Respiratory Pharmacology

Question 1

Give some things that occur to cause airway remodelling in asthma.

Answer 1

Smooth muscle hypertrophy
Mucous gland hyperplasia
Subepithelial fibrosis
Epithelial desquamation

Question 2

What should be done before initiating a new asthma drug therapy?

Answer 2

Establish good inhaler technique
Check compliance to pre-existing meds
Eliminate any triggers

Question 3

Name 2 (fast onset) short acting B2 agonists.

Comment on the action on mast cell degranulation of SABA.

Answer 3

Salbutamol
Terbutaline

Intermittent use - inhibits MCD
Regular use - increased MCD in response to allergen

Question 4

Name a fast onset and long duration B2 agonist.

Answer 4

Formoterol

Question 5

give 3 side effects of B2 agonists.

Answer 5

Tremens
Tachycardia
Palpitations

Question 6

Name one thing transactivated and one thing transrepressed by steroids.

Answer 6

Transactivation of lipocortin (inhibits PLA2) -> Less prostaglandins formed

Transrepression of COX2

Question 7

Give three properties conferred by the lipophillic constituent on the D ring of GCSs.

Answer 7

Very high affinity for the GCS receptor
Increased uptake and dwell time in tissue on local application
Rapid inactivation by liver

Question 8

Name two ICSs.

Which one of these undergoes extensive first pass metabolism.

What type of asthma do steroids work better on?

Answer 8

Budesonide
Beclomethasone

Budesonide

Eosinophillic

Question 9

Name a slow onset long duration B2 agonist.

Answer 9

Salmeterol

Question 10

What are some alternative step 3 and step 4 add ons in asthma?

Answer 10

high dose ICS
LTRA
Theophylline
Tiotropium

Question 11

Name two LTRA.

MOA?

Answer 11

Montelukast
Zafirlukast

Blocks CysLT1 receptor in airways. 
Stops mucosal edema formation
Bronchoconstriction 
Mucus secretion 
And inflammatory cell recruitment

Question 12

Give some side effects of LTRAs.

Answer 12

Angioedema
Dry mouth 
Anaphylaxis
Arthralgia 
Fever
gastric disturbances
Nightmares

Question 13

Give two MOA of theophylline

Side effects

Answer 13

Antagonise adenosine receptors
Inhibit PDE

Arryhtmias
Fits
Nausea
headaches
Reflux

Question 14

Name a LAMA.

Side effects?

Answer 14

Tiotropium

Dry mouth
Urinary retention
Glaucoma (especially if nebulised ipratropium)

Question 15

Name the step 5 add on for asthma treatment.

Answer 15

Oral steroids

Question 16

Name two biological therapies for asthma.

Answer 16

Anti IgE (Omalizumab) 
Anti IL-5 (Mepolizumab, Reslizumab) 

OmaliMepoli

Question 17

Why is bad for particle size in inhaled devices to be too small or big.

Answer 17

Too big - deposition in mouth and oropharync
Too small - inhaled to alveoli and exhaled without being deposited in the lungs

1-5 microns - most effective as they settle in the small airways

Question 18

Name four features of acute severe asthma

Answer 18

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HR >110
RR >25
PEF 33%-50% of predicted

Question 19

Name some life threatening asthma features.

Near fatal?

Answer 19

<33% PEF 
Bradycardia
Reduced respiratory effort 
Hypotension 
Sats below 92 
PaO2 <8 
Silent chest
Cyanosis 
Exhaustion, confusion and coma 

<6kPa
Mechanical ventilation

Question 20

Why should local anaesthetics be given with adrenaline?

Answer 20

Decreases blood flow - reduce absorption - therefore longer duration of anaesthesia