Respiratory Drugs

Question 1

What are LABAs combined with?

Answer 1

GCS

Question 2

Which are more effective bronchodilators in asthma, beta adrenoceptors agonists or muscarinic receptor agonists?

Answer 2

Beta adrenoceptor agonists

Question 2

What is theophylline?

Answer 2

Phosphodiesterase inhibitor

Smooth muscle relaxant

Adenosine inhibitor

Question 3

What are LABAs? and uLABAs?

Answer 3

Long acting beta2 adrenoceptors agonists

uLABA - ultra long acting beta2 adrenoceptor agonist

Question 3

What are some adverse effects of oral GCS?

Answer 3

Osteoporesis

Diabetes,

Muscle wasting

Hypertension

Growth suppression

Suppresion of adrenal, hypothalamus and pituitary axis

Need to wean off them

Question 4

How does transrepression work?

Answer 4

GCS bound to its receptor bind to AP-1 downstream from its activation by inflammatory cytokines - the inhibits AP-1 activating inflammatory transcription factors

Question 5

What are SAMAs and LAMAs?

Answer 5

Short and long acting murcarinic receptor agonists

Question 5

How does GCS transactivation work on a molecular level?

Answer 5

They diffuse into cells >

Dimerize with a co-factor >

Activate transcription factors that encode anti-inflammatory products

Question 6

T/F, combining inhaled GCS and LABAs improves symptoms, quality of life and exacerbation rate more than their use individually?

Answer 6

True

Question 6

What is the treatment for idiopathic pulmonary fibrosis?

Answer 6

None available

O2

Question 7

Which are more effective are providing symptomatic relief, SABAs or LABAs?

Answer 7

LABAs

Question 8

The end of GCS transrepression is …

Answer 8

Repressed transcription of:

Cytokines and their receptors

Inducible enzymes for inflammatory mediators (eg COX-2)

Adhesions molecules

Question 8

Compare the histopathology of severe asthma and COPD

Answer 8

Asthma:

More SM

More BM

COPD

More fibrosis

Loss of alveolar tethering

Both:

High Inflammation

Question 9

Which are more effective bronchodilators in COPD, beta adrenoceptors agonists or muscarinic receptor agonists?

Answer 9

Muscarinic are equally or more effective than adrenoceptor

Question 9

When are phosphodiesterase inhibitors used?

Answer 9

In severe and very severe COPD as it can reduce exacerbations

Question 10

What are the clinical effects of GCS treatment in COPD patients?

Answer 10

Improves symptoms

Better quality of life

Less frequent exacerbations

But it is associated with an increased risk of pneumonia

Question 11

What are the most important inhaled GCSs?

Answer 11

Budesonide

Fluticasone propionate

They are available in combinations with LABAs

Question 13

What is the difference between indacaterol, and salmeterol and formoterol

Answer 13

Indacaterol lasts an extra 12 hours (24 cf to 12hours)

Question 14

Where are muscarinic receptor in airways?

Answer 14

Smooth muscle (M3)

Question 15

What is the effect of LABAs?

Answer 15

Not 100% clear but they reduce the rate of exacerbations

Maybe anti-inflammatory

Chronically bronchodilate

Question 17

What ligand acts on muscarininc receptors in the airways?

Answer 17

ACh

Question 19

What are some other interventions for COPD?

Answer 19

Exercise

O2

Pulmonary rehab

Lung transplantation

Question 20

What are the two ways GCS are administered?

Answer 20

Inhaled (topical)

Oral (systemic)

Question 22

When are LABAs indicated?

Answer 22

Asthma, COPD

Prophylaxis only

Question 24

What are three LABAs?

Answer 24

Salmeterol and Formoterol and Indacaterol

Question 25

Why don't anti-histamines work for asthma?

Answer 25

Because there are many mediators in these conditions, histamine isn’t an importnat mediator of bronchospasm in asthma despite it working on H1 receptors on smooth muscle. Cystenile leukotriene can constrict the muscle for a much longer time, parasympathetic, comple ment system.

Question 26

Do GCS only transactivate?

Answer 26

No, they can also perform tranrepression

Question 27

What are some anti-inflammatory products that GCS activate the expression of?

Answer 27

Annexin-1 - turns off on going inflammation and recruitment Serpin A3 - anti-protease Beta2-adrenoceptor - to maintain agonist's effects

Question 28

Do LABAs improve survival in COPD patients? Why/why not?

Answer 28

No, because they don't prevent remodelling

Question 29

When are GCS indicated?

Answer 29

If inhaled beta agonists are required \>3 times per week

Question 30

Glucocorticoids overall affect in asthma is to

Answer 30

Reduce inflammatory cell number and activation Decrease the probability and severity of episodes of asthma

Question 31

What are some adverse effects of inhaled GCS?

Answer 31

Dysphonia Oral candidiasis Reduced serum cortisol

Question 32

What are some other treatments for COPD?

Answer 32

Antibiotics - for infections Antioxidants agents Mucolytics agents Antitusives Vasodilators (for hypertension)

Question 34

What makes LABAs long acting?

Answer 34

They are lipid soluble

Question 35

When are oral GCS indicated in asthma

Answer 35

Acute exascerbations Severe chronic asthma

Question 36

What is the difference between salmeterol and formoterol?

Answer 36

Salmeterol has a slow onset while formoterol has a fast onset

Question 37

What are the 4 effects of glucocorticoids on the inflammatory cells in asthma?

Answer 37

Reduce activity, recruitment and survival of eosinophils and T cells Reduce mast cell cytokine production Reduce macrophage cytokine production Reduce proliferation, cytokine production and collagen production by fibroblasts and smooth muscle cells

Question 38

Does tolerance to LABAs develop? If so then how?

Answer 38

Yes Reduced number of receptors

Question 39

What is the most common SABA?

Answer 39

Salbutamol