Pharma written

Question 1

Give an account about asthma therapy ?

Answer 1

Bronchodilator drugs: like beta agonist, antimuscarinic drugs, methylxathines

Anti-inflammatory drugs like corticoids, leukotriene antagonist and mast cell stabilizers

Question 2

Mechanism of action of beta agonist

Answer 2

B2 receptor stimulation–> activates adenyl cyclase —-> increase cAMP—->bronchodilatation

inhibit bronchoconstrictor mediators from mast cells

Increase ciliary activity

Question 3

Salmeterol & Formoterol should not be used as monotherapy

Answer 3

Because they have no anti-inflammatory action they should not be used as monotherapy for asthma. Should be combined with corticosteroids as long term control medications of asthma

Question 4

What are the adverse effects of Beta agonist?

Answer 4

Tachycardia

Tremors

Nervous tension

Tolerance

Hypokalemia due to increase activity of the Na/K ATPase pump

Question 5

Give the mechanism of action of methylxanthines

Answer 5

Methylxanthines inhibit phosphodiesterase enzyme type 4 (PDE4). Leads to accumulation of intracellular cAMP and cGMP leading to bronchodilation

Inhibition of PDE4 reduces release of cytokines.

Improves skeletal muscle contractility

Question 6

Adverse effects of thyophylline?

Answer 6

Gastrointestinal: nausea, anorexia, vomiting, abdominal pain, diarrhea, hyperacidity

Neurological: Headache, tremor, irritability, insomnia, confusion, dizziness, tinnitus, major seizures

Cardiovascular: Cardiac dysrhythmias

Allergic: Rashes, fever

Question 7

Mechanism of action of corticosteroids?

Answer 7

Inhibition production of inflammatory cytokines IL 1, 2, 3, 4 TNF

Inhibition of phospholipase A2 which inhibition breakdown of arachidonic acid which all metabolic products of arachidonic acid as leukotrienes

Inhibition of eosinophilic and lymphatic airway mucosal inflammation of asthmatic airways

Inhibition of antibody formation

Increase B2 agonist action

Question 8

Adverse of inhaled corticosteroids

Answer 8

Oropharyngeal candidiasis

Hoarseness of voice

Question 9

Why ciclesonide is preferred than other lipid soluble corticosteroids?

Answer 9

enters small airways with high lung deposition. Is a prodrug activated by cleavage by esterases in bronchial epithelial cells. It causes less dysphonia and candidiasis than other corticosteroids

Question 10

Give the reason mast cell stabilizers have little clinical use

Answer 10

Because cromolyn is not a bronchodilator, it is not useful managing an acute asthma attack. It also has short duration of action.

Question 11

Enumerate the clinical use of mast cell stabilizers

Answer 11

Bronchial asthma
Allergic rhinitis
Allergic conjunctivitis

Question 12

Give the clinical use of leukotrienes antagonist?

Answer 12

They are in benefit is asthma with concomitant allergic rhinitis

Question 13

Enumerate the side effects of leukotrienes antagonist

Answer 13

Insomnia and irritability
Vivid dreams
Vasculitis
Eosinophilia

Question 14

What are the indications of acetylcysteine?

Answer 14

Mucolytic adjuvant therapy for viscous secretions in acute and chronic pulmonary disease

Diagnostic bronchial studies

Acetaminophen antidote

Question 15

Therapeutic uses of mucolytics?

Answer 15

In conditions like COPD and bronchial asthma

Cystic fibrosis

Bronchiectasis

Emphysema

Chronic bronchitis and chronic otitis media

Question 16

Mechanism of action of Cimetidine

Answer 16

Selective competitive blocker of H2

Decrease Gastric acidity

Decrease formation of pepsin

Decrease secretion of intrinsic factor

Does not affect gut motility

Question 17

Give the adverse affects of cimetidine?

Answer 17

Sudden stop–> ulcer and bleeding rehappens

GIT—> Constipation or diarrhea

Hypersensitivity–> skin rash

Decrease hepatic blood flow

Anti Androgen in males

increase prolactin in females

Question 18

Explain; it is better to avoid clopidogrel with proton pump inhibitors

Answer 18

Clopidogrel is a prodrug that requires activation by the P450 enzyme, which is involved in metabolism of PPIs. PPIs could reduce clopidogrel activation.

Question 19

What are the advantages and diff P-CAB over PPI?

Answer 19

They have faster onset of action and achieve rapid acid suppression at fist dose

Inhibit effect of H/K ATPase enzyme without need for activation

They bind to active and inactive forms of proton pump

Don’t require enteric coat

Question 20

Give 4 adverse effects of proton pump inhibitor

Answer 20

Decrease bioavailability of vitamin B12 and digoxin

Long-term acid suppression leads to increased chronic inflammation in the gastric body

Decrease metabolism of Warfarin, Theophylline and Diazepam

CNS: Dizziness and drowsiness

Question 21

Mechanism of action of Proton Pump Inhibitor?

Answer 21

It is a prodrug activates in acid environment

It is a irreversible inhibitor H/K ATPase enzyme

Decrease Basal and stimulated gastric acidity but no effect on GIT motility

Question 22

Mechanism of action of metoclopramide as an anti-emetic?

Answer 22

Centrally blocks D2 receptor in CTZ

Peripherally–> Stimulates 5-HT4 receptors in enteric ganglia–> release of Ach—> increase gastric motility —> increase gastric emptying

Question 23

Give an account on the mucosal protective PGE1-E2

Answer 23

Prevents NSAID induced gastric ulcer and promotes ulcer healing.

Increase HCO3, Mucus while decreasing HCL

Misoprostol is an example

SE: Diarrhea, colic

Question 24

Give an account on the mucosal Sucralfate?

Answer 24

Increase mucus, PG. Decrease pepsin

SE: Constipation and decrease absorption

Gastrofate is an example

Question 25

Give an account on the mucosal Colloidal Bismuth

Answer 25

Increase Mucus, PG, decrease pepsin. Bactericidal against H. Pylori SE: black discoloration of stool and mouth

Question 26

Carbenoxolone Na

Answer 26

Increase Mucus, PG SE: Aldosterone like action Biogastrone/ Liquorice roots

Question 27

Give reason gastrofate "sucralfate" not given with H2 Blockers?

Answer 27

Because it acquires acid PH for activation

Question 28

Mechanism of action of Metoclopramide "primperan"?

Answer 28

Antiemetic: central: blocks D2-receptors in CTZ Peripheral: stimulate 5-HT4 receptors in enteric ganglia--> release Ach--> Gastric motility--> increase gastric emptying--> prokinetic agent

Question 29

Adverse affects of Metoclopramide "primperan"?

Answer 29

Dizziness Nervousness Parkinsonism Ataxia Hyperprolactinemia

Question 30

Uses of Metoclopramide "primperan"?

Answer 30

All vomiting EXCEPT motion sickness Gastric hypomotility GERD Hiccup increase absorption of concomitantly drugs

Question 31

Potassium-competitive acid blocker (P-CAB) side effects

Answer 31

Nausea, abdominal distention, diarrhoea Risk of fracture Hepatic function abnormalities Hypersensitivity reaction

Question 32

Domeperidone mechanism of action

Answer 32

CNS: blocks D2 receptor in CTZ Peripherally--> gastric motility ---> prokinetic

Question 33

What are the disadvantages

Answer 33

Colic Excreted in milk---> diarrhea in suckling baby Excreted in urine---> red discoloration

Question 34

Mechanism of action of leukotrienes

Answer 34

Zileuton is a 5 lipooxygenase inhibitor---> blocking leukotrienes synthesis Zafirleukast and Montelukast are LTD4 receptor antagonist -----> Blocking LTD4 receptors

Question 35

Bromhexine mechanism of action

Answer 35

Causes depolymerization of mucopolysaccharide of ground substance of sputum so they liquefy sputum.

Question 36

Ambroxol mechanism of action

Answer 36

Ambroxol accumulates in lamellar bodies, secretory lysosomes of type II pneumocytes that store surfactant, where in affects hydrogen and calcium ion homeostasis leads to loss of lamella.

Question 37

Acetylcysteine indication

Answer 37

Mucolytic adjuvant therapy for viscous secretions in acute and chronic pulmonary disease Diagnostic bronchial studies Acetaminophen antidote

Question 38

Pharmacodynamics of Acetylcysteine

Answer 38

It splits disulfide bonds that are responsible for holding the mucous material together This results in a decrease in the tenacity and viscosity of secretion.