Summary: Pharmacology And Nutrition

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• Dexamethasone is a synthetic gluco-corticosteroid. Which spectrum of side-effects may occur following long-term and high dose treatment with corticosteroids, and what are the symptoms?

  This is called Cushing syndrome, and the symptoms are: increase abdominal fat, poor 

  wound heeling, easy bruising, moon face with red cheeks, buffalo hump, 

  hypertension, thinning of skin, thin arms and legs. 

  
  

• Dexamethasone has a half life of 36-54 hours. What are the consequence of the log halflife for the dosing interval and dosage?

  such a long half-life is causing a gradual accumulation and it may take several dose-intervals before a steady-state level is reached. therefore a higher loading dose is advisable followed by a lower maintenance dose schedule in order to maintain the drug at the appropriate therapeutic level.

• How can corticosteriods like Dexamethansone be use in the treatment of asthma?

  in asthma corticosteroids act by reducing the inflammatory processe in the lungs. Theyare effective and commonly used as maintenance therapy to reduce swelling, mucus secretion and thightening in the airways

• Formoterol has more than 200-fold greater agonist activity at beta-2-receptors compared to beta1receptors. Why is this useful if you want to treat asthma?

  Beta1-receptors can mostly be found in the heart while Beta2-receptors are more commonly found in the lungs. To treat asthma you want a selective effect in the lungs and not in the heart. 

  
  

• Formoterol is a beta-2 agonist and is used to treat asthma patients. It is only slightly soluble in water. The dosage form is inhalation. Comment on the selectivity of formoterol in relation to the dosage form. 

  When inhaled, formoterol acts locally in the lungs as bronchodilator. It will have a fast and mostly local effect. 

  
  

• Formoterol is a sympathomimetic drug, used to treat asthma due to its effect of bronchodilation. It is generally administered locally, via inhalation. Nevertheless, systemic effects could occur, for example due to overdosing and because of swallowing. What could be the side-effects/adverse reactions when using this drug? Name 3. 

  One would expect increased sympathetic tone, which could result in: Nausea, vomiting, headache, tremor, agitation, palpitations, tachycardia, ventricular arrhythmias, hypokalemia, hyperglycemia. 

  
  

• - Ipratropium bromide is an anticholinergic agent used in asthma and certain forms of rhinitis where it inhibits the secretion from the serous and seromucous glands in the nose. Knowing this, please explain its primary mechanism of action 

  Ipratropium blocks muscarinergic receptors of the parasympathetic nervous system and inhibits the action of acetylcholine. In the lungs this leads to bronchodilation and contributes to the relief of symptoms of asthma. In the nose this causes the (symptomatic) inhibition of secretion of fluid.

• - Ipratropium bromide is an anticholinergic agent used in asthma and certain forms of rhinitis. The compound can be administered by inhalation or as nasal spray. Which possible side-effects are predictable from its mechanism ? 

  As the compound inhibits the activity of the parasympathetic nervous system, side-effects include dry mouth and constipation (due to ingestion). The compound is not absorbed to a large extent. 

  
  

• Ipratropium bromide is an anticholinergic agent used in asthma and certain forms of rhinitis. Its chemical structure is that of a quaternary ammonium compound. What are the pharmacokinetic consequences of this? 

  The molecule is hydrophilic (polar) and does not pass cell-membranes. Oral bio-availability is therefore negligible. 

• - Liraglitude is a long-acting glucagon-like peptide-1 agonist (GLP-1 agonist). It reduces meal-related hyperglycemia by increasing insulin secretion, delaying gastric emptying, and suppressing prandial glucagon secretion. Main indication is in diabetes. Which type of diabetes ? 

  Type 2 (DM2), because this type does not exclusively require the use of insulin. In DM2, GLP-1 receptor agonists (especially as an adjunct to diet and exercise) might improve glycemic control.