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BMS12 > Respiratory Pharmacology > Flashcards

Respiratory Pharmacology Flashcards

1
Q

Give two respiratory disorders which are related to the conducting zone.

A

Asthma

Allergic bronchitis

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2
Q

What type of respiratory disorders are related to the respiratory zone?

A

Chronic obstructive pulmonary diseases

  • Small airways disease
  • Emphysema
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3
Q

What happens in allergic asthma when the allergen is inhaled?

A

Localised immune cells in airways recognise allergen and become activated and release proinflammatory mediators:

  • Histamine
  • Prostaglandins
  • Leukotrienes
  • Cytokines

Released molecules cause:

  • Oedema
  • Mucus secretion
  • Bronchoconstriction/spasm
  • Inflammation
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4
Q

What are the three stages/changes in lung function after exposure to an allergen?

A

Immediate asthmatic response

Delayed/late asthmatic response

Airway/bronchial hyperresponsiveness

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5
Q

Describe the immediate asthmatic response. (2)

A

Decreased lung function within minutes and recover in 15-30 mins

Entirely due to bronchospasm caused by mediators (platelet-activating factor, leukotrienes) released from allergen-triggered mast cells

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6
Q

Describe the delayed asthmatic response.

A

Few hours after initial response (in 50-60% of asthmatics)

Airway narrowing mainly due to mucosal swelling/oedema as a result of inflammatory cells being recruited in response to the immediate response

Partly bronchospasm

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7
Q

Describe the airway hyperresponsiveness stage.

A

Non-allergen stimuli

Combined effects of bronchospasm on an inflamed oedematous airway which is very sensitive to any inhaled irritant

Body tries to heal and alters architecture of lungs = airways hyperplasia

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8
Q

What types of drugs can be used as bronchodilators?

A

β2-agonists

Muscarinic antagonists

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9
Q

What types of anti-inflammatory drugs are there? (5)

A

Glucocorticosteroids

Xanthines

Cromones

Leukotriene antagonists

Anti-IgE

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10
Q

What drugs are used to treat symptoms of asthma?

A

Short-acting β2-agonists/SABAs

Long-acting β2-agonists/LABAs

Theophylline (xanthine)

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11
Q

Give an example of a short-acting β2-agonist.

A

Salbutamol

Terbutaline

Fenoterol

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12
Q

Give an example of a long-acting β2-agonist.

A

Salmeterol

Formoterol

Indacaterol

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13
Q

What is the structure of a β2-agonist based on?

A

Adrenaline and isoprenaline

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14
Q

How can you increase the bioavailability of a β2-agonist?

A

Increase the length of the tail added to the endogenous structure

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15
Q

Give an example of an ultra LABA.

A

Vilanterol

Olodaterol

Carmoterol

Milveterol

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16
Q

Describe the mechanism of a β2-agonist on smooth muscle.

A
  1. Binds β2-adrenoceptors (GPCR) coupled to Gs protein
  2. Increased activity of adenylyl cyclase results in higher levels of cAMP
  3. Protein kinase A activated resulting in myosin light chain kinase phosphorylation
  4. Airway smooth muscle relaxation
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17
Q

What effect do β2-agonists have on mast cells?

A

Inhibit degranulation

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18
Q

What are some of the possible side effects of β2-agonists?

A

Tremor

Increased heart rate

Hypokalaemia

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19
Q

What do muscarinic antagonists do?

A

Prevent smooth muscle contraction and mucus secretion

Acts on M3 receptors (smooth muscle)

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20
Q

What are two muscarinic antagonists and how long do their effects last?

A

Ipratropium bromide - 6 hours

Tiotropium bromide - 24 hours

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21
Q

What are the possible side effects of muscarinic antagonists?

A

Dry mouth = ulcers and cannot swallow/eat

Urinary retention

Constipation

Acute angle glaucoma

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22
Q

What is the structure of glucocorticosteroid drugs based on?

A

Endogenous steroids

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23
Q

How do glucocorticoid steroids work?

A
  1. Enters cells by simple diffusion
  2. Associates with a nuclear/steroid receptor in cytoplasm (receptor is conjugated with a chaperonin)
  3. Chaperonin dissociates and complex moves into nucleus
  4. Binds to DNA to alter transcription
24
Q

Give an example of a chaperonin protein.

A

Heat-shock protein 90

25
Q

What do glucocorticosteroids generally do? (3)

A

Transactivation of annexin and β2-adrenoceptors

Inhibits mitogen kinase phosphatase 1

Transrepression of NFkB and AP-1

26
Q

What is another name for annexin?

A

Lipocortin

27
Q

What is annexin? (2)

A

Resolvin protein which finishes the inflammatory response (anti-inflammatory)

Inhibits PLA2

28
Q

What is mitogen kinase phosphatase 1?

A

Pro-inflammatory enzyme

29
Q

What are NFkB and AP-1?

A

Pro-inflammatory transcription factors which start de novo synthesis of pro-inflammatory mediators

30
Q

Which inflammatory mediators are upregulated by NFkB and AP-1 and what do they do? (4)

A

Cytokines - activate immune cells

Chemokines - cell motility

Adhesion molecules - expressed on inflammatory cells and endothelium

Pro-inflammatory enzymes - COX2, NOS

31
Q

What are the actions of glucocorticosteroids in asthma? (4)

A

Inhibition of leukotriene and cytokine synthesis to stop inflammatory response and recruitment of cells

Anti-oedema to increase air flow

Increase β-adrenoceptor function to enhance bronchodilation (by other drugs)

Decrease airway hyperresponsiveness

32
Q

What are possible side effects of inhaled glucocorticosteroids? (2)

A

Oral candidiasis

Hoarseness, cough, voice problems

33
Q

What are possible side effects of oral/prolonged high dose glucocorticosteroids? (4)

A

Growth retardation, easy bruising

Suppression of hypothalamic-pituitary axis

Osteoporosis, water retention, diabetes

Hypertension, weight gain, ocular hypertension

34
Q

Why can stopping steroid treatment be dangerous?

A

Inflammation build up and a trigger could cause death

35
Q

Which enzyme catalyses the formation of arachidonic acid from membrane phospholipids?

A

Phospholipase A2 (PLA2)

36
Q

What does zileuton do?

A

Direct inhibitor of 5-lipoxygenase

Prevents formation of leukotrienes

37
Q

What type of drug is montelukast?

A

Cysteinyl leukotriene receptor antagonist

38
Q

What do leukotrienes do? (4)

A

Cause:

  • Bronchoconstriction
  • Oedema
  • Cellular infiltration
  • Mucus production
39
Q

What are leukotriene antagonists and 5-LO inhibitors best used to treat?

A

Severe asthma

Aspirin-sensitive or exercise-induced asthma

40
Q

What are possible side effects of leukotriene antagonists and 5-LO inhibitors? (2)

A

Headache

GI disturbance (zileuton - hepatotoxicity and dyspepsia)

41
Q

Give an example of a xanthine. (2)

A

Theophylline

Aminophylline

42
Q

How do xanthines work?

A

Inhibit phosphodiesterase

Increased levels of cAMP

More PKA activated and myosin light chain kinase phosphorylation

Relaxation of airway smooth muscle

43
Q

What common substance has a similar structure to theophylline?

A

Caffeine

44
Q

Why must patients taking xanthine be monitored?

A

Narrow therapeutic window (10-20ug/ml) = watch out for side effects

Numerous drug interactions can affect plasma levels

45
Q

How does smoking affect xanthines?

A

Promotes plasma clearance of xanthines so decreases bioavailability

46
Q

Give an example of a cromone.

A

Sodium cromoglicate

Nedocromil sodium

47
Q

What do cromones do?

A

Reduce inflammatory cell activation and recruitment

48
Q

What are the possible side effects of xanthines?

A

Nausea, vomiting

Arrhythmias, hypotension

Hypokalaemia

Seizures

49
Q

How many times per day do you typically need to take leukotriene antagonists?

A

Once per day

50
Q

What are the cons of cromones? (2)

A

Very short half-life

Not as effective as glucocorticosteroids

51
Q

How are cromones administered?

A

Inhaled

52
Q

How are leukotriene antagonists administered?

A

Orally

53
Q

How is anti-IgE administered?

A

Subcutaneous injection

54
Q

What is IgE? (4)

A

Part of adaptive immune response

Recognises allergens

Produced by B-cells and sit on antigen-presenting cells with high affinity receptors

Cause release of mediators when activated

55
Q

Give an example of anti-IgE.

A

Omalizumab

56
Q

How does omalizumab work? (2)

A

Sequesters IgE out of circulation so it does not bind high affinity receptors on antigen-presenting cells

Decreases expression of high affinity receptors

BMS12 (7 decks)

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