Respiratory pharmacology

Question 1

what are some medications that induce pulmonary reactions?

Answer 1

1. beta-receptor agonists
2. hypersensitivity reaction to any medication
3. NSAIDs-aspirin
4. ASA angiotensin converting enzyyme inhibitors
5. antiarrhythimics

Question 2

list the two cells that are involved in the allergic asthma

Answer 2

IgE in B cells

sensitization in mast cells

Question 3

activation of effector cells, alveolar macrophages/mast cells indicates an asthma response in which wave?

Answer 3

1st wave (seconds to minutes -ACUTE)

1. activation of effector cells, alveolor macrophages/mast cells
   
   1. MO- secrete cytokines and process antigens
   2. mast cells degranulate -PRE-FORMED MEDIATORS
      
      1. HISTAMINE
         
         1. ​bronchoconstriction, vasodilation, mucous secretion

Question 4

which wave is a patient in which consists of neutrophil invasion mediated by cytokines?

Answer 4

2nd wave (Hours-ACUTE)

1. CHEMOTAXIS- neutrophil invasion mediated by cytokines
   
   1. GM-CSF(granulocyte/macrophagecolony stimulating factor) from macrophages
      
      1. increases synthesis of leukocytes in bone marrow
2. mast cell release INDUCED MEDIATORS= INFLAMMATION
   
   1. ​leukotriene
      
      1. bronchonconstriction, vasoconstriction, mucous secretion
   2. prostaglandins
      
      1. pain, bronchoconstriction, vasodilation, chemotaxis

Question 5

a patients hypersensitivity reaction shifts from Type 1 to Type 4, which wave is he/she in?

Answer 5

chronic (LATE PHASE>24hrs)

1. hyper-reactivity of airways to triggers
   
   1. ​chronic reactivity mediated largely by T cells and eosinophils
   2. non-specific bonchial hyper-reactivity ahs an inflammatory and neural component
2. increase Th2 cell activity
   
   1. sustains IgE synthesis, mast cell and eosinophil activity
3. EOSINOPHIL DEGRANULATION
   
   1. persistent release of INDUCED MEDIATORS
      
      1. ​LEUKOTRIENES-
         
         1. bronchoconstriction, vasoconstriction, mucous secretion
      2. GM-CSF from macrophages
         
         1. leukocyte synthesis in bone marrow

Question 6

list and highlite the stages in an asthma reaction

Answer 6

1. 1st wave
   
   1. seconds -minutes
   2. activation of
      
      1. alveolar MO
      2. MAST cells
   3. release preformed mediators
      
      1. ​histmine
2. 2nd wave
   
   1. hours -acute
   2. chemotaxis
      
      1. neutrophil invasion
   3. Mo release GM-CSF
   4. MAST cells release INDUCED MEDIATORS
      
      1. leukotrienes -bronchoconstriction, vasoconstriction, mucous secretion
      2. Prostaglandins-pain, bronchoconstriction, vasodilation, chemotaxis
3. chronic (Late phase)
   
   1. >24hrs
   2. hyper reactivity of airway triggers
      
      1. Tcell and eosinophils
         
         1. Type 1->Type4
         2. increased Th2
            
            1. increase IgE synthesis, mast cell and eosinophil activity
      2. eosinophil deganulation
         
         1. persistant INDUCED MEDIATORS
            
            1. ​leukotriens
            2. GM-CSF

Question 7

what is imperitive for advancing the drug to a patients lung?

Answer 7

spacer

1. allows direct delivery to affected organ
2. particle size is critical to the lung

Question 8

Dug X rapidly absorbes into the GI and takes several rounds of metabolism, drug y slowly absorbs into the blood system and is metabolized the first pass. Which drug is best for aersol delivery

Answer 8

To minimize systemic effects

1. poorly absorbed into to GI system
   
   1. 90% of all inhalants end up in the GI tract
2. rapidly inactivated via first pass metabolism

Question 9

what type of mimetic drug is preferred for the treatment of asthma? describe the desired receptor to stimulate

Answer 9

sympathomimetic- mimic the sympathetic nervous system.

B2-bronchial smooth muscle- relaxation (bronchodilation)

goal: relaxatio of smooth muscle

Question 10

describe the pathway of B2-AR, under normal stimulus.

Answer 10

NE-> B2 adronergic receptor = Gprotein->Ga/GTP activate adenylyl cyclase->f cAMP activates PKA->

• cAMP-PKA = decrease intracellular Ca++ levels

1. membrane = decrease Ca++ influx, increase Ca++ efflux
2. endoplasmic reticulum- enhance Ca++ uptake
3. decrease actin-myosin interactions

Question 11

sttimulating what autonomic system is equivelent to a B2 agonist. What is the desired goal of this stimulation? explain route

Answer 11

Sympathetic nervous system. decrease Ca++ in the cytosol

1. increase eflux, decrese influx
2. increase ER absorption
3. Decrease actin-myosin interaction

Question 12

list the short/long acting B2 agonists inhaled

Answer 12

1. short acting(onset 1-5 minutes)
   
   1. albuterol (prventil, ventolin)
   2. levalbuterol (xopenex)
2. long acting (effect last >12hrs)
   
   1. formoterol (foradil)

Question 13

list the glucocorticoids of inhaled and systemic treatment to asthma

Answer 13

1. inhaled
   
   1. budesonide (pulmicort)
2. systemic
   
   1. prednisone (oral)

Question 14

what are the muscarinic antagonists of the pulmonary system?

Answer 14

tiotropium