Pharm Resp Flashcards
(320 cards)
1
Q
SBA: What is the hallmark feature of asthma?
A
Answer: Reversible airflow limitation due to chronic airway inflammation.
2
Q
SBA: Which immune cells are primarily responsible for the late phase of an asthma attack?
A
Answer: Eosinophils.
3
Q
SBA: What is the role of mast cells in asthma?
A
Answer: Degranulate to release histamine and other inflammatory mediators during the early phase.
4
Q
Answer: Degranulate to release histamine and other inflammatory mediators during the early phase.
A
Answer: Interleukin-4 (IL-4).
5
Q
SBA: What is the primary effect of leukotrienes in asthma?
A
Answer: Induce bronchoconstriction, mucus production, and vascular permeability.
6
Q
SBA: What type of hypersensitivity reaction is asthma classified as?
A
Answer: Type I hypersensitivity.
7
Q
SBA: Which medication class targets the immediate bronchospasm during an asthma attack?
A
Answer: Beta-2 agonists (e.g., salbutamol).
8
Q
SBA: Which factor differentiates intrinsic asthma from extrinsic asthma?
A
Answer: Intrinsic asthma is triggered by non-allergic factors like cold air or exercise, while extrinsic asthma is IgE-mediated.
9
Q
SBA: What is the primary diagnostic criterion for obstructive airway disease in asthma?
A
Answer: Reduced FEV1/FVC ratio (<70%).
10
Q
SBA: What is the effect of acetylcholine binding to M3 receptors in asthma?
A
Answer: Bronchoconstriction.
11
Q
EMQ: Match the phase of asthma to its characteristic.
A
Early phase: Mast cell degranulation and mediator release.
Late phase: Eosinophil infiltration and airway remodeling.
12
Q
EMQ: Match the inflammatory mediator to its role in asthma.
A
Histamine: Vasodilation and increased mucus secretion.
Leukotrienes: Bronchoconstriction and increased vascular permeability.
IL-5: Attracts and activates eosinophils.
13
Q
EMQ: Match the trigger to the asthma subtype.
A
House dust mites: Extrinsic asthma.
Cold air: Intrinsic asthma.
Aspirin: Aspirin-exacerbated respiratory disease (AERD).
14
Q
EMQ: Match the therapeutic goal to the treatment approach.
A
Reliever medication: Beta-2 agonists.
Preventer medication: Inhaled corticosteroids.
Long-term control: Leukotriene receptor antagonists.
15
Q
EMQ: Match the diagnostic test to its purpose.
A
Spirometry: Confirms obstructive lung disease.
Skin prick test: Identifies allergic triggers.
Fractional exhaled nitric oxide (FeNO): Assesses airway inflammation.
16
Q
Describe the early and late phases of an asthma attack.
A
Answer:
Early phase: Immediate mast cell degranulation, release of histamine, prostaglandins, and leukotrienes causing bronchoconstriction.
Late phase: Eosinophil infiltration, continued inflammation, and airway remodeling. (2 marks)
17
Q
What are the hallmark symptoms of asthma?
A
Answer: Wheezing, dyspnoea, chest tightness, and coughing, often worse at night or with triggers. (2 marks)
18
Q
Explain the role of IgE in asthma pathophysiology.
A
Answer: IgE binds allergens, cross-links on mast cells, causing degranulation and mediator release. (2 marks)
19
Q
List three trigger factors for asthma.
A
Answer: Allergens (e.g., pollen, dust mites), exercise, cold air, or respiratory infections. (2 marks)
20
Q
What are the therapeutic goals for asthma management?
A
Answer: Minimize symptoms, reduce reliever use, prevent exacerbations, improve lung function, and avoid activity limitation. (2 marks)
21
Q
SBA: What is the primary genetic mutation responsible for cystic fibrosis?
A
Answer: Mutation in the CFTR gene.
22
Q
SBA: What is the first-line mucolytic recommended for patients with cystic fibrosis?
A
SBA: What is the first-line mucolytic recommended for patients with cystic fibrosis?
23
Q
SBA: Which bacterial pathogen is most commonly associated with lung infections in cystic fibrosis?
A
Answer: Pseudomonas aeruginosa.
24
Q
SBA: What is the recommended treatment for pancreatic insufficiency in cystic fibrosis?
A
Answer: Pancreatin (e.g., Creon).
25
SBA: Which CFTR modulator is classified as a "potentiator"?
Answer: Ivacaftor.
26
SBA: What is the key role of hypertonic sodium chloride in cystic fibrosis management?
Answer: Hydrates airway mucus and improves clearance.
27
SBA: How frequently should children with cystic fibrosis undergo routine review according to NICE guidelines?
Answer: Every 8 weeks.
28
SBA: What are the four ethical principles considered in medical decision-making for CFTR modulator funding?
Answer: Autonomy, beneficence, non-maleficence, and justice.
29
SBA: In cystic fibrosis, what complication is characterized by distal intestinal obstruction?
Answer: Distal intestinal obstruction syndrome (DIOS).
30
SBA: What is the mechanism of action of CFTR "correctors"?
Answer: Stabilize misfolded CFTR proteins and increase their membrane expression.
31
EMQ: Match the drug to its function.
Dornase alfa: Breaks down DNA in sputum to reduce viscosity.
Pancreatin: Aids in digestion for pancreatic insufficiency.
Hypertonic sodium chloride: Improves mucus clearance in the airways.
32
EMQ: Match the pathogen to its relevance in CF lung infections.
Pseudomonas aeruginosa: Chronic infection and biofilm formation.
Staphylococcus aureus: Common early-life pathogen.
Burkholderia cepacia complex: Associated with poor prognosis.
33
EMQ: Match the CFTR modulator to its action.
Ivacaftor: Potentiates CFTR channel activity.
Lumacaftor: Corrects CFTR misfolding.
Elexacaftor: Increases CFTR membrane expression.
34
EMQ: Match the complication to its characteristic feature.
Pancreatic insufficiency: Malabsorption of fat-soluble vitamins.
CF-related diabetes: Combination of insulin deficiency and resistance.
Osteoporosis: Result of chronic inflammation and malnutrition.
35
EMQ: Match the ethical principle to its description in drug funding.
Autonomy: Respecting patients’ decisions.
Justice: Ensuring fairness in access to treatment.
Beneficence: Acting in the best interest of the patient.
36
What are the primary aims of cystic fibrosis treatment?
Answer: Prevent lung infections, manage mucus clearance, treat malabsorption, and optimize lung function. (2 marks)
37
List the pharmacological treatments used in cystic fibrosis.
Answer:
Mucolytics: Dornase alfa, hypertonic sodium chloride.
Antibiotics: Targeting pathogens like Pseudomonas aeruginosa.
CFTR modulators: Ivacaftor, lumacaftor, tezacaftor, elexacaftor.
Pancreatic enzyme replacement therapy (e.g., pancreatin). (2 marks)
38
What monitoring is recommended for patients with cystic fibrosis?
Answer: Routine reviews (every 8 weeks for children, 3 months for adults), lung function tests (spirometry), and respiratory microbiology samples. (2 marks)
39
Describe the ethical principles guiding CFTR modulator funding decisions.
Answer: Autonomy, beneficence, non-maleficence, and justice, balanced with utilitarian principles to maximize benefit within limited resources. (2 marks)
40
Explain the role of non-drug treatments in cystic fibrosis management.
Answer: Airway clearance techniques, physiotherapy, regular exercise, and nutritional support. (2 marks)
41
SBA: What is the defining characteristic of uncontrolled asthma?
Answer: Symptoms on 3 or more days a week or use of a short-acting beta-agonist (SABA) 3 or more days a week, or nighttime awakening due to asthma at least once a week.
42
SBA: What is the mechanism of action of inhaled corticosteroids (ICS) in asthma management?
Answer: Reduce airway inflammation, edema, and mucus production by suppressing inflammatory mediator release.
43
SBA: What is the primary use of Maintenance and Reliever Therapy (MART) in asthma?
Answer: Combines a low-dose ICS with a long-acting beta-agonist (LABA) for both daily maintenance and symptom relief.
44
SBA: What is the first-line treatment for an acute exacerbation of COPD?
Answer: Short-acting bronchodilators (SABA/SAMA) administered via nebulizer or inhaler.
45
SBA: What is a key side effect of beta-2 agonists?
Answer: Hypokalemia.
46
SBA: How does smoking affect theophylline plasma levels?
Answer: Decreases plasma levels due to enzyme induction.
47
SBA: Which medication can cause oral candidiasis in asthma patients, and how can it be prevented?
Answer: Inhaled corticosteroids; use a spacer and rinse the mouth after inhalation.
48
SBA: What is the target oxygen saturation for COPD patients at risk of hypercapnic respiratory failure?
Answer: 88-92%.
49
SBA: What is the role of leukotriene receptor antagonists (e.g., Montelukast) in asthma management?
Answer: Reduce airway inflammation and bronchoconstriction by blocking leukotriene pathways.
50
SBA: What is the therapeutic range for theophylline plasma levels?
Answer: 10-20 mg/L.
51
EMQ: Match the drug to its side effect.
Beta-2 agonists: Hypokalemia and tachycardia.
Theophylline: Nausea, vomiting, and arrhythmias.
ICS: Oral candidiasis.
52
EMQ: Match the asthma/COPD treatment to its description.
MART: Combines ICS and LABA in one inhaler for daily and symptomatic use.
ICS/LABA: Prevents exacerbations and improves control in asthma.
SAMA: Provides rapid relief of bronchoconstriction in acute COPD exacerbations.
53
EMQ: Match the inhaler type to its advantage.
Pressurized metered-dose inhaler (pMDI): Cost-effective and widely available.
Dry powder inhaler (DPI): Does not require propellant.
Nebulizer: Delivers high doses for severe exacerbations.
54
EMQ: Match the clinical guideline to its focus.
NICE: Emphasizes stepwise treatment escalation.
BTS/SIGN: Comprehensive asthma management based on severity.
GOLD: Focuses on symptom-based COPD classification.
55
EMQ: Match the exacerbation management to its therapeutic approach.
Severe dyspnea and hypoxia: Oxygen therapy (88-92% target in COPD).
Signs of infection: Antibiotics.
Persistent symptoms after SABA: Systemic corticosteroids.
56
What are the treatment goals for asthma?
Answer: Control symptoms, reduce exacerbations, improve quality of life, and minimize reliever use. (2 marks)
57
Explain the stepwise management of asthma according to NICE guidelines.
Answer:
Step 1: SABA as needed.
Step 2: Add low-dose ICS.
Step 3: Add LABA (or MART).
Step 4: Medium-dose ICS or additional controller (e.g., LTRA). (2 marks)
58
Describe the GOLD guidelines for COPD management.
Answer:
Group A: Bronchodilator (e.g., SABA).
Group B: LABA or LAMA.
Group C: LAMA as first-line therapy.
Group D: Combination LABA + LAMA ± ICS. (2 marks)
59
What are the key components of exacerbation management in COPD?
Answer: Short-acting bronchodilators, systemic corticosteroids (e.g., prednisolone), antibiotics if infection is suspected, and oxygen therapy targeting 88-92%. (2 marks)
60
What monitoring is recommended for patients on theophylline?
Answer: Regular plasma concentration checks to maintain levels between 10-20 mg/L, monitor for hypokalemia, and adjust for drug interactions. (2 marks)
61
SBA: What is the primary mechanism of action of beta-2 agonists?
Answer: Activation of beta-2 adrenergic receptors, causing smooth muscle relaxation and bronchodilation.
62
SBA: What distinguishes LABAs from SABAs in terms of duration?
Answer: LABAs provide effects lasting up to 12 hours, while SABAs last about 4 hours.
63
SBA: What is the key structural feature contributing to the longer duration of LABAs?
Answer: A long hydrophobic tail that anchors the drug near the receptor.
64
SBA: What is the mechanism of action of leukotriene receptor antagonists (LTRAs)?
Answer: Block cysteinyl leukotriene receptors to reduce inflammation, bronchoconstriction, and mucus secretion.
65
SBA: Which leukotriene is primarily targeted by LTRAs?
Answer: LTD4.
66
SBA: What is a key side effect of theophylline?
Answer: Nausea, vomiting, or arrhythmias due to its narrow therapeutic index.
67
SBA: What is the role of histone deacetylase (HDAC) activation by theophylline?
Answer: Reverses corticosteroid resistance in severe asthma.
68
SBA: Which functional groups are essential for the activity of LTRAs?
Answer: Acidic groups, hydrogen-bond acceptors, and hydrophobic regions.
69
SBA: What is the half-life of LTRAs like montelukast?
Answer: Up to 10 hours.
70
SBA: What is the primary function of mucolytic agents in respiratory disease management?
Answer: Break down mucus to improve airway clearance.
71
EMQ: Match the drug to its mechanism of action.
Beta-2 agonists: Activate beta-2 adrenergic receptors.
LTRAs: Block cysteinyl leukotriene receptors.
Theophylline: Inhibits PDE4 and activates HDAC.
72
EMQ: Match the drug class to its therapeutic use.
SABAs: Immediate relief of asthma symptoms.
LABAs: Long-term control of asthma or COPD.
LTRAs: Preventive treatment for asthma.
73
EMQ: Match the drug to its potential side effect.
Theophylline: Arrhythmias.
LABAs: Tachycardia and hypokalemia.
LTRAs: Headaches.
74
EMQ: Match the pharmacophore-related feature to its drug.
Hydrophobic tail: LABAs.
Acidic group: LTRAs.
Lipophilic aromatic ring: LTRAs.
75
EMQ: Match the structural characteristic to the drug class.
Short duration of action: SABAs.
Anchoring hydrophobic group: LABAs.
Tetraene tail mimicked by aromatic rings: LTRAs.
76
Describe the mechanism of beta-2 agonists and their classification.
Answer: Activate beta-2 adrenergic receptors, causing bronchodilation.
SABAs (e.g., salbutamol): Short duration for acute relief.
LABAs (e.g., salmeterol): Long duration for maintenance. (2 marks)
77
What is the role of leukotriene receptor antagonists in asthma?
Answer: Block cysteinyl leukotriene receptors to reduce inflammation, bronchoconstriction, and mucus production (e.g., montelukast). (2 marks)
78
Explain the dual mechanisms of theophylline.
Answer: Inhibits phosphodiesterase-4 (PDE4) to increase cAMP and activate HDAC to reverse steroid resistance. (2 marks)
79
What are the common side effects of these drug classes?
Answer:
Beta-2 agonists: Tachycardia, tremor, hypokalemia.
LTRAs: Headaches and GI disturbances.
Theophylline: Narrow therapeutic index leading to nausea and arrhythmias. (2 marks)
80
Describe the structural feature that distinguishes LABAs from SABAs.
Answer: LABAs have a hydrophobic tail that increases receptor affinity and prolongs duration of action. (2 marks)
81
SBA: What is the purpose of a peak flow meter in asthma management?
Answer: Measures peak expiratory flow rate to assess airway obstruction.
82
SBA: How should a patient clean their inhaler spacer for optimal use?
Answer: Use warm water and mild detergent, rinse, and allow to air dry.
83
SBA: What is the recommended inhaler type for patients with poor coordination?
Answer: Pressurized metered-dose inhaler (pMDI) with a spacer.
84
SBA: What safety precaution should patients on long-term high-dose ICS follow?
Answer: Carry a steroid emergency card.
85
SBA: What is the primary reason for using spacers with pMDIs?
Answer: Increase the amount of medicine reaching the lungs.
86
SBA: What should a patient do if their peak flow reading is consistently below their personal best?
Answer: Seek medical advice as it may indicate poor asthma control.
87
SBA: Which guideline emphasizes the importance of using the same type of spacer consistently?
Answer: NICE guidelines.
88
SBA: What does the Asthma Slide Rule tool help identify?
Answer: Poorly controlled asthma and the need for treatment adjustment.
89
SBA: What is a common side effect of inhaled corticosteroids if a spacer is not used?
Answer: Oral candidiasis.
90
SBA: Which website provides comprehensive information on inhaler techniques and prescribing pathways?
Answer: RightBreathe.
91
EMQ: Match the device to its specific feature.
pMDI with spacer: Suitable for patients with poor hand-breath coordination.
DPI: Does not require a propellant.
Nebulizer: Delivers high doses for severe exacerbations.
92
EMQ: Match the test to its purpose.
eak flow meter: Assesses airway obstruction.
Spirometry: Diagnoses obstructive and restrictive lung diseases.
Fractional exhaled nitric oxide (FeNO): Measures airway inflammation.
93
EMQ: Match the safety measure to its recommendation.
Steroid emergency card: For prolonged high-dose ICS users.
Consistent spacer use: To ensure accurate ICS delivery.
Cleaning spacers: Regular cleaning with mild detergent and air drying.
94
EMQ: Match the inhaler technique issue to its solution.
Poor hand-breath coordination: Use a spacer with a pMDI.
Insufficient inhalation force: Switch to a nebulizer.
Dry mouth after ICS use: Rinse mouth after inhalation.
95
EMQ: Match the diagnostic tool to its correct interpretation.
Peak flow diary: Tracks variability in asthma control over time.
Asthma Slide Rule: Assesses symptom control and treatment adequacy.
FeNO: High levels indicate airway eosinophilic inflammation.
96
What is the purpose of using a peak flow meter in respiratory disease?
Answer: Measures peak expiratory flow rate to monitor disease control and detect exacerbations. (2 marks)
97
Describe the benefits of using a spacer with a pMDI.
Answer: Improves drug delivery to the lungs, reduces oral deposition, and minimizes side effects like oral candidiasis. (2 marks)
98
What safety measures should be followed for patients on long-term ICS therapy?
Answer: Use a spacer, rinse mouth after use, carry a steroid emergency card, and regularly review therapy. (2 marks)
99
How should a patient correctly use a peak flow meter?
Answer:
Sit or stand in a comfortable position.
Reset the pointer to zero.
Take a deep breath and blow out as hard and fast as possible.
Record the highest of three readings. (2 marks)
100
Explain how the Asthma Slide Rule and RightBreathe tools support treatment decisions.
Answer: Asthma Slide Rule identifies poorly controlled symptoms; RightBreathe provides tailored inhaler recommendations and videos. (2 marks)
101
SBA: What is the primary advantage of pulmonary drug delivery?
Answer: Rapid onset of activity and reduced systemic side effects.
102
SBA: What particle size is optimal for drug deposition in the alveolar region?
Answer: 1-5 µm.
103
SBA: Which propellants are currently used in pressurized metered-dose inhalers (pMDIs)?
Answer: Hydrofluoroalkanes (HFA-134a and HFA-227).
104
SBA: What is the main disadvantage of dry powder inhalers (DPIs)?
Answer: Requires adequate inspiratory effort from the patient.
105
SBA: Why are surfactants added to pMDI formulations?
Answer: To act as suspending agents and valve lubricants.
106
SBA: What is the main environmental concern with pMDIs?
Answer: They use hydrofluoroalkanes, which are potent greenhouse gases.
107
SBA: What method is used to fill pMDI canisters?
Answer: Cold filling or pressure filling.
108
SBA: What is the function of ethanol in pMDI formulations?
Answer: It acts as a co-solvent to increase drug solubility.
109
SBA: Which pulmonary drug delivery device is recommended for patients with severe respiratory difficulty?
Answer: Nebulizers.
110
SBA: How does the aerodynamic diameter influence drug deposition?
Answer: Smaller particles (1-5 µm) reach deeper into the lungs, while larger particles (>10 µm) are deposited in the upper airways.
111
EMQ: Match the pulmonary device to its primary advantage.
pMDI: Compact and portable.
DPI: Propellant-free design.
Nebulizer: Delivers high doses for severe cases.
112
EMQ: Match the component to its role in pMDI formulations.
Propellant (e.g., HFA-134a): Creates pressure to aerosolize the drug.
Surfactant: Ensures uniform suspension of drug particles.
Co-solvent (e.g., ethanol): Increases drug solubility.
113
EMQ: Match the inhaler type to its disadvantage.
pMDI: Requires coordination between inhalation and actuation.
DPI: Less effective in patients with low inspiratory effort.
Nebulizer: Bulky and requires a power source.
114
EMQ: Match the environmental impact to the delivery system.
pMDIs: Contribute to greenhouse gas emissions due to HFAs.
DPIs: Environmentally friendly, no propellant.
Nebulizers: Higher energy consumption.
115
EMQ: Match the drug delivery device to its historical development.
Medihaler (1956): First pMDI for adrenaline delivery.
Ventolin (1960s): First selective β2 agonist delivered via pMDI.
Salamol: Cost-effective alternative to Ventolin.
116
What are the primary advantages of pulmonary drug delivery?
Answer:
Rapid onset of action.
Lower systemic side effects due to localized delivery.
Useful for drugs with poor oral bioavailability (e.g., salbutamol). (2 marks)
117
Explain the role of particle size in pulmonary drug delivery.
Answer: Particles 1-5 µm in aerodynamic diameter are optimal for alveolar deposition. Larger particles are deposited in the upper airways, while smaller particles may be exhaled. (2 marks)
118
What are the key components of a pMDI, and their functions?
Answer:
Canister: Stores the formulation.
Propellant (e.g., HFAs): Aerosolizes the drug.
Metering valve: Controls the dose released per actuation. (2 marks)
119
Describe the main sustainability concerns with pMDIs.
Answer: HFAs are greenhouse gases; efforts are underway to replace them with more environmentally friendly alternatives. (2 marks)
120
What are the advantages and disadvantages of nebulizers compared to pMDIs and DPIs?
Answer:
Advantages: Effective for severe cases, no coordination needed.
Disadvantages: Bulky, requires a power source, time-consuming. (2 marks)
121
Answer:
Advantages: Effective for severe cases, no coordination needed.
Disadvantages: Bulky, requires a power source, time-consuming. (2 marks)
Answer: Spacers reduce the need for coordination and increase drug delivery to the lungs.
122
SBA: What is the function of lactose in DPI formulations?
Answer: It acts as a carrier particle to improve flow and uniform dosing.
123
SBA: What mechanism is used to aerosolize drugs in a jet nebulizer?
Answer: Compressed air passed through a Venturi nozzle creates low pressure, drawing liquid into a baffle for aerosolization.
124
SBA: Which type of nebulizer uses a vibrating mesh to create aerosols?
Answer: Mesh nebulizers.
125
SBA: What is the role of piezoelectric crystals in ultrasonic nebulizers?
Answer: Generate sound waves to create aerosol droplets.
126
SBA: What is a limitation of DPIs in elderly patients?
Answer: They require sufficient inspiratory effort, which may be reduced in elderly patients.
127
SBA: How does micronization improve DPI formulations?
Answer: Reduces particle size to below 5 µm for optimal lung deposition.
128
SBA: What is the primary disadvantage of nebulizers compared to inhalers?
Answer: Nebulizers are bulky and less portable.
129
SBA: What feature differentiates multidose DPIs from single-dose DPIs?
Answer: Multidose DPIs store multiple doses, whereas single-dose DPIs require manual loading of individual capsules.
130
SBA: What data can smart inhalers like the GoResp Digihaler record?
Answer: Usage frequency and inspiratory flow rate.
131
EMQ: Match the inhaler type to its feature.
Breath-actuated pMDI: Triggered by patient inspiration.
DPI: Uses patient inspiratory force to aerosolize the drug.
Nebulizer: Delivers high doses during normal breathing.
132
EMQ: Match the nebulizer type to its mechanism.
Jet nebulizer: Uses compressed air.
Ultrasonic nebulizer: Uses piezoelectric crystals.
Mesh nebulizer: Uses a vibrating mesh with laser-etched holes.
133
EMQ: Match the patient group to the recommended device.
Children under 5: Nebulizer with mask.
Elderly with poor lung function: pMDI with spacer.
Patients with arthritis: Breath-actuated pMDI.
134
EMQ: Match the DPI component to its function.
Lactose: Carrier particle for drug dispersion.
Micronized drug: Provides particles of optimal size for lung deposition.
Rotor in DPI: Generates turbulence to disaggregate powder.
135
EMQ: Match the drug delivery device to its environmental impact.
pMDI: Uses hydrofluoroalkane propellants with greenhouse effects.
DPI: Propellant-free design.
Nebulizer: High energy consumption.
136
What are the advantages of using spacers with pMDIs?
Answer: Reduces coordination requirement, increases lung deposition, decreases oral side effects like candidiasis. (2 marks)
137
Describe the formulation of DPIs.
Answer: Micronized drug particles (<5 µm) mixed with larger lactose carrier particles to improve flow and uniform dosing. (2 marks)
138
Explain the mechanism of action of jet nebulizers.
Answer: Compressed air passes through a Venturi nozzle to aerosolize the drug. Larger particles are trapped by a baffle. (2 marks)
139
List the key advantages and disadvantages of DPIs.
Answer:
Advantages: No propellants, environmentally friendly, portable.
Disadvantages: Requires sufficient inspiratory effort, less effective in patients with poor lung function. (2 marks)
140
What is the purpose of smart inhalers?
Answer: Record data like usage frequency and inspiratory flow rate, aiding in adherence monitoring and therapy optimization. (2 marks)
141
SBA: What is the primary advantage of the Respimat inhaler?
Answer: Creates a slow-moving aerosol mist with smaller particles, improving lung deposition.
142
SBA: What feature differentiates a non-pressurized MDI from a traditional pMDI?
Answer: It does not use a propellant and relies on mechanical actuation.
143
SBA: What is the particle size range for Technosphere aggregates in inhaled insulin?
Answer: 2-5 µm.
144
SBA: What was a common side effect reported with Afrezza inhaled insulin?
Answer: Cough.
145
SBA: What is the main component in e-cigarette formulations that facilitates aerosol generation?
Answer: Propylene glycol and glycerine.
146
SBA: Which gas delivery system is commonly used for patients with sleep apnea?
Answer: Continuous Positive Airway Pressure (CPAP).
147
SBA: How does scintigraphy assist in respiratory formulation evaluation?
Answer: Radiolabelled drug-carrier aggregates allow visualization of lung deposition using gamma cameras.
148
SBA: What is the role of a mesh nebulizer in pulmonary drug delivery?
Answer: Uses vibrating mesh technology to generate aerosolized droplets for inhalation.
149
SBA: What regulatory body provides guidance for licensing electronic cigarettes in the UK?
Answer: MHRA (Medicines and Healthcare products Regulatory Agency).
150
SBA: What is a critical limitation of inhaled insulin products like Exubera and Afrezza?
Answer: Poor commercial acceptance due to side effects and high cost.
151
EMQ: Match the device to its key advantage.
Respimat: Slow aerosol mist for improved lung deposition.
Mesh nebulizer: Efficient aerosol generation with minimal drug wastage.
CPAP system: Maintains airway pressure for sleep apnea management.
152
EMQ: Match the application to the pulmonary delivery system.
Insulin delivery: Technosphere inhaled insulin.
Radiolabelled drug evaluation: Scintigraphy.
Nicotine replacement therapy: Electronic cigarettes.
153
EMQ: Match the technology to its delivery method.
Vibrating mesh: Mesh nebulizer.
Compressed air: Jet nebulizer.
Mechanical actuation: Non-pressurized MDI.
154
EMQ: Match the inhalation system to its component.
E-cigarettes: Nicotine, glycerine, flavorings.
Medicinal gases: Oxygen with regulated flow.
Scintigraphy: Tc99m-radiolabelled drug aggregates.
155
EMQ: Match the product to its key drawback.
Exubera: High cost and bulky device.
Afrezza: Cough and disappointing sales.
CPAP: Requires compliance and may cause discomfort.
156
What are the benefits of using non-pressurized MDIs like Respimat?
Answer: Produce slow-moving aerosol mist with small particles, reducing the need for coordination and improving deposition. (2 marks)
157
Explain why pulmonary delivery is suitable for systemic drugs like insulin.
Answer: Large absorptive surface area (140 m²), permeable membrane, and low enzymatic activity in the lungs. (2 marks)
158
What are the limitations of current inhaled insulin products?
Answer: Side effects (e.g., cough), high cost, and poor patient acceptance. (2 marks)
159
Describe the role of scintigraphy in pulmonary drug research.
Answer: Radiolabelled formulations allow imaging of lung deposition, aiding in the evaluation of drug delivery efficiency. (2 marks)
160
List the key components of e-cigarette formulations and their functions.
Answer: Nicotine (active ingredient), propylene glycol/glycerine (aerosol generation), and flavorings. (2 marks)
161
SBA: What is the defining feature of COPD?
Answer: Airflow obstruction that is not fully reversible and progressive over time.
162
SBA: Which condition is caused by damage to the alveoli in COPD?
Answer: Emphysema.
163
SBA: What is the primary genetic risk factor for COPD?
Answer: Alpha-1 antitrypsin deficiency.
164
SBA: Which inflammatory cells are predominantly involved in COPD pathophysiology?
Answer: Neutrophils.
165
SBA: What is the primary spirometric criterion for diagnosing COPD?
Answer: FEV1/FVC ratio <70%.
166
SBA: What is the cardinal symptom triad of COPD?
Answer: Chronic cough, sputum production, and dyspnoea.
167
SBA: Why is smoking cessation the most effective intervention in COPD?
Answer: It slows the progression of lung function decline.
168
SBA: What is the mechanism of action of phosphodiesterase-4 (PDE4) inhibitors in COPD?
Answer: Inhibit PDE4 to reduce cytokine release and airway inflammation.
169
SBA: Why must oxygen therapy in COPD be administered cautiously?
Answer: High oxygen levels can suppress the hypoxic respiratory drive, leading to respiratory arrest.
170
SBA: What physiological change leads to the characteristic barrel chest in emphysema?
Answer: Hyperinflation due to loss of alveolar elastic recoil.
171
EMQ: Match the COPD subtype to its hallmark symptom.
Chronic bronchitis: Chronic cough with sputum production for at least 3 months over 2 consecutive years.
Emphysema: Dyspnoea with minimal cough, pink complexion, and pursed-lip breathing.
172
EMQ: Match the treatment to its primary purpose.
Smoking cessation: Slows disease progression.
Bronchodilators (e.g., LABA/LAMA): Relieves airflow obstruction.
PDE4 inhibitors: Reduces inflammation in moderate-to-severe COPD.
173
EMQ: Match the diagnostic criteria to the parameter.
Spirometry: FEV1/FVC ratio <70%.
Hypoxemia: PaO2 <8 kPa or SpO2 <88%.
Hypercapnia: PaCO2 >6.5 kPa.
174
EMQ: Match the drug to its side effect.
Inhaled corticosteroids: Oral candidiasis and osteoporosis.
LABA: Tachycardia and tremors.
PDE4 inhibitors: Diarrhoea and weight loss.
175
EMQ: Match the COPD severity stage to the corresponding FEV1 value.
Mild COPD: FEV1 ≥80% predicted.
Moderate COPD: FEV1 50-79% predicted.
Severe COPD: FEV1 <50% predicted.
176
What are the key pathophysiological changes in COPD?
Answer:
Chronic inflammation with neutrophil and macrophage activation.
Protease-antiprotease imbalance (e.g., neutrophil elastase vs. alpha-1 antitrypsin).
Mucus hypersecretion, ciliary dysfunction, and airway remodeling. (2 marks)
177
List the diagnostic criteria for COPD.
Answer:
Symptoms: Chronic cough, sputum production, dyspnoea.
Spirometry: FEV1/FVC ratio <70%. (2 marks)
178
Describe the role of long-acting bronchodilators in COPD management.
Answer: LABA and LAMA improve airflow, reduce symptoms, and prevent exacerbations. (2 marks)
179
What is the rationale for cautious oxygen use in COPD patients?
Answer: COPD patients may rely on hypoxic drive for respiration. High oxygen levels can suppress this drive, leading to respiratory acidosis or arrest. (2 marks)
180
How does alpha-1 antitrypsin deficiency contribute to COPD?
Answer: Reduces inhibition of neutrophil elastase, leading to alveolar destruction and emphysema. (2 marks)
181
SBA: What is the primary action of beta-2 agonists on airway smooth muscle?
Answer: Increase cAMP levels via adenylyl cyclase activation, leading to bronchodilation.
182
SBA: What receptor subtype is most important for parasympathetic control of bronchial smooth muscle?
Answer: M3 receptors.
183
SBA: Which neurotransmitter is responsible for sympathetic bronchodilation in the lungs?
Answer: Epinephrine, acting on beta-2 adrenoceptors.
184
SBA: What is the primary role of leukotriene receptor antagonists in asthma management?
Answer: Block cysteinyl leukotriene receptors to prevent bronchoconstriction.
185
SBA: What is the most common side effect of beta-2 agonists?
Answer: Tremor.
186
SBA: What is the mechanism of action of xanthines like theophylline
Answer: Inhibit phosphodiesterase (PDE), increasing cAMP levels and causing bronchodilation.
187
SBA: Which bronchodilator class is contraindicated without corticosteroids in asthma management?
Answer: Long-acting beta-2 agonists (LABAs).
188
SBA: Which type of innervation releases nitric oxide to cause bronchodilation?
Answer: Inhibitory non-adrenergic, non-cholinergic (NANC) nerves.
189
SBA: What particle size range is optimal for deposition in the small airways?
Answer: 1-5 µm.
190
SBA: How does mast cell activation contribute to asthma?
Answer: Releases inflammatory mediators like histamine, causing bronchoconstriction and increased mucus secretion.
191
EMQ: Match the drug class to its mechanism of action.
Beta-2 agonists: Increase cAMP via adenylyl cyclase activation.
Leukotriene receptor antagonists: Block cysteinyl leukotriene receptors.
Xanthines: Inhibit PDE and antagonize adenosine receptors.
192
EMQ: Match the receptor to its physiological effect.
M3 receptors: Bronchoconstriction and increased mucus production.
Beta-2 adrenoceptors: Bronchodilation and inhibition of mediator release.
Cysteinyl leukotriene receptors: Bronchoconstriction and airway inflammation.
193
EMQ: Match the unwanted effect to its bronchodilator class.
Tremor: Beta-2 agonists.
Narrow therapeutic window: Xanthines.
Dry mouth: Antimuscarinics.
194
EMQ: Match the bronchodilator to its duration of action.
Salbutamol: 4-6 hours (short-acting).
Salmeterol: 8-12 hours (long-acting).
Formoterol: Long-acting with rapid onset.
195
EMQ: Match the therapeutic aim to its treatment approach.
Rescue therapy: SABA (e.g., salbutamol).
Maintenance therapy: ICS and LABA combination.
Reduce inflammation: Inhaled corticosteroids.
196
Describe the role of the parasympathetic nervous system in bronchial tone regulation.
Answer: Parasympathetic activation via M3 receptors causes bronchoconstriction and increased mucus secretion. (2 marks)
197
What is the mechanism of beta-2 agonists in bronchodilation?
Answer: Beta-2 agonists increase cAMP through adenylyl cyclase activation, reducing intracellular calcium and causing smooth muscle relaxation. (2 marks)
198
List two bronchodilator classes other than beta-2 agonists and their mechanisms.
Answer:
Antimuscarinics: Block M3 receptors to reduce bronchoconstriction.
Xanthines: Inhibit PDE, increasing cAMP and antagonizing adenosine receptors. (2 marks)
199
Explain the importance of particle size in inhaled drug delivery.
Answer: Particles 1-5 µm in diameter reach the small airways, while larger particles are deposited in the upper airways or swallowed. (2 marks)
200
What are the key therapeutic aims in managing asthma and COPD?
Answer: Relieve bronchospasm, reduce inflammation, prevent exacerbations, and limit airway remodeling. (2 marks)
201
SBA: What is the main mechanism of action of muscarinic receptor antagonists in COPD management?
Answer: Blockade of M3 receptors, reducing bronchoconstriction and mucus secretion.
202
Answer: Blockade of M3 receptors, reducing bronchoconstriction and mucus secretion.
SBA: Which side effect is most commonly associated with inhaled muscarinic receptor antagonists?
203
SBA: What is the role of phosphodiesterase-4 inhibitors in COPD?
Answer: Inhibit PDE4, reducing cytokine release and airway inflammation.
204
SBA: Why is theophylline considered to have a narrow therapeutic index?
Answer: Plasma levels above the therapeutic range can cause cardiac dysrhythmias and seizures.
205
SBA: Which leukotriene receptor antagonist is most commonly used in asthma?
Answer: Montelukast.
206
SBA: What is the primary adverse effect of systemic corticosteroids in long-term use for COPD?
Answer: Osteoporosis.
207
SBA: What is the most common trigger of the cough reflex?
Answer: Stimulation of C fibers by irritants like smoke or dust.
208
SBA: Which mucolytic is commonly used to break disulfide bonds in mucus?
Answer: Acetylcysteine.
209
SBA: What is the primary target of omalizumab in severe allergic asthma?
Answer: Immunoglobulin E (IgE).
209
SBA: What are the phases of the cough reflex?
Answer: Irritation, inspiration, compression, expulsion, relaxation.
209
EMQ: Match the drug class to its mechanism of action.
Muscarinic receptor antagonists: Block M3 receptors.
Leukotriene receptor antagonists: Inhibit CysLT1 receptors.
Xanthines: Inhibit PDE, increasing cAMP.
210
EMQ: Match the bronchodilator to its common side effect.
Beta-2 agonists: Tremor.
Xanthines: Nervousness and insomnia.
Muscarinic antagonists: Dry mouth.
211
EMQ: Match the therapeutic target to its drug.
IL-5 pathway: Mepolizumab.
IgE: Omalizumab.
PDE4: Roflumilast.
212
EMQ: Match the cough type to its clinical feature.
Acute cough: Less than 3 weeks.
Chronic cough: More than 8 weeks.
Subacute cough: Resolves in 3-8 weeks.
213
EMQ: Match the cough therapy to its mechanism of action.
Expectorants: Increase bronchial secretions.
Mucolytics: Break disulfide bonds in mucus.
Antitussives: Suppress the cough reflex via opioid receptors.
214
Describe the role of long-acting muscarinic antagonists (LAMAs) in COPD.
Answer: Block M3 receptors to reduce bronchoconstriction and mucus production, improving airflow and reducing exacerbations. (2 marks)
215
What are the therapeutic effects of phosphodiesterase-4 inhibitors in COPD?
Answer: Reduce airway inflammation by inhibiting PDE4, lowering cytokine release from neutrophils and other inflammatory cells. (2 marks)
216
Explain the narrow therapeutic index of theophylline.
Answer: Small differences between therapeutic and toxic plasma levels can cause side effects like dysrhythmias and seizures. (2 marks)
217
List three common side effects of systemic corticosteroids.
Answer: Osteoporosis, adrenal suppression, and increased risk of infections. (2 marks)
218
What is the importance of mucolytics in respiratory disease?
Answer: Thin mucus by breaking disulfide bonds, aiding clearance in conditions like COPD and cystic fibrosis. (2 marks)
219
SBA: What is the validity period for NHS repeat prescriptions?
Answer: Up to one year from the date of issue.
220
SBA: What is required for a prescription from Switzerland to be valid in the UK?
Answer: Patient and prescriber details, medication details, prescriber signature, and date of issue.
221
SBA: What is the maximum duration of supply for a POM under an emergency request by a patient?
Answer: 30 days, except for items like contraceptives or inhalers.
222
SBA: How long must a pharmacy retain a signed order for the supply of adrenaline autoinjectors to schools?
Answer: Two years.
223
SBA: What label wording is mandatory for POMs supplied under emergency conditions?
Answer: "Emergency supply."
224
SBA: Which entity oversees the regulation of wholesale distribution of medicines?
Answer: Medicines and Healthcare products Regulatory Agency (MHRA).
225
SBA: What is a Serious Shortage Protocol (SSP)?
Answer: A guideline allowing pharmacists to amend prescriptions and supply alternatives during shortages.
226
SBA: Which medication type does not require record-keeping in the POM register?
Answer: Oral contraceptives.
227
SBA: For how long must the POM register be retained?
Answer: Two years from the date of the last entry.
228
SBA: What is the legal status of faxed prescriptions?
Answer: Not legally valid as they are not signed in indelible ink.
229
EMQ: Match the prescription type to its characteristics.
NHS repeat prescription: Valid for up to one year.
Private repeat prescription: First dispensing within six months; repeats depend on prescriber instructions.
Military prescription: FMed 296 form; private rules if pharmacy is not contracted by MOD.
230
EMQ: Match the entity to its supply requirements.
Schools: Signed order for adrenaline autoinjectors or salbutamol inhalers.
Midwives: Written requisition for midwifery medicines.
Drug treatment services: Supply naloxone under specific NHS or local authority arrangements.
231
EMQ: Match the supply type to its record requirements.
Emergency supply to a patient: Reason for supply and "Emergency supply" on the label.
Private prescription: Record in POM register.
Written requisition: Record not legally required but good practice.
232
EMQ: Match the prescriber to the medicines they can request.
Optometrist: Signed orders for POMs related to eye care.
Podiatrist: Signed orders for foot-related POMs.
Dentist: Any POM within their competence.
233
EMQ: Match the scenario to the legal guidance.
rescribing for family members: Permitted in exceptional circumstances (e.g., life-saving situations).
Supplying based on a faxed prescription: Not legally valid, use professional judgment.
Dispensing and prescribing by the same person: Should remain separate, with documented reasons if combined.
234
What are the requirements for a valid NHS repeat prescription?
Answer: Must have "RA" printed, valid for up to one year, signed by the doctor, and linked to repeat dispensing forms marked "RD." (2 marks)
235
How should private repeat prescriptions be handled?
Answer: First dispensing within six months of the date on the prescription; repeats depend on prescriber instructions, e.g., "Repeat x 3" allows four total supplies. (2 marks)
236
What are the record-keeping requirements for emergency supply at a patient’s request?
Answer: Record the reason for supply, patient details, medication details, and "Emergency supply" on the label. (2 marks)
237
Describe the protocol for supplying adrenaline autoinjectors to schools.
Answer: Requires a signed order containing the school’s name, product details, quantity, purpose, and headteacher’s signature. Retain the order for two years. (2 marks)
238
What is the importance of Serious Shortage Protocols (SSPs)?
Answer: Allows pharmacists to amend prescriptions to supply alternative medicines during shortages, improving patient care. (2 marks)
239
What is the inheritance pattern of cystic fibrosis?
Answer: Autosomal recessive.
240
What is the most common mutation associated with CF?
Answer: ΔF508 mutation.
241
What diagnostic test measures chloride levels in sweat for CF diagnosis?
Answer: Sweat test.
242
Which ion transport is primarily affected in CF?
Answer: Chloride ion transport.
243
What is the primary cause of death in CF patients?
What is the primary cause of death in CF patients?
244
What is the mechanism of action of dornase alfa in CF management?
Answer: DNAse enzyme reduces mucus viscosity.
245
What is the most common organism causing lung infections in adult CF patients?
Answer: Pseudomonas aeruginosa.
246
What type of diet is recommended for CF patients with pancreatic insufficiency?
Answer: High-calorie diet with pancreatic enzyme supplements.
247
What is the function of the CFTR protein?
Answer: Chloride ion channel regulating sweat, mucus, and digestive fluids.
248
Why is inhaled hypertonic saline used in CF?
Answer: To hydrate mucus and improve clearance.
249
Match the treatment to its therapeutic goal in CF.
Dornase alfa: Reduce mucus viscosity.
Hypertonic saline: Hydrate airway mucus.
Antibiotics: Control lung infections.
250
Match the diagnostic tool to its application in CF.
Sweat test: Measure chloride levels in sweat.
Heel prick test: Detect common CFTR mutations in newborns.
Nasal potential difference test: Assess ion transport abnormalities.
251
Match the organism to its typical infection stage in CF.
Staphylococcus aureus: Childhood.
Haemophilus influenzae: Adolescence.
Pseudomonas aeruginosa: Adulthood.
252
Match the symptom to its underlying cause in CF.
Fatty stools: Pancreatic enzyme deficiency.
Chronic cough: Thick, sticky mucus in airways.
Poor growth: Malabsorption of nutrients.
253
Match the gene therapy goal to its target in CF.
Gene editing: Correct CFTR mutations.
mRNA therapy: Produce functional CFTR protein.
254
Explain the role of CFTR mutations in CF pathophysiology.
Answer: CFTR mutation leads to defective chloride ion transport, causing dehydrated, thick mucus and impaired mucociliary clearance. (2 marks)
255
List two diagnostic methods for CF.
Answer: Sweat test and genetic testing for CFTR mutations. (2 marks)
256
What are the main goals of CF management?
Answer: Promote mucus clearance, prevent lung infections, provide adequate nutrition, and manage intestinal obstruction. (2 marks)
257
Describe the role of inhaled dornase alfa in CF treatment.
Answer: Reduces mucus viscosity by breaking down extracellular DNA. (2 marks)
258
What is the significance of stratifying treatment based on disease severity?
Answer: Tailors therapy to improve quality of life and limit exacerbations. (2 marks)
259
What is the validity period for NHS repeat dispensing prescriptions?
Answer: Up to one year.
260
What does WDA stand for in wholesale dealing?
Answer: Wholesale Distribution Authorisation.
261
What must be included on a school’s signed order for adrenaline autoinjectors?
Answer: Name of school, product details, and quantity required.
262
What is the maximum supply duration for emergency supply of a POM at a patient’s request?
Answer: 30 days.
263
What wording must appear on the label for emergency supplies?
Answer: "Emergency Supply."
264
Which prescribers can issue prescriptions legally valid in the UK from the EEA or Switzerland?
Answer: Approved health professionals from the EEA or Switzerland.
265
Which document must pharmacies maintain for recording private prescription supplies?
Answer: POM register.
266
What does an ‘RA’ on an NHS prescription indicate?
Answer: Repeat Authorisation.
267
What is the key difference between PSDs and PGDs?
Answer: PSDs are patient-specific; PGDs apply to defined groups.
268
What is the purpose of the "Choose Pharmacy EMS Module" in Wales?
Answer: To access the Welsh GP Record for relevant medication information.
269
5 EMQ Questions and Answers
Match the prescription type to its key feature.
NHS Repeat: Valid for one year.
Private Repeat: Number of repeats indicated on prescription.
Military: Treated as private unless covered by MOD contract.
270
Match the record to its requirement.
POM register: Emergency supply records.
Prescription record: Oral contraceptives exempt from keeping.
Signed order: School’s supply of salbutamol inhalers.
271
Match the WDA exemption to the condition.
Same legal entity: No WDA required.
For profit: Requires WDA.
For onward wholesale: Prohibited under exemption.
272
Match the supply type to its prescriber.
Optometrist: Signed order for POMs within their scope.
Paramedic: Supplied based on requisition for first aid.
Podiatrist: POMs they can administer.
273
Match the prescription requirement to its source.
EEA/Swiss prescription: Full prescriber and patient details.
Faxed prescription: Not legally valid.
Repeatable prescription: Supply within 6 months for first dispensing.
274
List the key requirements for private prescriptions.
Answer: Patient details, medication details, prescriber’s details, date, and signature. (2 marks)
275
What is the purpose of recording in the POM register?
Answer: Maintains audit trail for private prescriptions, emergency supplies, and requisitions. (2 marks)
276
Explain how emergency supply at the patient’s request works.
Answer: Pharmacist interviews patient, confirms immediate need and prior prescription, and supplies up to 30 days. (2 marks)
277
What is the role of the MHRA in wholesaling?
Answer: Oversees licensing and compliance with GDP standards. (2 marks)
278
Describe the difference between PSDs and PGDs.
Answer: PSDs are for named patients; PGDs cover defined patient groups for specific conditions. (2 marks)
279
SBA: What is the primary mechanism of action of short-acting muscarinic antagonists (SAMAs)?
Answer: Block M3 receptors to prevent bronchoconstriction.
280
SBA: What functional group in muscarinic antagonists contributes to their lack of CNS penetration?
Answer: Quaternary nitrogen.
281
SBA: How does the duration of action differ between SAMAs and LAMAs?
Answer: SAMAs act for 3-5 hours, while LAMAs last 12-24 hours.
282
SBA: Which corticosteroid is commonly used for its anti-inflammatory effects in asthma?
Answer: Fluticasone.
283
SBA: What is the mechanism of action of mucolytic agents like N-acetylcysteine?
Answer: Break disulfide bonds in mucus to reduce viscosity.
284
SBA: What is a potential adverse effect of inhaled corticosteroids?
Answer: Oral candidiasis.
285
SBA: What is the pharmacophore of beta-2 agonists required for activity?
Answer: Hydroxyl groups on the catechol ring.
286
SBA: What is the structural difference between SABA and LABA molecules?
Answer: LABAs have a longer hydrophobic tail, increasing receptor binding duration.
287
SBA: Which drug is an example of a long-acting muscarinic antagonist (LAMA)?
Answer: Tiotropium.
288
SBA: What type of reaction is involved in the thiol-disulfide exchange mechanism of mucolytics?
Answer: Substitution by a nucleophile.
289
EMQ: Match the drug to its respiratory application.
Ipratropium: Short-acting bronchodilator for COPD.
Fluticasone: Long-term anti-inflammatory therapy in asthma.
N-acetylcysteine: Mucolytic to reduce mucus viscosity.
290
EMQ: Match the muscarinic antagonist to its duration of action.
Ipratropium: 3-5 hours (SAMA).
Tiotropium: 24 hours (LAMA).
Glycopyrronium: 12 hours (LAMA).
291
EMQ: Match the mechanism to the drug class.
Blockade of M3 receptors: Muscarinic antagonists.
Thiol-disulfide exchange: Mucolytics.
Inhibition of phosphodiesterase: Xanthines.
292
EMQ: Match the corticosteroid to its application.
Prednisolone: Acute exacerbation of asthma.
Fluticasone: Long-term asthma management.
Ciclesonide: Pro-drug activated in the lungs.
293
EMQ: Match the drug to its adverse effect.
Inhaled corticosteroids: Oral candidiasis.
Beta-2 agonists: Tremor.
Muscarinic antagonists: Dry mouth.
294
Describe the role of SAMAs and LAMAs in respiratory management.
Answer:
SAMAs (e.g., ipratropium) provide short-term relief by blocking M3 receptors.
LAMAs (e.g., tiotropium) provide prolonged bronchodilation and reduce exacerbations. (2 marks)
295
Explain the mechanism of action of inhaled corticosteroids.
Answer: Inhibit inflammatory mediators (e.g., PGE2, leukotrienes) and upregulate beta-2 receptors to enhance bronchodilator response. (2 marks)
296
What structural feature extends the duration of action of LABAs compared to SABAs?
Answer: The hydrophobic tail of LABAs binds to receptor anchoring sites, prolonging action. (2 marks)
297
List two mucolytics and their mechanisms of action.
Answer:
N-acetylcysteine: Breaks disulfide bonds in mucus.
Carbocysteine: Reduces mucus viscosity. (2 marks)
298
What are the common adverse effects of these respiratory drug classes?
Answer:
Inhaled corticosteroids: Oral candidiasis, dysphonia.
Muscarinic antagonists: Dry mouth.
Beta-2 agonists: Tachycardia, tremor. (2 marks)
299
SBA: What is chirality in molecules?
Answer: Chirality refers to molecules that are non-superimposable mirror images, typically due to a chiral center bonded to four different groups.
300
SBA: What system is used to assign configurations to chiral centers?
Answer: The Cahn-Ingold-Prelog (CIP) priority rules, designating structures as R (rectus) or S (sinister).
301
SBA: What differentiates enantiomers?
Answer: How they rotate plane-polarized light and their interaction with chiral environments (e.g., biological receptors).
302
SBA: Which property of enantiomers is identical?
Answer: Physical properties like boiling point and solubility (except in chiral environments).
303
SBA: What is the role of polarimetry in chirality?
Answer: Measures specific optical rotation to determine enantiomeric purity and excess.
304
SBA: Who first demonstrated the separation of enantiomers?
Answer: Louis Pasteur, using sodium ammonium tartrate crystals.
305
SBA: What is racemic resolution?
Answer: The process of separating a racemic mixture into its individual enantiomers.
306
SBA: Why is chirality important in drug design?
Answer: Receptors and enzymes are chiral, leading to enantiomers having different pharmacological effects.
307
SBA: What is the primary method used in separating enantiomers via chromatography?
Answer: Using a chiral stationary phase to differentiate enantiomers by affinity.
308
SBA: How does (S)-Naproxen achieve enantiomeric purity?
Answer: Through asymmetric synthesis using a chiral catalyst.
309
EMQ: Match the term to its description.
Enantiomer: Non-superimposable mirror images.
Diastereomer: Non-mirror image stereoisomers.
Racemic mixture: 1:1 mixture of two enantiomers.
310
EMQ: Match the technique to its purpose.
Polarimetry: Determines specific optical rotation.
Chromatography: Separates enantiomers using a chiral column.
Crystallization: Separates based on solubility differences.
311
EMQ: Match the chiral drug to its clinical significance.
Thalidomide: Teratogenic effects linked to chirality.
Ibuprofen: Only the (S)-enantiomer is active.
Propranolol: Both enantiomers contribute to pharmacological effects.
312
EMQ: Match the chiral separation method to its principle.
Resolution: Separates racemic mixtures into enantiomers.
Asymmetric synthesis: Directly produces the desired enantiomer.
Chromatography: Exploits differences in chiral interactions.
313
EMQ: Match the stereochemical designation to its feature.
R: Clockwise priority arrangement.
S: Counterclockwise priority arrangement.
Racemic: Equal mix of R and S enantiomers.
314
Define chirality and explain its importance in pharmaceuticals.
Answer: Chirality refers to molecules with non-superimposable mirror images. It is crucial because biological receptors and enzymes are chiral, affecting drug efficacy and safety. (2 marks)
315
What methods are used to separate enantiomers?
Answer: Chromatography (chiral stationary phase), crystallization, and racemic resolution. (2 marks)
316
Describe the role of polarimetry in analyzing chirality.
Answer: Measures specific optical rotation to determine enantiomeric purity and excess. (2 marks)
317
List three examples of drugs with significant chiral relevance.
Answer:
Thalidomide: Teratogenic effects differ between enantiomers.
Ibuprofen: Only the (S)-enantiomer is active.
Propranolol: Both enantiomers contribute to pharmacological effects. (2 marks)
318
What is asymmetric synthesis, and why is it important?
Answer: A method to produce a single enantiomer directly using chiral catalysts, reducing waste and improving drug purity. (2 marks)
