farmaka

Question 1

Are H1 blockers reversible or irreversible inhibitors?

Answer 1

Reversible

Question 2

What are three first-generation H1 blockers?

Answer 2

Diphenhydramine, dimenhydrinate, and chlorpheniramine

Question 3

Name four second-generation H1 blockers.

Answer 3

Loratadine, fexofenadine, cetirizine, and desloratadine

Question 4

First-generation H1blockers usually end in ____, whereas second-generation H1blockers usually end in ____.

Answer 4

-en/-ine or -en/-ate, -adine

Question 5

A patient has motion sickness on a flight and would like to fall asleep. What class of medication would be useful for this patient?

Answer 5

H1 blockers (e.g., diphenhydramine), which are useful for allergies, motion sickness, and as sleep aids

Question 6

A patient takes chlorpheniramine for allergies. What side effects would you counsel the patient on?

Answer 6

Sedation, antimuscarinic symptoms, anti-α-adrenergic symptoms

Question 7

What is the clinical use of second-generation H1 blockers?

Answer 7

Allergies

Question 8

A truck driver has bad allergies. You want to prescribe a histamine blocker. Would diphenhydramine work for him?

Answer 8

No (although it treats allergies, it makes him too sleepy [second-generation H1-blockers are less sedating due to lower CNS activity])

Question 9

How does guaifenesin help a patient with a severe cough productive of sputum?

Answer 9

It thins respiratory secretions, but it does not reduce the cough reflex

Question 10

N-acetylcysteine is an expectorant. How does it work?

Answer 10

Dissolves mucous plugs by disrupting disulfide bonds (it is a mucolytic)

Question 11

A patient with cystic fibrosis is prescribed a medication that would loosen mucous plugs. What is the mechanism of action of this drug?

Answer 11

Disrupts disulfide bonds (N-acetylcysteine is a mucolytic)

Question 12

Which mucolytic is also used as an antidote for acetaminophen overdose?

Answer 12

N-acetylcysteine

Question 13

By what mechanism does dextromethorphan suppress cough?

Answer 13

It antagonizes NMDA glutamate receptors

Question 14

Dextromethorphan is a synthetic analog of what drug?

Answer 14

Codeine

Question 15

Excess use of dextromethorphan can produce what side effect?

Answer 15

Mild opioid effect

Question 16

A patient with a cough overdoses on an NMDA glutamate receptor antagonist. What drug can be used to treat the overdose?

Answer 16

Naloxone (dextromethorphan can cause opioid-like effects)

Question 17

Why does dextromethorphan have mild abuse potential?

Answer 17

If used in excess, it has a mild opioid effect

Question 18

A patient with depression takes a medication to suppress cough. She quickly becomes tachycardic & sweaty, & her fingers tremble. Diagnosis?

Answer 18

This is serotonin syndrome, seen when dextromethorphan is combined with another serotonergic agent such as certain antidepressants

Question 19

What is the main clinical function of pseudoephedrine and phenylephrine? By what mechanism?

Answer 19

Nasal decongestants via α-adrenergic agonism

Question 20

What are the clinical indications for pseudoephedrine and phenylephrine?

Answer 20

Reduce hyperemia, edema, nasal congestion; open obstructed eustachian tubes; and act as stimulant (pseudoephedrine only, used to make meth)

Question 21

A patient takes α-adrenergic agonists for nasal congestion. What side effects can be expected?

Answer 21

Can cause hypertension and central nervous system stimulation/anxiety

Question 22

Name the three types of drugs that are used for pulmonary hypertension.

Answer 22

Endothelin receptor antagonists, prostacyclin analogs, and PDE5 inhibitors

Question 23

Name a competitive endothelin receptor antagonist that is used to decrease pulmonary vascular resistance for pulmonary hypertension.

Answer 23

Bosentan

Question 24

A patient with COPD has a pulmonary artery pressure of 26 mmHg. He is prescribed an endothelin receptor antagonist. What must you monitor?

Answer 24

Monitor LFTs for hepatotoxic side effects (this patient has pulmonary hypertension from COPD, and the medication described is bosentan)

Question 25

What is the mechanism of action of sildenafil?

Answer 25

Inhibits cGMP PDE5 and prolongs nitric oxide vasodilatory effects

Question 26

A man with pulmonary hypertension and erectile dysfunction would benefit from which medication?

Answer 26

Sildenafil

Question 27

Name two prostacyclin analog medications that directly vasodilate pulmonary and systemic vascular beds for pulmonary hypertension.

Answer 27

Epoprostenol and iloprost

Question 28

A man with elevated pulmonary artery pressure is given a PGI2 analog that also works to inhibit platelet aggregation. Side effects?

Answer 28

Flushing and jaw pain (he has pulmonary artery hypertension, and the medication described is epoprostenol or iloprost)

Question 29

Bronchoconstriction is mediated by which two processes?

Answer 29

Inflammation and parasympathetic tone (these are targets for therapy)

Question 30

What is the mechanism of action of albuterol?

Answer 30

Albuterol relaxes bronchial smooth muscle through its agonism of β2-adrenergic receptors

Question 31

A typical patient with asthma takes a combination of drugs that targets which two pathways mediating bronchoconstriction?

Answer 31

Inflammation and parasympathetic tone

Question 32

Is albuterol used as a controller medication or for relief of symptoms during exacerbations?

Answer 32

Relief in acute asthma exacerbations

Question 33

Salmeterol and formoterol are ____ (short/intermediate/long)-acting agents. What class of drugs are they?

Answer 33

Long; β2-agonist

Question 34

List two adverse effects that a patient may experience while taking salmeterol.

Answer 34

Tremor and arrhythmias

Question 35

Name two inhaled corticosteroids commonly used to treat asthma.

Answer 35

Fluticasone and budesonide

Question 36

What mechanism of inhaled corticosteroids makes them useful to treat asthma?

Answer 36

They inhibit the synthesis of virtually all cytokines

Question 37

Inhaled corticosteroids are useful in treating asthma by inactivating what transcription factor?

Answer 37

Nuclear factor κB

Question 38

Nuclear factor κB induces the production of inflammatory agents including ____.

Answer 38

Tumor necrosis factor-α

Question 39

A patient has chronic asthma. What class of drugs is considered first-line therapy for this patient?

Answer 39

Inhaled corticosteroids

Question 40

Ipratropium is an example of what class of drugs?

Answer 40

Muscarinic antagonists

Question 41

Does ipratropium cause a competitive or a noncompetitive receptor blockade? Mechanism?

Answer 41

Competitive; prevents endogenous acetylcholine from inducing bronchoconstriction

Question 42

Ipratropium is used to treat chronic obstructive pulmonary disease, as is what other long-acting muscarinic antagonist?

Answer 42

Tiotropium

Question 43

Name two clinical indications for the use of ipratropium.

Answer 43

Asthma and chronic obstructive pulmonary disease

Question 44

A patient has both asthma and COPD. What is the mechanism of action of the drug that would be useful against both of his conditions?

Answer 44

Ipratropium is used against both, as it blocks muscarinic receptors competitively

Question 45

Name three examples of antileukotriene drugs.

Answer 45

Zileuton, zafirlukast, and montelukast

Question 46

Zileuton is an inhibitor of what pathway? Toxicity?

Answer 46

The 5-lipoxygenase pathway that produces leukotrienes from arachidonic acid; it is hepatotoxic

Question 47

What medication is used for allergic asthma resistant to inhaled corticosteroids and β2-agonists? Its mechanism of action?

Answer 47

Omalizumab, a monoclonal anti-immunoglobulin E antibody that binds unbound immunoglobulin E and blocks FcεRI binding

Question 48

Theophylline likely causes ____ by inhibiting phosphodiesterase and increasing what molecule?

Answer 48

Bronchodilation; cAMP

Question 49

What is the effect on bronchial smooth muscle of increased cAMP concentration?

Answer 49

Decreased bronchial tone (i.e., it causes bronchodilation)

Question 50

The use of what asthma drug is limited because of its narrow therapeutic index?

Answer 50

Theophylline, a methylxanthine

Question 51

A patient wants to try theophylline but is worried about side effects. What two side effects do you counsel the patient on?

Answer 51

Cardiotoxicity and neurotoxicity

Question 52

In addition to inhibiting phosphodiesterase, theophylline also blocks endogenous ____ from inducing bronchoconstriction.

Answer 52

Adenosine

Question 53

In the pathogenesis of asthma, the binding of antigens to immunoglobulin E on mast cells results in what?

Answer 53

The release of mediators such as leukotrienes and histamine from mast cells

Question 54

In the pathogenesis of asthma, the release of mediators from mast cells results in what two responses?

Answer 54

Bronchoconstriction (early) and inflammation (late)

Question 55

In asthma, the early response to the release of mediators is ____, whereas the late response to the release of mediators is ____.

Answer 55

Bronchoconstriction; inflammation

Question 56

In the treatment of asthma, what drug type prevents released mast cell mediators from inducing the late response of airway inflammation?

Answer 56

Steroids

Question 57

What is the primary function of methacholine? By what mechanism does it work?

Answer 57

Bronchoconstriction via muscarinic (M3) receptor agonism

Question 58

A physician cannot tell if a patient has asthma. What drug could be used in an asthma challenge test for this patient?

Answer 58

Methacholine