Respiratory Pharmacology

Question 1

What are the two classes of drugs used in asthma?

Answer 1

Relievers

Controllers/Preventors

Question 2

What are the threer subclasses of relievers?

Answer 2

SABAs

LABAs

CysLT₁ receptor antagonists

Question 3

Name three SABAs

Answer 3

Salbutamol

Albuterol

Terbutaline

Question 4

When are SABAs prescribed?

Answer 4

In mild intermittent asthma

To be used as needed

Question 5

How to SABAs work?

Answer 5

They act on the sympathetic nervous system

Increasing mucocilliary clearance

Decreasing mediator release from mast cells and monocytes

Question 6

What are the unwanted side effects of SABAs?

Answer 6

Tachycardia

Hypokalaemia

Dysrhythmia

Question 7

Name two LABAs

Answer 7

Salmetarol

Fomoterol

Question 8

When are LABAs prescribes?

Answer 8

In noctural asthma as an add-on therapy

Question 9

What must be given with a LABA

Answer 9

A corticosteroid

Question 10

How do CysTL₁ receptor antagonists work?

Answer 10

They act competitively at the CysTL₁ receptors to block the action of

• LTC₄
• LTD₄
• LTE₄

They relax bronchial smooth muscle in response to CysTL₃

Question 11

Name two CysTL₁ receptor antagonists?

Answer 11

Monteleukast

Zafirlukast

Question 12

When are CysTL₁ receptor antagonists prescribed?

Answer 12

As an add-on therapy against early and late bronchospasm

In antigen and exercise enduced asthma

As oral medication

NOT FOR ACUTE

Question 13

What are some unwanted effects of Cysteinyl Leukotriene receptor antagonists?

Answer 13

Headache

GI upset

Question 14

Name three classes of controller/preventors?

Answer 14

Glucocorticoids

Cromoglicate

Human monoclonal IgE antibodies

Methylxanthines

Question 15

Name two methyxanthines

Answer 15

Theophylline

Aminophylline

Question 16

How do methylxanthines work?

Answer 16

They inactivate cAMP & cGMP (secondary messengers that might relax smooth muscle and have an anti-inflammatory effect)

They increase mucociliary clearance

Question 17

What is the problem with methylxanthines?

Answer 17

They have a narrow therapeutic window

Numerous drug interactions

Question 18

What are the unwanted side effects of methylxanthines?

Answer 18

Dysrhythmia

Seizures

Hypotension

Nausea, Vomitting, abdo discomfort, headache

Question 19

Name two types of corticosteroids?

Answer 19

Mineralocorticoids

Glucocorticoids

Question 20

Name some glucocorticoids?

Answer 20

Cortisol (prednisolone)

Beclometasone

Budesonide

Dluticasone

Question 21

How to glucocorticoids work?

Answer 21

Via the adrenal cortex

They signal via nuclear receptors (GRalpha)

• alter mRNA levels
• alter rate of synthesis of mediator proteins
• modify the structure of chromatin by deacetylation of histones
• decrease the formation of T_H2
• increase transcription of antiinflammatory proteins
• decrease transcription of inflammatory proteins

Question 22

How to mineralocorticoids work?

Answer 22

Aldosterone

-retention of salt and water by the kidneys (no direct bronchidilator action)

Question 23

What are cromones used for?

Answer 23

2nd line prophylaxis

Question 24

What do cromones do?

Answer 24

They are mast cell stabilisers (supress histamine from mast cells)

They have no direct effect on bronchial smooth muscle

They have a weak anti-inflammary effect (decrease the sensitivity of irritant receptors associated with sensory-c fibres)

Question 25

How does sodium cromoglicate work?

Answer 25

It reduces both phases of an asthma attack (by inhalation-little systemic absorbtion)

Question 26

What do monoclonal antibioes do?

Answer 26

* *Amalizumab= IgE* Bind to IgE via F_c and supresses mast cell response to antigens, reducing the F_cE on inflammatory cells * *Mepolizumab= IL-5* * They are expensive and require IV administration.*