Respiratory

Question 1

Name the two categories of asthma drug

Answer 1

Relievers and preventers

Question 2

Name 3 classes of asthma reliever

Answer 2

B2-adrenoreceptor agonist
Methyl Xanthines
Anti-muscarinics

Question 3

Name 4 examples of B2-agonists

Answer 3

Short acting (Salbutamol, Rimiterol)
Long acting (Salmeterol, Formoterol)

Question 4

How do B2-agonists work?

Answer 4

Cause bronchodilation and decreased mucus secretion (sympathetic innervation)
adenylyl cyclase->cAMP, less Ca2+
Inhibition of mediator release from mast cells+monocytes

Question 5

What are the side effects of B2 adrenoreceptor agonists?

Answer 5

Down regulation of receptors,
hypokalemia (cAMP fuels Na+/K+ pump)
skeletal muscle tremor, restlessness, cardiac arrhythmia (rare), tachycardia, palpitations, nervous tension

Question 6

How does Salmeterol work?

Answer 6

Binds to an exosite via a flexible tail so repeatedly stimulates B2 adrenoreceptor
Useful for nocturnal asthma

Question 7

How does Formoterol work?

Answer 7

Dissolves in plasma membrane and diffuses out to stimulate the receptor (slowly released) s long acting B2 agonist

Question 8

What is Rimiterol?

Answer 8

Short acting B2-agonsit for treatment of asthma

Question 9

How do methyl xanthines work?

Answer 9

Inhibits breakdown of cAMP by phosphodiesterases so bronchodilation and inhibition of mast cell activation occurs

Question 10

Name 2 Methyl Xanthines and their administration

Answer 10

Theophyline- slow release oral (narrow therapeutic index)

Aminophyline (IV)

Question 11

Side effects of Theophyline?

Answer 11

Nausea, insomnia, dysrhythmia, convulsions, headache (similar to caffeine)

Question 12

What is Aminophyline?

Answer 12

An IV Methyl Xanthine to relieve asthma sufferers

Question 13

How do anti muscarinics work?

Answer 13

Block ACh at M1&M3 muscarinic receptors so block parasympathetic action of bronchoconstriction and mucus hypersecretion

Question 14

What are the problems with antimuscarinics for asthma?

Answer 14

Low efficacy- used with other drugs

Only side effect= dry mouth

Question 15

Give 3 examples of anti-muscarinics

Answer 15

Ipratropium, Oxitropium, Tiotropium (aTROPIne like)

Question 16

Name 4 classes of asthma preventer drugs

Answer 16

Corticosteroids, Cromones, Anti-Leukotrienes, Anti-IgE

Question 17

What corticosteroids are inhaled daily in moderate asthma?

Answer 17

Beclomethasone, Budesonide, Fluticasone

Question 18

What oral corticosteroid is given in severe asthma?

Answer 18

Prednisolone

Question 19

In status asthmaticus, what corticosteroid is given and how?

Answer 19

IV Hydrocortisone

Question 20

Name 2 Cromones and their side effects

Answer 20

Sodium Cromoglycate
Nedocromil Sodium (inhaled as dry powder so coughing and transient bronchospasm)

Question 21

How do Cromones work?

Answer 21

Prevents degranulation of mast cells so protects against immediate bronchoconstriction induced by allergens
Inhibits Bcell switching to IgE production and inhibits eosinophil accumulation in lungs

Question 22

How do Anti-Leukotrienes work?

Answer 22

Antagonsit of Cys-Leukotriene receptors on smooth muscle and eosinophils
Inhibits bronchoconstriction induced by Cys-LT & LTC4
Reduces eosinophilia and mucus secretion

Question 23

Side effects of anti-leukotrienes?

Answer 23

GI upset and headache (minimal)

Question 24

Name 3 Anti-Leukotrienes

Answer 24

Montelukast, Zafirlukast and Zileuton

Question 25

Name the Anti-IgE drug

Answer 25

OMALIZUMAB (Xolair)

Question 26

How do anti-IgE drugs work?

Answer 26

Antibody against IgE so binds to IgE in plasma and prevents mast cell degranulation
The complex is then excreted

Question 27

What is Omalizumab?

Answer 27

Anti IgE drug for treatment of asthma