Pharm Pulmonary Exam 1

Question 1

LABA

Answer 1

Long acting beta agonist

Question 2

SABA

Answer 2

Short acting Beta agonist

Most effective medication for relief of acute bronchospasm.

More than one canister per month suggests inadequate asthma control

Regularly scheduled use is not generally recommended

May lower effectiveness

May increase airway hyperresponsiveness

Question 3

LAMA

Answer 3

Long acting Muscarinic Antagonists

Question 4

Bronchodilators MOA

Answer 4

Activate Beta 2 receptors in smooth muscles of lung, promoting bronchodilation and thereby relieving bronchospasm.

Also suppress histamine release in the lung and increase ciliary motility

Open up bronchial tubes so that more air can move through.

Helps clear mucus from lungs.

As airway opens the mucus moves more freely and can be coughed out.

Question 5

Short acting Bronchodilators

Answer 5

Quick acting, Rescue
Relieve asthma symptoms very quickly by opening airways

Action starts within minutes after inhalation and last for 2 to 4 hours

Used 15- 20 minutes before exercise to prevent exercise induced asthma

Question 6

Long acting Bronchodilators

Answer 6

Used to provide control -
not quick relief of asthma

Lasts for at least 12 hours

Those containing formoterol begin their action within a few minutes, while those containing salmeterol take up to 45 minutes to begin their action

Question 7

Regularly scheduled of use of SABA is not generally recommended due to:

Answer 7

May lower effectiveness

May increase airway hyperresponsiveness

Question 8

Albuterol HFA

Answer 8

Ventolin (beta 2 agonist)

Indications
Bronchospasm
Exercise induced bronchospasm (2 puffs 15 minutes before exercise)

(Nebules, Syrup, Inhal soln 0.5%)

Interactions:
Avoid MAOI, tricyclics within 14 days (increased cardiovascular effects)

Adverse:
Hypokalemia,
Tremor, nervousness, headache, dizziness, hyperactivity, insomnia, weakness, tachycardia

Question 9

Bronchodilators Adverse effects

Answer 9

Inhaled:
(tachycardia, angina, tremors)

Oral:
Systemic exposure is much larger
adverse effects are more likely

Excessive dosage can lead to angina pectoris, tachydysrhythmia, tremor

Question 10

Ipratropium Bromide

Answer 10

Atrovent 17mcg
(Anti-cholinergic / Anti-muscarinic)

Bronchospasm associated with chronic bronchitis and emphysema
Asthma exacerbation (mod-severe)

Contra:
Allergy to atropine or its derivatives

Warning:
Narrow angle glaucoma

Interactions:
Other anti-cholinergics

Adverse:
Anti-cholinergic effects

Question 11

Ipratropium Bromide 20mcg
+
Albuterol 100mcg

Answer 11

Combivent

Contraindications:
Atropine allergy

Extreme caution within 2 weeks of MAOI’s or tricyclics (increased cardiovascular effect)

Question 12

Muscarinic antagonist MOA

Answer 12

Ipratropium
Tiotropium (longer acting)
Given by aerosol

Competitively blocks muscarinic receptors in the airways and effectively prevent the bronchoconstriction caused by vagal discharge. it has no effect on the inflammatory aspect of asthma

Question 13

MDI vs DPI

Answer 13

MDI
Metered Dose inhaler

Advantages -Non breath activated
Disadvantages - Patient coordination

DPI
Dry Powder Inhaler

Advantages - Breath activated, propellent not required

Question 14

Inhaled corticoid steroids

Answer 14

Mometasone
Fluticasone
Flunisolide
Ciclesonide
Budesonide

Question 15

LABA Adverse / Contras

Answer 15

Formoterol, Salmeterol
For: Bronchospasm

Adverse:
HA, pain, HTN, Dizzy, Nasal/throat irritation

Interactions
Alpha blocker, azoles, BB, Clarithromycin, Loops, MAOI’s, TCA’s, Quinidine, Nelfinavir/ritonavir

Precautions:
CVD, DM, COPD, Thyroid, glaucoma, seizure, hypokalemia, pregnancy, lactation,

Contra:
Acute asthma attack

Question 16

LABA Medications

Answer 16

Pure LABA’s
Salmeterol
Formoterol

LABA’s
Indacaterol
Oldaterol
Vilanterol

Question 17

Salmeterol

Answer 17

Adjunct to inhaled corticosteroids for the treatment of asthma in prevention of bronchospasm in reversible airway obstruction disease

Not for acute relief of bronchospasm

Contra:
***Treatment of asthma without use of inhaled corticosteroids
Primary treatment of status asthmaticus
Acute asthma, COPD

Warning
***Asthma related death

Question 18

Using LABA alone to treat asthma:

Answer 18

When using LABA alone to treat asthma without inhaled corticosteroids can lead to lung inflammation and an increased risk of asthma related death.

Question 19

LABA + ICS Meds

Answer 19

Advair
Fluticasone + Salmeterol

Airduo
Fluticasone + Salmeterol

Breo Ellipta
Fluticasone + vilanterol

Dulera
Mometasone + formoterol

Symbicort
Budesonide + Formoterol

Question 20

LTRA

Leukotriene receptor antagonist

Answer 20

Montelukast
Zileuton

Anti-leukotriene agents inhibit the action of leukotrienes by blocking the CysLT1 receptor or by interrupting production by 5-lipoxygenase

Question 21

LTRA
Leukotriene receptor antagonist
Anti-leukotriene agents inhibit the action of leukotrienes by blocking the CysLT1 receptor
What meds?

Answer 21

Montelukast
Zafirlukast
Pranlukast

MZP

Generally well tolerated

Be aware of possible psych , behavior, neurogenic issues

Question 22

LTRA
Leukotriene receptor antagonist
by interrupting production by 5-lipoxygenase

Answer 22

Zileutron

Generally has more adverse effects than the others

Question 23

Montelukast

Answer 23

Singulair (leukotriene receptor antagonist)

> 15 years old : One 10mg tablet

For seasonal allergic rhinitis. Reserve use for those who have an adequate response or intolerance to alternate therapies

Warning:
Serious neuropsychiatric events

Adverse:
URI, Fever, HA, Pharyngitis, cough, abdominal pain, diarrhea, otitis media, influenza, rhinorrhea, sinusitis

Question 24

Zileuton

Answer 24

Zyflo (5-lipooxygenase inhibitor)

Prophylaxis and chronic treatment of asthma

Not recommended for Children

Contra:
Active liver disease, ALT elevated 3x normal limit

Warnings:
Not for primary treatment of acute attacks
Monitor liver function

History of liver disease, Monitor liver function 1st 3 months, every 2-3 months for remainder of the year
Alcohol consumption, neuropsych events

Interactions
Potentiates theophylline (reduce dose of theophylline)

Question 25

Acute bronchiolitis

Answer 25

is broadly defined as a clinical syndrome of respiratory distress that occurs in children <2 years of age and is characterized by upper respiratory symptoms leading to lower respiratory infection with inflammation, which results in wheezing and or crackles. It typically occurs with primary infection or reinfection with a viral pathogen.

Question 26

Acute bronchiolitis | management of severe bronchiolitis

Answer 26

Supportive care (hydration, O2, Resp support) and anticipatory guidance are the mainstays of management of severe bronchiolitis

Question 27

Acute bronchiolitis | Children with first episode of bronchiolitis

Answer 27

Don't administer inhaled bronchodilators | (albuterol, Epi) to infants and children with first episode of bronchiolitis.

Question 28

Children with RSV bronchiolitis

Answer 28

Treated the same as children with bronchiolitis caused by other pathogens Supportive care is mainstay Pharmacotherapy is not routinely recommended

Question 29

Adults and Older Children with RSV bronchiolitis

Answer 29

Glucocorticoids and bronchodilators may be beneficial

Question 30

Interventions that have shown a reduced rate of progression and decreased mortality in observational studies include

Answer 30

Single agent combination therapy with ribavirin intravenous immune globulin palivizumab and/or glucocorticoids

Question 31

Ribavirin

Answer 31

Virazole (Nucleoside analogue) indications Sever lower respiratory infections due to RSV in hospitalized infants and young children Children; Treat within first 3 days of infection Contra: Pregnancy Cat X

Question 32

palivizumab

Answer 32

Synagis Class: Antiviral monoclonal antibody (IgG1K)

Question 33

Acute epiglottitis

Answer 33

Describes inflammation of the epiglottitis and adjacent supraglottic structures Airway is first priority Sniffing, tripod posture Swelling is generally improved after 2-3 days after ABX when caused by H. Flu

Question 34

Acute epiglottitis Tx

Answer 34

Combination of 3rd gen ceph and anti-staph agent (vanc) Ceph and vanc

Question 35

Croup (mild)

Answer 35

Single dose Dexamethasone or prednisolone

Question 36

Children with moderate croup

Answer 36

Stridor at rest with mild to moderate retractions should be evaluated in the office or the ED Tx: Nebulized Epi and Single dose of dexamethasone 0.6mg/kg (max 16mg) least invasive route

Question 37

Children with severe croup

Answer 37

Stridor at rest with marked retractions and significant distress or agitation should be seen in the ED Approach these children cautiously as anxiety may increase and worsen the airway obstruction Tx: Nebulized Epi and Single dose of dexamethasone 0.6mg/kg (max 16mg) least invasive route

Question 38

Why dexamethasone for moderate to severe croup

Answer 38

``` Most extensively studied inexpensive easy to administer longer duration of action compared with other agents 0.6mg/kg (max 16mg) least invasive route ```

Question 39

Hospital management of croup

Answer 39

``` Supportive care IV fluids, Fever reduction Repeated doses of nebulized EPI Humidified O2 (no repeated dosages of steroids) Monitor for worsening respiratory distress ```

Question 40

Pertussis in infants and children

Answer 40

Supportive care is mainstay Pay attention to fluid and nutritional status Avoid known triggers for paroxysmal coughing fits (Exercise, cold, nasopharyngeal suctioning) Symptomatic treatments with Bronchodilators, corticosteroids, antihistamines, antitussives haven't been proven to improve cough in pertussis

Question 41

Pertussis in infants and children | Treatment

Answer 41

Macrolides (Azithromycin, erythromycin) | Bactrim may be used as alternative

Question 42

For incompletely immunized children with well documented pertussis infection: Treatment

Answer 42

Complete immunization with an acellular pertussis containing vaccine DTAP or TDAP vaccine rather than just diphtheria toxoid/tetanus toxoid vaccine Children may return to school after they have completed 5 days of ABX or if untreated, 21 days after symptoms begin

Question 43

Pertussis in adults

Answer 43

Azithromycin or clarithromycin Bactrim is alternative TDaP is recommended at age11-12

Question 44

Patients with B. Pertussis infections:

Answer 44

Should avoid contact with young children and infants until they have completed at least 5 days of ABX. Should not return to work/school etc until after 5 days of ABX

Question 45

Pertussis prevention

Answer 45

Tetanus and diphtheria toxoids and acellular pertussis (TDaP) vaccination Routine vaccination: Previously did not receive Tdap at or after age 11: 1 dose Tdap, then Td or Tdap every 10 years

Question 46

Cystic fibrosis

Answer 46

For patients under 6 there is no evidence of best treatment Therapies focus on: ``` Clearance of airway secretions Reversal of bronchoconstriction Treatment of respiratory infections Replacement of pancreatic enzymes Nutritional and psychosocial support ```

Question 47

Cystic fibrosis for under 6 years old

Answer 47

For patients under 6 there is no evidence of best treatment Therapies focus on: ``` Clearance of airway secretions Reversal of bronchoconstriction Treatment of respiratory infections Replacement of pancreatic enzymes Nutritional and psychosocial support ```

Question 48

Cystic fibrosis managment

Answer 48

CFTR modulators - depends on age and genotype Airway clearance therapies - inhaled Dnase, inhaled hypertonic saline, chest physiotherapy Prevention/management of infections - vaccinations, infection control Bronchodilators - inhaled beta 2 adrenergic receptor agonist Anti-inflammatory therapy - azithromycin, ibuprofen, inhaled glucocorticoids Prevention of acute exacerbations - routine surveillance of sputum cultures or throat swabs

Question 49

CFTR

Answer 49

Cystic fibrosis transmembrane conductance regulator All patients with CF should undergo CFTR genotyping to determine if they carry one of the variants approved for CFTR modulator therapy Selection depends on variant and child's age

Question 50

Elexacaftor, Tezacaftor, Ivacaftor | Trikafta

Answer 50

Indications | Tx of CF in patients 12 and older who have at least one "F508del" mutation in the CFTR gene

Question 51

Foreign body aspiration in children

Answer 51

FB aspiration should be suspected in children who have sudden onset of lower respiratory symptoms, or those who do not respond to standard management of other suspected etiologies such as pneumonia, asthma, or croup Highest risk is children ages 1-3

Question 52

Hyaline membrane disease

Answer 52

Now known as Respiratory distress syndrome (RDS) It is caused by surfactant deficiency that leads to alveolar collapse and diffuse atelectasis Tx: Synchronized intermittent mandatory ventilation Administration of exogenous surfactants can be used in the delivery room as prophylaxis or as rescue

Question 53

poractant alfa

Answer 53

Curosurf (lung surfactant) indications Treatment (rescue) of respiratory distress syndrome (RDS) in premature infants

Question 54

Childhood asthma | Treatment for acute exacerbation

Answer 54

Treatment for acute exacerbation Goal: relieve the bronchoconstriction SABA - albuterol, levobuterol SAMA - Ipratropium Bromide Systemic glucocorticoids - Prednisone, prednisolone

Question 55

Childhood Asthma | Treatment for asthma management

Answer 55

Treatment for asthma management Patient education - Optimizing control of asthma symptoms and prevention Control of asthma triggers Monitoring for changes in symptoms or lung function Pharmacological therapy

Question 56

Childhood asthma | Treatment of asthma - control and prevention

Answer 56

Treatment of asthma - control and prevention inhaled glucocorticoids - Budesonide, fluticasone propionate, Beclomethasone Leukotriene modifiers - Montelukast Long acting beta agonist bronchodilator and inhaled steroid combo

Question 57

Carcinoid tumors

Answer 57

Carcinoid syndrome is relatively uncommon But it can appear in both parents with locoregional or disseminated disease. Surgical resection represents the preferred strategy for patients with locoregional lung NET's producing carcinoid syndrome. For unresectable disease, we recommend initiation of long acting somatostatin analog (SSA) therapy with octreotide

Question 58

Carcinoid syndrome symptoms

Answer 58

``` Skin flushing Hives NVD Cramps Bronchoconstriction Cough, wheezing, Dyspnea Hepatomegaly Pelvic fibrosis Cardiac valve lesions ```

Question 59

Carcinoid tumors with progressive or disseminated disease that is SSA resistant (somatostatin analog)

Answer 59

Everolimus

Question 60

Somatostatin analogs (SSA)

Answer 60

Injections of SSA'a can be used to lessen symptoms of carcinoid syndrome including diarrhea and flushing Octreotide (Sandostatin Depot) can be long or short acting They help block serotonin which helps with diarrhea and flushing

Question 61

Octreotide

Answer 61

Sandostatin (SSA) Warnings: DM, Hypothyroidism, CVD Adverse: Gallbladder abnormalities, GI Upset, Bradycardia, conduction abnormalities, arrhythmias, hyperglycemia, hypoglycemia, hypothyroidism

Question 62

Everolimus

Answer 62

Afinitor (mTOR Kinase inhibitor) Indications: In adults with progressive neuroendocrine tumors of pancreatic origin (PNET) or progressive, well differentiated, non functional endocrine Tumors (NET) of GI or lung origin with unresectable locally advanced or metastatic disease Not for treating functional carcinoid tumors Contraindications Allergy to other rapamycin derivatives Adverse: Stomatitis, infections, rash, fatigue, diarrhea, edema

Question 63

telotristat

Answer 63

Xermelo (tryptophan hydroxylase inhibitor) Indications: In combination with somatostatin analog therapy to treat carcinoid syndrome diarrhea in adults inadequately controlled by SSA therapy Adverse: Nausea, HA, Increased GGT, Depression, flatulence, decreased appetite Recently approved in the US for Diarrhea from carcinoid syndrome It targets overproduction of serotonin within neuroendocrine tumor cells and is taken in combo with a somatostatin analog when the SSA alone is not effective.

Question 64

Most common types of lung cancer

Answer 64

Most common Non small cell lung cancer = 85% (NSCL) Subtype of NSCL Most common Adenocarcinoma 40%

Question 65

NSCLC Non Small Cell lung Cancer Medication

Answer 65

Pembrolizumab monotherapy

Question 66

Patients with NSCLC | Non Small Cell lung Cancer

Answer 66

Initial management is largely determined by the stage of disease Early stages: surgical resection If extensive intrathoracic disease use concurrent chemoradiation Patients with advanced disease are managed palliatively with systemic therapy or local palliative modalities

Question 67

Patients with SCLC | Small cell lung cancer

Answer 67

Systemic Chemo because SCLC is spread throughout body For those with limited stage disease, thoracic radiation in combo with chemo is best Prophylactic cranial irradiation is often used to decrease brain metastases and prolong survival Both may be beneficial in those with a complete or partial response to initial systemic chemo

Question 68

pembrolizumab

Answer 68

Keytruda (human programmed death receptor (PD-1) blocking antibody) Indications First line single agent for stage 3 NSCLC for those who are not eligible for surgery or chemo Adverse: Fatigue, MSK pain, decreased appetite, pruritus, diarrhea, nausea Elimination: Half life 22 days

Question 69

Cisplatin

Answer 69

Platinum coordination complex Warning: Nephrotoxicity, peripheral neuropathy, NV, myelosuppression Adverse: Nephrotoxicity, peripheral neuropathy, NV, myelosuppression, ototoxicity

Question 70

Cisplatin MOA

Answer 70

Cytotoxicity results from selective inhibition of tumor DNA synthesis by formation of intra and interstrand crosslinks in the DNA molecule

Question 71

etoposide

Answer 71

Topoisomerase inhibitor Adverse: GI, mucositis, myelosuppression (neutropenia and thrombocytopenia may be fatal)

Question 72

Sphere of lung cancer complications

Answer 72

``` SPHERE S - Superior vena cava syndrome P - pancoast tumor H - Horner syndrome E - Pleural effusion R - Recurrent laryngeal symptoms (hoarseness) E - Endocrine ```

Question 73

Horner syndrome

Answer 73

``` SAMPLE S - Sympathetic nerve fiber injury A - Anhidrosis M - Miosis P - Ptosis L - Loss of ciliospinal reflex E - Enopthalmos ```

Question 74

Etiologies of Pulmonary nodules

Answer 74

Benign = Infectious granuloma mycobacteria, coccidiomycosis, histoplasmosis, TB Malignant = adenocarcinoma

Question 75

Paraneoplastic syndrome | Small cell carcinoma

Answer 75

SIADH → Hyponatremia Increased ACTH → Cushings syndrome Carcinoid → Flushing & diarrhea Eaton lambert syndrome SVC syndrome

Question 76

Paraneoplastic syndrome | Squamous cell carcinoma

Answer 76

PTHrp → Hypercalcemia Horner syndrome → Ptosis, miosis, anhidrosis Pancoast tumor → 1st, 2nd, thoracic nerve → Shoulder pain → Ulnar nerve pain

Question 77

Paraneoplastic syndrome SIADH

Answer 77

SCLC accounts for 75% of all malignancy related to SIADH

Question 78

Lambert Eaton Myasthenic Syndrome (LEMS)

Answer 78

50% are Autoimmune disorder diagnosed after age 40 can occur in children under age 10 50% also associated with small cell lung cancer Diagnosed after age 50

Question 79

Neurotransmitter associated with LEMS

Answer 79

ACH

Question 80

Treatment for LEMS in patients with weakness

Answer 80

Amifampridine

Question 81

amifampridine

Answer 81

Firdapse (potassium channel blocker) Indication: LEMS Contra: History of seizures

Question 82

amifampridine (Firdapse) MOA

Answer 82

Potassium channel blocker Blocks potassium channels allowing calcium channels to stay open longer this increases ACH release Increased ACH binding to muscle ACH receptors restores lost muscle strength

Question 83

Paraneoplastic syndrome

Answer 83

Hematologic ``` Anemia Leukocytosis Thrombocytosis Eosinophilia Hypercoagulable disorders ```

Question 84

ARDS

Answer 84

Typical regime Methylprednisolone 1mg/kg for 21-28 days or Dexamethasone 20mg IV QD for 5 days followed by 10mg QD for 5 days

Question 85

Which antibiotic is given for patients with CF and positive for Pseudomonas aeruginosa? ``` penicillin levofloxacin azithromycin vancomycin metronidazole ```

Answer 85

azithromycin

Question 86

Which of the following medications is a SABA? ``` albuterol (Ventolin) ipratropium bromide (Atrovent) salmeterol (Serevent) montelukast (Singulair) omalizumab (Xolair) ```

Answer 86

albuterol (Ventolin)**

Question 87

Which of the following medications is a LABA? ``` albuterol (Ventolin) ipratropium bromide (Atrovent) salmeterol (Serevent) montelukast (Singulair) omalizumab (Xolair) ```

Answer 87

salmeterol (Serevent)**

Question 88

Which of the following medications is a IgE antagonist? ``` albuterol (Ventolin) ipratropium bromide (Atrovent) salmeterol (Serevent) montelukast (Singulair) omalizumab (Xolair) ```

Answer 88

omalizumab (Xolair)**

Question 89

Which of the following medications is a LTRA? ``` albuterol (Ventolin) ipratropium bromide (Atrovent) salmeterol (Serevent) montelukast (Singulair) omalizumab (Xolair) ```

Answer 89

montelukast (Singulair)**

Question 90

Which of the following medications is a SAMA? ``` albuterol (Ventolin) ipratropium bromide (Atrovent) salmeterol (Serevent) montelukast (Singulair) omalizumab (Xolair) ```

Answer 90

ipratropium bromide (Atrovent)**

Question 91

Which antibiotics is usually the mainstay of therapy for patients with acute epiglottitis? ``` Ceftriaxone plus azithromycin Ceftriaxone plus clarithromycin Ceftriaxone plus metronidazole Ceftriaxone plus vancomycin Ceftriaxone plus amoxicillin ```

Answer 91

Ceftriaxone plus vancomycin

Question 92

What is the usual first-line agent (no allergies) for patients with pertussis? ``` Azithromycin metronidazole TMP-SMX vancomycin amoxicillin ```

Answer 92

Azithromycin**

Question 93

What is the usual alternative agent for patients with pertussis? ``` azithromycin metronidazole TMP-SMX vancomycin amoxicillin ```

Answer 93

TMP-SMX

Question 94

Which of the following medications has anticholinergic adverse effects? ``` albuterol (Ventolin) ipratropium bromide (Atrovent) salmeterol (Serevent) montelukast (Singulair) omalizumab (Xolair) ```

Answer 94

ipratropium bromide (Atrovent)**

Question 95

Which medication blocks the production of hormones such as serotonin, reducing the flushing and diarrhea associated with carcinoid syndrome? octreotide (Sandostatin) everolimus (Afinitor) telotristat ethyl (Xermelo) pembrolizumab (Keytruda)

Answer 95

octreotide (Sandostatin)

Question 96

Which medication is a mTor inhibitor? octreotide (Sandostatin) everolimus (Afinitor) telotristat ethyl (Xermelo) pembrolizumab (Keytruda)

Answer 96

everolimus (Afinitor)

Question 97

Which medication was recently approved in the U.S. for the treatment of diarrhea caused by carcinoid syndrome? octreotide (Sandostatin) everolimus (Afinitor) telotristat ethyl (Xermelo) pembrolizumab (Keytruda

Answer 97

telotristat ethyl (Xermelo)

Question 98

Which medication shows good promise as a first-line treatment of Stage III non-small cell lung cancer (NSCLC) in patients who are not candidates for surgical resection or definitive chemoradiation, or metastatic NSCLC? octreotide (Sandostatin) everolimus (Afinitor) telotristat ethyl (Xermelo) pembrolizumab (Keytruda)

Answer 98

pembrolizumab (Keytruda)

Question 99

Which is not considered a feature of Horner’s syndrome? Mydriasis Anhidrosis Enophthalmos Ptosis

Answer 99

Mydriasis

Question 100

Which medication is considered a human programmed death receptor-1 (PD-1)-blocking antibody? octreotide (Sandostatin) everolimus (Afinitor) telotristat ethyl (Xermelo) pembrolizumab (Keytruda)

Answer 100

pembrolizumab (Keytruda)

Question 101

Which of the following does not belong in the lung cancer complications mnemonic “Sphere?” Pancoast tumor Horner Syndrome Spherocytosis Pleural effusion

Answer 101

Spherocytosis

Question 102

Which of the below is a contraindication for the medication, amifampridine (Firdapse)? History of MI History of liver failure History of seizures History of atrial fibrillation

Answer 102

History of seizures

Question 103

Which neurotransmitter is most associated with the medication, amifampridine (Firdapse)? Dopamine Norepinephrine Serotonin Acetylcholine

Answer 103

Acetylcholine

Question 104

Which below drug is usually the mainstay drug for acute respiratory distress syndrome? ASA Clopidogrel (Plavix) Enoxaparin (Lovenox) methylprednisolone

Answer 104

methylprednisolone

Question 105

Immunomodulators

Answer 105

For patients whose asthma is inadequately controlled on high-dose inhaled glucocorticoids and LABAs, the anti-IgE therapy omalizumab (Xolair)may be considered if there is objective evidence of sensitivity to a perennial allergen (by allergy skin tests or in vitro measurements of allergen-specific IgE) and if the serum IgE level is within the established target range.

Question 106

Omalizumab

Answer 106

Not for relief of acute bronchospasm or status asthmaticus. Not indicated for treatment of other allergic conditions. Boxed Warning: Anaphylaxis. Antiasthmatic (IgE blocker).