Pharmacology

Question 1

What type of drug is Reslizumab

Answer 1

…mab = Monoclonal AntiBody

Question 2

What type of drug is Dexamethasone

Answer 2

…sone = corticosteroid

Question 3

What type of drug is Prednisolone

Answer 3

…lone = corticosteroid

Question 4

What type of drug is Salmeterol

Answer 4

…terol = bronchodilators

Question 5

What type of drug is Nintedanib

Answer 5

…nib = kinase iNhIBitor

Question 6

What are the 2 vital regions of the respiratory system

Answer 6

Conducting airways

Respiratory region

Question 7

What does the respiratory region consist of

Answer 7

Respiratory bronchioles
Alveolar ducts
Alveolar sacs

Question 8

What is most common device used to inhaled respiratory drugs

Answer 8

Inhaler

Question 9

What device delivers medication in form of an aerosol

Answer 9

Nebuliser

Question 10

Describe differences in blood flow between conducting airways and respiratory region

Answer 10

Conducting airways - smaller surface area and lower regional blood flow
Respiratory region - accounts for >95% of lungs surface area and is directly connected to the systemic circulation via the pulmonary circulation

Question 11

Deliver systems for inhaled drugs

Answer 11

Pressurised metered-dose inhalers (pMDIs)
Spacer devices
Dry powder inhalers (DPIs)
Nebulisers

Question 12

What causes bronchoconstriction of airways

Answer 12

Tightening of airway smooth muscle (ASM)
Lumenal occlusion by mucus and plasma
airway wall thickening

Question 13

In what diseases would you most commonly see bronchoconstriction

Answer 13

Asthma

COPD

Question 14

2 main categories of treating bronchoconstriction

Answer 14

Bronchodilation - adrenergic (sympathetic)

Block bronchoconstriction - anti-cholinergic (parasympathetic)

Question 15

Examples of bronchodilators

Answer 15

Beta 2 Adrenoreceptor Agonists

Question 16

How do Beta 2 Adrenoreceptor Agonists work

Answer 16

Act on B2-adenoreceptors to cause smooth muscle relaxation and bronchodilation
Also inhibits histamine release from lung mast cells

Question 17

Examples of Beta 2 Adrenoreceptor Agonists

Answer 17

SABA/Short acting B2-adrenoreceptor agonists
LABA/Long acting B2-adrenoreceptor agonists
ultra-LABA (E.g. Indacaterol - allow once daily dosing)

Question 18

Example of SABA

Answer 18

Salbutamol

Question 19

Example of LABA

Answer 19

Formoterol and Salmeterol

Question 20

What LABAs combined with in treatment of asthma

Answer 20

Inhaled cortiosteroids

Question 21

What are LABAs combined with in treatment of COPD

Answer 21

Inhaled Long-acting Anti-Muscarinic Agent (LAMA)

Question 22

What is effect of acetylcholine on airway smooth muscle

Answer 22

Contracts ASM by activating muscarinic receptors on smooth muscle cells

Question 23

What is effect of anticholinergics on muscarinic receptors

Answer 23

Block ACh binding

Question 24

What is Atropine

Answer 24

Naturally occuring anticholinergic found in deadly nightshade
Reverses bronchoconstriction caused by parasympathetic nerve stimulation

Question 25

What is the most effective anti-inflammatory drug for asthma

Answer 25

Glucocorticoids

Question 26

Effects of inhaled corticosteroids on asthma

Answer 26

improve the quality of life of patients with asthma improve lung function reduce frequency of exacerbations Can prevent irreversible airway changes

Question 27

Examples of Inhaled Corticosteroids

Answer 27

``` Beclomethasone dipropionate (pMDI and DPI) Budesenide ```

Question 28

How do inhaled corticosteroids reduce inflammation

Answer 28

Reduce numbers of inflammatory cells in airways: Suppress the production of chemotactic mediators Reduce adhesion molecule expression Inhibit inflammatory cell survival in the airway Suppress inflammatory gene expression in airway epithelial cells

Question 29

Side effects of ICS

Answer 29

``` Reduce SEs by giving at lowest effective dose Overuse in long-term can cause: Loss of bone density Adrenal suppression Cataracts, glaucoma ```

Question 30

Corticosteroid resistance in asthma and COPD

Answer 30

(Non-eosinophilic) Asthma - approx 10% patients require maximal dose and 1% require regular oral corticosteroids. Small no. patients are completely unresponsive to ICS. COPD - most patients are resistant to ics

Question 31

Mechanisms of corticosteroid resistance

Answer 31

Possible genetic causes – could this allow us to predict which patients will be resistant? Poor GR binding and nuclear translocation Reduced downstream cellular signalling following corticosteroid:GR binding

Question 32

*Interactions between B2 agonists and ICS

Answer 32

Glucocorticoids increase the transcription of the b2-receptor gene, resulting in increased expression of cell surface receptors. Long-acting b2-Agonists increase the translocation of GR from cytoplasm to the nucleus after activation by glucocorticoids This all leads to an overall greater efficacy and need for lower doses

Question 33

What cells largely drive inflammation in allergic asthma

Answer 33

Eosinophils | Lymphocytes

Question 34

What is Bronchiectasis

Answer 34

Obstructive lung disease Abnormal dilation of the bronchi - excessive sputum production and chest pain Associated with cystic fibrosis (but can have non CF bronchiectasis)

Question 35

Treating Bronchiectasis

Answer 35

Antibiotics - infective elements Physical therapy clears airways Surgery and transplantation in severe cases Medication

Question 36

Medical treatment bronchiectasis

Answer 36

Mucolytics treat hypersecretion B2 agonists most useful in COPD/asthma/Bronchiectasis overlap syndromes Anticholinergics and ICS have limited effect

Question 37

Complications of excessive fibrosis

Answer 37

excessive fibrous connective tissue leads to permanent scarring, airway wall thickening and breathing difficulties

Question 38

Fibrosis medical treatment

Answer 38

Some forms respond to corticosteroids PIRFENIDONE and NINTEDANIB are new drugs that significantly slow the rate of disease progression in Idiopathic Pulmonary Fibrosis

Question 39

What is Pirfenidone

Answer 39

Commonly used antifibrotic in IPF Anti-fibrotic, Anti-inflammatory and Anti-oxidant properties Oral

Question 40

Effects of pirfenidone

Answer 40

Reduces: fibroblast proliferation collagen production production of fibrogenic mediators

Question 41

What is Nintendanib

Answer 41

Tyrosine Kinase Inhibitor

Question 42

How does Nintendanib work

Answer 42

``` Tyrosine kinase inhibitor Inhibits VEGFR (Vascular endothelial growth factor receptor) and other growth factor receptors, which are some of the drivers of the fibrotic process ```