Drugs And Asthma Flashcards by Alice Caporn

Q

Muscarinic antagonists reduce the excessive mucus secretion which occurs in asthma and may increase clearance of bronchial secretions, true or false

A

True

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Q

True or false,status asthmaticus is another term for chronic asthma

A

False, it is another term for acute asthma

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Q

During an inflammatory reaction in the airways, mast cells release the following spasmogens

Histamine. 4. Tumour necrosis factor-alpha
Interleukins (IL-4, IL-5, IL-13). 5. Prostaglandin D2
Leukotrienes (LTC4, LTD4)

A

Histamine, leukotrienes and prostaglandin D2

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Q

True or false, the problem with stopping steroid treatment abruptly is that the body over produces steroids

A

False

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Q

When treating asthma, the aim of drug treatment is to reduce inflammation and prevent bronchodilation, true or false

A

False

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Q

True or false, salbutamol has a longer duration of action than salmeterol

A

False

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Q

Oropharangeal thrush and dysphonia are adverse effects associated with the use of inhaled steroids, true or false

A

True

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Q

True or false, chronic asthma involves recurrent attacks of reversible airway obstruction

A

True

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Q

True or false, stimulating B2 adrenoceptors involves activation of a G protein coupled receptor, and increSe in cAMP and activation of protein kinase A

A

True

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Q

Match the following bronchodilators with their MOA

Terbutaline. A. B2 adrenergic agonist
Monteleukast. B. Leukotriene Rs antagonist
Theophylline C. Muscarinic Rs antagonist
Ipratropium. D. Leukotriene Rs antagonist
Zafirleukast. E. Phosphodiesterase inhibitor
Salmeterol. F. B2 adrenergic Rs agonist

A

1 - A
2 - B
3 - E
4 - C
5 - D
6 - F

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Q

Which type of asthma is not as susceptible to drugs; chronic or acute?

A

Acute

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Q

True or false, the aim of drug treatment in asthma is to reduce inflammation and prevent bronchoconstriction

A

True

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Q

Asthma that is classified as non-atopic is triggered by what?

A

Intrinsic trigger; exercise, respiratory infection, atmospheric pollutants

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Q

Asthma that is classified as atopic is triggered by what?

A

Allergic trigger, extrinsic trigger; pollen, dust mite proteins, animal dander

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Q

During the early phase of an asthma attack mast cells release the following inflammatory mediators

Interleukins (IL-4, IL-5, IL-13)
Histamine
Macrophage inflammatory protein
Tumour necrosis factor
Prostaglandin D2
Chemo taxing & chemokines

A

Interleukins
Macrophage inflammatory protein
Tumour necrosis factor
Chemotaxins and chemokines

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Q

What happens during the late phase of an asthma attack; bronchospasm or inflammation

A

Inflammation

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Q

Which of the following is not a type of bronchodilator 
B2 adrenergic receptor agonist 
Theophylline 
Muscarinic receptor agonist 
Leukotriene receptor antagonist

A

Muscarinic receptor agonist - it is a Muscarinic receptor antagonist

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Q

How do B2 adrenergic receptor agonists work?

A

Act on B2 adrenoceptors on bronchiole smooth muscle to relax muscle

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Q

Salbutamol, salmeterol and terbutaline are all types of what drug

A

B2 adrenergic receptor agonists - bronchodilators

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Q

How long does it take for salbutamol to have its maximum effect?

A

30mins

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Q

What is the duration of action if salbutamol and terbutaline

A

4-6 hours

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Q

How often would an individual with asthma take salbutamol

A

As and when needed

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Q

What duration of action does salmeterol have

A

12 hours

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Q

How often should a patient take salmeterol

A

Twice daily

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Why are B2 agonists given by inhalation?

To decrease systemic effects

What is the most common unwanted effect of B2 agonists

Tremor

Some tolerance can be developed to B2 agonists, how can this be prevented

By using a glucocorticoid

True or false, theophylline is a phosphodiesterase inhibitor

True

When is theophylline used in the treatment of asthma?

As a second line treatment, when B2 agonists are not working

In acute asthma theophylline might be given, how would it be administered?

IV - severe bronchoconstriction so inhalation wouldn't work

Ipratropium is used in asthma, what kind of drug is it

Muscarinic receptor antagonist

How long does it take for the maximum effect of ipratropium to be reChed

30mins

What is the duration if action of ipratropium

3-5 hours

How is the Muscarinic receptor antagonist ipratropium administered

Aerosol Inhalation

The drugs monteleukast and zafirlukast and what types of drugs used to prevent exercise induced and aspirin sensitive asthma

Leukotriene receptor antagonists

How are the Leukotriene receptor antagonists monteleukast and zafirlukast administered

Orally

Where do the Leukotriene receptor antagonists work.?

At cysteinyl-leukotriene receptors (on bronchiole smooth muscle cells)

``` Which glucocorticoids are only occasionally given to people with asthma Beclomethasone Prednisolone Budesonide Hydrocortisone Fluticasone ```

Prednisolone and hydrocortisone

How are glucocorticoids administered to people with asthma

Inhalation

True or false, the actions of glucocorticoids are immediate

False, it takes a few days for their full effect

Glucocorticoids work as anti inflammatory drugs because they reduce which of the following 1. Cytokines 2. Spasmogens (LT4, LTD4) 3. Tumour necrosis factor 4. Leucocyte Chemotaxins (LTB4, PAF)

1, 2 and 4

True or false, the actions of glucocorticoids in asthma reduces bronchospasm and increases recruitment and activation of inflammatory cells

False, reduces both

Which intracellular receptors do glucocorticoids bind to in cytoplasm

GR alpha | GR beta

What do glucocorticoids inhibit that blocks the entire bronchoconstriction pathway

Phospholipase A2

For patients with severe asthma, give inhaled steroid with which additional agent

B2 agonist or theophylline

For acute asthma attacks which two glucocorticoids would be given, and how would they be administered

Hydrocortisone - IV | Prednisolone - oral

How can the adverse effects of inhaled steroids, such as oropharyngeal thrush and dysphonia be minimised

Using a spacer device

Why can oral/regular large doses of glucocorticoids hVe serious effects

Adrenal suppression - stop natural production of glucocorticoids Patients must carry a steroid card

Which drug can reduce both early (bronchoconstriction) and late (inflammation) phases of asthma attack

Cromoglicate

True or false, cromoglicate when used for the treatment of asthma is more effective in adults than children

No, children respond better than adults

The asthma drug cromoglicate is effective in asthma caused by what?

Antigen Exercise Irritants

Cromoglicate's mechanisms are not understood. It is a mast cell stabiliser, it is thought it may; 1. Reduce neuronal reflexes (desensitise to irritants) 2. Increase release of T cell cytokines 3. Affect inflammatory cells and mediators

1 & 3 It inhibits the release of T cell cytokines

What are the side effects of the asthma drug cromoglicate

Irritation of upper respiratory tract Hypersensitivity reactions - rare

How is the drug cromoglicate administered

Inhalation

Is the asthma drug cromoglicate used as a prophylaxis or in treatment

Prophylaxis

True or false, the effects of the drug cromoglicate are seen immediately

False, they take weeks to develop

Which asthma drug is recombinant DNA-derived humanised IgG1 monoclonal antibody

Omalizumab

How is the asthma drug omalizumab administered

Sub cut injection, every 2-3 weeks

Omalizumab is sub cutaneously injected every 2-3 weeks and is slowly absorbed, when is the peak plasma concentration

7-8 days

What does the asthma drug omalizumab bind to

IgE, which inhibits the binding if IgE to IgE receptors on the surface if mast cells and basophils, inhibiting the IgE mediated cascade of asthma

What side effects may be seen from the drug omalizumab

Anaphylaxis | Malignancies

What drug treatment would be used with someone who had mild asthma with rare attacks

Inhaled B2 agonist prn

What drug therapy would be used with someone with mild asthma, with more frequent attacks

Glucocorticoid for prophylaxis | B2 agonist prn

What drug therapy would be given for someone with moderate to servers asthma

B2 agonist with glucorticoid in combined inhaler