Bronchodilators: Beta adrenergic agonists

Question 1

In the sympathetic nervous system, which neurotransmitter is released at the preganglionic neuron at the pre-synapse?

1 - acetylcholine
2 - noradrenaline
3 - dopamine
4 - serotonin

Answer 1

1 - acetylcholine

Question 2

Acetylcholine is released at the preganglionic neuron. Which receptor does acetylcholine bind with at the post synapse of a neuron?

1 - nicotinic receptors
2 - adrenergic receptors
3 - muscarinic receptors
4 - GABA receptors

Answer 2

1 - nicotinic receptors

Question 3

In the sympathetic nervous system, which neurotransmitter is released at the postganglionic neuron at the pre-synapse in most cases?

1 - acetylcholine
2 - noradrenaline
3 - dopamine
4 - adrenaline

Answer 3

2 - noradrenaline
4 - adrenaline

• these are called catecholamines

Question 4

Noradrenaline and adrenaline are released at the postganglionic neuron. Which receptor does noradrenaline and adrenaline bind with at the post synapse of their target tissue?

1 - nicotinic receptors
2 - adrenergic receptors
3 - muscarinic receptors
4 - GABA receptors

Answer 4

2 - adrenergic receptors

Question 5

Which GPCR are all B-adrenergic receptors?

1 - Gaq
2 - Gai
3 - Gas

Answer 5

3 - Gas
- B1 can bind noradrenaline and adrenaline

• B2 and B3 can bind just adrenaline

Question 6

Gas GPCR are present on all B-adrenergic receptors. Organise the following intracellular pathway that occurs when these receptors become active?

1 - pKA moves around cell and phosphorylates target proteins triggering a cellular response
2 - adenylyl cyclase (AC) becomes active
3 - cAMP binds and activates protein kinase A (pKa)
4 - AC takes 2 phosphates from ATP and becomes cyclic adenosine monophosphate (cAMP)

Answer 6

2 - adenylyl cyclase (AC) becomes active
4 - AC takes 2 phosphates from ATP and becomes cyclic adenosine monophosphate (cAMP)
3 - cAMP binds and activates protein kinase A (pKa)
1 - pKA moves around cell and phosphorylates target proteins triggering a cellular response

Question 7

Gaq GPCR are present on alpha 1 receptors and become active when binding with adrenaline and/or noradrenaline. Organise the following intracellular pathway that occurs when these receptors become active?

1 - IP3 binds with the endoplasmic reticulum and opens Ca2+ channels, leading to increased intracellular Ca2+ and depolarisation
2 - pKC can then phosphorylate target proteins and induce cellular activity
3 - phospholipase C (PLC) becomes activated located in the cell membrane
4 - DAG binds protein kinase C (pKC) which becomes active due to increased Ca2+
5 - PLC cleaves hospholipid called phosphatidylinositol 4,5-bisphosphate (PIP2) forming inositol trisphosphate (IP3), which is soluble and diffuses freely in the cytoplasm, and the other part is diacylglycerol (DAG), bound to the cell membrane

Answer 7

3 - phospholipase C (PLC) becomes activated located in the cell membrane

5 - PLC cleaves hospholipid called phosphatidylinositol 4,5-bisphosphate (PIP2) forming inositol trisphosphate (IP3), which is soluble and diffuses freely in the cytoplasm, and the other part is diacylglycerol (DAG), bound to the cell membrane

1 - IP3 binds with the endoplasmic reticulum and opens Ca2+ channels, leading to increased intracellular Ca2+ and depolarisation

4 - DAG binds protein kinase C (pKC) which becomes active due to increased Ca2+

2 - pKC can then phosphorylate target proteins and induce cellular activity

Question 8

Where are B-adrenergic receptors located in the lungs?

1 - arterioles
2 - smooth muscle
3 - trachea to bronchi
4 - smooth muscle of trachea down to terminal bronchioles

Answer 8

4 - smooth muscle of trachea down to terminal bronchioles

• binds noradrenaline and adrenaline

Question 9

Asthma is a chronic inflammatory respiratory condition that causes narrowing of the lungs and difficult breathing. Which of the following can cause an asthma exacerbation?

1 - allergies
2 - air pollution
3 - airborne irritants
4 - respiratory infections
5 - exercise or physical activity
6 - weather and air temperature
7 - strong emotions
8 - medication
9 - all of the above

Answer 9

9 - all of the above

Question 10

Are asthma and COPD obstructive or restrictive?

Answer 10

• obstructive
• basically means airways are obstructed
• elastic tissue of lungs is lower reducing the recoil (snap back) but increasing the compliance (stretching the lungs)

Question 11

Which of the following are characteristics of an obstructive airway disease?

1 - increased lung compliance (lungs can expand well)
2 - narrowing of all size of airways (small, medium and large)
3 - decreased recoil (ability to snap back to normal size and remove air from lungs)
4 - ok to inhale, but difficult to exhale
5 - all of the above

Answer 11

5 - all of the above

Question 12

Is COPD reversible?

Answer 12

• generally no
• narrowing of airways caused by progressive airflow obstruction that is not fully reversible

Question 13

Is asthma reversible?

Answer 13

• generally yes
• chronic asthma can lead to permanent airway narrowing though

Question 14

What is the FEV1 to diagnose a patient with an obstructive lung disease such as asthma and COPD?

1 - <100%
2 - <90%
3 - <80%
4 - <70%

Answer 14

4 - <70%

Question 15

Which of the following is not a layer of the lumen in the respiratory airways?

1 - smooth muscle
2 - lamina propria
3 - epithelial cells
4 - endothelium cells

Answer 15

4 - endothelium cells
- present in blood vessels

Question 16

Delivering drugs to the lungs is very difficult. Which of the following are factors that contribute the amount of a drug that reaches the lungs?

1 - Size of the particle
2 - Inspiratory flow rate
3 - Distance needed for the particle to travel (determined by the method of inhalation)
4 - all of the above

Answer 16

4 - all of the above

Question 17

Which short acting beta agonist (SABA) drug is a core drug we need to be aware of?

1 - Formoterol
2 - Ipratropium bromide
3 - Salbutamol
4 - Serevent

Answer 17

1 - salbutamol

• commercial name is ventolin

Question 18

Which 2 of the following is Salbutamol indicated in the use of?

1 - asthma
2 - COPD
3 - pneumonia
4 - cystic fibrosis

Answer 18

1 - asthma
2 - COPD

Question 19

Is the SABA salbutamol recognised as a reliever or preventer for the treatment of asthma?

Answer 19

• reliever
• used to relieve bronchospasm in acute asthma attacks
• also helpful for breathlessness and wheezing in chronic asthma

Question 20

Which 2 of the following are the long acting beta agonist (LABA) drugs that we need to be aware of?

1 - Formoterol
2 - Ipratropium bromide
3 - Salmeterol
4 - Serevent

Answer 20

1 - Formoterol
3 - Salmeterol

Question 21

Formoterol and Salmeterol are the 2 LABA that we need to be aware of. What are the 2 indications for the use of these 2 LABAs?

1 - chronic asthma
2 - COPD
3 - pneumonia
4 - cystic fibrosis

Answer 21

1 - chronic asthma
2 - COPD

• theses LABAs 1st line in patients if Salbutamol (SABA) is ineffective at relieving symptoms

Question 22

In a patient with chronic asthma or COPD, Formoterol and Salmeterol (LABAs) are indicated. However, depending on the patients responsiveness, which 2 of the following are these LABAs typically combined with?

1 - anti-histamines
2 - inhaled corticosteroid
3 - montelukast
4 - tiotropium or aclidinium (LAMA)

Answer 22

2 - inhaled corticosteroid
4 - tiotropium or aclidinium (LAMA)

• it can be the following:

LABA + LAMA +/or inhaled corticosteroid

Question 23

In asthma, Formoterol and Salmeterol (LABAs) can be used with SABA. But if a LABA is used the patient must also be prescribed an inhaled corticosteroid. Why is this?

1 - increases effectiveness of LABA
2 - LABAs do not work in isolation
3 - LABAs with inhaled corticosteroids is associated with increased asthma deaths

Answer 23

3 - LABAs with inhaled corticosteroids is associated with increased asthma deaths

Question 24

What is the mechanisms of action for SABA and LABA medications?

1 - inhibit Gas GPCR
2 - inhibit Gaq GPCR
3 - agonist of Gas GPCR
4 - agonist of Gaq GPCR

Answer 24

3 - agonist of Gas GPCR
- all Beta receptors are Gas
- induce relaxation of smooth muscles in the lungs causing bronchodilation

Question 25

Which of the following is NOT a function of Beta 2 adrenergic receptors? 1 - bronchodilation 2 - vasodilation of blood to smooth muscle 3 - ionotropic 4 - gluconeogenesis

Answer 25

3 - ionotropic - increases heart contraction force

Question 26

In addition to bronchodilation, short acting beta agonist (SABA) posses other useful therapeutic effects on the lungs. Which of the following is NOT one of the therapeutic effects of SABA? 1 - stabilise mast cells, inhibiting inflammation 2 - enhance mucociliary clearance 3 - ⬇️ vascular permeability 4 - inhibit IgE production

Answer 26

4 - inhibit IgE production

Question 27

Salbutamol is the short acting beta agonist (SABA) drug we need to know. This is thought of as a reliever as it is fast acting, but doesn't last for long. How quickly does this 1 - start in 30 mins and last for 1 hour 2 - start immediately and last for 1 hour 3 - start in 10 mins and last for 3-5 hours 4 - start in 10 mins and last for 10 hours hour

Answer 27

3 - start in 10 mins and last for 3-5 hours - administered as an inhaler

Question 28

Formoterol and Salmeterol are the 2 LABA we need to be aware of. How quickly do long acting beta agonist (LABA) drugs take to work and last for? 1 - start in 10 mins and last for 10 hours hour 2 - start immediately and last for 10-12 hours hour 3 - start in 30 mins and last for 3-5 hours 4 - start in 30 mins and last for 10-12 hours hour

Answer 28

4 - start in 30 mins and last for 10-12 hours hour

Question 29

Beta receptors are involved in the fight or flight response. Therefore B-agonists such as the SABA and LABAs can have adverse events. Which of the following is NOT an adverse event of SABA and LABAs when administered via an inhaler? 1 - muscle tremors (B2 receptors) 2 - dry cough 3 - tachycardia and palpitations (B1 receptors) 4 - angina 5 - anxiety and agitation 6 - hypokalaemia and raised lactate

Answer 29

4 - angina - LABAs can also cause muscle cramps - increased lactate is due to gluconeogensis and pyruvate utilisation - can also lead to hyperglycaemia

Question 30

B-agonist such as Salbutamol (SABA), Formoterol and Salmeterol (LABAs) also cause hypokalaemia. How does this occur? 1 - activated Beta receptors cause K+ to move extracellularly 2 - activated alpha receptors leads to K+ moving into cells via K+ channels 3 - Na+/K+ ATPase are stimulated by B agonists causing K+ to flood into cells

Answer 30

3 - Na+/K+ ATPase are stimulated by B agonists causing K+ to flood into cells

Question 31

Salbutamol (SABA), Formoterol and Salmeterol (LABAs) are the core B-agonists we need to be aware of. Which of the following is NOT a symptom that patients with asthma/COPD present with and need to use the SABA and LABA? 1 - breathlessness 2 - tachycardia 3 - chest tightness 4 - wheeze

Answer 31

2 - tachycardia

Question 32

If a patient has exacerbation of their asthma or COPD, the green inhaler for the delivery of the SABA Salbutamol may be insufficient. How is this alternatively delivered to a patient? 1 - nebuliser with 6 L oxygen for asthma and 6 L air for COPD 2 - nebuliser with 6 L air for asthma and 6 L oxygen for COPD 3 - gas re-breathe mask with 6 L air for asthma and 6 L oxygen for COPD 4 - gas re-breathe mask with 6 L O2 for asthma and 6 L air for COPD

Answer 32

1 - nebuliser with 6 L oxygen for asthma and 6 L air for COPD

Question 33

Although the SABA salbutamol is used through inhalation normally. Which of the following is NOT a method of administration in emergency or exacerbation of asthma or COPD? 1 - nebulised 2 - intravenous 3 - oral 4 - suppositories

Answer 33

4 - suppositories

Question 34

What is the only way LABA can be administered? 1 - intravenously 2 - subcutaneously 3 - inhaled 4 - orally

Answer 34

3 - inhaled - often called preventers