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Pharmacology > Asthma > Flashcards

Asthma Flashcards

1
Q

What type of asthma is reversible and controlled by drugs?

A

Chronic

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2
Q

What 2 features of asthma are drugs directed against?

A

Inflamed airways

Bronchoconstriction

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3
Q

What is the 3 part aim of drug treatment?

A

Reduce inflammation
Prevent bronchoconstriction
Restore airways calibre to normal

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4
Q

What is involved in the early phase of an asthma attack?

A

Bronchospasm

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5
Q

What is involved in the late phase of an asthma attack?

A

Infalmmation

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6
Q

In the early phase of an asthma attack, mast cells release which 3 spasmogens?

A

Histamine
Leukotrienes LTC4 & LTD4
Prostaglandin D2

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7
Q

In the early phase of an asthma attack, mast cells release what inflammatory mediators?

A

Interleukins
Macrophage inflammatory protein
Tumour necrosis factor
Chemotaxin & chemokines attack leukocytes to area

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8
Q

What happens in the progressing inflammatory reaction?

A

Th2 lymphocytes & eosinophils invade and release cytokines, chemokine & toxic proteins

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9
Q

What do agents from inflammatory cells cause?

A

Damage to & loss of bronchial epithelium
Smooth muscle cell hypertrophy & hyperplasia
Hyper reactivity to irritant stimuli

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10
Q

What are the 4 types of bronchodilator?

A

B2 adrenergic receptor agonists
Theophylline
Muscarinic receptor antagonists
Leukotriene receptor antagonists

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11
Q

Other than action on b2 adrenoceptors, what do b2 adrenergic receptor agonists do?

A

Inhibit mediator release from mast cells & monocytes

Act on cilia to increase mucus clearance

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12
Q

What are short acting b2 adrenergic receptor agonists?

A

Salbutamol, terbutaline

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13
Q

Over what time scale do salbutamol and terbutaline act?

A

Max effect 30 mins

Lasts 4-6 hours

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14
Q

What is a longer acting b2 adrenergic receptor agonist?

A

Salmerterol

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15
Q

What is the duration of action of salmerterol?

A

12 hours

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16
Q

What is the dosage of salmeterol in patients not controlled with glucocorticoids?

A

Twice daily

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17
Q

What is an unwanted effect of b2 agonists caused by absorption into systemic circulation?

A

Tremor

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18
Q

How is tolerance to b2 agonists prevented?

A

Glucocorticoids

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19
Q

What is the action of theophylline?

A

Phosphodiesterase inhibitor

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20
Q

How is theothylline used?

A

With steroid when asthma response to b2 agonist inadequate

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21
Q

How is theothylline administered?

A

Sustained release tablet

I.V in acute severe asthma

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22
Q

What is the main muscarinic receptor antagonist?

A

Ipratropium

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23
Q

When are muscarinic receptor agonists used?

A

Supplementary to b2 agonists and steroids when they are insufficient

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24
Q

Over what period does the muscarinic receptor agonists dose take effect?

A

Max effect 30 mins

Lasts 3-5 hours

25
Q

How is ipratropium (muscarinic) administered?

A

Aerosol inhalation

26
Q

What are the actions of muscarinic antagonists?

A

Bronchodilation
Inhibit elevated mucus secretion
Increase clearance of bronchial secretions

27
Q

What mechanism brings the actions of muscarinic antagonists?

A

Block action of endogenous acetylcholine at muscarinic receptors

28
Q

What happens when increased levels of Ach are released from cholinergic nerves in airways

A

Muscarinic receptors activated
Smooth muscle contract
Narrowed airways

29
Q

What are 2 examples of leukotriene receptor antagonists?

A

Montelucast (O.D)

Zafirlukast (B.I.D)

30
Q

How are leukotriene receptor antagonists administered?

A

Orally

31
Q

What asthma do leukotriene receptor antagonists prevent?

A

Exercise induced

Aspirin sensitive

32
Q

How are leukotriene receptor antagonists used?

A

Add on for uncontrolled, mild-moderate asthma

33
Q

What do leukotriene antagonists do?

A

Prevent actions of LTC4 & LTD4 which are bronchial spasmogens and stimulate mucus secretion

34
Q

What are the unwanted effects of leukotriene antagonists?

A

Headache, GI disturbance

35
Q

What are the main anti-inflammatory drugs?

A

Glucocorticoids

36
Q

What are the 4 glucocorticoids?

A

Beclometasone diproprionate
Budesonide
Fluticasone propionate
Prednisolone/hydrocortisone

37
Q

How are anti-inflammatory drugs administered?

A

Usually inhalation

38
Q

How long does the full effect of anti-inflammatory drugs take?

A

Several days

39
Q

What do glucocorticoids do?

A

Reduce production of cytokines, spasmogens and leucocyte chemotaxins

40
Q

What is the mechanism of glucocorticoid action?

A 
Enter cells
Bind to receptors in cytoplasm
Receptor moves to nucleus
Binds to DNA in nucleus
Alters gene
41
Q

How are glucocorticoids used for severe asthma?

A

With addition agents e.g. budesonide + b2 agonist or theophylline

42
Q

How are glucocorticoids used for acute exacerbations?

A

I.V hydrocortisone + oral prednisolone

43
Q

What are the unwanted effects of inhaled glucocorticoids?

A

Oropharyngeal thrush & dysphonia

44
Q

How are adverse effects of glucocorticoids minimised?

A

Spacer

45
Q

What are the unwanted effects of oral/ regular large doses of glucocorticoids

A

Adrenal suppression

46
Q

What drug can reduce both early and late phase asthma?

A

Cromoglicate

47
Q

Cromoglicate is effective in asthma caused by what?

A

Antigen
Exercise
Irritants

48
Q

What are the downsides to cromoglicate?

A

Unpredictable

Children respond better

49
Q

What are the adverse effects of cromoglicate?

A

Irritated upper respiratory tract

50
Q

How is cromoglicate administered?

A

Inhalation by aerosol, nebuliser solution or powder

51
Q

What biological agent is used to treat asthma?

A

Omalizumab (xolair)

52
Q

What is omalizumab?

A

Recombinant DNA-derived humanised IgG1 monoclonal antibody

53
Q

How is omalizumab administered?

A

Sub cut every 2-3 weeks

54
Q

When is the peak plasma concentration of omalizumab?

A

7-8 days

55
Q

How does omalizumab work?

A

Binds to human IgE
Inhibit IgE binding to recpetor on mast cells/basophils
Inhibits IgE mediated cascade of asthma

56
Q

How is mild asthma with rare attacks best treated?

A

Inhaled b2 agonist when required

57
Q

How is mild asthma with more frequent attacks best treated?

A

Glucocorticoid for prophylaxis

B2 agonist when needed for acute attack

58
Q

How is moderate to severe asthma best treated?

A

B2 agonist with glucocorticoid in combined inhaler

Pharmacology (7 decks)

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