Treatment Of Asthma And COPD

Question 1

What is asthma

Answer 1

A chronic inflammatory disorder of bronchial airways that result in airway obstruction in response to external stimuli

Question 2

How is airway inflammation caused

Answer 2

Antigens elicit the production of IgE antibodies. These antibodies attach themselves to the surface of mast cells and basophils.
Exposure to the same antigen after some time results in antigen-antibody reaction on lung mast cells which trigger the release of histamine and cysteinyl leukotrienes, agents that produce bronchoconstriction, mucus secretion and pulmonary edema.

Question 3

What other chemotactic mediators are produced by mast cells

Answer 3

Leukotriene B4
Cytokines

Question 4

Symptoms of asthma

Answer 4

Acute bronchoconstriction
Shortness of breath
Chest tightness
Rapid respiration
Wheezing
Cough

Question 5

Two classes of anti asthmatic drugs

Answer 5

Bronchodilators
Anti-inflammatory agents

Question 6

Classes of bronchodilators

Answer 6

B2- agonists
Antimuscarinics
Xanthine derivatives

Question 7

Classes of anti-inflammatory agents

Answer 7

Corticosteroids
Mast cell stabilisers
Leukotriene antagonists
Anti-IgE monoclonal antibody
Long acting B2 agonists

Question 8

Mention long acting and short acting B2 agonists

Answer 8

Long acting
- Salmeterol
- Formoterol

Short acting
- Albuterol
- Fenoterol
- Terbutaline

Question 9

MOA of B-agonists

Answer 9

They bind to B-adrenergic receptors which are abundant on airway smooth muscle cells and stimulate adenyl cyclase and increase the formation of intracellular cAMP, thereby relaxing airway smooth muscles and inhibiting release of bronchoconstricting mediators from mast cells.

Question 10

Difference between selective and non selective B-agonists

Answer 10

Non selective B-agonists activate both a and B adrenoreceptors while selective B-agonists activate B1 and B2 adrenoreceptors, having higher affinity for B2-adrenoreceptors (the predominant subtype in the airway)

Question 11

Example of non selective B-agonists

Answer 11

Epinephrine

Question 12

What is the drug of choice to treat acute anaphylaxis

Answer 12

Epinephrine

Question 13

What is the time epinephrine takes to work and the duration of action

Answer 13

Within 15 mins

60-90 mins

Question 14

Disadvantages of epinephrine

Answer 14

• Not effective orally
• Hyperglycaemia
• CVS side effects (tarchycardia, arrythmia, hypertension)
• Not suitable for patients with hypertension and heart failure

Question 15

Ways to administer short acting B2 agonists

Answer 15

Inhalation
Orally
IV
Subcutaneous

Question 16

What is the onset and duration of action for short acting B2 agonists

Answer 16

15 to 30 mins

4 to 6 hours

Question 17

Duration of action for long acting selective B-agonists

Answer 17

12 hrs

Question 18

Administration of long acting selective B-agonists

Answer 18

Inhalation

Question 19

What class of drug is used to treat nocturnal asthma

Answer 19

Long acting selective B-agonists

Question 20

What class of drugs are combined with long acting selective B2- agonists

Answer 20

Corticosteroids

Question 21

Advantages of long acting selective B2-agonists

Answer 21

• Minimal CVS effects so suitable for asthmatic patients with hypertension or heart failure

Question 22

What is the MOA of muscarinic receptor antagonists

Answer 22

Block muscarinic receptors (M2, M3)

Question 23

Examples of Antimuscarinics

Answer 23

Ipratropium
Tiotropium

Question 24

Administration of Antimuscarinics

Answer 24

Aerosol Inhalation

Question 25

Which bronchodilators are the main choice in COPD

Answer 25

Antimuscarinics

Question 26

Examples of xanthine derivatives

Answer 26

Methylxanthines Theophylline

Question 27

Adverse effects of theophylline

Answer 27

Gastric pain, vomiting Tremors Hypotension Convulsions Insomnia

Question 28

MOA of theophylline

Answer 28

Raised intracellular cAMP by inhibiting phosphodiesterase - Antagonism of adenosine (a potent bronchoconstrictor) at A2 receptors

Question 29

What is the MOA of anti inflammatory agents

Answer 29

Reduce the number of inflammatory cells in the airways and prevent blood vessels from leaking fluid into the airway tissues

Question 30

What do corticosteroids do in the airways

Answer 30

Reduce the number of inflammatory cells in asthmatic airways (eosinophils, T-lymphocytes, mast cells, and dendritic cells) Achieved by - suppressing the production of chemotactic mediators and adhesion molecules - inhibiting the survival in the airways of inflammatory cells

Question 31

How do corticosteroids perform their job

Answer 31

Inhibition of phospholipase A2 Upregulate B2 receptors

Question 32

Routes of administration for corticosteroids

Answer 32

Inhalation (budesonide and fluticasone) Orally (Prednisone) Injection ( Hydrocortisone and dexamethasone)

Question 33

Onset of action for corticosteroids

Answer 33

2 to 4 weeks

Question 34

Maximum action duration

Answer 34

9 to 12 months

Question 35

List mast cell stabilisers

Answer 35

Nedocromil

Question 36

MOA of mast cell stabilisers

Answer 36

Stabilization of mast cell membrane

Question 37

Administration of mast cell stabilisers

Answer 37

Inhalation

Question 38

Which asthma prophylaxis is more preferred in children than adults

Answer 38

Mast cell stabilisers

Question 39

Examples of leukotriene receptor antagonists

Answer 39

Zarfilukast Montelukast Pranlukast

Question 40

Examples of anti-IgE antibodies

Answer 40

Omalizumab

Question 41

MOA of monoclonal antibodies

Answer 41

Prevents IgE binding with it's receptors on mast cells and basophils leading to decrease in release of allergic mediators

Question 42

Treatment of COPD

Answer 42

- Inhaled bronchodilators - Inhaled glucocorticoids - Oxygen therapy