Saturday, February 28, 2015

Study group discussion: Drug therapy for asthma

Which is the physiological antagonist of histamine?

Acetylcholine?

No.

It's ephedrine or adrenaline.

Which are the classes of drugs used for acute control of asthma?

B 2 agonists.

Epinephrine.

Yes, epinephrine.. But that too comes under b2 agonist.

Steroids?

No, steroids is for long term control

Two more classes of drugs!

Methylxanthine? Theophylline!
Montelukast?
Ipratropium!

Yup. Second class is theophylline or aminophyline. The third class is anti-cholinergics.

But not montelukast..That's also for chronic use.

What is the function of montelukast?

Leukotriene receptor antagonist!

Leukotrienes when binding to their receptors it cause bronchoconstriction. Monteluekast used in maintenance therapy of asthma. But not useful in acute exacerbation.

Mast cell stabilizers, that is, ketotifen and sodium chromoglycate?

Mast cell stabilizers are also chronic for use.

And IgE antibody? Omalizumab?

That too for chronic use.

Even MgSO4 is used in acute management of asthma.

Yup.

Next one.

Why does use of aspirin cause asthma?

Arachidonic acid forms two type of substances via the cyclo-oxygenase and lipo-oxygenase pathways. Aspirin inhibits the cyclooxygenase pathway.
Hence, all of the arachidonic acid gets diverted to lipo-oxygenases.
And if you remember L4, B4 are the major mediators of acute attack of asthma.

Oh yeah.. That's why leukotriene antagonists are used, they inhibit LT C4 , D4

Exactly.

There are the major cause of bronchoconstriction!

As cyclo cycle is inhibited..arachidonic acid is used more in lipo cycle!

LT antagonists act on cysLT1!

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