Lecture 20 - The beta 2-adrenoceptor agonist: risk and reward Flashcards Preview

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Flashcards in Lecture 20 - The beta 2-adrenoceptor agonist: risk and reward Deck (29):
1

Cold air causes..

an increase in smooth muscle responsiveness and hence, the airways narrow

2

The airway will remodel over time - causing...

thickening in muscle - will now react too much to allergins in asthsma for instance

3

What are the 3 ways of increased airway obstruction?

Airway smooth msucle shortening (narowing of lumen)

Bronchial wall oewdema (swelling, encroachment of lumen)

Mucus hypersecretion (occulision of lumen)

4

What obstruction casues are targetted by relievers, controllers and preventers

Airway smooth msucle shortening and Bronchial wall oewdema

5

Where do controllers act?

used chronically

again on the smooth msucle - reduce the liklihood of spasm

6

What are the 'preventor' class of drugs

anti-inflammatory
used chronically


act on inflammatory cells to reduce the burden of mediators generated in the allergic reaction

7

The contractile mechanism is regulated by...

intracellular calcium

8

What are the mechanisms increasing free calcium

TRP chanels

voltage operated calcium chanels

pohospholipase C release, which triggers release of IP3, which then releases Ca from IC stores

9

What are the mechanisms decreasingfree calcium

Plasma Ca2+ ATOase - extrusion (out of cell)

sarcoplasmic reticulum Ca2+ ATPase (SERCA) - pumps calcium back into internal stores

10

The sets of release and reuptake Ca systems are able to generate waves of Ca through the smooth muscle cells, these waves trigger..

the contractile apparatus

11

What triggers Ca2+ osscilations

Phospo-lipase C, signalling molecule associaed with GPCR

12

The Ca2+ osscillations actives ____ ___ _____ _____,

which then phosphorylates the Myosin light chain, which the confers on the actin filaments the ATPase activity which allows then to slide over each other and shorten (muscle contraction

Myosin Light Chain Kinase

13

The Phospo-lipase C can also active which other enzymes

Rho kinase and protein kinase C

14

Rho kinase and protein kinase C inhibit...

Myosin light chain phosphatase

this is the regulatory enzyme that turns off contraction, by removing phosphate from the Myosin light chain

15

Hence the Rho kinase and protein kinase C signalls reinforce the ...

original signal, by inhibiting the inhibition of actomyosin crossbridge formation and hence, contraction

16

Protein kinase A, has influence which oppose...

the GPCR signalling mechanism
- inhibits Ca2+ ossilations
- stimulates Myosin light chain phosphatase

17

Protein kinase A is targeted by

the beta-2-adrenoceptor

18

How does B2-adrenoceptors agonists relax airway smooth muscle?

Couple though b2-atrnoceptors, couples to Gs protein which actives adenolate cyclase

Adenolate cyclase casues an increase in cAMP, which acivates PROTEIN KINASE A (which inhibits the calcium waves)

19

PKA inhibits the ip3R receptor, meaning...

Ca2+ cannot escapes the intracellular stores

20

PKA also stimulates the re-uptake of Ca via..

SERCA pump - takes Ca out of cytoplasm and hence reduces the waves

21

What are the key features of Short-acting B2-adrenoceptor agonists are relievers?

Short acting agents, mainstay of acute bronchodilator therapy

rapid (2-5min) onset, B2-selective (very important)

Variable degrees of efficacy, could be imporatnt in the evelpoment of tolerance

22

What are the adverse effects of Short-acting B2-adrenoceptor agonists?

tachycardia, tremor, hypokalemia

23

the controllers are used _____

prophylactic

12hrs duration - reduced the likelihood that the asthmatic would have their airways constrict enough to have symptoms

24

The long-acting b2-adrenoceptors agonists (controllers) are now combined with ..

inhaled glucocorticoid in single actuator

reduces the likelihood of symptomes, no substantial anti-inflammatory action

25

What is the history of b2-agonists and their associated mortality?

60s - Isoprenaline -excess mortailty (lack of selectivity, targetted CVS )

Late 80s - Fenoterol in NZ - excess mortality, asthma deaths in particular

90s LABA (long acting Beta-agonists) - was closely monitored. reduced the exacerbations of asthma

00s - SMART trial - suggested issues

26

Higher efficacy liekly to be an explanation to asthma exacerbations?

No, becuase some members of the class of drugs are actually partial agonsits

27

true or False

Excessive use could be a explanation for current exacerbations

True

28

The absence of b2-AR in mice models seems to..

interfere with the acquisition of the allergic component

There may be some signalling from the empty b2-AR, in some cell types this could be adverse, by create the right environment of the allergic asthma

29

In a system with baseline stimulation of b2AR , you can see the effects of..

inverse agonists