Pathophysiology of Asthma

Question 1

What does chronic mean

Answer 1

persistent

Question 2

What does a idiosyncratic mean

Answer 2

doctors don’t have a fucking clue

Question 3

What do dust mites eat

Answer 3

keratin

Question 4

What are the main differences in an asthmatic airway and a healthy airway

Answer 4

Asthmatic has a mucus plug, Goblet cells metaplasia, epithelial desquamation, thickening of basement membrane and smooth muscle hypertrophy and hyperplasia

Question 5

What white blood cells infiltrate the oedema in an asthma patient

Answer 5

Eosinophils and neutrophils

Question 6

What does the mucus plug contain

Answer 6

eosinophils

Question 7

What causes Epithelial desquamation

Answer 7

Eosinophil bearing igE antibody

Question 8

What does a histamine do

Answer 8

constriction of smooth muscle

Question 9

What are Leukotrienes

Answer 9

C4 D4 E4 and constriction off airways smooth muscle

Question 10

What is the first line of drugs for asthma

Answer 10

B2 adrenergic agonists

Glucocorticoids

Question 11

What is the 1st phase of an asthma allergen inhaled thing called

Answer 11

Early phase = bronchospasm

Question 12

What is the 2nd phase of an asthma allergen inhaled thing called

Answer 12

Late phase = inflammation

Question 13

What drugs are needed for an early phase attack and late phase attack

Answer 13

Early phase = bronchodilators

Late phase = Anti inflammatory

Question 14

Where are the smooth muscle cells

Answer 14

bronchioles

Question 15

What are the types of bronchodilator

Answer 15

B2 adrenergic receptor agonists
Theophylline
Muscarinic receptor antagonist
Leukotriene receptor antagonists

Question 16

What do Beta2 act on

Answer 16

Beta 2 adrenoceptors on bronchiole smooth muscle to relax muscle

Question 17

What kind of receptor is a Beta 2 receptor

Answer 17

G-protein coupled receptors

Question 18

Where does the Gs (stimulatory protein) come from

Answer 18

cell membrane

Question 19

What happens to the Beta 2 receptor

Answer 19

It undergoes a conformational change

Question 20

What secondary thing happens after Gs has fucked the receptor

Answer 20

A fucks it ( adenylate cyclase)

Question 21

What does Adenylate cyclase do ma g

Answer 21

Uses ATP to activate Cyclic AMP which then makes the inactive PKA become activated

Question 22

What does activated PKA do

Answer 22

Protein Phosphorylation

Question 23

what does protein phosphorylation do

Answer 23

MUSCLE RELAXATION

Question 24

What are the 3 types of Beta 2 agonists

Answer 24

Short acting - 30 min effect and lasts 4-6 hours use as needed
Longer-acting (LABA) - lasts 12 hours and twice daily
Ultra-long acting

Question 25

What is the brown inhaler

Answer 25

Corticosteroid

Question 26

What is the blue inhaler

Answer 26

Bronchodilators

Question 27

What are the unwanted effects of the Beta 2 receptors

Answer 27

termor due to skeletal muscle having Beta 2 receptors

Question 28

What is a xanthine compound

Answer 28

Theophylline

Question 29

what does Theophylline do

Answer 29

Phosphodiesterase PDE inhibitors

Question 30

When is Theophylline given

Answer 30

severe asthma when Beta 2 isnt sufficient

Question 31

Side effects to Theophylline

Answer 31

CNS - stimulant soo tremor Cardiovascular - stimulates heart GI tract - anorexia vomiting

Question 32

When are Muscarinic receptor antagonists given

Answer 32

when B2 antagonists and steroids arent working

Question 33

The action of Muscarinic receptor antagonists

Answer 33

competes with ACh and prevents it stimulating smooth muscles

Question 34

Leukotriene receptor antagonists

Answer 34

Prevent exercise-induced and aspirin-sensitive asthma

Question 35

What does a leukotriene receptor antagonist do

Answer 35

Binds too leukotriene receptors and stops them causing bronchoconstriction and stops them stimulating mucus secretions

Question 36

What do leukotriene C4 and D4 do

Answer 36

Bronchial spasmogens and stimulate mucus secretions

Question 37

What do leukotrienes act on

Answer 37

Leukotriene receptors dumb ass

Question 38

What does aspirin inhibit

Answer 38

Cyco oxygenase thus more arachidonic acid converts to leukotrienes

Question 39

What doesn't work on a lot of people

Answer 39

Leukotriene antagonists ( only 40% of asthmatics)

Question 40

What is the mechanism of glucocorticoid action

Answer 40

``` Enters cells Binds to intracellular receptors in the cytoplasm (GRalpha and GR Beta) Receptor complex moves to the nucleus Binds to DNA in the nucleus Alters gene transcription ```

Question 41

What does the mechanism of glucocorticoid inhibit

Answer 41

Phospholipase A2 thus the Cyclo-oxygenase and 5-lipoxygenase pathway

Question 42

How long does the glucocorticoid take too work

Answer 42

Hours

Question 43

Why would glucocorticoid be taken IV

Answer 43

So they can travel to the sight of action

Question 44

Do children respond better than adults to drugs

Answer 44

yes

Question 45

What is given in subcutaneous injection every 2-3 weeks

Answer 45

OMALIZUMAB - IgG monoclonal antibodies

Question 46

What cells make the IgE

Answer 46

B cell

Question 47

what is OMALIZUMAB only for

Answer 47

allergic asthma as it binds to IgE

Question 48

side affects of OMALIZUMAB

Answer 48

anaphylaxis