respiratory pharmacology

Question 1

What do the post ganglionic fibres supply (sympathetic division) (2)

Answer 1

Sub mucosal glands
Smooth muscle of blood vessels

Question 2

Where are parasympathetic preganglionic fibres found

Answer 2

brainstem

Question 3

Where are cell bodies of parasympathetic post ganglionic fibres found

Answer 3

walls of the bronchi and bronchioles

Question 4

What does stimulation of post ganglionic cholinergic fibres cause (2)

Answer 4

bronchial smooth muscle fibre contraction
Increased mucus secretion

Question 5

What does stimulation of post ganglionic non-cholinergic fibres cause

Answer 5

bronchial smooth muscle relaxation

Question 6

What does smooth muscle contraction result from

Answer 6

phosphorylation of regulatory music light chains in the presence of elevated intracellular calcium ions

Question 7

What is required for smooth muscle relaxation

Answer 7

return of intracellular calcium ion concentration to a basal level

Question 8

What are example of reliever medications (4)

Answer 8

short acting beta2 adrenoceptor agonists
Long acting beta2 adrenoceptor agonists
CystLTI receptor antagonists
Methylxanthines

Question 9

What are examples of controller/prevent or medications (4)

Answer 9

glucocorticoids
Cromoglicate
Humanised monoclonal IgE antibodies
Methylxanthines

Question 10

What are beta2 adrenoceptor agonists

Answer 10

physiological antagonists of all spasmogens

Question 11

Salbutamol

Answer 11

shorting acting beta2 adrenoceptor agonists

Question 12

Sale troll and formoterol

Answer 12

long acting beta2 adrenoceptor agonists

Question 13

Montelukast and zafirlukast

Answer 13

CysLTI antagonists

Question 14

Theophylline

Answer 14

Methylxanthine, combines bronchodilator and anti-inflammatory actions

Question 15

Effects of methylxanthines (4)

Answer 15

inhibit mediator release from mast cells
Increase mucus clearance
Increase diaphragmatic contractility
Reduce fatigue

Question 16

Describe glucocorticoids (3)

Answer 16

suppress inflammation
Do not alleviate early stage bronchospasm
Long term treatment

Question 17

Which type of drug is effective against early bronchospasm

Answer 17

cysLTIs, in combination with other drugs

Question 18

Effects of glucocorticoids (5)

Answer 18

decrease formation of TH2 cytokines
Apoptosis
Preventing immunoglobulin production
Prevent allergen-induced influx into lungs
Reduce number of mast cells

Question 19

Describe cromones (4)

Answer 19

second-line drugs
Infrequently used
Prophylaxis of allergic asthma
No direct effect on bronchial smooth muscle

Question 20

Where are M1 receptors found

Answer 20

Ganglia

Question 21

Where are M2 receptors found

Answer 21

post-ganglionic neurone terminals

Question 22

Where are M3 receptors found

Answer 22

airway smooth muscle

Question 23

Action of M3 receptors

Answer 23

mediate contraction to ACh
Evoke increased secretion

Question 24

Muscarinic receptor antagonists (4)

Answer 24

Antagonists of bronchoconstriction
Reduce bronchospasm
Block ACh mediated basal tone
Decrease mucus secretion

Question 25

Ipratropium

Answer 25

short acting muscarinic antagonist

Question 26

Triotropium and glycopyrronium

Answer 26

long acting muscarinic antagonists

Question 27

Which medication is a non-selective blocker

Answer 27

Ipratropium

Question 28

How are adverse effects of generalised parasympathetic blockage avoided

Answer 28

The quaternary ammonium group reduces systemic absorption and systemic exposure

Question 29

What drugs are effective as a combination treatment for COPD and why

Answer 29

LABA and LAMA as they work by complementary mechanisms to cause smooth muscle relaxation

Question 30

When is the LAMA/LABA combination likely to be most effective

Answer 30

When both drugs are deposited in the same location in the airways

Question 31

What other drugs maybe be used in treatment of COPD (2)

Answer 31

glucocorticoids PDE4 inhibitors

Question 32

By what methods can drugs be transported across the nasal epithelium (4)

Answer 32

Transcellular diffusion Paracellular diffusion Carrier mediated transported Vesicle mediate transport

Question 33

What factors affect drug absorption in the respiratory tract (4)

Answer 33

physical barrier of the epithelium Degradation by proteases Particle clearance Macrophage action

Question 34

What are the targets of treatment for rhinitis (4)

Answer 34

Anti-inflammatory Mediator-receptor blockade Nasal blood flow Anti-allergic

Question 35

what drugs are used in the anti-inflammatory component of rhinitis treatment + what are the effects (3)

Answer 35

Glucocorticoids Reduced vascular permeability Reduced inflammatory cell recruitment and activation Reduced cytokine and mediator release

Question 36

How are glucocorticoids administered in treatment of rhinitis

Answer 36

intranasal spray - sometimes orally

Question 37

What drugs are used in the mediator receptor blockade component of rhinitis treatment (3)

Answer 37

anti-histamines Muscarinic receptor antagonists CysLTi receptor antagonists

Question 38

What does H1 receptor antagonists do

Answer 38

Reduce effects of mast cell derived histamine

Question 39

In what types of allergic rhinitis are H1 receptor antagonists effective against

Answer 39

Perennial Seasonal Episodic

Question 40

What symptom are H1 receptor antagonists not effective at reducing

Answer 40

congestion

Question 41

What methods of administration are used for H1 receptor antagonists

Answer 41

oral Intranasal

Question 42

What are examples of H1 receptor antagonists

Answer 42

Loratidine Fexodenadine Certrizine

Question 43

Describe anticholinergic drug action

Answer 43

Block acetylcholine receptors

Question 44

What symptom do anti-cholinergic drugs effect

Answer 44

Only rhinorrhoea

Question 45

How are anti-cholinergic drugs administered + what is an adverse effect

Answer 45

intranasal Dryness of the nasal membrane

Question 46

Describe the action of cystLTis

Answer 46

Reduce effects of cysLTs on nasal mucosa

Question 47

What types of asthma can cysLTIs treat

Answer 47

Perennial and seasonal

Question 48

How are cysLT inhibitors administered

Answer 48

orally

Question 49

What is an example of a cysLT inhibitor

Answer 49

Montelukast

Question 50

What medication is used to target nasal blood flow in treatment of rhinitis

Answer 50

Vasoconstrictors

Question 51

describe action vasoconstrictors (3)

Answer 51

Mimic effect of noradrenaline Cause vasoconstriction via activation of beta1 adrenoceptors This decreases swelling in the vascular mucosa

Question 52

What is an example of a vasoconstrictor used in treatment of rhinitis

Answer 52

Oxymetazoline

Question 53

Why is long term use of vasoconstrictors not recommended

Answer 53

there can be a rebound increase in nasal congestion upon continuation due to desensitisation and down regulation

Question 54

What medication can be used for anti-allergic component of rhinitis treatment

Answer 54

sodium chromoglicate