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Respiratory > Pharmacotherapy of airflow obstruction > Flashcards

Pharmacotherapy of airflow obstruction Flashcards

1
Q

What are the 2 main drug categories for airway obstruction?

A

Preventers - Anti-inflammatory
Relievers - Bronchodilators

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2
Q

How do eosinophils and neutrophils react to corticosteroids?

A

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

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3
Q

What are some types of monoclonal antibodies against Th2 cytokines?

A

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

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4
Q

When are monoclonal antibodies used in the treatment of asthma?

A

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

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5
Q

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

A

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

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6
Q

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

A

Salbutamol
Terbutaline

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7
Q

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

A

Inhaled glucocorticosteroid (e.g. beclometasone)

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8
Q

What are some examples of Inhaled CorticoSteroids (ICS)?

A

Beclometasone
Budesonide
Fluticasone
Mometasone

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9
Q

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

A

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

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10
Q

What are some examples of Long Acting ß Agonists?

A

Formoterol
Salmeterol

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11
Q

What are some examples of Long Acting Muscarinic Antagonists?

A

Glycopyrronium
Tiotropium
Umeclidinium

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12
Q

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

A

Montelukast

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13
Q

What are some examples of Xanthines?

A

Theophylline
IV Aminophylline

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14
Q

What drugs are used as in refractory asthma?

A

5 days oral corticosteroids 40mg per day
Biologics

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15
Q

What are some examples of an anti-IgE drug?

A

Omilizumab

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16
Q

What is an example of an anti-IL5 drug?

A

Mepolizumab

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17
Q

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

A

Benralizumab

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18
Q

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

A

Dopilumab

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19
Q

What is an example of an anti-TSLP drug?

A

Tezepelumab

20
Q

What colour is a SABA (Salbutamol inhaler)?

A

Blue

21
Q

What colour is an ICS (Beclometasone) inhaler?

A

Brown

22
Q

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

A

Purple

23
Q

How long does a SABA give relief for?

A

3-5 hours

24
Q

How long does a LABA give relief for?

A

~12hours

25
Q

What is the risk of inhaled corticosteroids?

A

They can cause pneumonia in COPD due to local immune suppression

26
Q

What are some examples of oral glucocorticosteroids?

A

Prednisolone
Beclometasone

27
Q

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

A

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

28
Q

What diseases are ICSs used as first line controller therapy?

A

Asthma
Eosinophilic COPD (ACO syndrome)

29
Q

What is the use of spacers on inhalers?

A

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

30
Q

How are cell membrane phospholipids converted to cysteine leukotrienes?

A

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

31
Q

What are the functions of Leukotrienes in asthma?

A

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

32
Q

Which condition are leukotriene receptor antagonists used in?

A

Asthma, not COPD (Useful in allergic rhinitis)

33
Q

What comorbidities can anti-IgE drugs be useful in?

A

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

34
Q

What do anti-IgE drugs do?

A

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

35
Q

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

A

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

36
Q

How do anti-IL4 receptor drugs work?

A

Blocks IL4/13 signaling

37
Q

What comorbidities can anti-IL4 receptor drugs work?

A

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

38
Q

What do anti-TSLP drugs do?

A

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

39
Q

What is TSLP?

A

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

40
Q

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

A

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

41
Q

What is the risk of ß agonist overuse?

A

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

42
Q

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

A

Enhancement of the cholinergic reflex

43
Q

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

A

Inhibition of acetylcholine release

44
Q

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

A

Mediation of bronchoconstriction and mucus secretion

45
Q

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

A

Ipratropium

Respiratory (23 decks)

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