Pharmacology Quiz 4 - Respiratory Part

Front 1

With asthma, it is found to have contracted airway smooth muscle, mucosal thickening from ___a___ and cellular infiltration, and ___b____ that block smaller airways.

Back 1

a) edema

b) mucous plugs

Front 2

The pathophysiology of asthma involves the release of chemical mediators from ________ and _________.

Back 2

mast cells and eosinophils

Front 3

An example of of a chemical mediator that contracts smooth muscle is ___a____, which is released by ___b_____.

Back 3

a) histamine

b) mast cells

Front 4

Besides the release of chemical mediators, another pathophysiological method of asthma involves abnormality in regulation of smooth muscle ____a____, which is due to an increase in ____b______ activity..

Back 4

a) tone

b) cholinergic

Front 5

T/F
Besides the release of chemical mediators and abnormalities of smooth muscle, another pathophysiological method of asthma involves chronic airway inflammation due to an increased number of inflammatory cells even between acute attacks.

Back 5

true

Front 6

T/F
The early reaction phase of an asthma attack is also called "slow reacting substance of anaphylaxis" and involves leukotrienes.

Back 6

false
(the late phase)

Front 7

The acute phase of an asthma attack is usually due to ____a_____ release, which happens in seconds, and within a few minutes you will start making ____b____.

Back 7

a) histamine, tryptase

b) prostaglandins, leukotrienes

Front 8

After a few minutes into an asthma attack, after leukotrienes and PGs are being made, ___a____ are activated to release ___b_____.

Back 8

a) t-cells (T lymphocytes)

b) interleukins

Front 9

During the late reaction of an asthma attack, interleukins activate _________. Give some specific examples of these...

Back 9

eosinophils

ex) ECP (eosinophil chemotactic protein)
MBP (major basic protein)

Front 10

Neutrophils release ________ during late reaction phase of an asthma attack to cause cellular infiltration and edema.

Back 10

proteases, PAF

Front 11

When someone is having an asthma attack, you will immediately get degranulation of mast cells. Granule content release contains all of the following except
a) histamine
b) proteases
c) leukotrienes
d) heparin
e) TNF

Back 11

c) leukotrienes

Front 12

Within minutes after an asthma attack, you will get membrane derived lipid mediators to release all of the following except
a) interleukins
b) prostaglandins
c) platelet activating factors
d) leukotrienes

Back 12

a) interleukins

Front 13

Over hours of time of an asthma attack, you will get cytokine production that will release __________. What are some examples?

Back 13

interleukins
IL-2-6, IL-8, TNF

Front 14

What are some anatomical differences that you can see within an asthmatic's bronchi versus a normal patient's bronchi?

Back 14

smooth muscle and epithelium are much thicker

Front 15

What are signs and symptoms of asthma?

Back 15

wheezing
coughing
tachypnea (rapid breathing)
dypsnea (labored breathing)

Front 16

Which of the following is a therapeutic approach for asthma?
a) reverse bronchospasm
b) remove trigger of antigen
c) control inflammation
d) A & C
e) all of the above

Back 16

e) all of the above

Front 17

T/F
B2-agonists relax smooth muscle dependent of whatever is causing contraction.

Back 17

false
(independent of...)

Front 18

A short acting B2 agonist includes all of the following except
a) piruterol
b) metaproterenol
c) levalbuterol
d) formoterol
e) all of these are SA-B2 agonists

Back 18

d) formoterol
(this is a long-acting B2 agonist)

Front 19

What are some therapeutic approaches to reversing bronchospasms?
a) cromolyn
b) steroids
c) ipratropium
d) nedocromil
e) A, B, C
f) A & B
g) all of the above

Back 19

c) ipratropium
(others include B2 agonists and theophylline)

Front 20

What can help remove the trigger or antigen involved with asthma?
a) theophylline
b) nedocromil
c) cromolyn
d) lipoxygenase inhibitors
e) a & b
f) b & c
g) all of the above

Back 20

f) b & c
cromolyn and nedocromil

Front 21

Which of the following helps control inflammation in asthma?
a) steroids
b) cromolyn
c) ipratropium
d) lipoxygenase inhibitors
e) a, b, c
f) a & d
g) none of the above

Back 21

f) a & d
steroids and lipoxygenase inhibitors

Front 22

Which of the following is NOT an adverse reaction to B2 agonists?
a) headache
b) insomnia
c) hyperglycemia
d) dizziness
e) hypertension

Back 22

e) hypertension
(causes HYPOtension)

Front 23

Ipratropium and tiotropium help in reversing bronchospasm, but only do so by blocking contraction due to ________.

Back 23

ACh
(wont work if being blocked by something else)

Front 24

Ipratropium + albuterol (Combivent) has a (a) slower/faster onset and (b) less/more bronchodilation effect than B2 agonists.

Back 24

a) slower

b) less

Front 25

Which of the following is a nonselective muscarinic antagonist?
a) tiotopium
b) beclomethasone
c) budesonide
d) ipratropium
e) triamcinolone

Back 25

d) ipratropium
(tiotropium is more selective)

Front 26

All of the following are adverse effects of muscarinic antagonists like ipratropium and tiotropium except:
a) blurred vision
b) dizziness
c) bronchospasm
d) palpitations
e) dry mouth

Back 26

b) dizziness

Front 27

Which of the following have been studied to show that there is an increase in CV risks such as MI, strokes, and CVA's?
a) albuterol and salmuterol
b) theophylline
c) ipratropium and tiotropium
d) fluticasone and mometasone
e) none of the above

Back 27

c) ipratropium and tiotropium

Front 28

Theophylline inhibits ___(a)____, which causes the metabolism of cAMP to (b)decrease/increase and cGMP to (c) decrease/increase.

Back 28

a) phosphodiesterase (PDE 4, 5)

b) increase

c) increase

Front 29

Theophylline works antagonistically on which receptor?

Back 29

Adenosine receptor antagonist
(A2B)

Front 30

Besides theophylline working mechanistically to inhibit phosphodiesterases PDE 4,5 and antagonize adenosine receptor A2B, is works with anti-inflammation actions to inhibit inflammatory mediators in which stage of response? (early or late response?)

Back 30

late

Front 31

Adverse effects of Theophylline include of the following except:
a) smooth muscle relaxant
b) arrhythmias
c) hyperglycemia
d) stimulates gastric acid
e) diuretic effects
f) convulsions

Back 31

c) hyperglycemia
(B2 agonists cause this)

Front 32

What is the dose of Theophylline that may cause CNS effects like convulsions and cardiac effects like arrhythmias?

Back 32

doses >20mcg/ml

Front 33

What are the therapeutic levels for Theophylline?

Back 33

5-20mcg/ml

Front 34

At what dose range can theophylline cause nausea, vomiting, and cardiac effects?

Back 34

15-20mcg/dl

Front 35

At what dose range can Theophylline cause toxic effects, leading to seizures and arrhythmias?

Back 35

30-40mcg/ml

Front 36

Which of these agents is used to remove the asthma trigger or antigen?
a) budesonide
b) flunisolide
c) cromolyn
d) tiotropium
e) theophylline

Back 36

c) cromolyn
(also Nedocromil)

Front 37

Cromolyn stabilizes ___a____ and must be taken (b) before/after antigen insult.

Back 37

a) mast cells

b) before

Front 38

The mechanism in which Cromolyn and Nedocromil works is unknown, but they are thought to work on _________ involving granules moving to membranes.

Back 38

Ca++

Front 39

How do corticosteroids work?
a) they remove trigger or antigen
b) they inhibit anti-inflammatory cascade
c) they reverse bronchospasm
d) they inhibit phosphodiesterases to increase cAMP and cGMP
e) a & d
f) b & d
g) none of the above

Back 39

b) they inhibit anti-inflammatory cascade

Front 40

Corticosteroids works up to __a__ weeks for maximal effects and can cause ____b____.

Back 40

a) 8 weeks

b) oral candidiasis (thrush),
suppression of growth in children,
inhibition of immune system

Front 41

All of the following are examples of corticosteroids except
a) flunisolide
b) fluticasone
c) beclomethasone
d) metoproterenol
e) budesonide
f) all of the above are examples of corticosteroids

Back 41

d) metoproterenol

Front 42

Leukotriene antagonists
a) reverse bronchospasm
b) remove trigger or antigen
c) control inflammation
d) none of the above

Back 42

c) control inflammation
(so do corticosteroids!)

Front 43

Which leukotriene antagonist inhibits CYP, and which CYP does it inhibit?
a) Zafirlukast, CYP1C9 & CYP3A4
b) Zafirlukast, CYP2C9 & CYP3A4
c) Montelukast, CYP1C9 & CYP3A4
d) Montelukast, CYP2C9 & CYP3A4
e) Zileuton, CYP1C9 & CYP2C9
f) none of the above

Back 43

b) Zafirlukast, CYP2C9 & CYP3A4

Front 44

Montelukast is a __a___ antagonist that inhibits the __b___ receptor that mediates inflammation, bronchial constrictions, and mucous secretions.

Back 44

a) LTD4

b) cysLT1

Front 45

What agents are effective to use in Aspirin-induced asthma and where in the pathway does it work?

Back 45

leukotriene anatagonists

blocks cyclooxygenase from transforming arachidonic acid into PGG2

Front 46

____a____ converts arachidonic acid into PGG2, whereas ______b______ converts arachidonic acid into 5-HPETE.

Back 46

a) cyclooxygenase

b) 5-lipoxygenase

Front 47

5-HPETE is converted into ___a___, and which ones (after this conversion) are considered to be the "slow reacting substances of anaphylaxis? (b)"

Back 47

a) LTA4

b) LTC4, LTD4, and LTE4
(LTB4 is NOT)

Front 48

After cyclooxygenase converts arachidonic acid into PGG2, which one relaxes blood vessels and inhibits platelet activation? (a)

Which one does the opposite and contracts blood vessels and activates platelets? (b)

Back 48

a) PGI2

b) TXA

Front 49

After cyclooxygenase converts arachidonic acid into PGG2, which one is involved in muscle contraction?

Back 49

PGE2

Front 50

_____a____ is the agent used to control inflammation that can give flu-like syndromes and drowsiness, and it is a ______b__________.

Back 50

a) Zileuton

b) 5-lipoxygenase inhibitor

Front 51

Zileuton can cause all of the following except
a) drowsiness
b) hepatic enzyme elevation
c) inhibition of CYP1A2
d) flu-like syndrome
e) inhibition of CYP3A4
f) a & c
g) all of the above are adverse effects of Zileuton

Back 51

g) all of the above are adverse effects of Zileuton

Front 52

Which agent used to control inflammation is administed through subcutaneous injection only every 2-4 weeks?

Back 52

Omalizumab

Front 53

Omalizumab is recombinant ___a___ derived from humanized __b___ monoclonal antibodies.

Back 53

a) DNA

b) IgE

Front 54

Omalizumab binds to circulating ___a___ which (b) decreases/increases high affinity receptors on ____c_____, preventing degranulation.

Back 54

a) IgE

b) decreases

c) mast cells

Front 55

Adverse effects of Omalizumab include all of the following except
a) stimulates gastric acid
b) anaphylaxis
c) GI disturbances
d) secondary malignancies
e) all of the above are adverse effects of Omalizumab

Back 55

a) stimulates gastric acid