Pharmacology - Asthma

Question 1

d: cholinergic

Answer 1

relating to or denoting nerve cells in which acetylcholine acts as a neurotransmitter

Question 2

Where are the cell bodies of the preganglionic fibres located?

Answer 2

in the brainstem

Question 3

where are the cell bodies of postganglionic fibres embedded in?

Answer 3

the walls of the bronchi and the bronchioles

Question 4

Name the 2 things the stimulation of postganglionic cholinergic fibres cause

Answer 4

bronchial smooth muscle contraction

increased mucus secretion

Question 5

what is bronchial smooth muscle contraction mediated by?

Answer 5

contraction mediated by M3 muscarinic ACh receptors on ASM cells

Question 6

what does ASM stand for?

Answer 6

Airway Smooth Muscle

Question 7

what is increased mucus secretion mediated by?

Answer 7

M3 muscarinic ACh receptors on gland (goblet) cells

Question 8

Name the thing stimulation of postganglionic noncholinergic fibres cause and what is it mediated by?

Answer 8

bronchial smooth muscle relaxation mediated by nitric oxide (NO) and vasoactive intestinal peptide (VIP)

Question 9

There’s no nerve supply of bronchial smooth muscle in humans so what supplies submucosal glands and smooth muscle of blood vessels instead?

Answer 9

post-ganglionic sympathetic fibres

Question 10

Name 4 things stimulation of sympathetic nerves supply

Answer 10

bronchial smooth muscle relaxation
decreased mucus secretion
increased mucociliary clearance
vascular smooth muscle contraction

Question 11

what is bronchial smooth muscle relaxation mediated by? and what are these activated by?

Answer 11

via beta2-adrenoceptors (β2-ADR) on ASM cells activated by adrenaline released from the adrenal gland

Question 12

What is decreased mucus secretion mediated by?

Answer 12

mediated by beta 2-adrenoceptors on gland (goblet) cells

Question 13

What is increased mucociliary clearance mediated by?

Answer 13

mediated by 2-adrenoceptors on epithelial cells (mucociliary escalator)

Question 14

What is vascular smooth muscle contraction mediated by?

Answer 14

, mediated by α1-adrenoceptors on vascular smooth muscle cells

Question 15

d: asthma

Answer 15

a respiratory condition marked by spasms in the bronchi of the lungs, causing difficulty in breathing. It usually results from an allergic reaction or other forms of hypersensitivity

Question 16

give 4 causes of asthma

Answer 16

allergens (in atopic individuals)
exercise-cold, dry air
viral respiratory infections
smoke dust pollutants etc

Question 17

What is asthmaticus?

Can it be Fatal?

Answer 17

acute severe asthma attacks can be fatal

Question 18

give 4 symptoms of asthma

Answer 18

tight chest
wheezing
difficulty in breathing
cough

Question 19

What is the cause of chronic asthma?

Answer 19

involves pathological changes to the bronchioles that result from long standing inflammation

Question 20

Describe the process by which chronic asthma occurs

Answer 20

increased mass of smooth muscle (hyperplasia and hypertrophy)
accumulation of interstitial fluid (oedema)
increased secretion of mucus
epithelial damage (exposing sensory nerve endings)
Sub-epithelial fibrosis

Question 21

What is the effect of airway narrowing via inflammation and bronchoconstriction on, airway resistance, FEV1 and PEFR?

Answer 21

increase resistance

decreasing FEV1 + PEFR

Question 22

How do the bronchioles become hypersensitive in asthma?

Answer 22

epithelial damage, exposes sensory nerve endings, contributes to increased sensitivity of airways to bronchoconstrictor influences may cause neurogenic inflammation

Question 23

d: neurogenic inflammation

Answer 23

is inflammation arising from the local release by afferent neurons of inflammatory mediators

Question 24

name some sensory nerve endings that may be exposed during epithelial damage

Answer 24

C-fibres

irritant receptors

Question 25

name the tests and what spasmogens are used to reveal hyper-responsiveness

Answer 25

Provocation tests | histamine/ methacholine

Question 26

What 2 phases does an asthma attack occur of?

Answer 26

bronchospasm and delayed inflammatory response

Question 27

What is the main thing thought to cause asthma?

Answer 27

to be due to an immune imbalance between TH1 and TH2 lymphocyte-mediated responses

Question 28

What TH response dominates in mild to moderate asthma?

Answer 28

TH2

Question 29

What TH responses are involved in severe asthma?

Answer 29

TH2 +TH1

Question 30

What is TH1 response?

Answer 30

Cell-mediated immune response involving IgG and macrophages

Question 31

What is TH2 response?

Answer 31

Antibody-mediated immune response involving IgE

Question 32

How is TH2 lymphocyte activation caused?

Answer 32

: allergen through airway epithelium > CD4+ express to THO cells that mature to TH2 cells> these activate B cells that mature to IgE secreting B cells Th2 cells also release IL4 & IL13 which cause mast cells to express IgE receptors

Question 33

How are IgE receptors activated?

Answer 33

are activated on mast cell > stimulates calcium entry > release of leukotrienes that cause airway smooth muscle contraction

Question 34

What do relievers act as and name some?

Answer 34

Act as bronchodilators SABAs LABAs CysLT1 receptor antagonists

Question 35

What do controllers/preventors act as and name some?

Answer 35

Act as anti-inflammatory agents that reduce airway inflammation Glucocorticoids Cromoglicate Humanised monoclonal IgE antibodies

Question 36

What drug is both a reliever and a controller?

Answer 36

methylxanthines

Question 37

What does SABA and LABA stand for?

Answer 37

short acting beta 2 adrenoreceptor agonists | long acting beta 2 adrenoceptor agonists

Question 38

Name a SABA and describe how fast react?

Answer 38

salbutamol rapid 5min

Question 39

Name 2 LABAs and how fast works and what always must be administered with?

Answer 39

salmeterol formoterol nocturnal lasts 8 hours always be administered with glucocoticoid

Question 40

Name a CysLT1 Receptor Antagonists and what it does and what way administered?

Answer 40

Monteleukast | - blocks CysLT1 receptor for LTs from Mast Cells Bronchodilator (administered orally).

Question 41

Name 2 methylxanthines what they do and what it is nature

Answer 41

(Theophylline, Aminophylline) – Inhibits PDE3 – bronchodilator and anti-inflammatory actions

Question 42

what do glucocorticoids do?

Answer 42

decreases Th2 cytokines, Mast Cells, IgE antibodies) – prevent inflammation + resolve established inflammation

Question 43

what are the 2 roles of glucocorticoids in asthma?

Answer 43

prevent inflammation | resolve established inflammation

Question 44

name the 3 glucocorticoids and admin in mild/moderate asthma?

Answer 44

beclomethasone budesonide fluticasone inhalation

Question 45

what are the most common side affects to glucocorticoids? why?

Answer 45

most common adverse effects (due to deposition of steroid in the oropharynx) are: dysphonia (hoarse and weak voice) oropharyngeal candidiasis (thrush)

Question 46

what glucocorticoid is used in chronic/severe asthma

Answer 46

Oral prednisolone may be used in combination with an inhaled steroid to reduce the oral dose required and minimise unwanted systemic effects. Bronchodilator drugs are co-administered

Question 47

name a Monoclonal antibodies directed against IgE

Answer 47

omalizumab

Question 48

why is Monoclonal antibodies directed against IgE not used regularly?

Answer 48

expensive