asthma

Question 1

Episodic narrowing of airway walls thought to be caused by an underlying chronic inflammatory disorder

Answer 1

Asthma

Question 2

SYMPATHOMIMETIC AGENTS
Bind to β receptors on airway smooth
muscle cells → stimulate adenylyl cyclase →
increase cyclic AMP →

Answer 2

relaxing airway smooth muscle

Question 3

Bronchodilation is promoted by__

Answer 3

Camp (adenylyl cyclase or PDE)

Question 4

Epinephrine_ max bronchodilati

Answer 4

15 minutes and last about 60-90 minutes

Question 5

● Potent, non-selective β1 and β2 bronchodilator
● Inhalation of 80-120 mcg as aerosol with maximal
bronchodilation in 5 mins and duration of 60-90 mins
● Increased mortality in the UK (1960s) due to cardiac
dysrhythmias
● Now rarely used for asthma

Answer 5

isoproterenol

Question 6

Non-selective adrenergic

Answer 6

Epinephrine, isoproterenol, ephedrine

Question 7

S/e of epinephrine

Answer 7

Tachycardia, arrhythmia, worsening angina pectoris

Question 8

Isoproterenol: ___ mcg as aerosol with maximal broncodilation in _ min and duration of -

Answer 8

80-120mcg, 5 min. 60-90 min

Question 9

Longer duration than epinephrine, lower potency, central effects

Answer 9

Ephedrine

Question 10

Results from frequent or overuse of LABA and SABA

Answer 10

Tachyphylaxis

Question 11

SABA

Answer 11

Salbutamol 
terbutaline 
levalbuterol 
metaproterenol 
pributerol

Question 12

Optimal size

Answer 12

1-5um

Question 13

LABA

Answer 13

Salmeterol
Formoterol
Fenoterol
clenbuterol

Question 14

Given as an add-on for inhaled steroids

Answer 14

LABA

Question 15

Neurotransmitter  in  the
parasympathetic NS (released by vagus nerves) that promotes bronchoconstriction

Answer 15

Acetylcholine

Question 16

Blocks bronchoconstrictive effects of histamine, bradykinin, and eicosanoids
(mediators released during asthma attacks)

Answer 16

atropine (Datura stramonium)

Question 17

Inhaled irritants are sensed by the _____ pathways of the vagus nerve

Answer 17

Efferent

Question 18

Parasympathetic - 2 possible mechanisms

Answer 18

Triggers chemical mediators, initiate reflex bronchoconstriction or release tachykinins

Question 19

May last up to 6 hrs, quaternary ammonium derivative of atropine

Answer 19

Ipatropium Br

Question 20

Particular good response in subgroup of asthmatics with psychogenic exacerbations

Also useful in patient intolerant of β2 agonists

Answer 20

ipatropium br

Question 21

Drug of choice for rapid symptomatic relief of

dyspnea in asthma bronchoconstriction

Answer 21

SABA

Question 22

 Longer duration of action

 Maintenance therapy for COPD

Answer 22

Tiotropium br

Question 23

Dissociates most rapidly from M2 receptors

some degree of receptor selectivity

Answer 23

Tiotropium br, Aclidinium

Question 24

Tiotropium: __mcg OD (24hr duration)

Answer 24

18mcg

Question 25

Aclidinium: ___ mcg BID (12hr duration)

Answer 25

Aclidinium

Question 26

T or F | Antocholinergic agents have only modest inhibition to histamine, bradykinin or PGF2a

Answer 26

T

Question 27

Anticholinergics only frequent side effect

Answer 27

dry mouth

Question 28

prototype drug of methylxanthines

Answer 28

Aminophylline

Question 29

Theophylline-ethylenediamine complex, commonly used in IV preparation

Answer 29

aminophylline

Question 30

METHYLXANTHINES USED IN ASTHMA: BRONCHODILATOR DRUGS (Phosphodiesterase inhibitors)

Answer 30

o THEOPHYLLINE o AMINOPHYLLINE o DOXOFYLLINE

Question 31

Methylxanthines toxicity

Answer 31

- adverse cns effects | - urticaria

Question 32

Do not directly relax airway smooth muscles, no value in acute bronchoconstriction – central to the pathophysiology of asthma is that it is a chronic inflammatory disease so steroids are very important because of their anti-inflammatory action.

Answer 32

glucocorticoids

Question 33

Greatly enhances therapeutic index of these drugs (Can be given higher doses with very little side effects), targets the drug directly to site of inflamm

Answer 33

inhale glucocorticoids

Question 34

Inhaled glucocorticoids includes:

Answer 34

o Fluticasone o Budesonide o Betamethasone o Fluticasone Furoate

Question 35

For acute and chronic severe asthma

Answer 35

Glucocortiloid:systemic | prednisolone, methylprednisolone

Question 36

Dose for exacerbations: | Prednisolone:

Answer 36

40-60mg/day children: 1-2mg/kg/day 5-10 days max

Question 37

for persistent asthma

Answer 37

alternate-day therapy with oral prednisolone

Question 38

better tx (gold standard)

Answer 38

inhaled glucocorticoids

Question 39

Inhaled steroids systemic adverse effect

Answer 39

``` HPA axis suppression Bone resorption Carbohydrate and lipid metab Cataracts Skin thinning Purpura Dysphonia Candidiasis Growth retardation ```

Question 40

Known adverse effects of systemic steroids:

Answer 40

``` o Consequences that result from PA suppression o Fluid and electrolyte abnormalities o Hypertension o Hyperglycemia o Increased susceptibility to infection (due to decreased immunity) o Osteoporosis -myopathy -behavioural disturbances -cataracts -growth arrest -cushing syndrome ```

Question 41

Inflammatory mediators produced from the | lipoxygenase pathway

Answer 41

Cysteinyl Leukotrienes (CysLTs)

Question 42

∼1000 times more potent than Histamine | as a bronchoconstrictor.

Answer 42

LTD4

Question 43

LTRAs

Answer 43

Montelukast | Zafirlukast

Question 44

 Potent and selective inhibitor of 5- lipoxygenase  Not commonly prescribed due to hepatic toxicity  Not locally available

Answer 44

Leukotriene Synthesis Inhibitors | o Zileuton

Question 45

o Selective high-affinity competitive antagonists for the CysLT1 receptor o Orally active o Antagonists of LTC4 and LTD4

Answer 45

LTRA

Question 46

has effectiveness in asthma-induced asthma, and exercised-induces asthma

Answer 46

LTRAs

Question 47

LEUKOTRIENE PATHWAY INHIBITORS: TOXICITY

Answer 47

Very rarely: systemic eosinophilia and vasculitis with features similar to Churg-Strauss syndrome. o Often associated with a reduction in glucocorticoid therapy, may represent the unmasking of a pre-existing disease.

Question 48

may interact with warfarin and increase | prothrombin times.

Answer 48

Zafirlukast

Question 49

First biological agent approved for the treatment of asthma

Answer 49

Omalizumab

Question 50

Indicated for adults and adolescents >12 years of age with allergies and moderate-to-severe persistent asthma

Answer 50

Omalizumab

Question 51

Oxygen therapy: GOAL

Answer 51

02 saturation of atleast 95%