ALS Lecture 7 - Pharmacology of Airways Obstruction DONE

Question 1

classic asthma starts in

Answer 1

childhood

Question 2

classic asthma gives

Answer 2

bronchoconstriction

Question 3

classic asthma has a

Answer 3

double reaction

Question 4

1st asthma response

Answer 4

starts after 15mins of allergen, ends in ~15mins without treatment

Question 5

2nd asthma response

Answer 5

75% is late reaction, more difficult to treat

Question 6

asthma is characterised by

Answer 6

eosinophils

Question 7

label the diagram of asthma pathophysiology

Answer 7

done

Question 8

asthma pathophysiology (5 steps)

Answer 8

1. IgE directed against allergen
2. IgE produced by B lymphocyte, sticks onto mast cells
3. degranulation of mast cells and inflammatory mediators
   4, bronchospasm, vasodilation, mucus secretion, oedema

Question 9

asthma inflammation causes

Answer 9

mucus plugs to block airways

Question 10

asthma histology of airway

Answer 10

filled with mucus, nuclei of inflammatory cells

Question 11

eosinophils stain and how up

Answer 11

pink, stained with eosin

Question 12

asthma medication types (5)

Answer 12

SABA, LABA, corticosteroids (inhaled), leukotriene receptor antagonist, combination inhalers

Question 13

bronchoconstriction is mediated by

Answer 13

smooth muscle contraction, beta agonists reverse this

Question 14

action of beta receptors on smooth muscle (3 steps)

Answer 14

1. stimulated
2. release cAMP
3. relax smooth muscle

Question 15

label the diagram of montelukast combined with a steroid affects the dual pathways of inflammation

Answer 15

done

Question 16

short acting beta agonist (SABA) example

Answer 16

Salbutamol, 4-5hrs

Question 17

long acting beta agonist (LABA) example

Answer 17

Salmetrol, Formoterol, 12-24hrs

Question 18

leukotriene receptor antagonist MOA (2 steps)

Answer 18

1. block leukotriene receptors

2. stop eosinophil recruitment

Question 19

leukotriene receptor antagonist example

Answer 19

Montelukast

Question 20

antimuscarinics MOA (3 steps)

Answer 20

1. blocks activity of muscarinic ACh receptor

2. bronchial dilation, decreased secretions

Question 21

long-acting muscarinic antagonist example

Answer 21

tiotropium

Question 22

methylxanthines act as

Answer 22

bronchodilators, relax smooth muscle

Question 23

methylxanthines are used in

Answer 23

asthma, COPD

Question 24

methylxanthines MOA (5 steps)

Answer 24

1. inhibits phosphodiesterase which usually degrades cAMP
2. increased cAMP
3. activates PKA
4. inhibits TNF-alpha, leukotriene synthesis
5. reduces inflammation and innate immunity

Question 25

methylxanthine example

Answer 25

theophylline

Question 26

label the diagram of MOA of steroids

Answer 26

done

Question 27

steroids are very effective at getting rid of _______ as they ____ ______

Answer 27

eosinophils, cause apoptosis

Question 28

corticosteroids MOA (5 steps)

Answer 28

1. attaches to and activates receptor 2. receptor forms dimer 3. dimer acts on DNA 4. up regulates beta-receptor gene = more beta receptors 5. down regulating cytokine genes = less inflammation

Question 29

only ____ inflammation responds to _____

Answer 29

eosinophilic, steroids

Question 30

oral steroids used to be given but

Answer 30

give lots of side effects

Question 31

side effects of oral steroids

Answer 31

cushing's syndrome

Question 32

50-70% of inhaled steroids end up

Answer 32

in stomach

Question 33

inhaled steroids don't give side effects as they are

Answer 33

metabolised on first pass through liver so don't get into systemic circulation

Question 34

if patient is non-responsive to steroids, this may be due to (3)

Answer 34

poor compliance, poor technique, misdiagnosis

Question 35

label the diagram of omalizumab

Answer 35

done

Question 36

omalizumab blocks

Answer 36

IgE

Question 37

IL-5 from innate lymphocyte also calls in

Answer 37

eosinophils

Question 38

IL-5 blockers are injectable treatments used in _____ _____ with _____ _____

Answer 38

severe asthmatics, eosinophilic reaction

Question 39

label the diagram of IL-5 blockers

Answer 39

done

Question 40

label the triangle

Answer 40

done

Question 41

copd includes

Answer 41

emphysema, chronic bronchitis

Question 42

2 phenotypes of COPD patients

Answer 42

- pink puffers, mostly emphysema | - blue bloaters, mostly chronic bronchitis, neutrophilic inflammation so no steroid respsonse

Question 43

eosinophilic bronchitis responds to

Answer 43

steroids

Question 44

label the spirometry graph

Answer 44

done

Question 45

to differentiate between eosinophilic and neutrophilic airway inflammation, look at the

Answer 45

full blood count

Question 46

blood eosinophils above ___ indicate ______ ______ ______

Answer 46

0.3, steroid responsive disease