Respiratory

Question 1

Respiratory diseases include

Answer 1

1. allergic rhinitis
2. asthma
3. COPD
4. Tuberculosis
5. Pneumonia
6. COVID-19

Question 2

Basic respiratory drugs

Answer 2

1. bronchodilators - open airway
2. anti-inflammatory drugs - prevent closure
3. mucolytics - breakup mucus

a. antitussive - stops coughing
b. mast cell stabilizer - inhibit histamine release
c. corticosteroids - suppress inflammation
d. expectorants - produce thinner mucus
e. beta-adrenergics agents - dilate bronchi

Question 3

Allergic rhinitis

Answer 3

inflammation of nasal mucosa due to allergen

Question 4

Allergy mechanism

Answer 4

1. Initial exposure
   body produced IgE against initial exposure of allergen, IgE binds to suface of mast and basophil cells
2. Subsequent exposure
   allergen binds to IgE on mast and basophil cells
3. Allergic reaction
   binding triggers release of chemical mediators (etc. histamine) from mast and basophil cell
4. Inflammation
   mediators cause inflammation and adverse effects (allergy)

Question 5

Allergic rhinitis treatment

Answer 5

1. antihistamines
   - most effective taken as prophylaxis (but can diminish with long term use)
2. internasal corticosteroids (1st choice)
   - takes 2-3 weeks of therapy for optimal results
3. decongestants
   - internasal can cause rebound congestionn
   - oral is slow to act

Question 6

Asthma

Answer 6

chronic pulmonary disease with both inflammatory & bronchospasm compoents

Question 7

Asthma mechanism

Answer 7

Mast cell lining bronchial passageway releases potent mediators of immune & inflammatory responses - increased mucus secretion

during asthma attack: acute bronchoconstriction/ bronchospasm

Question 8

Asthma main 3 airway problems

Answer 8

1. reversible obstruction
2. increased reaction of airway to external stimuli
3. inflammation

Question 9

Asthma treatments

Answer 9

Termination of acute bronchospasm:
1. beta-adrenergic agents (bronchodilator)
2. xanthines
3. anticholinergics

Prevention of acute bronchospasm
1. corticosteroids
2. mast cell stabilizers
3. leukotrine modifiers
4.麻杏石甘汤

Question 10

Asthma, beta-adrenergic agents

Answer 10

Acts as bronchodilator

Short-acting: for acute asthma; Salbutamol

Long-acting: for chronic/persistent asthma (used in combination with inhaled corticosteroids); Salmeterol

Question 11

Asthma; Anticholingerics

Answer 11

blocks P(arasympathetic)NS, causing bronchodilation

taken via inhalation; Ipratropium
Usually taken with beta-adrenergic agents

Question 12

Asthma; Xanthines

Answer 12

Narrow margin of safety due to broad drug interaction

Second-line drug

Question 13

Asthma; inhaled corticosteroids

Answer 13

For asthma prevention, effective for long-term

Anti-inflammatory; reduces mucus production & edema

Question 14

Asthma; mast cell stabilizers

Answer 14

inhibit release of histamines

Question 15

Asthma; leukotrine modifiers

Answer 15

modify action of leukotrines (potent inflammatory mediators) released by mast cells

Anti-inflammatory; bronchodilator

approved for asthma prevention, but not effective for relieving bronchospasm

Question 16

Asthma; 麻杏甘石汤

Answer 16

TCM:
ventilates lung qi
clears lung heat
relieves cough and dyspnea

Pharmacology:
Stimulates B adrenergic receptor to tighten the lung and treat asthma

Reduces neutrophil/cytokine storm and reduces hypersensitivity, hence mitigating inflammatory response

Question 17

Chronic Pulmonary Obstructive Disease (COPD)

Answer 17

Chronic bronchitis:
- excessive mucus produced due to inflammation and irritation
- mucus causes airway obstruction; dyspenea and cough

Emphysea:
- terminal stage COPD
- bronchioles lose elasticity, aveoli dilate to try and improve oxygen intake, causing eventual rupture

Question 18

COPD treatment

Answer 18

1. short-acting beta agents; Salbutamol
2. long-acting beta agents; Salmeterol
3. Inhaled corticosteroids; Budenoside
4. Combined inhalers (long-acting beta agents + inhaled corticosteroids); formeterol & budenoside ( symbicort)
5. mucolytics and expectorants to relieve mucus thickness and aid removal

Question 19

Tuberculosis

Answer 19

Air-borne disease transmitted through fine respiratory droplets

Question 20

symptoms of TB

Answer 20

1. Poor appetite
2. Night sweats
3. Weakness
4. Fever
5. Dry cough
6. Weight loss
7. GI symptoms

Question 21

TB diagnosis

Answer 21

TB skin test, bloods and imaging

Question 22

TB treatment

Answer 22

Intitial phase (2mo):
Isoniazide, rifampin, pyrainamide and ethambutol daily
Continuous phase (4mo):
isoniazide & rifampin

Question 23

Pneumonia

Answer 23

Infection that inflamed airsacs and causes pus or fluid to fill

Question 24

Pneumonia treatment

Answer 24

Prevention:
PCV13 or PPSV23 vaccine

Viral:
oseltamivir (Tamiflu), zanamivir (Relenza), or peramivir (Rapivab)

Bacterial:
Antibiotics etc. azithromycin, levofloxacin or doxycycline, tetracycline

Question 25

COVID-19 Symptoms

Answer 25

1. Lungs: immune cells crowd inflamed aveolus, diminishing oxygen uptake; causing cough, fever and laboured breathing 2. Liver: elevated enzyme levels causing liver strain (due to drugs or immune system) 3. Kidneys: virus attack kidneys and causes drop in BP 4. Intestines: rich in ACE2 receptors, prone to attack and causes diarrehea 5. Brain: stroke, seizures, inflammation 6. Eyes: conjuctivitis, inflammation of membrane 7. Nose: virus damages nerve endings causing loss of smell 8. Heart and blood vessels: binds to ACE2 receptors and cause blood clots, causing inflammation and MI

Question 26

COVID-19 Mechanism

Answer 26

primary means of spread: respiratory droplets (contact-based) enters and binds to ACE2 receptor

Question 27

COVID-19 diagnosis

Answer 27

Uses 'lateral flow test' tests for covid-19 neutralizing antibodies. If neutralizing antibodies are present, the Au-RBD and ACE2 interaction can be blocked (neutralizing antibodies bing to RBD so it can't bind to ACE2) to give good results (no line).

Question 28

COVID-19 Vaccine mechanism

Answer 28

1. part of the virus's genetic code is turned into a vaccine for injection 2. vaccine enters the human cell to instruct it to produce coronavirus spike protein 3. the body releases antibodies and activates T-cells that learn to fight off the spike protein Hence if infected with the coronavirus again, the body is better equipped to fight off the virus

Question 29

Covid vaccine types (of priority)

Answer 29

1. Protein subunit 2. RNA-based 3. Non-replicating viral vector 4. Inactivated 5. Live-attenuated

Question 30

Covid-19 TCM mechanism

Answer 30

Epidemic damp-toxin（湿毒疫） invades lung 气, causing 肺热 (inflammation)则瘀毒 (phlegm) Direct cytotoxic effect -> heat from virus (etc. lung, stomach heat) Inflammation and dysregulation of immune system -> heat and toxin caused by the immune system Apoptosis and injury of multiple tissue/organs -> prolonged heat and fire in the body

Question 31

Covid-19 drugs

Answer 31

银翘散(银花&连翘 has antiviral properties to inhibit viral replication)