cholinergic reflex

Question 43

What is the effect of stimulation of M2 receptors in the lungs?

Answer 43

Inhibition of acetylcholine release

Question 44

What is the effect of stimulation of M3 receptors in the lungs?

Answer 44

Mediation of bronchoconstriction and mucus secretion

Question 45

What is an example of a short acting muscarinic receptor antagonist?

Answer 45

Ipratropium