Questions and Answers
What is a key contributor to bronchial narrowing in asthma?
Which category of drugs is primarily used for immediate relief during an asthmatic attack?
What is the mechanism of action for beta-2 selective agonists?
Which of the following agents is used to control inflammation in asthma?
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What symptom is associated with the inflammatory response in asthma?
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Which class of drugs is considered a preventer for recurrent asthmatic attacks?
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What effect do leukotrienes have in the context of asthma?
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Which bronchodilator is used for long-term asthma management?
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Which type of hypersensitivity response is involved in the pathophysiology of asthma?
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Which of the following mediators is primarily involved in the early phase response of asthma?
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What is the primary action of leukotriene inhibitors in the treatment of asthma?
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Which of the following statements best describes the mechanism of action of beta-agonist bronchodilators?
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Which pharmacological agents are responsible for the late phase response in asthma?
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What primary effect do the pro-inflammatory primary mediators released from mast cells have in asthma?
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Which of the following medications specifically targets interleukin-5 (IL-5) in the treatment of asthma?
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Which combination of drugs is most commonly used for long-term management of asthma?
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What is a primary mechanism of action of anti-inflammatory monoclonal antibodies in asthma management?
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What characterizes status asthmaticus in patients with asthma?
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Which of the following is NOT a recognized treatment to manage status asthmaticus?
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Which of the following statements about leukotriene receptor antagonists is true?
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What pharmacological effect do calcium channel blockers have concerning asthma?
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What is the primary goal of pharmacological therapy in bronchial asthma?
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Study Notes
Overview of Asthma
- Asthma characterized by recurrent cough, breathing difficulties, chest tightness, and wheezing.
- Airway hypereactivity triggered by allergens leads to widespread airway narrowing.
Pathophysiology of Asthma
- Type 1 hypersensitivity response occurs on allergen exposure.
- Initial allergen exposure results in production of reaginic IgE antibodies, which bind to mast cells in the airway mucosa.
- Upon re-exposure, Ag-IgE complex formation activates mast cells, releasing inflammatory mediators.
Inflammatory Mediators
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Primary Mediators: Histamine, tryptase, proteases, leukotrienes C4&D4, prostaglandins (PG).
- Cause bronchial smooth muscle contraction and increased vascular permeability.
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Secondary Mediators: Interleukins 4 & 5, GM-CSF, and cytokines contribute to late-phase response.
- Mepolizumab, reslizumab, benralizumab, and dupilumab target IL-5.
Pharmacological Basis of Therapy
- Targets bronchial smooth muscle contraction and inflammatory activity.
- Bronchodilators used to relieve airway narrowing caused by muscle contraction.
- Anti-inflammatory agents control inflammation-related airway narrowing.
Pharmacological Agents Categories
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Relievers: Immediate acting bronchodilators, such as:
- Short-Acting Beta Agonists (SABAs): Albuterol, terbutaline, metaproterenol, among others.
- Preventers: Long-term injectable agents controlling inflammation, such as corticosteroids combined with Long-Acting Beta Agonists (LABAs).
Bronchodilators
- β2 Selective Agonists act by binding to β2 adrenoceptors, stimulating adenylyl cyclase, increasing cAMP, relaxing smooth muscle, and inhibiting inflammatory cell functions.
- SABAs include salbutamol, albuterol.
- LABAs such as salmeterol and formoterol used in combination with steroids for long-term control.
Other Therapeutic Agents
- Anti-IgE Monoclonal Antibodies: Omalizumab; used to prevent IgE interaction with receptors.
- Other Agents: K+ channel openers like cromakalim, calcium channel blockers, nitric oxide donors.
Combination Therapy
- Utilizes inhalation drugs that combine LABAs with inhaled steroids for long-term management.
- Examples include:
- Salmeterol + fluticasone dipropionate
- Formoterol + budesonide
Status Asthmaticus
- Represents severe, acute exacerbation of asthma episodes, resistant to treatment.
- Requires immediate medical intervention and hospitalization.
- Management includes systemic and inhalational anti-asthmatic drugs, oxygen therapy, intravenous fluids, and assisted ventilation if necessary.
Conclusion
- Effective pharmacological treatment for bronchial asthma focuses on mitigating bronchoconstriction and inflammation.
- A comprehensive understanding of asthmatic pathophysiology informs therapeutic strategies.
Sample MCQ Key Points
- Adrenoceptor agonists have various effects and potential applications beyond asthma, such as in glaucoma and cardiogenic shock.
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Description
This quiz explores the pharmacological aspects related to pro-inflammatory cells and their effects, such as sustained bronchoconstriction, mucus hyper-secretion, and IgE production. Test your understanding of the pathophysiology and treatment options for bronchial hypereactivity.
