Lippincott Chapter 29: Drugs for Disorders of the Respiratory System Flashcards
29.1 A 12-year-old girl with a childhood history of asthma
complained of cough, dyspnea, and wheezing after
visiting a riding stable. Her symptoms became so
severe that her parents brought her to the emergency
room. Which of the following is the most appropriate
drug to rapidly reverse her bronchoconstriction?
A. Inhaled fluticasone.
B. Inhaled beclomethasone.
C. Inhaled albuterol.
D. Intravenous propranolol.
E. Oral theophylline.
Correct answer = C. Inhalation of a rapid-acting β2
agonist,
such as albuterol, usually provides immediate bronchodila-
tion. An acute asthmatic crisis often requires intravenous
corticosteroids, such as methylprednisolone. Inhaled beclo-
methasone and fluticasone treat chronic airway inflamma-
tion but will not provide any immediate effect. Propranolol is
a nonselective β-blocker and would aggravate the patient’s
bronchoconstriction. Theophylline has been largely replaced
with β2
agonists and is no longer recommended for acute
bronchospasm.
29.2 A 9-year-old girl has severe asthma, which required
three hospitalizations in the last year. She is now
receiving therapy that has greatly reduced the frequency
of these severe attacks. Which of the following therapies
is most likely responsible for this benefit?
A. Inhaled albuterol.
B. Inhaled ipratropium.
C. Inhaled fluticasone.
D. Oral theophylline.
E. Oral zafirlukast.
Correct answer = C. Administration of a corticosteroid
directly to the lung significantly reduces the frequency of
severe asthma attacks. This benefit is accomplished with
minimal risk of the severe systemic adverse effects of oral
corticosteroid therapy. Albuterol is used only to treat acute
asthmatic episodes. The other agents may reduce the
severity of attacks, but not to the same degree or consis-
tency as fluticasone (or other corticosteroids).
29.3 A 68-year-old male has COPD with moderate airway
obstruction. Despite using salmeterol twice daily
as prescribed, he reports continued symptoms of
shortness of breath with mild exertion. Which one of the
following agents would be an appropriate addition to his
current therapy?
A. Systemic corticosteroids.
B. Albuterol.
C. Tiotropium.
D. Roflumilast.
E. Theophylline.
Correct answer = C. The addition of an anticholinergic bron-
chodilator to the LABA salmeterol would be appropriate and
provide additional therapeutic benefit. Systemic corticoste-
roids are used to treat exacerbations in patients with COPD,
but not recommended for chronic use. The addition of a
SABA (albuterol) is less likely to provide additional benefit
since the patient is already using medication with the same
mechanism of action. Roflumilast is not indicated as the
patient only has moderate airway obstruction. Theophylline
is an oral bronchodilator that is beneficial to some patients
with stable COPD. However, because of its toxic potential,
its use is not routinely recommended.
29.4 A 58-year-old female ceramics worker with a COPD
exacerbation has recently been discharged from the
hospital. This is the third hospitalization in the past
year for this condition, although the patient reports
only mild symptoms in between exacerbations. The
patient is currently still on the same drug regimen
prior to her admission of salmeterol inhalation twice
daily and tiotropium inhalation once daily. Her current
FEV1
is below 60%. Which of the following would be an
appropriate change in her medication regimen?
A. Chronic systemic corticosteroids.
B. Discontinue the tiotropium.
C. Discontinue the salmeterol.
D. Change the salmeterol to a combination product that
includes both a LABA and an inhaled corticosteroid
(for example, salmeterol/fluticasone DPI).
E. Theophylline.
Correct answer = D. The addition of an inhaled corticoste-
roid may provide additional benefit since the patient has
significant airway obstruction and frequent exacerbations
requiring hospitalization. Systemic corticosteroids are used
on a short-term basis to treat exacerbations in patients with
COPD but are not recommended for chronic use. It is not rou-
tinely recommended to discontinue a long-acting broncho-
dilator unless the patient experiences an adverse effect or
experiences no therapeutic benefit. In this case, the patient
reports only mild symptoms in between exacerbations, sug-
gesting she may be benefiting from both bronchodilators.
Theophylline is an oral bronchodilator that is beneficial to
some patients with stable COPD. However, because of its
toxic potential, its use is not routinely recommended.
29.5 A 32-year-old male with a history of opioid addiction
presents with symptoms of an upper respiratory system
infection for the past 5 days. It is determined to be viral
in nature, and no treatment of the underlying infection
is appropriate. Which of the following is appropriate
symptomatic treatment for this patient’s cough?
A. Guaifenesin/dextromethorphan.
B. Guaifenesin/codeine.
C. Cromolyn.
D. Benzonatate.
E. Montelukast.
Correct answer = D. Benzonatate suppresses the cough
reflex through peripheral action and has no abuse potential.
Dextromethorphan, an opioid derivative, and codeine, an
opioid, both have abuse potential. Neither cromolyn nor
montelukast is indicated for cough suppression..Benzonatate is a non narcotic cough medication ,in a class of medications called antitussives (cough suppressants).Benzonatate works by numbing the throat and lungs, making the cough reflex less active.
29.6 Due to its anti-inflammatory mechanism of action,
which of the following medications requires regular
administration for the treatment of asthma?
A. Tiotropium MDI.
B. Salmeterol DPI.
C. Mometasone DPI.
D. Albuterol MDI.
Correct answer = C. Inhaled corticosteroids have direct anti-
inflammatory properties on the airways and require regular
dosing to be effective. Tiotropium is recommended for the
treatment of COPD, not asthma. Salmeterol and albuterol
are both bronchodilators but do not have anti-inflammatory
properties.
29.7 All of the following are preferred antihistamines for the
management of allergic rhinitis except:
A. Chlorpheniramine.
B. Fexofenadine.
C. Loratadine.
D. Cetirizine.
E. Intranasal azelastine.
Correct answer = A. Chlorpheniramine is a first-generation
antihistamine and is usually not a preferred treatment due
to its increased risk of adverse effects of sedation, perfor-
mance impairment, and other anticholinergic effects. All of
the other agents are second-generation antihistamines and
are generally better tolerated, making them preferred treat-
ments for allergic rhinitis.
29.8 Which of the following medications inhibits the action
of 5-lipoxygenase and consequently the action of
leukotriene B4
and the cysteinyl leukotrienes?
A. Cromolyn.
B. Zafirlukast.
C. Zileuton.
D. Montelukast.
E. Theophylline.
Correct answer = C. Zileuton is the only 5-lipoxygenase
inhibitor available. While zafirlukast and montelukast both
inhibit the effects of leukotrienes, they do so by blocking
the receptor itself. Cromolyn inhibits mast cell degranulation
and the release of histamine. Theophylline is a bronchodila-
tor that has no effect on leukotrienes.
29.9 Which of the following describes appropriate inhaler
technique for a dry powder inhaler?
A. Inhale slowly and deeply just before and
throughout actuation of the inhaler.
B. Use a large-volume chamber (spacer) to decrease
deposition of drug in the mouth caused by
improper inhaler technique.
C. Inhale quickly and deeply to optimize drug
delivery to the lungs.
D. Rinse mouth in a “swish-and-spit” method with
water prior to inhaler use to decrease the chance
of adverse events.
Correct answer = C. “Quick and deep” inhalation is required
for effective use of a DPI. Inhaling “slowly and deeply” and
the use of a spacer describe techniques associated with an
MDI, not DPI. Mouth rinsing may be appropriate for either
type of inhaler if the medication being administered is an
inhaled corticosteroid, but this should always be done fol-
lowing inhaler use, not prior to use.
29.10 Which of the following categories of allergic rhinitis
medications is most likely to be associated with rhinitis
medicamentosa (rebound nasal congestion) with
prolonged use?
A. Intranasal corticosteroid.
B. Intranasal decongestant.
C. Leukotriene antagonist.
D. Oral antihistamine.
Correct answer = B. Intranasal decongestants should be
used no longer than 3 days due to the risk of rebound nasal
congestion (rhinitis medicamentosa). For this reason, the
α-adrenergic agents have no place in the long-term treat-
ment of allergic rhinitis.
