Pharmacology Flashcards
(13 cards)
What types of drugs act as relievers in asthma treatment? (3)
SABAs, LABAs and CysLT receptor antagonists
methylxanthines
What types of drugs act as controllers/preventors in asthma treatment? (3)
Glucocorticoids, cromoglicate and humanised monoclonal IgE antibodies
(methylxanthines)
What are the 5 steps of asthma drug management?
1 - v. mild and intermittent - SABAs
2 - SABA required more than once a day? Add regular inhaled glucocorticoid (ICS)
3 - inadequate control? Add LABA. If good then continue LABA, if insufficient then increase ICS dose
4 - If persistent + poorly controlled, increase ICS dose. Could also add CysLT receptor antagonist/theophylline/oral beta2 agonist)
5 - still inadequate control? Introduce oral glucocorticoid + refer for specialist care
List the features of a drug given via aerosol
Pharmacokinetics - slow absorption, rapidly cleared
Dose - low, delivered rapidly to target
Systemic conc. - low
Incidence of adverse effects - low
Effectiveness - good in mild-moderate disease
List the features of a drug given via oral
Pharmacokinetics - good absorption, slow clearance
Dose - high systemic dose necessary to achieve appropriate conc. in lung
Systemic conc. - high
Incidence of adverse effects - high (drug dependent)
Effectiveness - good, even in severe disease
Examples of Beta2-adrenoreceptor agonists? (Both SABAs and LABAs)
SABAs
- salbutamol, terbutaline
LABAs - not useful in acute attacks, never used as monotherapy and must always be used in conjunction with an ICS
- salmeterol, formoterol
Examples of CysLT receptor antagonists?
montelukast, zafirlukast
Examples of methylxanthines?
theophylline, aminophylline
How do methylxanthines work?
uncertain! But have a very narrow therapeutic window, hence lots of adverse effects
How do CysLT receptor antagonists work?
act competitively on the CysLT receptor to relax bronchial smooth muscle - CysLTs are derived from mast cells/infiltrating inflammatory cells, cause smooth muscle contraction, increased mucus secretion and oedema.
What are the layers of the adrenal cortex, and what do they secrete?
From out to in…
- zona glomerulosa (mineralocorticoids e.g. aldosterone)
- zona fasciculata (glucocorticoids e.g. cortisol)
- zona reticularis
Name some synthetic corticosteroids
Inhaled -
beclometasone, budesonide and fluticasone.
All very frequently used for their anti-inflammatory effect in asthma treatment
Oral -
prednisolone
Describe the suppressing effects that glucocorticoids have on the inflammatory process in bronchial asthma
Decrease the formation of Th2 cytokines (e.g. IL-4 and IL-5) and cause apoptosis
Prevent allergen-induced influx of eosinophils into lung
Prevent production of IgE antibodies
Reduce the number of mast cells and decrease Fc (IgE) receptor expression
