Resp Pharm

Question 1

mechanism N-acetlycysteine

Answer 1

mucolytic

opens disulfide bonds in mucoproteins to lower mucous viscosity

Question 2

synergistic effect of beta2 agonists on steroids

Answer 2

beta2 enhance activity of GR recepotr > increased nuclear translocation > enhanced binding to DNA > enhanced steroid effect

Question 3

most effective bronchodilators

Answer 3

beta2 agonists

Question 3

oral steroid adverse effect

Answer 3

inhibit ACTH+cortisol secretion by negative feedback on pituitary

HPA axis suppression

(depends on dose, length of treatment)

Question 4

indications ipratropium bromide

Answer 4

acute severe asthma (less effective than B2 agonists)

Question 4

side effects ivacaftor

Answer 4

serious hepatic dysfunction

Question 5

therapeutic use cromolyn sodium

Answer 5

chronic control of asthma,

porphylaxis bronchospasm

NOT a rescue medication

Question 5

most effective and most prescribed treatment for chronic inflammation of asthma

Answer 5

beclomethasone (steroid)

Question 6

metyhlxanthines (theophylline) mechanism

Answer 6

nonselective PDE inhibitor > elevation of cAMP and cGMP >increase PKA

AND PDE isoenzymes play role in SMC relaxation

AND adensosine receptor antagonism > prevents histamine+leukotriene release

Question 8

adverse effects omalizumab

Answer 8

injection site reaction

anaphylaxis after first dose, sometimes longer than a year after treatment begins

Question 9

three classes of broncho dilators

Answer 9

B2 adrenergic agonists (sympathomimetics)

Theophylline (a methylxanthine)

Anticholinergic agents (muscarinic antagonists)

Question 10

mechanism Fornase alpha

Answer 10

dna-ase breaks down neutrophil released DNA

reduces viscosity > increases mucus clearance and reduces infection

Question 11

treatment route leukotriene antagonists (zafirlukast, zileuton)

Answer 11

oral

Question 11

indicated in cystic fibrosis

Answer 11

dornase alpha (rhDNAase)

Ivacaftor

Question 12

oral steroids indicated in acute asthma is

Answer 12

lung function

Question 13

reasoning for single dose of systemic steroids in morning

Answer 13

coincides with normal diurnal increaes in plasma cortisol > less adrenal suppression than would occur at night

Question 13

indications leukotriene antagonists (zafirukast, zileuton)

Answer 13

mild-moderate asthma,

increases lung fxn, reduces need for B2 rescue

(less effective than ICS, may be added-onto ICS)

Question 13

impact in COPD oral corticosteroids

Answer 13

generally no response

ICS are of reduced impact as well

Question 15

mechanism of action omalizumab

Answer 15

prevents IgE binding to FceRI on mast cells and other inflammatory receptors on other cells (FceRII, CD23)

Question 16

indication systemic steroids

Answer 16

signal dose in morning, short course for exacerbations of asthma

Question 18

mechanism of action beta agonist bronchodilators

Answer 18

stimualate beta 2 >

activation Gs-adenyl cyclase-cAMP-PKA pathway

Pka phosphylates,

decrease calcium

Question 19

B2 agonist side effects

Answer 19

muscle tremor

tachycardia

hypokalemia (muscle uptake of K)

restlessness

hyoxemia

Question 20

side effects inhaled steroids

Answer 20

dermal thinning and skin capillary fragility

cataracts, osteoperosis (if also oral)

growth suppression in children

hoarsness (vocal cord atrophy)

(no evidence of atrophy to airway, increased lung infection)

Question 21

mechanism ivacaftor (specific indication)

Answer 21

for patients with mutation in G551D

increase Cl channel transport > impoves FEv1

Question 22

duration of action albuteral salmeterol

Answer 22

3-6 hours \>12 horus

Question 23

pharmacokinetics Omalizumab

Answer 23

subQ 2-4week admin

Question 24

mechanism of action cromolyn sodium

Answer 24

mast cell stabilizer

Question 26

adverse effects ipratropium bromide

Answer 26

(anticholinergic) dry mouth constipation blurred vision dyspepsia cognitive impairment

Question 27

adverse effects leukotriente antagonists (zafirlukast, zileuton)

Answer 27

hepatic dysfunction (monitor liver enzymes)

Question 28

leukotriene antagonists (and sub-class)

Answer 28

zilueton - 5-LO inhibitor Zafirlukast (cys-LT1 receptor inhibitor)

Question 30

other B2 agonist effects in airways

Answer 30

prevent mast cell mediator release prevent bronchial mucosal edema enhance mucociliary clearance reduce reflex cholinergic bonchoconstriction

Question 31

albuterol vs salmeterol

Answer 31

albuterol short acting salmeterol longer acting (and slower onset)

Question 32

therapuetic action anticholinergics (ipratropium bromide)

Answer 32

relax airway smooth muscle decrease mucus scretion

Question 34

other drugs indicated in COPD

Answer 34

Azithromycin antibiotics N-acetyl cystein (mucolytic) (with albuterol)

Question 35

pharmacokinetics ipratropium bromide (anticholinergic)

Answer 35

inhaled 30-90minutes maximal response last 4-6hours

Question 37

steroid (beclomethasone) side-therapeutic effect \> enhance transcription of

Answer 37

B receptor gene \> enhancing action of B2 agonists

Question 38

therapeutic impact zafirlukast, zileuton

Answer 38

(leukotriene mdoifiers) block bronchorestriction block airway hyperresonsiveness black mucus secertion block eosinophillic inflammation block plasma exudation

Question 39

indication inhaled corticosteroids dose schedule

Answer 39

first line for persisten ashthma any pt who needs B2 agonist more than twice weekly (twice daily)

Question 40

mechanism beclomethasone

Answer 40

bind GR, \> translocate to nucleus to inhibit HAT activity (can no longer acetylate histones activitating inflammatory factors) **ALSO **recruit HDAC2 \> reverses acetylation and deactivates activated inflammatory genes

Question 41

inhaled B2 agonists

Answer 41

Albuterol salmeterol

Question 41

indications for COPD why?

Answer 41

anticholinergics (**ipratropium bromide)** (greater relative impact in narrowed airways of COPD)

Question 42

contraindications n-acetylcysteine

Answer 42

asthmatics (side effect = bronchospasms)

Question 43

theophylline toxicity

Answer 43

headache palpitation dizziness, nausea, hypotension, tachycarida restlessness, seizures

Question 44

acute response actors in asthma response long-term actors (hours)

Answer 44

acute - histamine leukotrienes, cytokines, proteases long-term - cytokines, chemokines

Question 45

indications omalizumab

Answer 45

severe poorly controlled asthma severe concomitant allergic rhinitis