pharmacology

Question 1

what controls the airways para or sympathetic

Answer 1

parasympathetic

Question 2

is parasympathetic preganglionic Cholinergic or nitrergic

Answer 2

cholinergic

Question 3

where do parasympathetic preganglionic fibres come from

Answer 3

brainstem

Question 4

where do parasympathetic post ganglionic fibres act on

Answer 4

bronchioles

Question 5

what are the neurotransmitters and receptors of the cholinergic fibres and what do they do

Answer 5

ACh and M3, M3 increases phospho C which converts IP2 to PIP3 which opens calcium channels

Question 6

what are the neurotransmitters of the non-cholinergic fibres and what do they do

Answer 6

NO and VIP, dilation

Question 7

what do sympathetic post ganglionic fibres act on

Answer 7

submucosal glands and smooth muscles of arterial vessels (a1)

Question 8

what do sympathetic post ganglionic fibres act on, causing what to be released

Answer 8

adrenal glands, adrenaline

Question 9

what receptors does adrenaline act on and what does this cause

Answer 9

B2, dilation, decreased mucous secretion, increased mucociliary clearance

Question 10

which 2 ways can cause contraction in airway smooth muscle

Answer 10

hormonal (ACh on m3, causing IP3) and depolarisation (calcium influx), both cause Ca influx

Question 11

how does calcium cause contraction

Answer 11

Ca binds to calmodium which activates myosin light chain kinase (MLCK), MLCK used ATP to phosphorylate MLC and myosin slides past actin

Question 12

what caused relaxation of MLC

Answer 12

dephosphorylation of MLC by myosin phosphate (MP),

Question 13

is asthma obstructive or restrictive and reversible or irreversible

Answer 13

obstructive, reversible

Question 14

what are pathological changes of asthma

Answer 14

1) increased smooth muscle mass, 2) accumulation of interstitial fluid 3) increased mucous secretion 4) epithelial damage 5) sub epithelial fibrosis

Question 15

What happens to FEV1 and peak flow in asthamtics

Answer 15

decrease

Question 16

what causes hypersensitivity of airways

Answer 16

epithelial damage exposing nerve endings

Question 17

what is the difference between mild and severe asthma

Answer 17

mild = hypersensitivity and minor hyperactivity, severe = hypersensitivity and hyper activity

Question 18

why does hypersensitivity to an allergen mean

Answer 18

when allergen eg pollen is inhaled, there is a very strong immune inflammatory response

Question 19

in non-atopic individuals what happens when pollen is inhaled

Answer 19

dendritic cell phagotyoses and TH0 cells produce TH1 (normally IgG

Question 20

in atopic individuals what happens when pollen is inhaled

Answer 20

strong TH2 response, release interleukins (IL4) and activate B cells producing IgE

Question 21

in severe asthma what T cells are involved

Answer 21

TH2 and TH1

Question 22

what does IgE bind to

Answer 22

FcE on mast cells and eisonophils

Question 23

what do mast cells and eisonophils release

Answer 23

leukotrienes, histamina and chemokines

Question 24

what are the 2 components of an asthma attack

Answer 24

initial phase (bronchospasm and early inflammation), followed by delayed stage (inflammation and bronchospasm)

Question 25

what cells cause early stage

Answer 25

mast cells

Question 26

what cells cause late stage

Answer 26

eosinophils

Question 27

what are the main relievers in asthma - bronchodilators

Answer 27

SABA's, LABA's, CysLT1 antagonist

Question 28

what are the main controllers in asthma - anti-inflammatory

Answer 28

glucocorticoids and cromoglicate

Question 29

what is both a controller and reliever

Answer 29

methylxanthines

Question 30

what action to beta2 adrenoreceptor agonists have on ASM

Answer 30

cause relaxation by stimulating adenyly cylcase to increase cAMP which activates PKA which inhibits MCLK and activates MP

Question 31

what are the types of beta2 adrenoreceptor agonists

Answer 31

SABA's eg salbutamol, LABA's eg salmenterol and formoterol, ultra-LABA

Question 32

what is CysLT1 used for and an example

Answer 32

acute bronchospasm, taken orally, not for severe asthma. eg Montelukast, orally

Question 33

what is known about methylxanthines

Answer 33

very narrow therapeutic window and lots of side affects eg Theophylline, orally

Question 34

what are the 2 main classes or corticosteroids

Answer 34

glucocorticoids and mineralocorticoids, inhaled

Question 35

what does cortisol do

Answer 35

decreased inflammatory and immunological response

Question 36

what do mineralocorticoids do

Answer 36

salt and water retention

Question 37

what is the action mechanism of glucocorticoids

Answer 37

bind to GRa and alter transcription of anti-inflammatory proteins, not bronchodilators

Question 38

for chronic and severe asthma what is the last step before hospitalisation

Answer 38

prednisolone, orally, is a glucocorticoids

Question 39

what are cromones used for

Answer 39

mast cell stabilisation, reduces inflammatory response, eg sodium cromoglicate

Question 40

is COPD obstructive or restrictive and irreversible or reversible

Answer 40

obstructive, irreversible (sometimes reversible eg exacerbations)

Question 41

COPD often branches into what 2 conditions

Answer 41

emphysema and chronic bronchitis

Question 42

what is emphysema

Answer 42

Collapsing alveoli and loss of elastic recoil, losing SA for gas exchange, can cause SOB

Question 43

what is chronic bronchitis

Answer 43

inflammation of bronchioles and bronchi, increased sputum production, can cause coughing and SOB

Question 44

what does M1 do

Answer 44

allow transmission of ACh from pre to post ganglionic fibres (this allows contriction)

Question 45

what does M3 do

Answer 45

allows ACh to activate constriction of ASM

Question 46

What does M2 do

Answer 46

inhibits further release of ACh, (aids broncodilation)

Question 47

what does SAMA act on and give an example

Answer 47

non selective of M1, M2 and M3, is inhaled, ipratropium

Question 48

what does LAMA act on and give an example

Answer 48

inhaled, acts on M3, eg tiotropium

Question 49

give an example of an ultra-LABA

Answer 49

Indacaterol

Question 50

what does a PDE4 inhibitor do

Answer 50

supresses inflammation by acting on eosinophils eg Rofumilast

Question 51

what is rhinitis

Answer 51

inflammation of nasal mucosa causing sneezing, rhinorrhoea (runny nose) and a blocked nose (common cold, hay fever)

Question 52

what antibody is produced in allergic rhinitis

Answer 52

IgE

Question 53

what drugs can be given for rhinitis

Answer 53

H1 and CysLT1 receptor antagonists, sodium chromoglicate and Glucocorticoids

Question 54

what are H1 receptor antagonists more commonly known as

Answer 54

anti-histamines