Pulmonary Pharmacology

Question 1

Inhaled bronchodilator for symptom relief and acute bronchodilation

Answer 1

Short-acting B agonists (SABAs)

Question 2

Can be used in asthma, COPD and exercise-induced bronchospasm

Answer 2

Albuterol (salbutamol)

Question 3

Inhaled dose of albuterol )salbutamol

Answer 3

180 ug (2 puffs) every 4 to 6 hrs as needed

Question 4

Nebulized dose of albuterol (salbutamol)

Answer 4

2.5 mg via oral inhalation every 6-8 hrs as needed over 5-15 mins

Question 5

Oral dose of albuterol (salbutamol)

Answer 5

2-4 mg by mouth every 6-8 hrs

Question 6

Albuterol(salbutamol) can be inhaled as

Answer 6

Levalbuterol (active isomer so half the dose)

Question 7

SABA bronchodilator that is inhaled through MDI nebulizer

Answer 7

Levalbuterol

L-albuterol

Question 8

SABA which is similar to albuterol given via MDI nebulizer

Answer 8

Pirbuterol

Question 9

Dose of pirbuterol

Answer 9

400 ug (2 puffs) every 4-6 hrs

Question 10

Examples of SABAs

Answer 10

Albuterol (salbutamol)
Levalbuterol (L-albuterol)
Pirbuterol

Question 11

Add on therapy to ICS in asthma and can be used alone in COPD

Answer 11

Long-acting B agonists (LABAs)

Question 12

Examples of LABAs

Answer 12

Formoterol
Arformoterol
Salmeterol
Indacaterol
Olodaterol

Question 13

LABAs for Asthma add-on to ICS

Answer 13

Formoterol

Question 14

LABA used for maintenance and treatment of severe COPD

Answer 14

Formoterol

Question 15

Inhaled dose of formoterol

Answer 15

12 ug every 12 hr

Question 16

Nebulized dose of formoterol

Answer 16

20 ug in 2 ml twice per day

Question 17

LABA used as reliever of bronchospasm

Answer 17

Formoterol

Question 18

LABA used for severe COPD

Answer 18

Arformoterol

Question 19

LABA used in maintenance for treatment for COPD

Answer 19

Salmeterol

Question 20

Inhaled dose of arformoterol

Answer 20

15 ug in 2 ml twice daily

Question 21

Inhaled dose of salmeterol

Answer 21

50 ug twice daily

Question 22

Inhaled dose of indacaterol

Answer 22

Inhaled (DPI) 75 cetazolamide once daily

Question 23

Inhaled dose olodaterol

Answer 23

2.5 cetazolamide once daily

Question 24

Muscarinic receptor antagonists inhaled as bronchodilators

Answer 24

Anticholinergics

Question 25

Examples of anticholinergics

Answer 25

``` Ipratropium bromide Albuterol/ipatropium combination Tiotropium bromide Umeclidinium bromide Aclidium bromide Glycopyrrolate ```

Question 26

Inhaled dose of ipratropium bromide

Answer 26

2 puffs (17 ug/puff) 3-4x a day

Question 27

Dose of albuterol/ipratropium combination

Answer 27

Albuterol 103 ug/ipratropium 18 ug/puff | 2 puffs 4 times daily

Question 28

Ipratropium bromide are replaced by

Answer 28

LAMAs

Question 29

Anticholinergics that should be avoided spraying in the eyes

Answer 29

Ipratropium bromide

Question 30

Adverse effects of ipratropium

Answer 30

Dry mouth, Tachycardia, urinary retention, glaucoma

Question 31

Dose of tiotropium bromide

Answer 31

2.5 ug via oral inhalation (2 puffs of 1.25 ug/actuation) once daily

Question 32

Anticholinergics that should be a caution in patients with urinary retention or glaucoma history

Answer 32

Tiotropium bromide

Question 33

Inhaled dose (DPI) of umeclidinium bromide

Answer 33

6.25 ug (1 puff) once daily

Question 34

Inhaled dose (DPI) of aclidinium bromide

Answer 34

400 ug (1 puff) once daily

Question 35

Inhaled dose (DPI) of glycopyrrolate

Answer 35

1 capsule (15.6 ug) inhaled twice daily

Question 36

Combination inhalers for the maintenance treatment of COPD

Answer 36

LAMA-LABA combination inhalers

Question 37

Examples of LAMA-LABA combination inhalers

Answer 37

Glycopyrrolate/ Umeclinium/Vilanterol Tiotropium/olodaterol

Question 38

Maintenance treatment for asthma

Answer 38

Inhaled corticosteroids

Question 39

Examples of corticosteroids

Answer 39

1. Beclomethasone (dipropionate) BDP 2. Fluticasone propionate 3. Budesonide 4. Ciclesonide

Question 40

Inhaled dose of beclomethasone

Answer 40

MDI/PDI 88 ug (1 spray= 44 ug) twice daily

Question 41

Has more systemic than any other ICS

Answer 41

Beclomethasone dipropionate

Question 42

Local effects of Beclomethasone

Answer 42

Hoarse voice | Candidiasis

Question 43

Systemic effects of Beclomethasone

Answer 43

Growth suppression Bruising Adrenal suppression

Question 44

Beclomethasone dipropionate should not exceed

Answer 44

440 ug twice daily

Question 45

Inhaled dose of fluticasone propionate

Answer 45

MDI/DPI | 50, 100, 250 ug 2 puffs, twice daily

Question 46

Dose of fluticaosne should exceed

Answer 46

1000 ug daily

Question 47

ICS that has fewer systemic effects than BDP

Answer 47

Fluticasone propionate

Question 48

Inhaled dose of budesonide

Answer 48

Inhaled via jet nebulizer either once daily or divided into 2 doses (maximum daily dose 0.5 mg/d

Question 49

ICS that is used in children less than 8 who cannot use PDI

Answer 49

Budesonide

Question 50

Inhaled dose of ciclesonide

Answer 50

MDI 80 ug twice daily

Question 51

Has the least-systemic effects of all ICS and maybe effective once daily

Answer 51

Ciclesonide

Question 52

Maintenance treatment in asthma and COPD

Answer 52

ICS/LABA Combination inhalers

Question 53

Examples of ICS/LABA combination

Answer 53

Fluticasone propionate/salmeterol Budesonide/formoterol Fluticasone furoate/vilanterol

Question 54

ICS/LABA combination where the starting dose should be based on the asthma severity

Answer 54

Fluticasone propionate/salmeterol

Question 55

Inhaled dose of budesonide/formoterol

Answer 55

Inhaled MDI 80 ug budesonide and 4.5 ug formoterol per inhalation twice daily

Question 56

Inhaled dose of fluticasone furoate/vilanterol

Answer 56

Inhaled DPI 1 inhalation | Fluticasone furoate 100 ug/vilanterol 25 ug once daily

Question 57

ICS/LABA combi that Uses lowest-dose that maintains asthma control

Answer 57

Fluticasone propionate/salmeterol

Question 58

ICS/LABA combination that is used only in severe COPD or asthma-COPD overlap

Answer 58

Fluticasone propionate/salmeterol

Question 59

Short course or oral maintenance for asthma and COPD

Answer 59

Systemic corticosteroids

Question 60

Examples of systemic corticosteroids

Answer 60

Prednisone Prednisolone Hydrocortisone succinate Methyprednisolone

Question 61

Oral dose of prednisone

Answer 61

40-80 mg once daily or divided dose for 3-10 days for acute exacerbation

Question 62

Systemic corticosteroids that has minimal dose for maintenance

Answer 62

Prednisone

Question 63

Dose of hydrocortisone succinate

Answer 63

IM/IV: 100-500 mg every 12 h for acute severe asthma

Question 64

Systemic corticosteroids for patients not able to take oral steroids

Answer 64

Hydrocortisone succinate

Question 65

Dose of methylprednisolone

Answer 65

IV: 100-1000 mg for acute severe asthma

Question 66

Systemic corticosteroids that is rarely indicated because of steroids side effects

Answer 66

Methyprednisolone

Question 67

Antileukotrienes for Asthma Maintenance

Answer 67

Montelukast Zafirlukast Zileuton

Question 68

Oral dose of montelukast

Answer 68

10 mg/day

Question 69

Oral dose of Zafirlukast

Answer 69

20 mg twice per day

Question 70

Oral dose of Zileuton

Answer 70

600 mg four times/d or 1200 mg twice/d

Question 71

Antileukotrienes that causes hepatic dysfunction

Answer 71

Zileuton

Question 72

Adverse effects of antileukotrienes

Answer 72

Headache | Churg-Strauss syndrome

Question 73

Add-on maintenance for SEVERE asthma and COPD

Answer 73

Methylxanthines

Question 74

Examples of methylxanthines

Answer 74

Theophylline (oral) | Aminophylline (IV)

Question 75

Methylxanthines used for severe exacerbation that does not respond to nebulized B agonists

Answer 75

Aminophylline (IV)

Question 76

Maintenance for severe COPD

Answer 76

Phosphodiesterase 4 Inhibitor

Question 77

Example of PDE4 Inhibitor

Answer 77

Roflumilast

Question 78

Oral dose of roflumilast

Answer 78

500 ug once daily

Question 79

Maintenance treatment for severe asthma

Answer 79

Omalizumab

Question 80

Administration of Omalizumab

Answer 80

Subcutaneous administration

Question 81

Dose of Omalizumab

Answer 81

Dose depends on total IgE: given every 2-4 weeks

Question 82

Adverse effects of Omalizumab

Answer 82

Occasional headache and anaphylaxis

Question 83

PDE4 inhibitor added to maximal inhaled therapy if severe disease with acute exacerbations and chronic bronchitis

Answer 83

Roflumilast

Question 84

ICS with reduced oral bioavailability thus reduced adverse effects (BFMC)

Answer 84

Budesonide Fluticasone Mometasone Ciclesonide

Question 85

Preferred ICS in patients who need high doses of ICSs in children

Answer 85

>1000 ug Budesonide Fluticasone propionate

Question 86

ICS with longest duration of action and suitable for once-daily dosing

Answer 86

Fluticasone furoate

Question 87

Reverses reduction in HDAC2 expression that reduces corticosteroids responsiveness in severe asthma

Answer 87

Low-dose theophylline | Nortriptyline

Question 88

PDE subfamily important for anti-inflammatory effects

Answer 88

PDE4B