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asthma Flashcards

1
Q

What causes an asthma in general

A

bronchoconstriction and inflammatory cells and debris filling the airways

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2
Q

what are the characteristic of asthma

A
  1. recurrent reversible airway obstruction
  2. hyperresponsiveness of airway
  3. chronic airway inflammation
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3
Q

What are the types of inflammation for asthma

A

type 1 inflammation: allergic asthma

type 2 inflammation: eosinophilic asthma

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4
Q

what is type 1 inflammation mediated by

A

IgE

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5
Q

What happens during a type 1 inflammation reaction

A

antigen bounded to IgE crosslinks on the Fc3RI receptor on mast cell

mast cell degranulates, releasing histamines, leukotrienes and other inflammatory mediators

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6
Q

what interleukins promote mast cell activity

A

IL4 and IL13 plays a role in IgE production

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7
Q

WHat happens in a type 2 inflammation reaction

A

IL5 causes eosinophils to have a late reaction, releasing other inflammatory mediators

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8
Q

How does B2 agonist help with asthma

A

bronchodilation

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9
Q

What are some examples of fast acting B2 agonists and long acting B2 agonist

A

fast acting: salbutamol, formoterol(fast acting and long acting)

long acting: salmeterol

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10
Q

what is long acting B2 agonist contraindicated for

A

for patients of all ages without concomitant use of asthma preventer medication like inhaled corticosteroids

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11
Q

How long does formoterol act, what is its onset of action timing, how is it taken

A

12 hr, fast acting 2-3 minutes, via inhalation/ oral

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12
Q

what is the duration of action for salbutamol, what is the method of administration

A

3-6 hrs, via IV in emergency

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13
Q

What are the adverse effects of B2 agonist

A

too high a dose can escape into systemic absorption causing

  1. tremors, muscle cramp, peripheral vasodilation, hypokalemia, hyperglycemia, tachycardia palpitation, B2 adrenoceptor tolerance
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14
Q

How does B2 agonist regulate bronchial tone

A

It increases adenylyl cyclase, converts Ac to phosphodiesterases, increase cAMP which promotes bronchodilation

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15
Q

What are examples of muscarinic receptor antagonist

A

ipratropium bromide(short acting), and tiotropium bromide(long acting)

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16
Q

What are some adverse effect of muscarinic receptor antagonist

A
  • parasympatholytic effects like dry mouth, urinary retention especially in elderly
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17
Q

How does muscarinic receptor antagonist regulate bronchial tone

A

blocking ach which causes bronchoconstriction through parasympathetic effects

18
Q

What molecules causes bronchoconstriction

A

leukotriene, adenosine, acetylcholine

19
Q

what is the mechanism of action for methylxanthines

A

inhibits phosphodiesterases , blocks adeosine receptors, increase adrenaline release from adrenal medulla, CNS stimulant action on respiration

has some anti-inflammatory effect on mast cell and T cell, and also decrease microvascular leakiness

20
Q

What are some examples of methylxanthine

A

theophylline and aminophylline

21
Q

What are the adverse effect of methylxanthine

A

narrow therapeutic window

many drug drug interactions

GI effect: nausea, vomitting, abdominal discomfort, anorexia

CNS effect: tremor, nervousness, anxiety, insomnia, seizure

CVS: arrythmia

22
Q

What are some ways in general that are used for anti inflammatory

A
  1. inhaled corticosteroids
  2. leukotriene pathway inhibitors
  3. mast cell stabilisers
  4. anti IgE monoclonal antibody
  5. anti IL4, IL5 signallng monoclonal antibodies
23
Q

why is inhaled corticosteroids good

A
  1. high receptor binding affinity ( so low dose required)
  2. extensive first pass metabolism ( lesser systemic side effects)
  3. highly lipophillic ( can be absorbed by tissues much easier)
24
Q

What are some examples of inhaled corticosteroid

A
  1. budesonide
  2. fluticasone
  3. ciclesonide
25
what is the adverse effect of fluticasone
greater risk of adrenal suppression, affect adrenal gland secretion
26
Ciclesonide is a prodrug, what is it activated by
esterase, which is found in the lungs
27
What are the effects of glucocorticoid receptor
1. reduce pro inflammatory mediators, T cell, mast cell, decrease pro inflammatory cytokines, decrease mucus, decrease shedding of epithelial cells, decrease 5-LOX, reduce production of leukotrienes, decrease inducible nitric oxide synthase, which decrease nitric oxide production 2. increase anti inflammatory mediators like annexin A1 and B2 adrenoceptors
28
what is inhaled corticosteroids used for
1. first line prophylactic for asthma treatment 2. nocturnal asthma due to delayed eosinophilic reaction
29
what are some adverse effect of inhaled corticosteroid
1. oropharyngeal candidiasis 2. dysphonia 3. cough/ throat irritation 4. adrenal suppression 5. easy bruising 6. posterior subcapsular cataract 7. osteoporosis
30
What are some example of leukotriene pathway inhibitors
1. 5LOX inhibitor like zileuton 2. cysLT receptor antagonist like montelukast
31
What are leukotriene pathway inhibitors good for
treating aspirin induced/ nsaid exacerbated asthma treat exercise induced asthma
32
What are some side effect of leukotriene pathway inhibitors
few and mild, gi disturbances, headache suicide thinking and neurophychiatric adverse effect in some patients
33
What is an example of a mast cell stabiliser
cromoglicic acid
34
What does cromoglicic acid do
decrease mast cell degranulation induced by IgE mediated Fc3ri crosslinking decrease secretion of inflammatory mediators from eosinophils, neutrophils and macrophages control chloride channels to inhibit cellular activation increase secretion of annexin A1, inhibits prostaglandin and leukotriene
35
What is cromoglicic acid used for
prophylactic control of asthma by inhalation only. prophylactic control of allergic rhinitis, allergic conjunctivities, vernal keratoconjunctivitis
36
what is an example of anti ig-E monoclonal antibody
omalizumab
37
What does omalizumab do
depletes level of free IgE in serum, so reduced binding to antigen, decreases Fc3RI expression on mast cell, reduce the trigger of allergic asthma
38
What are the cons of anti-IgE monoclonal antibody
-expensive - associated with small increase in risk of heart attack, transient ischemic attacks and blood clot - potential for anaphylaxis
39
What are examples of anti IL4 and IL5 signalling monoclonal antibodies
Reslizumab (IL5) Dupilumab(IL4)
40
What is reslizumab and dupilumab indicated for
patients with severe persistent eosinophilic asthma older than 18

pharmaco (19 decks)

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