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X Pharmacological Treatment Of Disease > Asthma > Flashcards

Asthma Flashcards

1
Q

what is the definition of asthma?

A

a chronic inflammatory disorder of the airways in susceptible individuals, inflammatory symptoms are usually associated with widespread but variable airflow obstruction and an increase in airway response to a variety of stimuli. obstruction is often reversible, either spontaneously or with treatment

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2
Q

how many people in the uk die of asthma each year?

A

1200

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3
Q

how many people in the uk are admitted to hospital because of asthma each year?

A

80,000+ anually

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4
Q

what are the key pathophysiological features of asthma?

A

bronchoconstriction
muscosal oedema
excessive secretion of mucus
epithelial damage

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5
Q

what are the trigger factors of asthma?

A 
house dust mites
exercise
air pollution
occupational allergens
food allergy
drugs
seasonal variation
emotional disturbance
cold, dry air
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6
Q

what are the classifications of asthma and what do they mean?

A

intrinsic (non-allergic)

extrinsic (allergic)

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7
Q

what age group does intrinsic asthma typically affect?

A

older patients

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8
Q

what age group does extrinsic asthma typically affect?

A

children (childhood)

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9
Q

what is the cause of intrinsic asthma?

A 
hypersensitive airways (IgE normal)
constrict to non-specific stimuli
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10
Q

what is the cause of extrinsic asthma?

A

type 1 hypersensitivity reaction

familial tendency

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11
Q

what are the triggers of intrinsic asthma?

A

aspirin, beta blockers
cold, dry air
exercise
respiratory infections

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12
Q

what are the triggers of extrinsic asthma?

A

pollen
food allergy
occupational allergens
house dust mites

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13
Q

what do you do to diagnose asthma?

A

lung function tests:
peak flow meter
or
spirometer

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14
Q

what does peak flow meter measure?

A

max rate of air flow on forced expiration

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15
Q

what does a spirometer measure?

A

FVC - forced vital capacity (total volume of expired air after full expiration)

FEV1 - air forcibly expired in 1 second

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16
Q

what do you do with FVC and FEV1 values?

A

FEV1/FVC should be 70-80%

asthma can be 20-30%

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17
Q

what do you give to a patient along with spirometer to diagnose asthma?

A

beta-2 agonist to reduce bronchoconstriction
then do spirometer again
should see an improvement

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18
Q

what happens if beta-2 agonist is given but the bronchoconstriction doesn’t improve?

A

COPD

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19
Q

what is COPD?

A

bronchitis and emphysema

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20
Q

how does early phase asthma work?

A
  1. trigger/ non-specific stimulus activates mast cells
  2. i) mast cells release LTC4 and LTD4, histamine and PGD2 which increase bronchospasm
    ii) mast cells release chemotaxins and cytokines which lead to late phase asthma
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21
Q

how does late phase asthma work?

A
  • infiltration of Th2 cells -> cytokine release
  • infiltration of monocytes
  • activation of eosinophils

i) these all lead to LTC4 and LTD4 and other mediators - these cause airway inflammation and airway hyperactivity which leads to bronchospasm, coughing and wheezing
ii) these all lead to EMBP and ECP - these lead to increase airway inflammation and airway hyperactivity which leads to bronchospasm, coughing and wheezing

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22
Q

what 3 ways of treating asthma are there?

A

relievers
controllers
preventers

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23
Q

what 3 kinds of relievers are there? (bronchodilators)

A

beta-2 agonists (short acting)
anti-cholinergics (short acting)
theophylline (short acting)

24
Q

what 5 kinds of controllers are there?

A 
beta-2 agonists (long acting)
anti-cholinergics (long acting)
theophylline (Slow Release)
leukotriene modifiers
omalizumab
25
Q

what kinds of preventers are there?

A

corticosteroids - inhaled/oral

cromolyns

26
Q

give 2 examples of an inhaled short-acting beta-2 adrenoreceptor agonist

A

salbutamol, terbutaline

27
Q

give 2 examples of an inhaled long-acting beta-2 adrenoreceptor agonist

A

salmeterol, formoterol

28
Q

what do inhaled beta-2 adrenoreceptor agonists do?

A

relax bronchiolar smooth muscle by stimulating beta-2 adrenoreceptors

fast acting
effects last hours

29
Q

what are the side effects of inhaled beta-2 adrenoreceptor agonists?

A

tachycardia, fine tremor

30
Q

what is the mechanism of action of inhaled beta-2 adrenoreceptor agonists?

A
  1. e.g. salbutamol stimulates beta-2 receptor
  2. adenylate cyclase is stimulated
  3. adenylate cyclase catalyses ATP -> cAMP
  4. cAMP causes relaxation
31
Q

what do oral beta-2 adrenoreceptor agonists do? (bambuterol)

A 
slower acting
longer lasting
additional symptom control (nocturnal)
used only in addition to inhaled glucocorticoids
patients with inhaler difficulty
32
Q

what is an example of a beta-2 adrenoreceptor agonist?

A

bambuterol/salmeterol

33
Q

what are the 2 theories of salmeterol function?

A

1) side chain binds to exoreceptor site near beta-2 adrenoreceptor, keeping it in close proximity to the receptor
2) durg enters lipid bilayer and attaches to receptor from within the membrane

34
Q

what are 2 examples of anti-cholinergic drugs?

A

ipratropium bromide

tiotropium bromide

35
Q

what do anti-cholinergic drugs do?

A

prevent vagally-mediated bronchoconstriction by blocking muscarinic ACh receptors of bronchial smooth muscle cells

alternative to inhaled beta-2 agonists if they have side effects

slower onset of inhaled beta-2 agonists, less effective but last longer

36
Q

how do anti-cholinergic drugs work?

A

block muscarinic ACh receptor

37
Q

what are 3 examples of methylxanthines?

A

theophylline, theobromine, caffeine

38
Q

how does theophylline work?

A

oral bronchodilator
slow release form available
added for additional nocturnal symptoms

39
Q

what are the side effects of theophylline?

A

serious!

tachycardia, persistant vomiting

indicate toxicity

40
Q

methylxanthines: what is the mechanism of phosphodiesterase (PDE) inhibition?

A

“normally” adrenaline/noradrenaline activates beta-2 receptor which activates adenylate cyclase. adenylate cyclase catalyses ATP -> cAMP.

cAMP causes relaxation, and is also turned into 5’-AMP by PDE THEOPHYLLINE INHIBITS THIS

So leads to cAMP build up in smooth muscle to cause bronchodilation

41
Q

methylxanthines: what is the mechanism of adenosine receptor antagonism?

A

theophylline acts as inhibitor of adenosine A1 and A2 receptors
antagonism of these receptors leads to bronchoconstriction and inflammation
inhibition of adenosine receptors could cause bronchodilation and reduce histamine reduced from mast cells

42
Q

what kinds of purine receptors are there and what are their subtypes?

A

P1 and P2

P1: A1, A2, A3 all respond to adenosine
P2: P2x and P2y respond to ATP and/or ADP

43
Q

what happens when adenosine acts on P1 receptors?

A

decreased heart rate
decreased blood pressure
decreased GI function
lethargy

44
Q

how is the effects of P1 receptor stimulation by adenosine reversed?

A

caffeine

45
Q

what is the summary mechanism of action of bronchodilatiors?

A

acetylcholine causes bronchoconstriction, but muscarinic antagonists decrease this

adenosine causes bronchoconstriction, but theophylline decrease this

cAMP causes bronchodilation, beta agonists increase ATP -> cAMP

cAMP causes bronchodilation, theophylline decreases the conversion of cAMP -> AMP to increase cAMP levels

46
Q

what cortiosteroids can be used to treat asthma?

A

inhaled- beclomethasone

oral- hydrocortisone and prednisolone

47
Q

what is the mechanism of action of corticosteroids of asthma?

A

suppression of inflammation by various mechanisms (revise steroid pathways)

reduce circulating immunocompetant cells and macrophages

inhibition of inflammatory mediators i.e. prostaglandins, leukotrienes and platelet activating factor

48
Q

what is sodium cromoglycate?

A

mast cell stabilizer

49
Q

what does sodium cromoglycate do?

A

inhibits early and late phases of asthma

prophylactic use only (not for asthma attacks)

50
Q

what is the mechanism of action of sodium cromoglycate?

A

reduce influx of calcium into antigen-sensitised mast cells -> inhibits release of histamine and other mediators

51
Q

what are the 4 theories about the mechanism of action of sodium cromoglycate?

A

1) inhibit mast cell degranulation and eosinophils
2) inhibit nerve stimulation (e.g. by irritants) that causes bronchoconstriction
3) inhibit action of platelet activating factor
4) inhibit release of cytokines from T-cells

52
Q

how can asthma be treated by leukotriene synthesis inhibitor?

A

5-lipooxygenase inhibitors

immediate lung function improvement

53
Q

what is an example of a leukotriene inhibitor?

A

Zileuton

54
Q

how can asthma be treated by a leukotriene receptor antagonist?

A

inhibits inflammation, mucosal oedema and bronchoconstriction

used in adults and children
oral
patients with aspirin-sensitive asthma which involves LT production

55
Q

what is an example of a leukotriene receptor antagonist?

A

Zafirlukast

56
Q

how can you treat asthma with omalizumab?

A

humanised monoclonal antibody, selectively binds to IgE, preventing binding of IgE to FCepsilonRI antibody

limits release of inflammatory mediators

57
Q

when do you use omalizumab?

A

add on with severe allergic asthma with usual treatment

X Pharmacological Treatment Of Disease (9 decks)

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