Respiratory Pharmacology

Front 1

Agents effective against the late phase of inflammation in asthma will:
A) activate histamine receptors
B) inhibit phosphodiesterase
C) Inhibit adenosine receptors
D) Block cytokine production

Back 1

D) Block cytokine production

Front 2

Which of the following agents used primarily for asthma bronchospastic symptoms also benefits COPD patients by decreasing mucous production?
A) anticholinergics
B) chromolyn
C) short acting beta2 adrenergic agonists
D) long acting beta2 adrenergic agonists

Back 2

A) anticholinergics

Front 3

Which of the following decreases toxicity of respiratory pharmeceutical agents?
A) Steroids
B) Aerosolized drug delivery
C) Non-steroidal anti-inflammatory agents
D) Use of non-selective beta2 adrenergic agonists

Back 3

B) Aerosolized drug delivery

Front 4

4) Albuterol has which of following actions/uses:
A) Inhibition of phosphodiesterase
B) Blockade of 5-lipoxygenase
C) Induction of lipocortin-1
D) Increases cyclic AMP (cAMP)

Back 4

D) Increases cyclic AMP (cAMP)

Front 5

Which of the following is true regarding leukotriene modifiers for respiratory disease:
A) Include agents that block leukotriene receptors
B) Are typically used only for quick relief of acute asthma symptoms
C) Do not have any appreciable toxicity
D) Decrease levels of circulating IgE 

Back 5

A) Include agents that block leukotriene receptors

Front 6

Which of the following is true of corticosteroids:
A) Inhibit phospholipase A2 by increasing lipocortin-1 synthesis
B) Increase cytokine production
C) Increase need for daily use of beta2-adrenergic agents
D) Only toxicity is liver damage

Back 6

A) Inhibit phospholipase A2 by increasing lipocortin-1 synthesis

Front 7

Which of the following would be useful for treatment of non-compliant asthmatics?
A) Long acting beta2-adrenergic agonists
B) Omalizumab
C) Oral steroids
D) Cromolyn

Back 7

B) Omalizumab

Front 8

 
8) Complications of systemic glucocorticoids include:
A) Seizures
B) Anaphylaxis
C) Hyperglycemia
D) Hypotension

Back 8

C) Hyperglycemia

Front 9

Omalizumab does which of the following as part of it’s primary site of action?
A) Decreases circulating IgE levels
B) Decreases mucous production
C) Inhibits smooth muscle contraction
D) Increases leukotriene levels

Back 9

A) Decreases circulating IgE levels

Front 10

A primary difficulty with use of theophylline is:
A) Immunosuppression
B) Variable kinetics and severe dose-related toxicities
C) Activation of phosphodiesterase
D) Activation of beta-adrenergic receptors

Back 10

B) Variable kinetics and severe dose-related toxicities

Front 11

True or False:
For mild asthma, the recommended asthma treatment is inhaled corticosteroids.

Back 11

FALSE.

For mild asthma, just use inhaled short-acting beta-2 agonist. Inhaled corticosteroids are for more persistent moderate to severe asthma.

Front 12

What are the drugs asthmatics should avoid? (4 general groups)

Back 12

- NSAIDs, especially salicylates, as aspirin sensitive asthma can occur
- beta-blockers
- drugs prone to liberate histamine (toxins, venoms, etc.)
- CNS depressants (respiratory depressant too)

Front 13

What are the QUICK RELIEF (3) and which are LONG-TERM CONTROL (6) asthma medication groups?

Back 13

QUICK RELIEF:
- short acting inhaled beta2 agonists
- anticholinergics
- systemic corticosteroids

LONG-TERM CONTROL
- inhaled corticosteroids
- cromolyn/ nedocromil
- long-acting-beta2 agonists
- leukotriene modifiers
- omalizumab
- methylxanthines

Front 14

Do bronchodilators...
A. affect bronchial smooth muscle tone
B. have antiinflammatory effects
C. decrease bronchiolar responsiveness
D. prevent acute bronchoconstriction
E. treat acute bronchoconstriction

Back 14

Bronchodilators
A. affect bronchial smooth muscle tone - YES
B. have antiinflammatory effects - NO
C. decrease bronchiolar responsiveness - NO
D. prevent acute bronchoconstriction - YES
E. treat acute bronchoconstriction - YES

Front 15

Name the three groups of bronchodilators and state whether they are quick acting or long acting.

Back 15

Groups of bronchodilators:
- sympathomimetics (can be either)
- anticholinergics (quick acting)
- methylxanthines (long acting)

Front 16

_________ is a non-selective beta receptor stimulant. What is its major disadvantage?

Back 16

Epinephrine.

Major disadvantage is it stimulates cardiac beta1 receptors and can produce arrhythmias. Older nonselective agents have been largely replaced by more selective beta2 agonists.

Front 17

Name the beta2 agonists that are short acting and which are long acting?

Back 17

SHORT-ACTING: "LAMP"
Levalbuterol
Albuterol
Metaproterenol
Pirbuterol

LONG-ACTING:
Salmeterol
Formoterol

Front 18

True or False:
Short acting beta2 agonists can prevent exercise induced bronchospasm.

Back 18

TRUE.

Short acting beta2 agonists ("LAMP" , Levalbuterol, Albuterol, Metaproterenol, Pirbuterol) are the first choice for treating acute symptoms and are usually used just for symptomatic treatment while the long acting ones are used as prophylaxis but the short acting beta2 agonists can indeed prevent exercise induced bronchospasm.

Front 19

Which of the following is FALSE about long-actinge beta2 agonists?
A. They decrease nocturnal asthma
B. They decrease use of short-term beta2 agonists
C. They can eliminate use of short term beta2 agonists for rescue
D. They do NOT reduce bronchial hyperresonsiveness
E. They are often used in combo with inhaled corticosteroids

Back 19

The false statement is:

C. They can eliminate use of short term beta2 agonists for rescue

THEY DO NOT ELIMINATE THE USE OF SHORT-TERMS as the short-terms are used as rescue inhalers!!!

Front 20

What side effects of beta2 agonists must you caution patients about? (5)

Back 20

- do NOT use too frequently as the drug's efficacy will decline (tachyphylaxis, or beta2 receptor desensitization
- tremors
- tachycardia
- metabolic disturbances like hyperglycemia, hypokalemia, hypomagnesemia
- muscle cramps possible

Front 21

What do anticholinergics do with regards to asthma treatment? (2)
(Hint: Block two characteristics of asthma...)

Back 21

Block contraction of airway smooth muscles and block the increase in secretion of mucus occuring in response to vagus activity.

By blocking muscarinic effect, allows the sympathetic effect (bronchodilation) to be more prominent.

Anticholinergics include ipratropium bromide (Atrovent) and tiotropium bromide (Spiriva).

Hint 21

A.Block contraction of airway smooth muscle
B. Block increase in response to vagus activity
C. Decrease use of short term beta2 agonists
D. Prevent exercise induced bronchospasms
E. Reduce bronchial hyperresponsiveness

Front 22

What do anticholinergics do for asthma and which of the following are anticholinergics?

A. Albuterol (Ventolin, Proventil)
B. Aminophylline
C. Formoterol
D. Ipratropium (Atrovent)
E. Salmeterol
F. Tiotropium (Spiriva)
G. Theophylline

Back 22

Anticholinergics Block contraction of airway smooth muscles and block the increase in secretion of mucus occuring in response to vagus activity.

By blocking muscarinic effect, allows the sympathetic effect (bronchodilation) to be more prominent.

The two anticholinergics to know are
D. Ipratropium (Atrovent)
F. Tiotropium (Spiriva)

Front 23

Short-acting beta2 agonists and anticholinergics are both used for quick relief of acute asthma attacks. When use one over the other?

Back 23

When asthma patients cannot tolerate short-acting beta2 agonists, they resort to anticholinergics.

Front 24

Methylxanthines are a group of bronchodilators used for asthma.
A. Name the prototypical drug from this category
B. Are methylxanthines short-acting or long-acting?
C. What is it's indicated use?
D. What two things does it NOT do?
E. What makes it rather difficult and cumbersome to utilize?

Back 24

A. prototypical drug : theophylline
B. long-acting
C. indicated use for chronic treatment of asthma to decrease incidence of bronchoconstriction, AND for stimulation of respiration in apnea of prematurity, AND can prevent edema
D. DOES NOT: prevent late-phase rxn, reduce bronchial hyperresponsiveness
E. 2 reasons: has narrow therapeutic window so constantly need to check plasma levels, and clearance is age-dependent (younger slower) and dz states markedly increase half-life of drug.

Front 25

Mast stabilizers are used for asthma prophylaxis.
A. Name the generic mast cell stabilizer drug.
B. What is it's safety profile?

Back 25

Cromolyn

Inhibit release of mediators of inflammation and bronchoconstriction from mast cells

DOESNOT: affect airway smooth muscle tone, nor reverse bronchospasm

B. Cromolyn has a very good safety profile! Its side effects are minor and occur on the site of deposition- throat irritation, cough, mouth dryness

as 1st line agent in prophylactic treatment of mild to moderate asthma in children

Front 26

Which of the following actually decreases bronchiolar hyperresponsiveness?
A. beta2 agonists
B. anticholinergics
C. methylxanthines
D. mast stabilizers (cromolyn)
E. corticosteroids

Back 26

E. corticosteroids !!!

but they have no effect on bronchoconstriction

BUT corticosteroids ARE the most effective anti-inflammatory agents via inhibition of the synthesis or release of mediators of inflammation

Front 27

What is used as asthma prophylaxis and considered THE most effective for long-term treatment for control of asthma symptoms in all age groups?
A. leukotriene inhibitors
B. anticholinergics
C. methylxanthines
D. mast stabilizers (cromolyn)
E. corticosteroids

Back 27

E. corticosteroids

daily inhaled steroids decrease symptomatic days in asthmatics

Front 28

Name the pharmacologic actions of corticosteroids with regards to asthma treatment. (8)

Back 28

- Inhibit cytokine and chemokine production
- Inhibit eicosanoid synthesis
- Inhibit accumulation of basophils, eosinophils and other leukocytes
- Decrease vascular permeability
- Decrease the use of inhaled beta2receptor agonists for “rescue”.
- ** Induce synthesis of the polypeptide lipocortin-1, (annexia-A1), which inhibits PLA2
- ** Interact with glucocorticoid response elements in inflammatory cells: neutralize transcription factors for cytokine synthesis
- Resolve established inflammation in the lung

** NOTE DUAL ROLE OF GLUCOCORTICOID RECEPTORS IN INHIBITING INFLAMMATION

Front 29

What are possible side effects with inhaled corticosteroids? (4)

Back 29

- thrush (oral candidiasis)
- hoarseness (dysphonia)
- reflex cough
- still need to monitor growth in children, osteoporosis, cataracts

recommended use is with spacer, rinse mouth after use. High doses increase risk of side effects

Front 30

What is the utilitiy of systemic steroids, if any, with regards to asthma treatment?

Back 30

ONLY USE for severe asthma exacerbations, NOT USED FOR LONG TERM CONTROL.

adjust dose to minimum needed as mood disturbances, weight gain, loss of glucose control in diabetics, HTN, striae, ecchymoses, acne and hirsutism can occur as well as fluid and electrolyte disturbances and lotsa other stuff

Front 31

Leukotrienes (LTs) are naturally produced eicosanoids (signaling molecules made by oxygenation of essential fatty acids) lipid mediators, which may be responsible for asthma and allergies. So what are leukotriene inhibitors used for?

Back 31

Allergic or exercise induced asthma prophylaxis. (not for acute treatment of asthma attack)

this is an alternative to low-dose steroids in patients that do not respond to steroids or do not want to take inhaled steroids.

Front 32

Regarding leukotriene inhibitors Montelukast , Zafirlukast and Zileuton, which ...
A. is relatively safe
B. has high liver toxicity

Back 32

Montelukast is relatively safe (FDA received post-marketing reports of psychiatric symptoms)

Zafirlukast and Zileuton : high liver toxicity

Front 33

Regarding Omalizumab,
A. what is it?
B. how does it decrease the release of mediators of the allergic response?

Back 33

A. Humanized Mab directed against IgE

B. Decreases IgE levels & inhibits IgE receptor abundance on the surface of basophils and mast cells release of mediators of the allergic response

Given SC as single dose q 2-4 wks;
peak serum concentrations in 7-8 days. Indicated in patients with: inadequately controlled with inhaled steroids, complications of inhaled steroids, compliance issues.

Front 34

What asthma medication is indicated when:
- the patient is inadequately controlled with inhaled steroids
- there are complications of inhaled steroids,
- compliance issues

Back 34

Omalizumab

Side effects:
pain and bruising at injection site
anaphylaxis in 0.2% of patients
slight increase in incidence of cancer

Front 35

Newer combined products for asthma treatment include:
A. Advair, which is a combo of...
B. Symbicort, which is a combo of...

Budesonide, Fluticasone, Formoterol, Salmeterol

Back 35

A. Advair = Fluticasone + Salmeterol
B. Symbicort = Budesonide + Formoterol

for long term maintenance treatment in 12+ y/o pts

Front 36

What is the new corticosteroid for asthma AND allergic rhinitis treatment?
A. Omalizumab
B. Symbicort
C. Ciclesonide
D. Zileuton

Back 36

C. Ciclesonide

Front 37

Which of the following is NOT indicated for use during pregnancy?
A. Albuterol
B. Budesonide
C. Montelukast
D. Zileuton

Back 37

D. Zileuton, a leukotriene inhibitor, showed teratogenicity in animal studies

Front 38

Treatment of rhinitis includes what groups of meds? (6)

Back 38

- decongestants (alpha agonists)
- antihistamines
- glucocorticoids
- LT inhibitors
- Cromolyn
- Omalizumab

Front 39

One of the treatments for rhinitis is decongestants (alpha agonists). What is the oral drug and what are the two topical drugs?

Back 39

Oral: pseudoephedrine (Sudafed)

Topical: phenylephrine, oxymetazoline

Front 40

Which rhinitis treatment drug group can exhibit rebound [symptom it treats] if used longer than 3 days?
A. decongestants
B. antihistamines
C. glucocorticoids
D. leukotriene inhibitors
E. Cromolyn

Back 40

A. decongestants

Front 41

Antihistamines commonly have what side effect? Name some antihistamines.
A. irritability and insomnia
B. CNS sedative effect
C. irritation and dryness, burning of nasal mucosa, sore throat, HA

Back 41

B. CNS sedative effect

1st gen: Benadril
2nd gen: loratadine (Claritin)
3rd gen: FEXOFENADINE (Allegra)

Front 42

For allergic rhinitis, of the three leukotriene inhibitors, which is the only one you can use?

Back 42

Montelukast

Front 43

What is the DOC for mild to moderate seasonal rhinitis? For moderate to sever rhinitis?
A. decongestants
B. antihistamines
C. glucocorticoids
D. leukotriene inhibitors
E. Cromolyn

Back 43

mild to moderate:
B. antihistamines, esp.
3rd gen: FEXOFENADINE (Allegra)

moderate to severe:
C. glucocorticoids

Front 44

Which are superior to use together than alone?
A. decongestant + glucocorticoid
B. LT inhibitor + anithistamine

Back 44

B. LT inhibitor + anithistamine

Front 45

Your patient with seasonal rhinitis just finds out she is pregnant. What rhinitis treatments are safe to use? (4)

Back 45

- 2nd gen H1-antihistamines (Loratidine / Claratin)
- intranasal corticosteroids
- montelukast
- cromolyn

Front 46

All of the following are antitussives. Which is an expectorant and which are cough suppressants?
A. Codeine
B. Dextromethorphan
C. Gualfenesin
D. Hydrocodone

Back 46

Expectorant (peripherally acting agents. Drugs that stimulate the outflow of repsiratory tract fluid and modify the viscosity of secretions): C. Gualfenesin

Cough Suppressant (centrally acting drugs, drugs reduce the sensitivity of the cough center and vagus nerve, dulls perception of cough stimul): Codein, dextromethorphan, hydrocodone

Front 47

What is dornase alpha and what is it used for?

Back 47

dornase alpha is a newer recombinant human DNAase that decreases viscosity of mucus. Used for CF patients.

Front 48

Alpha-1-antitrypsin is used to treat some forms of:
A. asthma
B. COPD
C. cough
D. cystic fibrosis

Back 48

B. COPD

Front 49

N-acytlcystein is a [ mucolytic / PDE4 inhibitor ] and roflumilast is a [ mucolytic / PDE4 inhibitor ]. Both of these are used to treat what by reducing the viscosity of pulmonary secretions and facilitating their removal.

Back 49

N-acytlcystein is a mucolytic.
Roflumilast is a PDE4 inhibitor.

Front 50

What is a synthetic pulmonary surfactant prep used in respiratory distress syndrome in premies?
A. Roflumilast
B. N-acyticystein
C. Colfosceril
D. Guaifenesin
E. Dextromethorphan

Back 50

C. Colfosceril

Front 51

Cough suppressant dextromethorphan should NOT be taken with
A. MAOIs
B. selective serotonin reuptake inhibitors
C. CNS depressants (alcohol, antihistamines, psychotropics)
D. CYP450 inhibitors
E. all of the above

Back 51

E. all of the above!!!

Also: Can trigger histamine release (allergy), limited use in kids with atopic allergies

Front 52

Which COPD drug has significant side effects that include nausea, headache, diarrhea, and weight loss?

Back 52

PDE4 inhibitor