Non-Disease Specific Pharmacology Therapeutics 2018-2020 Flashcards
1
Q
1. What type of receptor is the glucocorticoid receptor? A. G-protein coupled receptor B. Ligand-gated ion channel C. Nuclear receptor D. Receptor tyrosine kinase
A
Chapter 25 Answers:
1. C, Nuclear receptor.
The glucocorticoid receptor is a nuclear receptor.
Chapter 25: Resolution of Allergic Inflammation
Middleton’s Allergy Principles and Practice, 8th Edition
2
Q
1. What term defines the mass of drug emitted per actuation that is actually available for inhalation at the mouth? A. Emitted dose (ED) B. Fine particle dose (FPD) C. Fine particle fraction (FPF) D. Labeled dose (LD)
A
- A, Emitted dose (ED), p. 1067.
The mass of drug emitted per actuation that is available for inhalation at the mouth is the emitted dose or delivered dose.
Chapter 66: Aerosol and Aerosol Drug Delivery Systems
Middleton’s Allergy Principles and Practice, 8th Edition
3
Q
2. Which of the following is the primary determinant of the site of lung deposition, distribution of the drug within the lung, and resulting deposition efficiency? A. Breath hold B. Inspiratory flow rate C. Sedimentation rate D. The size of an aerosol particle
A
- D, The size of an aerosol particle, p. 1068.
The size of an aerosol particle is the primary determinant of the site of lung deposition,distribution of the drug within the lung, and resulting deposition
efficiency.
4
Q
3. As the mass of an aerosol particle decreases and the air stream velocity decreases, particlessmaller than 5 µm tend to deposit on which of the following airways? A. Large conducting airways B. Esophagus C. Oropharynx D. Small airways
A
- D, Small airways, p. 1068.
Particles smaller than 5 µm tend to deposit by sedimentation and diffusion on successively
smaller airways as the mass of an aerosol particle decreases and the air stream velocity
decreases.
5
Q
4. In addition to the particle size, what additional factor may make it possible to target specific regions in the lung for therapy? A. Expiratory flow rate B. Inspiratory flow rate C. Inspiratory to expiratory ratio D. Total lung deposition
A
- B, Inspiratory flow rate, p. 1069.
It may be possible to target specific regions in the lung for therapy by selection of particle
size and inspiratory flow rate.
6
Q
- Nebulizers are used for liquid formulations. Which of the following describes an ultrasonic nebulizer?
A. A piezoelectric crystal vibrates at a high frequency withsufficient intensity to create
standing waves on the surface of the liquid overlying the crystal
B. Compressed air or oxygen breaks up a thin film of fluid into droplets suitable for inhalation
C. Controls the entire inhalation maneuver by applying a positive pressure delivered with a
computer-controlled compressor
D. Vents supplemental air into the nebulizer across the venturi jet in the nebulizer bow
A
- A, A piezoelectric crystal vibrates at a high frequency withsufficient intensity to create standing waves on the surface of the liquid overlying the crystal, 1072-4.
An ultrasonic nebulizer incorporates a piezoelectric crystal vibrates at a high frequency with sufficient intensity to create standing waves on the surface of the liquid overlying the crystal.
7
Q
6. Most current ultrasonic nebulizers producing aerosols operate at frequencies above what MHz? A. 1 B. 10 C. 100 D. 1000
A
- A, 1, p. 1073.
Most current ultrasonic nebulizers operate at frequencies above 1 MHz, producing aerosols withMMADs between 2 and 12 µm, with an output that is two to three times higher than with
most jet nebulizers
8
Q
7. Which HFA inhaled corticosteroid has a built-in spacer? A. Beclomethasone dipropionate B. Ciclesonide C. Flunisolide D. Fluticasone propionate
A
- C, Flunisolide, p. 1076.
The HFA inhaled corticosteroid flunisolide has a built-in spacer.
9
Q
8. Adding which of the following to the standard therapy for cystic fibrosis produces sustained improvement in lung function for up to 52 weeks? A. Atenolol B. Mannitol C. Metoprolol D. Olodaterol
A
- B, Mannitol, p. 1080.
A new study has shown that adding inhaled dry powder mannitol to standard therapy for cystic
fibrosis produces sustained improvement in lung function for up to 52 weeks.
10
Q
- A component of many highly active antiretroviral therapy (HAART) regimens, which
nucleoside reverse transcriptase inhibitor causes a potentially fatal hypersensitivity reaction in
patients, more commonly in HLA B5701-positive individuals?
A. Abacavir
B. Emtricitabine
C. Lamivudine
D. Zidovudine
A
- A, Abacavir, p. 1180.
Abacavir (ABC) causes a potentially fatal systemic illness in up to 8% of patients, typically
within the first 9-11 days of treatment. Manifestations of this illness include high fever, diffuse rash, malaise, nausea, myalgia, arthralgia, and abdominal pain. Treatment-naïve white patients with higher CD8+ T cell counts at treatment initiation are at higher risk, and the HLA B5701 allele is the dominant risk factor for this hypersensitivity with a PPV greater than 70%. Lack of this allele has a NPV of 95-98%. Prescreening for this allele before starting ABC is now recommended. If signs of hypersensitivity occur, this drug must be discontinued and can never be safely reintroduced.
Chapter 73: Human Immunodeficiency Virus and Allergic Disease
Middleton’s Allergy Principles and Practice, 8th Edition
11
Q
- Minor determinants of penicillin are most commonly associated with what type of reactions?
A. Acute generalized exanthematous pustulosis (AGEP)
B. Anaphylaxis
C. Drug rash with eosinophilia and systemic symptoms (DRESS}
D. Urticaria
A
- B, Anaphylaxis, p. 1276.
The minor determinants of penicillin are of major clinical importance because they are generally associated with anaphylaxis.
Chapter 79: Drug Allergy
Middleton’s Allergy Principles and Practice, 8th Edition
12
Q
2. P-i mechanism explains for which of the following bizarre phenomenon? A. Delayed onset drug allergy B. Erythema multiforme C. First encounter drug hypersensitivity D. Toxic epidermal necrolysis
A
- C, First encounter drug hypersensitivity, p. 1276.
The P-i concept by Pichler and colleagues described the direct pharmacologic interaction of
drugs with immune receptors. A chemically inert drug that is unable to covalently bind to
peptides or proteins may activate the immune system by directing binding and reversibly to
HLA molecules on APCs or TCRs on certain T cells.
13
Q
3. Type IVa reactions involve the secretion of large amounts of which cytokine? A. CXCL8 B. IFN – γ C. IL – 5 D. IL – 13
A
- B, IFN- γ. Figure 79-7. P. 1281.
Type IVa reactions involve Th1 type immune reaction that activates macrophages
resulting in large amounts of IFN – γ.
14
Q
- Patients requiring taxanes can be treated for infusion reactions with which of the following?
A. Decreasing the rate of infusion
B. Decreasing the rate of infusion, antihistamines, corticosteroids
C. Increasing rate of infusion
D. Increased rate of infusion, antihistamines, corticosteroids
A
- B, Decreasing the rate of infusion, antihistamines, corticosteroids, p. 1284.
Taxanes can lead to mast cell degranulation by nonimmune mechanisms. Such infusions are
common with the first infusion. Slowing the infusion and pretreatment with antihistamines,
steroids can prevent hypersensitivity reactions.
15
Q
5. The definitive diagnosis of IgE mediated drug allergy involves A. lymphocyte activation testing. B. provocative drug testing. C. skin prick testing. D. intradermal and skin prick testing.
A
- B, Provocative drug testing, Page 1287.
Intradermal and prick skin testing are methods of diagnosing drug allergies however the most
definitive way is provocative drug challenge. Patients are given gradually increasing doses of
the drug. Provocative drug tests should not be done if there was a reaction within 4–6 weeks,
patient used antihistamines, steroids, or has underlying uncontrolled conditions (urticaria,
asthma, URI, etc). Provocative drug testing may not be helpful for non-IgE mediated reactions.
