Pharmacology of Bronchodilators
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Questions and Answers

What is the effect of β-agonists on bronchial secretion and muco-cilliary clearance?

  • It decreases bronchial secretion and improves muco-cilliary clearance. (correct)
  • It increases both bronchial secretion and muco-cilliary clearance.
  • It has no effect on bronchial secretion and muco-cilliary clearance.
  • It increases bronchial secretion and decreases muco-cilliary clearance.

    • What is the duration of action of Short-acting selective β2 agonists (SABA)?

  • 12 hours
  • 24 hours
  • 3-4 hours (correct)
  • 6-8 hours

    • What is the advantage of Long-acting selective β2 agonists (LABA) over Short-acting selective β2 agonists (SABA)?

  • They are less selective.
  • They have a shorter duration of action.
  • They have a longer duration of action. (correct)
  • They are less potent.

    • Why should Long-acting selective β2 agonists (LABA) not be used alone?

    <p>Because they may increase the risk of asthma-related death due to ischemia or arrhythmia.</p> Signup and view all the answers

    What is a common adverse effect of β-agonists?

    <p>Hypokalemia</p> Signup and view all the answers

    What is the mechanism of action of β-agonists?

    <p>They stimulate adenylate cyclase enzyme.</p> Signup and view all the answers

    Why are β-agonists often combined with corticosteroids?

    <p>To decrease the risk of asthma-related death.</p> Signup and view all the answers

    What is the class of drugs that includes Salbutamol and Terbutaline?

    <p>Short-acting selective β2 agonists (SABA)</p> Signup and view all the answers

    What is the main use of inhaled ipratropium in patients?

    <p>For patients who cannot tolerate adrenergic agonists</p> Signup and view all the answers

    What is a potential adverse effect of nebulized tiotropium given via a face mask?

    <p>Acute glaucoma</p> Signup and view all the answers

    What is a mechanism of action of theophylline?

    <p>Inhibition of PDE-IV</p> Signup and view all the answers

    What is the main difference between aminophylline and sustained release theophylline?

    <p>Aminophylline is used for quick relief, while sustained release theophylline is used for long-term control</p> Signup and view all the answers

    What is a potential interaction of theophylline with other drugs?

    <p>Elevated theophylline blood levels with ciprofloxacin and erythromycin</p> Signup and view all the answers

    Why have atropine derivatives been largely replaced?

    <p>Due to their replacement by β2 agonists and corticosteroids</p> Signup and view all the answers

    What is a potential adverse effect of tiotropium?

    <p>Bitter taste</p> Signup and view all the answers

    What is the main benefit of adding tiotropium to treatment in moderate or severe exacerbations?

    <p>Provides additive benefit in the emergency care setting</p> Signup and view all the answers

    What is the recommended approach when switching patients from oral to inhaled corticosteroid?

    <p>Reduce the oral dose gradually to avoid adrenal suppression</p> Signup and view all the answers

    What is a common side effect of inhalation therapy with corticosteroids?

    <p>Oral thrush</p> Signup and view all the answers

    What is a long-term adverse effect of high-dose and systemic corticosteroid use?

    <p>All of the above</p> Signup and view all the answers

    What is the principal advantage of montelukast and zafirlukast?

    <p>They are taken orally and are easy to use</p> Signup and view all the answers

    What is a side effect of montelukast and zafirlukast?

    <p>All of the above</p> Signup and view all the answers

    What is the recommended dosage of montelukast for children?

    <p>4 mg once daily</p> Signup and view all the answers

    What is the frequency of awakening in mild persistent asthma?

    <p>Not more than twice a week</p> Signup and view all the answers

    What is the characteristic of a patient with acute severe asthma?

    <p>Sweating, cyanosis, and tachycardia</p> Signup and view all the answers

    What is the purpose of yearly administration of Influenza vaccine?

    <p>To prevent influenza</p> Signup and view all the answers

    What is the purpose of measuring bone density every 3 years in patients taking corticosteroids?

    <p>To monitor for osteoporosis</p> Signup and view all the answers

    What is the dose of budesonide considered as high dose?

    <p>800 micrograms</p> Signup and view all the answers

    What is the recommended oxygen saturation level in acute severe asthma?

    <p>94-98%</p> Signup and view all the answers

    What is the recommended treatment in acute severe asthma if there is inadequate response to bolus therapy?

    <p>Continuous nebulization</p> Signup and view all the answers

    What is the benefit of steroids in acute severe asthma?

    <p>All of the above</p> Signup and view all the answers

    What is the purpose of identifying the antigen in asthma management?

    <p>To avoid the antigen</p> Signup and view all the answers

    What is the component of MART (Maintenance and Reliever Therapy) in asthma management?

    <p>ICS and a fast-acting LABA</p> Signup and view all the answers

    What is the recommended dose of magnesium sulphate for acute severe asthma patients not responding to SOS?

    <p>2g IV over 20 mins</p> Signup and view all the answers

    Why is prednisolone the preferred corticosteroid for oral administration during pregnancy?

    <p>Very little of the drug reaches the fetus</p> Signup and view all the answers

    In what population may the use of a spacer with inhalers be advised?

    <p>Both children and elderly</p> Signup and view all the answers

    What is a potential side effect of ICSs in high doses in children?

    <p>Affect on growth</p> Signup and view all the answers

    What is the recommended duration of corticosteroid treatment for acute severe asthma?

    <p>Until recovery</p> Signup and view all the answers

    Why may parenteral β2-agonists be used in emergency during pregnancy?

    <p>Because they can be used in emergency situations</p> Signup and view all the answers

    What is a potential side effect of anticholinergics in elderly patients?

    <p>Increased risk of urine retention</p> Signup and view all the answers

    Why may theophylline be avoided in elderly patients?

    <p>Because it has a higher risk of side effects in general</p> Signup and view all the answers

    Study Notes

    Bronchodilators

    • β2 Agonists:
      • Mechanism of action: ↑Adenylate cyclase enzyme → ↑cAMP
      • Effects:
        • Bronchodilatation
        • ↓ Bronchial secretion & improve muco-cilliary clearance
        • Mast cell stabilization → ↓ Release of mediators
      • Types:
        • Short-acting selective β2 agonists (SABA):
          • Salbutamol
          • Terbutaline
          • Bambuterol
          • Used for quick relief of acute asthma attacks
        • Long-acting selective β2 agonists (LABA):
          • Salmeterol
          • Formoterol
          • Used for long-term control of asthma
      • Adverse effects:
        • Tachycardia
        • Tremors
        • Nervous tension
        • Tolerance
        • Hypokalemia
        • Increased risk of asthma-related death if used alone

    Anticholinergic Drugs

    • Ipratropium (SAMA) and Tiotropium (LAMA):
      • Mechanism of action: Block muscarinic receptors in the airways
      • Effects:
        • Prevent bronchospasm
        • Decrease mucus gland hypersecretion
      • Uses:
        • In patients who cannot tolerate adrenergic agonists
        • In moderate or severe COPD exacerbations
      • Adverse effects:
        • Bitter taste
        • Acute urinary retention
        • Acute glaucoma
        • Paradoxical bronchoconstriction

    Methylxanthines

    • Theophylline:
      • Mechanism of action:
        • Inhibition of PDE-IV → ↑cAMP & ↑cGMP
        • Block of adenosine receptors
      • Effects:
        • Bronchodilatation
        • Mast cell stabilization
        • Improve diaphragmatic contractility
      • Uses:
        • Relieves acute attacks of bronchial asthma
        • Used in long-term control of asthma
      • Adverse effects:
        • Seizures or potentially fatal arrhythmia
        • Interacts with many drugs

    Leukotriene Modifiers

    • Montelukast:
      • Mechanism of action: Prevents mast cell degranulation
      • Effects:
        • Inhibits both antigen- and exercise-induced asthma
        • Reduces symptoms of allergic rhinoconjunctivitis
      • Adverse effects:
        • Insomnia
        • Irritability
        • Vivid dreams
        • Vasculitic rash & eosinophilia

    Corticosteroids

    • Inhaled Corticosteroids (ICS):
      • Mechanism of action:
        • Reduces inflammation
        • Prevents mast cell degranulation
      • Effects:
        • Reduces severity and number of exacerbations
        • Used in long-term control of asthma
      • Adverse effects:
        • Minimal with inhalation therapy
        • High dose and long-term adverse effects:
          • Growth suppression in children
          • Hypothalamic-Pituitary-Adrenal (HPA) suppression
          • Cataracts
          • Dermal thinning
          • Osteoporosis

    Management of Bronchial Asthma

    • General Measures:
      • Stop smoking
      • Identify and avoid antigens
      • Treat upper respiratory tract infections
      • Yearly administration of influenza vaccine
      • Avoid stress and emotions
      • Avoid severe muscle exercise
      • Avoid drugs that can precipitate asthma
    • Stepwise Treatment:
      • Maintenance and Reliever Therapy (MART)
      • Acute severe asthma treatment:
        • Nebulized β2-agonist
        • Nebulized ipratropium bromide
        • Oxygen therapy
        • Steroids
        • Magnesium sulphate (IV) as next step
        • IV salbutamol if no response
    • Treatment in Special Populations:
      • Pregnancy and breast feeding:
        • β2-agonists, theophylline, and prednisolone can be taken as normal
        • Prednisolone is the preferred corticosteroid for oral administration
      • Elderly:
        • Use of spacer with inhalers may be advised
        • ICSs may have higher side effects
        • Avoid theophylline and anticholinergics
      • Children:
        • Use of spacer with inhalers may be advised
        • ICSs in high doses may affect growth

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    Description

    This quiz covers the different types of bronchodilators, their mechanisms of action, and their effects on the respiratory system. It includes questions on beta-agonists, corticosteroids, methylxanthines, and anticholinergic drugs.

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