Asthma Pharmacology

Question 1

what are the drugs used as relievers

Answer 1

SABAs
LABAs
CystLT antagonists

Question 2

What is the role of reliever drugs in asthma

Answer 2

Act as bronchodilators

Question 3

What drugs are used as preventers in asthma

Answer 3

Glucocorticoids
Cromoglicate
Humanised monoclonal IgE

Question 4

What is the role of preventer drugs in asthma

Answer 4

Act as anti-inflammatory

Reduce airway inflammation

Question 5

Which drug is used for both relieving and prevention in asthma

Answer 5

Methylxanthines

Question 6

what is the main role of beta 2 adrenoreceptor agonists

Answer 6

act as physiological antagonists of all spasminogens

Question 7

What is an example of a SABA

Answer 7

Salbutamol

Question 8

What is the first line treatment for mild, intermittent asthma

Answer 8

SABAs

Question 9

What effects does a SABA cause on the airways

Answer 9

bronchial smooth muscle relaxation
increase mucus clearance
decrease mediator release from mast cells and monocytes

Question 10

What are some side effects of SABAs

Answer 10

fine tremor
tachycardia
arrhythmia
hypokalaemia

Question 11

What is an example of LABA

Answer 11

Salmeterol, formoterel

Question 12

When would a LABA be prescribed

Answer 12

useful in nocturnal asthma

Question 13

Which other drugs should LABAs be used with

Answer 13

Glucocorticoids

Question 14

Why can asthmatics not use non-selective beta agonists (e.g. propranolol)

Answer 14

Risk of bronchospasm

Question 15

What is an example of CysLT1 receptor antgonist

Answer 15

Montelukast

Question 16

How do CysLT1 receptor antagonists work

Answer 16

They act competitively at CysLT1 receptors to block CysLTs causing smooth muscle contraction, mucus secretion and oedema

Question 17

examples of CysLTs

Answer 17

LTC4
LTD4
LTE4

Question 18

What are CysLTs derived from

Answer 18

mast cells

Question 19

What is the result of using CysLT antagonist

Answer 19

bronchodilation (early phase)

Anti-inflammatory (late phase)

Question 20

What types of asthma are CysLT1 receptor antagonists effective in

Answer 20

mild persistent asthma (as add on therapy)
severe asthma (in combination with corticosteroids)
Antigen induced and exercise induced bronchospasm

Question 21

What are 2 examples of methylxanthines

Answer 21

theophylline and aminophylline

Question 22

what is the effect of methyxantines

Answer 22

bronchodilation
anti-inflammatory
inhibit mediator release from mast cells
increase mucus clearance

Question 23

how do methyanthines improve lung ventilation

Answer 23

increase diaphragmatic contractility and reduce fatigue

Question 24

why are methylxanthines problematic

Answer 24

very narrow therapeutic window
adverse effects in both therapeutic and supra-therapeutic concentrations
numerous drug interactions

Question 25

what are the side effects of methylxanthines

Answer 25

``` dysrhythmia seizures hypotension nausea vomiting abdominal discomfort headache ```

Question 26

what are the 2 major classes of steroid hormone produced by adrenal cortex

Answer 26

glucocorticoid | mineralcorticoids

Question 27

which class of steroid hormone produced fro adrenal gland is used in treatment of asthma

Answer 27

glucocorticoid

Question 28

glucocorticoid increases/decreases inflammatory response

Answer 28

decreases

Question 29

glucocorticoid increases/decreases immune response

Answer 29

decreases

Question 30

glucocorticoid increases/decreases liver glycogen deposition

Answer 30

increases

Question 31

glucocorticoid increases/decreases gluconeogenesis

Answer 31

increases

Question 32

glucocorticoid increases/decreases glucose output from the liver

Answer 32

increases

Question 33

glucocorticoid increases/decreases glucose utilisation

Answer 33

decreases

Question 34

glucocorticoid increases/decreases protein catabolism

Answer 34

increases

Question 35

glucocorticoid increases/decreases bone catabolism

Answer 35

increases

Question 36

glucocorticoid increases/decreases gastric acid and pepsin secretion

Answer 36

increases

Question 37

what are some examples of synthetic derivatives of cortisol

Answer 37

beclometasone budesonide fluticasone

Question 38

why are glucocorticoids used in the prophylaxis of asthma

Answer 38

they have no direct bronchodilator effect when given acutely, hoover they can minimise adverse systemic effects

Question 39

what type of nuclear receptor do glucocorticoids signal via

Answer 39

GRalalpha

Question 40

are glucortcoids lipophilic or lipophobc

Answer 40

lipophilic

Question 41

how do glucocorticoids enter the cell

Answer 41

diffuse across the plasma membrane

Question 42

where do glucocorticoids combine with GRalpha

Answer 42

within the cytoplasm

Question 43

what happens with glucocorticoid combine with GRalpha

Answer 43

produce dissociation of inhibitory heat shock proteins and activates the receptor

Question 44

what do glucocorticoids do to genes when I the promoter region

Answer 44

transactivate (switch transcription on for anti-inflammatory genes) trans-repressed (switch transcription off)

Question 45

where do glucocorticoids act to regulate genes

Answer 45

glucocorticoid response elements (GREs)

Question 46

where is the glucocorticoid response element

Answer 46

within the promotor region of specific genes

Question 47

What do glucocorticoids do to TH2 cytokines

Answer 47

decrease their formation | induce apoptosis

Question 48

How do glucocorticoids act on mast cells

Answer 48

reduce the number of cells and decrease Fce expression

Question 49

How do glucocorticoids act on immunoglobulins

Answer 49

prevent IgE production

Question 50

which inflammatory cells do glucocorticoids decrease

Answer 50

``` Eosinophil T-lymphocyte cytokines mast cells Macriphage cytokines Dendritic cells ```

Question 51

Which structural cells do glucocorticoids affect

Answer 51

epithelial - decease cytokines and mediaors Endothelial cells - leak Airway smooth muscle - increase beta 2 receptors and decrease cytokines mucus gland - decrease secretion

Question 52

Common side effects of glucocorticoids

Answer 52

dysphonia | oropharyngeal candidiasis

Question 53

Which steroid is used in chronic, severe or rapidly deteriorating asthma

Answer 53

oral prednisolone in combination with inhaled steroid

Question 54

What is the action of cromones

Answer 54

they produce a weak anti-inflammatory effect

Question 55

when are cromones used

Answer 55

prophylactically in treatment of atopic asthma

Question 56

what is a specific cromone agent

Answer 56

sodium cromoglicate

Question 57

what is an example of monoclonal antibodies against IgE

Answer 57

Omalizumab

Question 58

how does Omalizumab work?

Answer 58

brinds to IgE via Fc t prevent attachment to FCe receptors on mast cells

Question 59

what is an example of monoclonal antibody against IL5

Answer 59

mepolizumab