Anti-inflammatory Drugs & Cough Flashcards
(41 cards)
1
Q
Use of Anti-inflammatory Drugs
A
- Reduce severity and frequency of asthma attacks
- Limit progression of disease by inhibiting remodelling
- Reduce night-time asthma attacks by preventing late-phase
2
Q
Glucocorticoids
A
- Mainly used anti-inflammatory
properties in asthma - Not a bronchodialator not relieving early phase
- Prevents progression of chronic asthma
- Effective in acute severe asthma
- Add-on inhalational therapy in asthma when bronchodilator is used more than once daily
3
Q
Glucocorticoid mechanism
A
- Glucicorticoids drugs bind to the glucocorticoid receptors in the cytoplasm
- Complex migrates into nucleaus and binds to glucocorticoid response elements
- effects inhibit glucocorticoid response element - decrease pro inflammatory COX-2
- effect stimulatory glucocorticoid response element increase anti-inflammatory gene products IL-10
4
Q
Immunosupression response of Glucocorticoids
A
- IL-10 Decreases cytokine formation
decreases recruitment and activation of inflammatory T cells - Inhibit esponses responsible for production of IgE and its receptors and for recruiting eosinophils
- Effect early phase and causes late phase of asthma
5
Q
Anti-inflammatory response of Glucocorticoids
A
- inhibits phospholipase A2
- decreased inflammatory mediators
also suppress COX-2 induction ↓inflammatory prostanoid production - Reduce severity of early phase response and prevent late phase response
6
Q
Glucocorticoids impact on inflammatory cascade
A
- Upregulate Beta 2 adrenoreceptors - regular use of beta 2 adenorecptor agonist (LABA) use with ICS
- Eventually reduce number of mast cells
– May have some effect on early phase
7
Q
Formulation of corticosteroids: Inhaled
Examples
A
- Beclometasone dipropionate (BDP)
- Budesonide
- Fluticasone propionate (2 x potent as BDP)
- Mometasone
8
Q
Formulation of corticosteroids: oral
Examples
A
- Prednisolone
- Given as a single dose in the morning to mimic the body’s
cortisol secretion
9
Q
Formulation of corticosteroids: IV
Example
A
- Hydrocortisone
10
Q
Glucocorticoids Unwanted effects that are uncommon with inhaled
A
- Systemic effects only in high doses
– Spacers minimise
11
Q
Glucocorticoids unwanted side effects: Oropharyngeal candidiasis
A
- Suppress T-lymphocytes important
against fungal infection
– Spacer devices reduce
12
Q
Glucocorticoids unwanted side effects: Regular high doses
A
- Adrenal suppression esp in
children
13
Q
Other unwanted side effects of Glucocorticoids
A
- Iatrogenic Cushings
- Osteoporosis
- Increased risk of pneumonia in elderly with COPD
- Poor absorption from GI tract
– Fluticasone / mometasone unwanted effects less likely
Steroid card
14
Q
Mast cell stabilisers
A
- Variable efficacy shown in antigen, exercise and irritant induced asthma - not a bronchodialator
- Weak anti-inflammatory effects
- Reduce immediate & late-phase responses
– Reduce bronchial hyper-reactivity
15
Q
How is the mast cell stablisation mechanism unclear
A
- Mast cell stablisation plays no part in oral anti-histamines
- Drepresses signal from irritant receptors
- May inhibit cytokine release
16
Q
Immunotherapies: Omalizumab
A
- Monoclonal antibody
- Anti-IgE antibody –
- Once binds to IgE these are
removed from circulation - IgE receptors also reduced
- Reduces mediator release from
mast cells - Gradually reduces inflammation
- prophylaxis severe and persisitant
- Risk of anaphylaxis with injection
17
Q
Reflex cough action
A
- Afferent sensory stimulus to an efferent motor response
- A forceful movement of respiratory muscles to affect the reflex
- essential reflex response of the airways under both physiological and pathophysiological conditions
18
Q
Two roles of a cough
A
- The final pathway of mucociliary clearance
- Part of the defence mechanisms against inhaled particles and
noxious substances
19
Q
Causes of a cough
A
- Irritants-smokes, fumes, dusts, etc.
- Diseased conditions like COPD, tumors of thorax, etc.
- Pressure on respiratory tracts
- Infections
20
Q
Components of cough reflex
A
- Cough receptors
- Afferent nerves
- Cough center (medulla)
- Efferent nerves
- Effector muscles
21
Q
Irritation
A
A stimulus irritates the upper
airways and results in a reflex action leading to cough
22
Q
Inspiration
A
Occurs to achieve optimum
thoracic gas volume thus allowing the
most efficient use of the expiratory muscles
23
Q
Compression
A
With the glottis closed, the
abdominal muscles and the thoracic cage actively contracts, leading to high
intrathoracic pressures
24
Q
Expulsion
A
The glottis opens and a high airflow results. The force of expression is increased by collapsing the airways following the explosive decompression caused by glottic opening
25
Relaxation
At the end of the cough,
the intrathoracic pressure decreases
as the expiratory muscles relax and a
transient bronchodilatation occurs
26
Mechanism of ACE
- ACE metabolises bradykinin which is potent vasodialator peptide that exerts its vasodialatory action via B2 receptors
- Aterioles dilate due to the release of prostacyclin, nitric oxide, and endothelium-derived hyperpolarizing factor
27
ACE inhibitor effect on bradykinin
- Increase in bradykinin levels contributing to vasodilator action
28
What is bradykinin
- Chemical irritation of c fibres of
respiratory tract – through release of proinflammatory peptides
- Substance p and histamine – these stimulate hyper stimulate
the cough reflex
29
Classification of cough
- Dry or chesty
* Classified as acute, subacute or chronic
30
Acute cough
- Been present for less than three weeks and can be divided into infectious and non-infectious causes
31
Subacute cough
Resolves over three to eight weeks
32
Chronic Cough
- Coughs are those present for more than eight
weeks
33
Chronic Cough cause
- Environmental irritants
- Conditions within the lungs
- Conditions in the upper airways
- Conditions within the chest cavity
- Digestive causes
- Asthma and COPD common
34
Antitussives
- Cough suppressants
- All in clinical use are opioid analgesics
* Suppress cough in doses below those required
for pain relief
* Action is poorly defined
* Suppress cough centre
35
What do dry cough drugs do
- Increase bronchial secretion or reduce its viscosity to facilitate removal
36
Secretion enhancers
Sodium citrate, potassium iodide, guaiacol, tolu
balsam, ammonium salts
37
Mucolytics: Acteylcysteine
- Actively breaking down sulphide bonds thinning mucus
- Useful in cystic fibrosis and COPD
38
COPD treatment efficacy: ICS
- Very effective in asthma but may only reduce exacebations in COPD
39
Side effects of ICS
- Adrenocortical suppression
- Bone mineral density reduced – osteoporosis
- Candidiasis of mouth and throat
- Resistance in certain individuals
40
Phosphodiesterase type 4 inhibitors
- Inhibition of PDE results in cAMP accumulation e.g. Roflumilast
- found in airways smooth muscle and inflammatory cells in COPD
- Reduced cytokines released from neutrophils
– Reduced accumulation of T-cells in lungs
– Reduced cell death of airway cells
41
Treatment of acute exacerbations of oxygen
- use low strength O2 in COPD 24%
- Become tolerant to prolonged CO2 retention & respiratory drive is maintained by low levels of O2
- High strength O2 will cause respiratory arrest
