week 1 RH[S- respiratory pharm

Question 1

What is asthma?

Answer 1

Asthma is a chronic inflammatory disease of the airways characterized by episodes of acute bronchoconstriction.

Question 2

What are the three categories of asthma medications?

Answer 2

Controller medications, reliever medications, and add-on therapies.

Question 3

What are the first-line controller medications in asthma?

Answer 3

Inhaled corticosteroids (ICS).

Question 4

What are the first-line reliever medications in asthma?

Answer 4

β2 adrenoceptor agonists.

Question 5

What are examples of add-on therapies for severe asthma?

Answer 5

LAMAs, LTRAs, monoclonal antibodies, low-dose oral corticosteroids.

Question 6

What is the first-line treatment in acute severe asthma?

Answer 6

High-concentration oxygen therapy to maintain SpO₂ >90%.

Question 7

Name three inhaled short-acting β2 adrenergic agonists (SABAs).

Answer 7

Albuterol, terbutaline, pirbuterol.

Question 8

Name two inhaled long-acting β2 adrenergic agonists (LABAs).

Answer 8

Salmeterol, formoterol.

Question 9

What is the mechanism of action of β2 agonists?

Answer 9

They activate β2 receptors, increasing cAMP, which leads to bronchodilation.

Question 10

Why are LABAs not used as monotherapy in asthma?

Answer 10

Because they lack anti-inflammatory action and increase the risk of fatal asthma attacks.

Question 11

What is the difference between formoterol and salmeterol in terms of onset of action and agonist type?

Answer 11

Formoterol is a full agonist with rapid onset; salmeterol is a partial agonist with slower onset.

Question 12

Name one short-acting and one long-acting muscarinic antagonist.

Answer 12

Ipratropium (SAMA), Tiotropium (LAMA).

Question 13

What is the mechanism of action of inhaled anticholinergics?

Answer 13

They block muscarinic receptors in the airways, causing bronchodilation.

Question 14

When is ipratropium preferred over SABAs?

Answer 14

In β-blocker-induced bronchospasm

Question 15

What is the primary methylxanthine used in asthma?

Answer 15

Theophylline.

Question 16

What is the mechanism of theophylline?

Answer 16

Inhibits phosphodiesterase, increasing cAMP and causing bronchodilation.

Question 17

Why is theophylline rarely used today?

Answer 17

Due to narrow therapeutic window, side effects, and drug interactions.

Question 18

Name four common inhaled corticosteroids.

Answer 18

Beclomethasone, budesonide, flunisolide, fluticasone.

Question 19

Name three systemic corticosteroids used in asthma.

Answer 19

Prednisolone, prednisone, dexamethasone.

Question 20

What is the main mechanism of corticosteroids in asthma?

Answer 20

They inhibit inflammatory cytokines and phospholipase A2, reducing inflammation.

Question 21

What is the most common adverse effect of ICS?

Answer 21

Oropharyngeal candidiasis.

Question 22

What are long-term risks of ICS use in children?

Answer 22

Deceleration of vertical growth.

Question 23

Name two mast cell stabilizers used in asthma.

Answer 23

Cromolyn and nedocromil.

Question 24

What is the mechanism of cromolyn and nedocromil?

Answer 24

They inhibit mast cell degranulation, preventing bronchospasm.

Question 25

Are cromolyn and nedocromil used for acute asthma attacks?

Answer 25

No, they are not bronchodilators.

Question 26

Name one 5-lipoxygenase inhibitor and two LTRAs.

Answer 26

Zileuton (5-LO inhibitor); Montelukast, zafirlukast (LTRAs).

Question 27

What is the main adverse effect of zileuton?

Answer 27

Hepatotoxicity.

Question 28

What black box warning is associated with montelukast?

Answer 28

Neuropsychiatric events including suicidal thoughts.

Question 29

What type of inflammation is targeted by monoclonal antibodies in asthma?

Answer 29

Type 2 inflammation (TH2-mediated, involving IL-4, IL-5, IL-13).

Question 30

What does omalizumab target?

Answer 30

IgE.

Question 31

What is the mechanism of omalizumab?

Answer 31

It binds IgE, preventing its interaction with mast cells and basophils.

Question 32

What serious adverse effect is associated with omalizumab?

Answer 32

Anaphylaxis (life-threatening in ~0.2% of cases).

Question 33

How is omalizumab administered?

Answer 33

Subcutaneously every 2–4 weeks, dose based on circulating IgE levels.

Question 35

Why has SABA-only treatment for intermittent asthma fallen out of favor?

Answer 35

SABA-only treatment is associated with increased risk of severe exacerbations and does not treat underlying inflammation.

Question 36

What is the preferred treatment for mild asthma per updated GINA guidelines?

Answer 36

As-needed low-dose ICS-formoterol.

Question 37

What is the alternative to as-needed ICS-formoterol for mild asthma?

Answer 37

Regular low-dose ICS + as-needed SABA.

Question 38

When should asthma therapy be stepped down?

Answer 38

After maintaining good asthma control for ≥3 months to minimize side effects.

Question 39

What are key components of managing acute asthma exacerbations?

Answer 39

1) oxygen, 2) Inhaled SABA, 3) systemic corticosteroids, and 4) inhaled SAMA (for severe cases). 5) failed t o respond to initial treatment add IV mg so4

Question 40

When is intravenous magnesium sulfate considered in asthma?

Answer 40

If response to initial intensive treatment is inadequate in acute care settings.

Question 41

How is asthma severity currently defined?

Answer 41

By the level of treatment needed to achieve control and prevent exacerbations.

Question 42

Define mild asthma under the GINA guidelines.

Answer 42

Well controlled with as-needed ICS-formoterol or low-dose ICS + SABA.

Question 43

Define moderate asthma.

Answer 43

Controlled with low/medium-dose ICS-LABA (Step 3 or 4 therapy).

Question 44

Define severe asthma.

Answer 44

Uncontrolled despite high-dose ICS-LABA or requires such treatment to remain controlled.

Question 45

What characterizes COPD?

Answer 45

Chronic, progressive, irreversible airflow obstruction.

Question 46

What are the three cardinal symptoms of COPD?

Answer 46

Dyspnea, chronic cough, and sputum production.

Question 47

What is the most important risk factor for COPD?

Answer 47

Smoking.

Question 48

What is the role of bronchodilators in COPD?

Answer 48

Central to symptom management | maintainance

Question 49

What is the role of bronchodilators in COPD?

Answer 49

Central to symptom management, used regularly to prevent symptoms.

Question 50

What treatment is preferred for patients with persistent dyspnea?

Answer 50

Combination LABA + LAMA.

Question 51

Is ICS monotherapy recommended in COPD?

Answer 51

No, it is not recommended for stable COPD.

Question 52

When is triple therapy (LABA + LAMA + ICS) indicated in COPD?

Answer 52

If eosinophils ≥300 cells/μL or if the patient has concomitant asthma.

Question 53

What is the initial pharmacotherapy for Group A COPD patients?

Answer 53

LABA or LAMA

Question 54

What is the initial pharmacotherapy for Group B COPD patients?

Answer 54

LABA + LAMA.

Question 55

What is the initial pharmacotherapy for Group E COPD patients?

Answer 55

LABA + LAMA; add ICS if eosinophils ≥300 cells/μL.

Question 56

What drugs are used during a COPD exacerbation?

Answer 56

SABA ± SAMA, systemic corticosteroids, antibiotics (if infection), oxygen.

Question 57

When is long-term oxygen therapy indicated in COPD?

Answer 57

For patients with severe hypoxemia.

Question 58

What mucolytic is commonly used in COPD?

Answer 58

N-Acetylcysteine.

Question 59

What antibiotics can reduce exacerbations in COPD?

Answer 59

Azithromycin and erythromycin.

Question 60

What are the hallmark symptoms of allergic rhinitis?

Answer 60

Sneezing, nasal pruritus, rhinorrhea, and nasal congestion.

Question 61

What are first-line drugs for allergic rhinitis?

Answer 61

Glucocorticoid nasal sprays and second-generation oral antihistamines.

Question 62

What are common glucocorticoid nasal sprays?

Answer 62

Beclomethasone, flunisolide, budesonide, fluticasone.

Question 63

What symptoms are best treated by oral antihistamines?

Answer 63

Sneezing and itching (less effect on congestion).

Question 64

Why are second-generation antihistamines preferred?

Answer 64

They cause less sedation than first-generation agents.

Question 65

What is the most effective combination therapy for allergic rhinitis?

Answer 65

Intranasal glucocorticoid + intranasal antihistamine.

Question 66

What is cromolyn's mechanism in allergic rhinitis?

Answer 66

Mast cell stabilizer – inhibits release of histamine.

Question 67

What is montelukast's role in allergic rhinitis?

Answer 67

A leukotriene receptor antagonist used in patients intolerant to first-line therapy.

Question 68

How do decongestants relieve nasal symptoms?

Answer 68

Via α1 adrenergic receptor-mediated vasoconstriction in nasal mucosa.

Question 69

What is a major risk of intranasal decongestants used >3 days?

Answer 69

Rebound congestion (rhinitis medicamentosa).

Question 70

What are common side effects of oral decongestants?

Answer 70

Insomnia, palpitations, tachycardia, hypertension, arrhythmias.

Question 71

What is ipratropium bromide used for in allergic rhinitis?

Answer 71

Reduces nasal discharge (rhinorrhea), but not sneezing or congestion.

Question 72

What is the most common adverse effect of ipratropium nasal spray?

Answer 72

Headache, nosebleeds, nasal dryness.

Question 73

When is immunotherapy considered for allergic rhinitis?

Answer 73

When medications fail or in patients with multiple allergens or unavoidable triggers.

Question 74

What are two common antitussive medications?

Answer 74

Codeine and dextromethorphan.

Question 75

How do codeine and dextromethorphan suppress cough?

Answer 75

By acting on the cough center in the medulla.

Question 76

Why is dextromethorphan preferred over codeine?

Answer 76

Lower risk of abuse and safer side effect profile.