Immunopharmacology - Asthma

Question 1

Airway inflammation leads to what? (3)

Answer 1

Hyperresponsiveness
Obstruction
Symptoms

Question 2

What causes asthma?

Answer 2

Narrowing caused by bronchoconstriction and airway inflammation

Question 3

Host factors of asthma? (4)

Answer 3

Genetic predisposition
Airway hyperresponsiveness
Gender
Race/Ethnicity

Question 4

Environmental factors of asthma?(8)

Answer 4

Indoor allergens
Outdoor allergens
Tobacco smoke
Air pollution
Respiratory infections
socioeconomic factors
Diet and drugs
Obesity

Question 5

What is the most common precipitant of asthma exacerbations among children less than 5y/o?

Answer 5

Respiratory viral infections

Question 6

3 main triggers of acute exacerbation?

Answer 6

Inflammatory factors
Irritants (odor, temp, exercise)
Others (food additives, tobacco, medication)

Question 7

Early phase of asthma starts after specific/non-specific stimulation of what cells?
Release of which kinds of mediators?
This leads to what symptoms? (4)
It is easily reversed by wha?

Answer 7

Airway mast cells
Histamine, PGs, LTs, PAF
Bronchospasm, mucosal edema, vasodilation, initiation of late phase reaction
Beta2 agonists

Question 8

Late Phase of asthma recruits which cells? (5)

Treated and prevented by which drugs?

Answer 8

Eosinophils, lymphocytes, basophils, macrophages, neutrophils
Corticosteroids

Question 9

Mechanism of the inflammatory reaction? (3)

Answer 9

1. Bronchiole lining is irritated
2. Top lining peels off, clogging the lumen of the airway with debris
3. Next layer of the lining leaks mucus into the lumen

Question 10

3 neural/immune components in asthma? do they cause bronchoconstriction or bronchodilation?

Answer 10

1/ Cholinergic innervation (Ach binds to M3 receptors on smooth muscle cells) : bronchoconstriction

2. Sympathetic innervation (adrenergic receptors are present on SMCs) : bronchodilation
3. Tissue response cells (mast cells or eosinophils release chemokines) : bronchoconstriction

Question 11

7 drugs for asthma

Answer 11

1. Sympathomimetic agents
2. Methylxanthine drugs
3. Antimuscarinic drugs
4. Corticosteroids
5. Cromolyn and Nedocromil
6. Leukotriene pathway inhibitors
7. New generation drugs

Question 12

Sympathomimetic agents are what kind of drug?
They increase production of ________
Bronchoconstriction or bronchodilation?

Answer 12

Beta agonists
cAMP
bronchodilation

Question 13

3 non-selective sympathomimetic agents?

How are they administered?

Answer 13

Epinephrine
Ephedrine
Isoproterenol
Microaerosol or injection

Question 14

3 beta2-adrenergic receptor-selective sympathomimetic agents?

Answer 14

Terbutaline
Metaproterenol
Salbutamol
Inhalers/tablets/parenteral routes

Question 15

3 methylxanthine drugs? Most effective?
They inhibit what? (2)
Net effect?

Answer 15

Theophylline (most effective)
Theobromine
Caffeine
Inhibit PDE and Adenosine
Bronchodilation

Question 16

2 antimuscarinic drugs?
What do they do?
Which readily enters CNS?
More effective or less effective than Beta agonists?

Answer 16

Atropine (readily enters CNS)
Ipratropium
Block effects of Ach at muscarinic receptors
Less effective

Question 17

2 corticosteroids?
What do they do?
Is it a permanent cure?

Answer 17

Prednisone
Methylprednisolone
Block production of cytokines by mast cells/eosinophils
NO

Question 18

2 leukotriene pathway inhibitors?

Answer 18

5-LO inhibitors

Leukotriene receptor antagonists

Question 19

Example of a 5-LO inhibitor?

Answer 19

Zileuton

Question 20

Three examples of Leukotriene receptor antagonist?

Answer 20

Zafirlukast
Montelukast
Pranlukast

Question 21

4 other drugs used to treat asthma? roles?

Answer 21

1. Omalizumab : Anti-IgE monoclonal Ab (blocks actin of IgE
2. Nifedipine/Verapamil : Calcium channel blockers
3. Nitric Oxide donors (smooth cell relaxation)
4. Future therapies: monoclonal Ab directed against chemokine

Question 22

Clinical management of mild asthma attacks?

Answer 22

Inhalation of Beta-receptor agonist or subcutaneous injection of epinephrine

Question 23

Clinical management of severe asthma attacks? (3)

Answer 23

Treatment with oxygen
Frequent administration of aerosolized salbutamol
Systemic treatment with prednisone

Question 24

The two relievers of asthma?

Answer 24

Short-acting Beta2-agonists

Anticholinergics

Question 25

The controllers of asthma?

Answer 25

Long acting Beta2-agonists

Question 26

The two preventers of asthma?

Answer 26

Inhaled corticosteroids

Leukotriene receptor antagonists