asthma

Question 1

acute asthma

Answer 1

bronchodilators

beta 2 agonist

anticholinergic

theophylline

magnesium sulphate

Question 2

chronic asthma

Answer 2

blocks IgE - Omalizumab

mast cell stabilizer - (-crom-)

5LOX enzyme inhibitor - Zileuton

Leukotriene receptor antagonist - (Monteleukast, Zafirleukast, Pranlukast)

interleukin 4 blocker - Dupilumab

interleukin 5 blocker - Mepolizumab, Reslizumab, Benralizumab

broad action- corticosteroids(DOC)

Question 3

MOA of beta 2 agonist

Answer 3

B2 is Gs type of GPCR
Stimulation increases adenylyl cyclase
leads to increase cAMP
bronchodilation

also increases mucus production

Question 4

bera 2 agonist for asthma

Answer 4

1. non specific beta 2 agonist

Epinephrine (alpha, beta) - sc - brittle asthma
Ephedrine (alpha, beta)
Isoprenaline (beta)

2. specific beta 2 agonist

SABA - Salbutamol (Albuterol) - shortest, Terbutaline, Pirbuterol

LABA- Salmeterol, Bambuterol (prodrug whose active form in Terbutaline)

ultra LABA - Indacaterol - longest, Vilanterol, Oladaterol, Clenbuterol (anabolic action-banned)

both SABA + LABA - Formeterol - Single Maintenance and Reliever Therapy

Levosalbutamol and Arformeterol - enantiomers

Question 5

routes of Beta 2 agonist bronchodilators

Answer 5

inhalers-all
oral-all
sc inj- Terbutaline
iv inj- Salmeterol

inj- emergency - Status Asthmaticus

Question 6

adverse effect of beta 2 agonist

Answer 6

tremors (most common)
tachycardia
tachyphylaxis (treatment - add or increase dose of corticosteroids)
hypokalemia
hyperglycemia

Question 7

MOA of anticholinergic bronchodilators

Answer 7

blocks M3 receptors which are Gq type of GPCR and thus, decreases phospholipase A2 and decreases IP3 + DAG and decreases Ca2+

reduces mucous production (bad)

Question 8

anticholinergic for asthma

Answer 8

inhalers only

Ipratropium(shortest) - SAMA - Status Asthmaticus
acute attacks
Tiotropium
Oxytropium
Umeclidinium
Aclidinium(longest)

new: Revefenacin, Glycopyrrolate

Question 9

SE of anticholinergics

Answer 9

Reduce mucous production
dry eye/mouth
constipation
urinary retention

Question 10

paradoxical bronchoconstriction

Answer 10

Ipratropium

Block presynaptic M2 on vagus - Increased Act release

inhalers: EDTA, benzalkalonium Cl

Question 11

Methylxanthines

Answer 11

Theophylline
Aminophylline
Hydroxyethyltheophylline
Doxophylline
Choline theophyllinate
Etophylline

Question 12

MOA of theophylline

Answer 12

Phosphodiesterase 4 inhibitor > 3,5
Adenosine (A!) receptor blocker
Calcium release inhibitor
Histone protein acetylation
Inhibits IL-5 synthesis

Question 13

specific PDE 4 inhibitors for asthma

Answer 13

Roflumilast
Cilomilast
Ibudilast

new BD recently approved for COPD or asthma

Question 14

Therapeutic range of theophylline

Answer 14

5-15 microgram/ml
requires TDM

Question 15

Theophylline metabolism

Answer 15

metabolised by CYP1A2

Question 16

CYP inducers

Answer 16

Gresiofulvin
Phenobarbitone
Phenytoin
Rifampicin
smoking

Question 17

CYP inhibitor

Answer 17

Ciprofloxacin
Omeprazole
Cimetidine
Allopurinol
Erythromycin

Question 18

all uses of magnesium

Answer 18

tocolytic (relaxes uterus)
antavid (acidity treatment)
barium and calcium poisoning
laxative
eclampsia (seizures in pregnancy)
Torsades de pointes
Status Asthmaticus

Question 19

Theophylline toxicity

Answer 19

increased urination
increased seizures
GIT upset
headaches
arrhythmia

Question 20

1st sign of Mg toxicity

Answer 20

loss of deep tendon reflexes
(loss of patellar reflex - knee jerk)

Question 21

Antidote of Mg toxicity

Answer 21

Ca gluconate

Question 22

mast cell stabilizer

Answer 22

Nedocromyl
Cromoglycate (called Cromolyn)

Question 23

ICS

Answer 23

Beclamethasone
Fluticasone + most potent
Mometasone
Triamcinolone
Budesonide - most commonly used
Flunisolids
Ciclesonide