Pharm Resp Flashcards

1
Q

SBA: What is the hallmark feature of asthma?

A

Answer: Reversible airflow limitation due to chronic airway inflammation.

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2
Q

SBA: Which immune cells are primarily responsible for the late phase of an asthma attack?

A

Answer: Eosinophils.

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3
Q

SBA: What is the role of mast cells in asthma?

A

Answer: Degranulate to release histamine and other inflammatory mediators during the early phase.

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4
Q

Answer: Degranulate to release histamine and other inflammatory mediators during the early phase.

A

Answer: Interleukin-4 (IL-4).

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5
Q

SBA: What is the primary effect of leukotrienes in asthma?

A

Answer: Induce bronchoconstriction, mucus production, and vascular permeability.

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6
Q

SBA: What type of hypersensitivity reaction is asthma classified as?

A

Answer: Type I hypersensitivity.

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7
Q

SBA: Which medication class targets the immediate bronchospasm during an asthma attack?

A

Answer: Beta-2 agonists (e.g., salbutamol).

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8
Q

SBA: Which factor differentiates intrinsic asthma from extrinsic asthma?

A

Answer: Intrinsic asthma is triggered by non-allergic factors like cold air or exercise, while extrinsic asthma is IgE-mediated.

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9
Q

SBA: What is the primary diagnostic criterion for obstructive airway disease in asthma?

A

Answer: Reduced FEV1/FVC ratio (<70%).

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10
Q

SBA: What is the effect of acetylcholine binding to M3 receptors in asthma?

A

Answer: Bronchoconstriction.

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11
Q

EMQ: Match the phase of asthma to its characteristic.

A

Early phase: Mast cell degranulation and mediator release.
Late phase: Eosinophil infiltration and airway remodeling.

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12
Q

EMQ: Match the inflammatory mediator to its role in asthma.

A

Histamine: Vasodilation and increased mucus secretion.
Leukotrienes: Bronchoconstriction and increased vascular permeability.
IL-5: Attracts and activates eosinophils.

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13
Q

EMQ: Match the trigger to the asthma subtype.

A

House dust mites: Extrinsic asthma.
Cold air: Intrinsic asthma.
Aspirin: Aspirin-exacerbated respiratory disease (AERD).

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14
Q

EMQ: Match the therapeutic goal to the treatment approach.

A

Reliever medication: Beta-2 agonists.
Preventer medication: Inhaled corticosteroids.
Long-term control: Leukotriene receptor antagonists.

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15
Q

EMQ: Match the diagnostic test to its purpose.

A

Spirometry: Confirms obstructive lung disease.
Skin prick test: Identifies allergic triggers.
Fractional exhaled nitric oxide (FeNO): Assesses airway inflammation.

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16
Q

Describe the early and late phases of an asthma attack.

A

Answer:
Early phase: Immediate mast cell degranulation, release of histamine, prostaglandins, and leukotrienes causing bronchoconstriction.
Late phase: Eosinophil infiltration, continued inflammation, and airway remodeling. (2 marks)

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17
Q

What are the hallmark symptoms of asthma?

A

Answer: Wheezing, dyspnoea, chest tightness, and coughing, often worse at night or with triggers. (2 marks)

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18
Q

Explain the role of IgE in asthma pathophysiology.

A

Answer: IgE binds allergens, cross-links on mast cells, causing degranulation and mediator release. (2 marks)

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19
Q

List three trigger factors for asthma.

A

Answer: Allergens (e.g., pollen, dust mites), exercise, cold air, or respiratory infections. (2 marks)

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20
Q

What are the therapeutic goals for asthma management?

A

Answer: Minimize symptoms, reduce reliever use, prevent exacerbations, improve lung function, and avoid activity limitation. (2 marks)

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21
Q

SBA: What is the primary genetic mutation responsible for cystic fibrosis?

A

Answer: Mutation in the CFTR gene.

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22
Q

SBA: What is the first-line mucolytic recommended for patients with cystic fibrosis?

A

SBA: What is the first-line mucolytic recommended for patients with cystic fibrosis?

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23
Q

SBA: Which bacterial pathogen is most commonly associated with lung infections in cystic fibrosis?

A

Answer: Pseudomonas aeruginosa.

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24
Q

SBA: What is the recommended treatment for pancreatic insufficiency in cystic fibrosis?

A

Answer: Pancreatin (e.g., Creon).

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25
Q

SBA: Which CFTR modulator is classified as a “potentiator”?

A

Answer: Ivacaftor.

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26
Q

SBA: What is the key role of hypertonic sodium chloride in cystic fibrosis management?

A

Answer: Hydrates airway mucus and improves clearance.

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27
Q

SBA: How frequently should children with cystic fibrosis undergo routine review according to NICE guidelines?

A

Answer: Every 8 weeks.

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28
Q

SBA: What are the four ethical principles considered in medical decision-making for CFTR modulator funding?

A

Answer: Autonomy, beneficence, non-maleficence, and justice.

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29
Q

SBA: In cystic fibrosis, what complication is characterized by distal intestinal obstruction?

A

Answer: Distal intestinal obstruction syndrome (DIOS).

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30
Q

SBA: What is the mechanism of action of CFTR “correctors”?

A

Answer: Stabilize misfolded CFTR proteins and increase their membrane expression.

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31
Q

EMQ: Match the drug to its function.

A

Dornase alfa: Breaks down DNA in sputum to reduce viscosity.
Pancreatin: Aids in digestion for pancreatic insufficiency.
Hypertonic sodium chloride: Improves mucus clearance in the airways.

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32
Q

EMQ: Match the pathogen to its relevance in CF lung infections.

A

Pseudomonas aeruginosa: Chronic infection and biofilm formation.
Staphylococcus aureus: Common early-life pathogen.
Burkholderia cepacia complex: Associated with poor prognosis.

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33
Q

EMQ: Match the CFTR modulator to its action.

A

Ivacaftor: Potentiates CFTR channel activity.
Lumacaftor: Corrects CFTR misfolding.
Elexacaftor: Increases CFTR membrane expression.

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34
Q

EMQ: Match the complication to its characteristic feature.

A

Pancreatic insufficiency: Malabsorption of fat-soluble vitamins.
CF-related diabetes: Combination of insulin deficiency and resistance.
Osteoporosis: Result of chronic inflammation and malnutrition.

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35
Q

EMQ: Match the ethical principle to its description in drug funding.

A

Autonomy: Respecting patients’ decisions.
Justice: Ensuring fairness in access to treatment.
Beneficence: Acting in the best interest of the patient.

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36
Q

What are the primary aims of cystic fibrosis treatment?

A

Answer: Prevent lung infections, manage mucus clearance, treat malabsorption, and optimize lung function. (2 marks)

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37
Q

List the pharmacological treatments used in cystic fibrosis.

A

Answer:
Mucolytics: Dornase alfa, hypertonic sodium chloride.
Antibiotics: Targeting pathogens like Pseudomonas aeruginosa.
CFTR modulators: Ivacaftor, lumacaftor, tezacaftor, elexacaftor.
Pancreatic enzyme replacement therapy (e.g., pancreatin). (2 marks)

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38
Q

What monitoring is recommended for patients with cystic fibrosis?

A

Answer: Routine reviews (every 8 weeks for children, 3 months for adults), lung function tests (spirometry), and respiratory microbiology samples. (2 marks)

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39
Q

Describe the ethical principles guiding CFTR modulator funding decisions.

A

Answer: Autonomy, beneficence, non-maleficence, and justice, balanced with utilitarian principles to maximize benefit within limited resources. (2 marks)

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40
Q

Explain the role of non-drug treatments in cystic fibrosis management.

A

Answer: Airway clearance techniques, physiotherapy, regular exercise, and nutritional support. (2 marks)

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41
Q

SBA: What is the defining characteristic of uncontrolled asthma?

A

Answer: Symptoms on 3 or more days a week or use of a short-acting beta-agonist (SABA) 3 or more days a week, or nighttime awakening due to asthma at least once a week.

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42
Q

SBA: What is the mechanism of action of inhaled corticosteroids (ICS) in asthma management?

A

Answer: Reduce airway inflammation, edema, and mucus production by suppressing inflammatory mediator release.

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43
Q

SBA: What is the primary use of Maintenance and Reliever Therapy (MART) in asthma?

A

Answer: Combines a low-dose ICS with a long-acting beta-agonist (LABA) for both daily maintenance and symptom relief.

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44
Q

SBA: What is the first-line treatment for an acute exacerbation of COPD?

A

Answer: Short-acting bronchodilators (SABA/SAMA) administered via nebulizer or inhaler.

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45
Q

SBA: What is a key side effect of beta-2 agonists?

A

Answer: Hypokalemia.

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46
Q

SBA: How does smoking affect theophylline plasma levels?

A

Answer: Decreases plasma levels due to enzyme induction.

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47
Q

SBA: Which medication can cause oral candidiasis in asthma patients, and how can it be prevented?

A

Answer: Inhaled corticosteroids; use a spacer and rinse the mouth after inhalation.

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48
Q

SBA: What is the target oxygen saturation for COPD patients at risk of hypercapnic respiratory failure?

A

Answer: 88-92%.

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49
Q

SBA: What is the role of leukotriene receptor antagonists (e.g., Montelukast) in asthma management?

A

Answer: Reduce airway inflammation and bronchoconstriction by blocking leukotriene pathways.

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50
Q

SBA: What is the therapeutic range for theophylline plasma levels?

A

Answer: 10-20 mg/L.

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51
Q

EMQ: Match the drug to its side effect.

A

Beta-2 agonists: Hypokalemia and tachycardia.
Theophylline: Nausea, vomiting, and arrhythmias.
ICS: Oral candidiasis.

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52
Q

EMQ: Match the asthma/COPD treatment to its description.

A

MART: Combines ICS and LABA in one inhaler for daily and symptomatic use.
ICS/LABA: Prevents exacerbations and improves control in asthma.
SAMA: Provides rapid relief of bronchoconstriction in acute COPD exacerbations.

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53
Q

EMQ: Match the inhaler type to its advantage.

A

Pressurized metered-dose inhaler (pMDI): Cost-effective and widely available.
Dry powder inhaler (DPI): Does not require propellant.
Nebulizer: Delivers high doses for severe exacerbations.

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54
Q

EMQ: Match the clinical guideline to its focus.

A

NICE: Emphasizes stepwise treatment escalation.
BTS/SIGN: Comprehensive asthma management based on severity.
GOLD: Focuses on symptom-based COPD classification.

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55
Q

EMQ: Match the exacerbation management to its therapeutic approach.

A

Severe dyspnea and hypoxia: Oxygen therapy (88-92% target in COPD).
Signs of infection: Antibiotics.
Persistent symptoms after SABA: Systemic corticosteroids.

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56
Q

What are the treatment goals for asthma?

A

Answer: Control symptoms, reduce exacerbations, improve quality of life, and minimize reliever use. (2 marks)

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57
Q

Explain the stepwise management of asthma according to NICE guidelines.

A

Answer:
Step 1: SABA as needed.
Step 2: Add low-dose ICS.
Step 3: Add LABA (or MART).
Step 4: Medium-dose ICS or additional controller (e.g., LTRA). (2 marks)

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58
Q

Describe the GOLD guidelines for COPD management.

A

Answer:
Group A: Bronchodilator (e.g., SABA).
Group B: LABA or LAMA.
Group C: LAMA as first-line therapy.
Group D: Combination LABA + LAMA ± ICS. (2 marks)

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59
Q

What are the key components of exacerbation management in COPD?

A

Answer: Short-acting bronchodilators, systemic corticosteroids (e.g., prednisolone), antibiotics if infection is suspected, and oxygen therapy targeting 88-92%. (2 marks)

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60
Q

What monitoring is recommended for patients on theophylline?

A

Answer: Regular plasma concentration checks to maintain levels between 10-20 mg/L, monitor for hypokalemia, and adjust for drug interactions. (2 marks)

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61
Q

SBA: What is the primary mechanism of action of beta-2 agonists?

A

Answer: Activation of beta-2 adrenergic receptors, causing smooth muscle relaxation and bronchodilation.

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62
Q

SBA: What distinguishes LABAs from SABAs in terms of duration?

A

Answer: LABAs provide effects lasting up to 12 hours, while SABAs last about 4 hours.

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63
Q

SBA: What is the key structural feature contributing to the longer duration of LABAs?

A

Answer: A long hydrophobic tail that anchors the drug near the receptor.

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64
Q

SBA: What is the mechanism of action of leukotriene receptor antagonists (LTRAs)?

A

Answer: Block cysteinyl leukotriene receptors to reduce inflammation, bronchoconstriction, and mucus secretion.

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65
Q

SBA: Which leukotriene is primarily targeted by LTRAs?

A

Answer: LTD4.

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66
Q

SBA: What is a key side effect of theophylline?

A

Answer: Nausea, vomiting, or arrhythmias due to its narrow therapeutic index.

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67
Q

SBA: What is the role of histone deacetylase (HDAC) activation by theophylline?

A

Answer: Reverses corticosteroid resistance in severe asthma.

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68
Q

SBA: Which functional groups are essential for the activity of LTRAs?

A

Answer: Acidic groups, hydrogen-bond acceptors, and hydrophobic regions.

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69
Q

SBA: What is the half-life of LTRAs like montelukast?

A

Answer: Up to 10 hours.

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70
Q

SBA: What is the primary function of mucolytic agents in respiratory disease management?

A

Answer: Break down mucus to improve airway clearance.

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71
Q

EMQ: Match the drug to its mechanism of action.

A

Beta-2 agonists: Activate beta-2 adrenergic receptors.
LTRAs: Block cysteinyl leukotriene receptors.
Theophylline: Inhibits PDE4 and activates HDAC.

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72
Q

EMQ: Match the drug class to its therapeutic use.

A

SABAs: Immediate relief of asthma symptoms.
LABAs: Long-term control of asthma or COPD.
LTRAs: Preventive treatment for asthma.

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73
Q

EMQ: Match the drug to its potential side effect.

A

Theophylline: Arrhythmias.
LABAs: Tachycardia and hypokalemia.
LTRAs: Headaches.

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74
Q

EMQ: Match the pharmacophore-related feature to its drug.

A

Hydrophobic tail: LABAs.
Acidic group: LTRAs.
Lipophilic aromatic ring: LTRAs.

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75
Q

EMQ: Match the structural characteristic to the drug class.

A

Short duration of action: SABAs.
Anchoring hydrophobic group: LABAs.
Tetraene tail mimicked by aromatic rings: LTRAs.

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76
Q

Describe the mechanism of beta-2 agonists and their classification.

A

Answer: Activate beta-2 adrenergic receptors, causing bronchodilation.
SABAs (e.g., salbutamol): Short duration for acute relief.
LABAs (e.g., salmeterol): Long duration for maintenance. (2 marks)

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77
Q

What is the role of leukotriene receptor antagonists in asthma?

A

Answer: Block cysteinyl leukotriene receptors to reduce inflammation, bronchoconstriction, and mucus production (e.g., montelukast). (2 marks)

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78
Q

Explain the dual mechanisms of theophylline.

A

Answer: Inhibits phosphodiesterase-4 (PDE4) to increase cAMP and activate HDAC to reverse steroid resistance. (2 marks)

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79
Q

What are the common side effects of these drug classes?

A

Answer:
Beta-2 agonists: Tachycardia, tremor, hypokalemia.
LTRAs: Headaches and GI disturbances.
Theophylline: Narrow therapeutic index leading to nausea and arrhythmias. (2 marks)

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80
Q

Describe the structural feature that distinguishes LABAs from SABAs.

A

Answer: LABAs have a hydrophobic tail that increases receptor affinity and prolongs duration of action. (2 marks)

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81
Q

SBA: What is the purpose of a peak flow meter in asthma management?

A

Answer: Measures peak expiratory flow rate to assess airway obstruction.

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82
Q

SBA: How should a patient clean their inhaler spacer for optimal use?

A

Answer: Use warm water and mild detergent, rinse, and allow to air dry.

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83
Q

SBA: What is the recommended inhaler type for patients with poor coordination?

A

Answer: Pressurized metered-dose inhaler (pMDI) with a spacer.

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84
Q

SBA: What safety precaution should patients on long-term high-dose ICS follow?

A

Answer: Carry a steroid emergency card.

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85
Q

SBA: What is the primary reason for using spacers with pMDIs?

A

Answer: Increase the amount of medicine reaching the lungs.

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86
Q

SBA: What should a patient do if their peak flow reading is consistently below their personal best?

A

Answer: Seek medical advice as it may indicate poor asthma control.

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87
Q

SBA: Which guideline emphasizes the importance of using the same type of spacer consistently?

A

Answer: NICE guidelines.

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88
Q

SBA: What does the Asthma Slide Rule tool help identify?

A

Answer: Poorly controlled asthma and the need for treatment adjustment.

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89
Q

SBA: What is a common side effect of inhaled corticosteroids if a spacer is not used?

A

Answer: Oral candidiasis.

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90
Q

SBA: Which website provides comprehensive information on inhaler techniques and prescribing pathways?

A

Answer: RightBreathe.

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91
Q

EMQ: Match the device to its specific feature.

A

pMDI with spacer: Suitable for patients with poor hand-breath coordination.
DPI: Does not require a propellant.
Nebulizer: Delivers high doses for severe exacerbations.

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92
Q

EMQ: Match the test to its purpose.

A

eak flow meter: Assesses airway obstruction.
Spirometry: Diagnoses obstructive and restrictive lung diseases.
Fractional exhaled nitric oxide (FeNO): Measures airway inflammation.

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93
Q

EMQ: Match the safety measure to its recommendation.

A

Steroid emergency card: For prolonged high-dose ICS users.
Consistent spacer use: To ensure accurate ICS delivery.
Cleaning spacers: Regular cleaning with mild detergent and air drying.

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94
Q

EMQ: Match the inhaler technique issue to its solution.

A

Poor hand-breath coordination: Use a spacer with a pMDI.
Insufficient inhalation force: Switch to a nebulizer.
Dry mouth after ICS use: Rinse mouth after inhalation.

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95
Q

EMQ: Match the diagnostic tool to its correct interpretation.

A

Peak flow diary: Tracks variability in asthma control over time.
Asthma Slide Rule: Assesses symptom control and treatment adequacy.
FeNO: High levels indicate airway eosinophilic inflammation.

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96
Q

What is the purpose of using a peak flow meter in respiratory disease?

A

Answer: Measures peak expiratory flow rate to monitor disease control and detect exacerbations. (2 marks)

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97
Q

Describe the benefits of using a spacer with a pMDI.

A

Answer: Improves drug delivery to the lungs, reduces oral deposition, and minimizes side effects like oral candidiasis. (2 marks)

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98
Q

What safety measures should be followed for patients on long-term ICS therapy?

A

Answer: Use a spacer, rinse mouth after use, carry a steroid emergency card, and regularly review therapy. (2 marks)

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99
Q

How should a patient correctly use a peak flow meter?

A

Answer:
Sit or stand in a comfortable position.
Reset the pointer to zero.
Take a deep breath and blow out as hard and fast as possible.
Record the highest of three readings. (2 marks)

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100
Q

Explain how the Asthma Slide Rule and RightBreathe tools support treatment decisions.

A

Answer: Asthma Slide Rule identifies poorly controlled symptoms; RightBreathe provides tailored inhaler recommendations and videos. (2 marks)

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101
Q

SBA: What is the primary advantage of pulmonary drug delivery?

A

Answer: Rapid onset of activity and reduced systemic side effects.

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102
Q

SBA: What particle size is optimal for drug deposition in the alveolar region?

A

Answer: 1-5 µm.

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103
Q

SBA: Which propellants are currently used in pressurized metered-dose inhalers (pMDIs)?

A

Answer: Hydrofluoroalkanes (HFA-134a and HFA-227).

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104
Q

SBA: What is the main disadvantage of dry powder inhalers (DPIs)?

A

Answer: Requires adequate inspiratory effort from the patient.

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105
Q

SBA: Why are surfactants added to pMDI formulations?

A

Answer: To act as suspending agents and valve lubricants.

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106
Q

SBA: What is the main environmental concern with pMDIs?

A

Answer: They use hydrofluoroalkanes, which are potent greenhouse gases.

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107
Q

SBA: What method is used to fill pMDI canisters?

A

Answer: Cold filling or pressure filling.

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108
Q

SBA: What is the function of ethanol in pMDI formulations?

A

Answer: It acts as a co-solvent to increase drug solubility.

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109
Q

SBA: Which pulmonary drug delivery device is recommended for patients with severe respiratory difficulty?

A

Answer: Nebulizers.

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110
Q

SBA: How does the aerodynamic diameter influence drug deposition?

A

Answer: Smaller particles (1-5 µm) reach deeper into the lungs, while larger particles (>10 µm) are deposited in the upper airways.

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111
Q

EMQ: Match the pulmonary device to its primary advantage.

A

pMDI: Compact and portable.
DPI: Propellant-free design.
Nebulizer: Delivers high doses for severe cases.

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112
Q

EMQ: Match the component to its role in pMDI formulations.

A

Propellant (e.g., HFA-134a): Creates pressure to aerosolize the drug.
Surfactant: Ensures uniform suspension of drug particles.
Co-solvent (e.g., ethanol): Increases drug solubility.

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113
Q

EMQ: Match the inhaler type to its disadvantage.

A

pMDI: Requires coordination between inhalation and actuation.
DPI: Less effective in patients with low inspiratory effort.
Nebulizer: Bulky and requires a power source.

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114
Q

EMQ: Match the environmental impact to the delivery system.

A

pMDIs: Contribute to greenhouse gas emissions due to HFAs.
DPIs: Environmentally friendly, no propellant.
Nebulizers: Higher energy consumption.

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115
Q

EMQ: Match the drug delivery device to its historical development.

A

Medihaler (1956): First pMDI for adrenaline delivery.
Ventolin (1960s): First selective β2 agonist delivered via pMDI.
Salamol: Cost-effective alternative to Ventolin.

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116
Q

What are the primary advantages of pulmonary drug delivery?

A

Answer:
Rapid onset of action.
Lower systemic side effects due to localized delivery.
Useful for drugs with poor oral bioavailability (e.g., salbutamol). (2 marks)

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117
Q

Explain the role of particle size in pulmonary drug delivery.

A

Answer: Particles 1-5 µm in aerodynamic diameter are optimal for alveolar deposition. Larger particles are deposited in the upper airways, while smaller particles may be exhaled. (2 marks)

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118
Q

What are the key components of a pMDI, and their functions?

A

Answer:
Canister: Stores the formulation.
Propellant (e.g., HFAs): Aerosolizes the drug.
Metering valve: Controls the dose released per actuation. (2 marks)

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119
Q

Describe the main sustainability concerns with pMDIs.

A

Answer: HFAs are greenhouse gases; efforts are underway to replace them with more environmentally friendly alternatives. (2 marks)

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120
Q

What are the advantages and disadvantages of nebulizers compared to pMDIs and DPIs?

A

Answer:
Advantages: Effective for severe cases, no coordination needed.
Disadvantages: Bulky, requires a power source, time-consuming. (2 marks)

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121
Q

Answer:
Advantages: Effective for severe cases, no coordination needed.
Disadvantages: Bulky, requires a power source, time-consuming. (2 marks)

A

Answer: Spacers reduce the need for coordination and increase drug delivery to the lungs.

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122
Q

SBA: What is the function of lactose in DPI formulations?

A

Answer: It acts as a carrier particle to improve flow and uniform dosing.

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123
Q

SBA: What mechanism is used to aerosolize drugs in a jet nebulizer?

A

Answer: Compressed air passed through a Venturi nozzle creates low pressure, drawing liquid into a baffle for aerosolization.

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124
Q

SBA: Which type of nebulizer uses a vibrating mesh to create aerosols?

A

Answer: Mesh nebulizers.

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125
Q

SBA: What is the role of piezoelectric crystals in ultrasonic nebulizers?

A

Answer: Generate sound waves to create aerosol droplets.

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126
Q

SBA: What is a limitation of DPIs in elderly patients?

A

Answer: They require sufficient inspiratory effort, which may be reduced in elderly patients.

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127
Q

SBA: How does micronization improve DPI formulations?

A

Answer: Reduces particle size to below 5 µm for optimal lung deposition.

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128
Q

SBA: What is the primary disadvantage of nebulizers compared to inhalers?

A

Answer: Nebulizers are bulky and less portable.

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129
Q

SBA: What feature differentiates multidose DPIs from single-dose DPIs?

A

Answer: Multidose DPIs store multiple doses, whereas single-dose DPIs require manual loading of individual capsules.

130
Q

SBA: What data can smart inhalers like the GoResp Digihaler record?

A

Answer: Usage frequency and inspiratory flow rate.

131
Q

EMQ: Match the inhaler type to its feature.

A

Breath-actuated pMDI: Triggered by patient inspiration.
DPI: Uses patient inspiratory force to aerosolize the drug.
Nebulizer: Delivers high doses during normal breathing.

132
Q

EMQ: Match the nebulizer type to its mechanism.

A

Jet nebulizer: Uses compressed air.
Ultrasonic nebulizer: Uses piezoelectric crystals.
Mesh nebulizer: Uses a vibrating mesh with laser-etched holes.

133
Q

EMQ: Match the patient group to the recommended device.

A

Children under 5: Nebulizer with mask.
Elderly with poor lung function: pMDI with spacer.
Patients with arthritis: Breath-actuated pMDI.

134
Q

EMQ: Match the DPI component to its function.

A

Lactose: Carrier particle for drug dispersion.
Micronized drug: Provides particles of optimal size for lung deposition.
Rotor in DPI: Generates turbulence to disaggregate powder.

135
Q

EMQ: Match the drug delivery device to its environmental impact.

A

pMDI: Uses hydrofluoroalkane propellants with greenhouse effects.
DPI: Propellant-free design.
Nebulizer: High energy consumption.

136
Q

What are the advantages of using spacers with pMDIs?

A

Answer: Reduces coordination requirement, increases lung deposition, decreases oral side effects like candidiasis. (2 marks)

137
Q

Describe the formulation of DPIs.

A

Answer: Micronized drug particles (<5 µm) mixed with larger lactose carrier particles to improve flow and uniform dosing. (2 marks)

138
Q

Explain the mechanism of action of jet nebulizers.

A

Answer: Compressed air passes through a Venturi nozzle to aerosolize the drug. Larger particles are trapped by a baffle. (2 marks)

139
Q

List the key advantages and disadvantages of DPIs.

A

Answer:
Advantages: No propellants, environmentally friendly, portable.
Disadvantages: Requires sufficient inspiratory effort, less effective in patients with poor lung function. (2 marks)

140
Q

What is the purpose of smart inhalers?

A

Answer: Record data like usage frequency and inspiratory flow rate, aiding in adherence monitoring and therapy optimization. (2 marks)

141
Q

SBA: What is the primary advantage of the Respimat inhaler?

A

Answer: Creates a slow-moving aerosol mist with smaller particles, improving lung deposition.

142
Q

SBA: What feature differentiates a non-pressurized MDI from a traditional pMDI?

A

Answer: It does not use a propellant and relies on mechanical actuation.

143
Q

SBA: What is the particle size range for Technosphere aggregates in inhaled insulin?

A

Answer: 2-5 µm.

144
Q

SBA: What was a common side effect reported with Afrezza inhaled insulin?

A

Answer: Cough.

145
Q

SBA: What is the main component in e-cigarette formulations that facilitates aerosol generation?

A

Answer: Propylene glycol and glycerine.

146
Q

SBA: Which gas delivery system is commonly used for patients with sleep apnea?

A

Answer: Continuous Positive Airway Pressure (CPAP).

147
Q

SBA: How does scintigraphy assist in respiratory formulation evaluation?

A

Answer: Radiolabelled drug-carrier aggregates allow visualization of lung deposition using gamma cameras.

148
Q

SBA: What is the role of a mesh nebulizer in pulmonary drug delivery?

A

Answer: Uses vibrating mesh technology to generate aerosolized droplets for inhalation.

149
Q

SBA: What regulatory body provides guidance for licensing electronic cigarettes in the UK?

A

Answer: MHRA (Medicines and Healthcare products Regulatory Agency).

150
Q

SBA: What is a critical limitation of inhaled insulin products like Exubera and Afrezza?

A

Answer: Poor commercial acceptance due to side effects and high cost.

151
Q

EMQ: Match the device to its key advantage.

A

Respimat: Slow aerosol mist for improved lung deposition.
Mesh nebulizer: Efficient aerosol generation with minimal drug wastage.
CPAP system: Maintains airway pressure for sleep apnea management.

152
Q

EMQ: Match the application to the pulmonary delivery system.

A

Insulin delivery: Technosphere inhaled insulin.
Radiolabelled drug evaluation: Scintigraphy.
Nicotine replacement therapy: Electronic cigarettes.

153
Q

EMQ: Match the technology to its delivery method.

A

Vibrating mesh: Mesh nebulizer.
Compressed air: Jet nebulizer.
Mechanical actuation: Non-pressurized MDI.

154
Q

EMQ: Match the inhalation system to its component.

A

E-cigarettes: Nicotine, glycerine, flavorings.
Medicinal gases: Oxygen with regulated flow.
Scintigraphy: Tc99m-radiolabelled drug aggregates.

155
Q

EMQ: Match the product to its key drawback.

A

Exubera: High cost and bulky device.
Afrezza: Cough and disappointing sales.
CPAP: Requires compliance and may cause discomfort.

156
Q

What are the benefits of using non-pressurized MDIs like Respimat?

A

Answer: Produce slow-moving aerosol mist with small particles, reducing the need for coordination and improving deposition. (2 marks)

157
Q

Explain why pulmonary delivery is suitable for systemic drugs like insulin.

A

Answer: Large absorptive surface area (140 m²), permeable membrane, and low enzymatic activity in the lungs. (2 marks)

158
Q

What are the limitations of current inhaled insulin products?

A

Answer: Side effects (e.g., cough), high cost, and poor patient acceptance. (2 marks)

159
Q

Describe the role of scintigraphy in pulmonary drug research.

A

Answer: Radiolabelled formulations allow imaging of lung deposition, aiding in the evaluation of drug delivery efficiency. (2 marks)

160
Q

List the key components of e-cigarette formulations and their functions.

A

Answer: Nicotine (active ingredient), propylene glycol/glycerine (aerosol generation), and flavorings. (2 marks)

161
Q

SBA: What is the defining feature of COPD?

A

Answer: Airflow obstruction that is not fully reversible and progressive over time.

162
Q

SBA: Which condition is caused by damage to the alveoli in COPD?

A

Answer: Emphysema.

163
Q

SBA: What is the primary genetic risk factor for COPD?

A

Answer: Alpha-1 antitrypsin deficiency.

164
Q

SBA: Which inflammatory cells are predominantly involved in COPD pathophysiology?

A

Answer: Neutrophils.

165
Q

SBA: What is the primary spirometric criterion for diagnosing COPD?

A

Answer: FEV1/FVC ratio <70%.

166
Q

SBA: What is the cardinal symptom triad of COPD?

A

Answer: Chronic cough, sputum production, and dyspnoea.

167
Q

SBA: Why is smoking cessation the most effective intervention in COPD?

A

Answer: It slows the progression of lung function decline.

168
Q

SBA: What is the mechanism of action of phosphodiesterase-4 (PDE4) inhibitors in COPD?

A

Answer: Inhibit PDE4 to reduce cytokine release and airway inflammation.

169
Q

SBA: Why must oxygen therapy in COPD be administered cautiously?

A

Answer: High oxygen levels can suppress the hypoxic respiratory drive, leading to respiratory arrest.

170
Q

SBA: What physiological change leads to the characteristic barrel chest in emphysema?

A

Answer: Hyperinflation due to loss of alveolar elastic recoil.

171
Q

EMQ: Match the COPD subtype to its hallmark symptom.

A

Chronic bronchitis: Chronic cough with sputum production for at least 3 months over 2 consecutive years.
Emphysema: Dyspnoea with minimal cough, pink complexion, and pursed-lip breathing.

172
Q

EMQ: Match the treatment to its primary purpose.

A

Smoking cessation: Slows disease progression.
Bronchodilators (e.g., LABA/LAMA): Relieves airflow obstruction.
PDE4 inhibitors: Reduces inflammation in moderate-to-severe COPD.

173
Q

EMQ: Match the diagnostic criteria to the parameter.

A

Spirometry: FEV1/FVC ratio <70%.
Hypoxemia: PaO2 <8 kPa or SpO2 <88%.
Hypercapnia: PaCO2 >6.5 kPa.

174
Q

EMQ: Match the drug to its side effect.

A

Inhaled corticosteroids: Oral candidiasis and osteoporosis.
LABA: Tachycardia and tremors.
PDE4 inhibitors: Diarrhoea and weight loss.

175
Q

EMQ: Match the COPD severity stage to the corresponding FEV1 value.

A

Mild COPD: FEV1 ≥80% predicted.
Moderate COPD: FEV1 50-79% predicted.
Severe COPD: FEV1 <50% predicted.

176
Q

What are the key pathophysiological changes in COPD?

A

Answer:
Chronic inflammation with neutrophil and macrophage activation.
Protease-antiprotease imbalance (e.g., neutrophil elastase vs. alpha-1 antitrypsin).
Mucus hypersecretion, ciliary dysfunction, and airway remodeling. (2 marks)

177
Q

List the diagnostic criteria for COPD.

A

Answer:
Symptoms: Chronic cough, sputum production, dyspnoea.
Spirometry: FEV1/FVC ratio <70%. (2 marks)

178
Q

Describe the role of long-acting bronchodilators in COPD management.

A

Answer: LABA and LAMA improve airflow, reduce symptoms, and prevent exacerbations. (2 marks)

179
Q

What is the rationale for cautious oxygen use in COPD patients?

A

Answer: COPD patients may rely on hypoxic drive for respiration. High oxygen levels can suppress this drive, leading to respiratory acidosis or arrest. (2 marks)

180
Q

How does alpha-1 antitrypsin deficiency contribute to COPD?

A

Answer: Reduces inhibition of neutrophil elastase, leading to alveolar destruction and emphysema. (2 marks)

181
Q

SBA: What is the primary action of beta-2 agonists on airway smooth muscle?

A

Answer: Increase cAMP levels via adenylyl cyclase activation, leading to bronchodilation.

182
Q

SBA: What receptor subtype is most important for parasympathetic control of bronchial smooth muscle?

A

Answer: M3 receptors.

183
Q

SBA: Which neurotransmitter is responsible for sympathetic bronchodilation in the lungs?

A

Answer: Epinephrine, acting on beta-2 adrenoceptors.

184
Q

SBA: What is the primary role of leukotriene receptor antagonists in asthma management?

A

Answer: Block cysteinyl leukotriene receptors to prevent bronchoconstriction.

185
Q

SBA: What is the most common side effect of beta-2 agonists?

A

Answer: Tremor.

186
Q

SBA: What is the mechanism of action of xanthines like theophylline

A

Answer: Inhibit phosphodiesterase (PDE), increasing cAMP levels and causing bronchodilation.

187
Q

SBA: Which bronchodilator class is contraindicated without corticosteroids in asthma management?

A

Answer: Long-acting beta-2 agonists (LABAs).

188
Q

SBA: Which type of innervation releases nitric oxide to cause bronchodilation?

A

Answer: Inhibitory non-adrenergic, non-cholinergic (NANC) nerves.

189
Q

SBA: What particle size range is optimal for deposition in the small airways?

A

Answer: 1-5 µm.

190
Q

SBA: How does mast cell activation contribute to asthma?

A

Answer: Releases inflammatory mediators like histamine, causing bronchoconstriction and increased mucus secretion.

191
Q

EMQ: Match the drug class to its mechanism of action.

A

Beta-2 agonists: Increase cAMP via adenylyl cyclase activation.
Leukotriene receptor antagonists: Block cysteinyl leukotriene receptors.
Xanthines: Inhibit PDE and antagonize adenosine receptors.

192
Q

EMQ: Match the receptor to its physiological effect.

A

M3 receptors: Bronchoconstriction and increased mucus production.
Beta-2 adrenoceptors: Bronchodilation and inhibition of mediator release.
Cysteinyl leukotriene receptors: Bronchoconstriction and airway inflammation.

193
Q

EMQ: Match the unwanted effect to its bronchodilator class.

A

Tremor: Beta-2 agonists.
Narrow therapeutic window: Xanthines.
Dry mouth: Antimuscarinics.

194
Q

EMQ: Match the bronchodilator to its duration of action.

A

Salbutamol: 4-6 hours (short-acting).
Salmeterol: 8-12 hours (long-acting).
Formoterol: Long-acting with rapid onset.

195
Q

EMQ: Match the therapeutic aim to its treatment approach.

A

Rescue therapy: SABA (e.g., salbutamol).
Maintenance therapy: ICS and LABA combination.
Reduce inflammation: Inhaled corticosteroids.

196
Q

Describe the role of the parasympathetic nervous system in bronchial tone regulation.

A

Answer: Parasympathetic activation via M3 receptors causes bronchoconstriction and increased mucus secretion. (2 marks)

197
Q

What is the mechanism of beta-2 agonists in bronchodilation?

A

Answer: Beta-2 agonists increase cAMP through adenylyl cyclase activation, reducing intracellular calcium and causing smooth muscle relaxation. (2 marks)

198
Q

List two bronchodilator classes other than beta-2 agonists and their mechanisms.

A

Answer:
Antimuscarinics: Block M3 receptors to reduce bronchoconstriction.
Xanthines: Inhibit PDE, increasing cAMP and antagonizing adenosine receptors. (2 marks)

199
Q

Explain the importance of particle size in inhaled drug delivery.

A

Answer: Particles 1-5 µm in diameter reach the small airways, while larger particles are deposited in the upper airways or swallowed. (2 marks)

200
Q

What are the key therapeutic aims in managing asthma and COPD?

A

Answer: Relieve bronchospasm, reduce inflammation, prevent exacerbations, and limit airway remodeling. (2 marks)

201
Q

SBA: What is the main mechanism of action of muscarinic receptor antagonists in COPD management?

A

Answer: Blockade of M3 receptors, reducing bronchoconstriction and mucus secretion.

202
Q

Answer: Blockade of M3 receptors, reducing bronchoconstriction and mucus secretion.

A

SBA: Which side effect is most commonly associated with inhaled muscarinic receptor antagonists?

203
Q

SBA: What is the role of phosphodiesterase-4 inhibitors in COPD?

A

Answer: Inhibit PDE4, reducing cytokine release and airway inflammation.

204
Q

SBA: Why is theophylline considered to have a narrow therapeutic index?

A

Answer: Plasma levels above the therapeutic range can cause cardiac dysrhythmias and seizures.

205
Q

SBA: Which leukotriene receptor antagonist is most commonly used in asthma?

A

Answer: Montelukast.

206
Q

SBA: What is the primary adverse effect of systemic corticosteroids in long-term use for COPD?

A

Answer: Osteoporosis.

207
Q

SBA: What is the most common trigger of the cough reflex?

A

Answer: Stimulation of C fibers by irritants like smoke or dust.

208
Q

SBA: Which mucolytic is commonly used to break disulfide bonds in mucus?

A

Answer: Acetylcysteine.

209
Q

SBA: What is the primary target of omalizumab in severe allergic asthma?

A

Answer: Immunoglobulin E (IgE).

209
Q

SBA: What are the phases of the cough reflex?

A

Answer: Irritation, inspiration, compression, expulsion, relaxation.

209
Q

EMQ: Match the drug class to its mechanism of action.

A

Muscarinic receptor antagonists: Block M3 receptors.
Leukotriene receptor antagonists: Inhibit CysLT1 receptors.
Xanthines: Inhibit PDE, increasing cAMP.

210
Q

EMQ: Match the bronchodilator to its common side effect.

A

Beta-2 agonists: Tremor.
Xanthines: Nervousness and insomnia.
Muscarinic antagonists: Dry mouth.

211
Q

EMQ: Match the therapeutic target to its drug.

A

IL-5 pathway: Mepolizumab.
IgE: Omalizumab.
PDE4: Roflumilast.

212
Q

EMQ: Match the cough type to its clinical feature.

A

Acute cough: Less than 3 weeks.
Chronic cough: More than 8 weeks.
Subacute cough: Resolves in 3-8 weeks.

213
Q

EMQ: Match the cough therapy to its mechanism of action.

A

Expectorants: Increase bronchial secretions.
Mucolytics: Break disulfide bonds in mucus.
Antitussives: Suppress the cough reflex via opioid receptors.

214
Q

Describe the role of long-acting muscarinic antagonists (LAMAs) in COPD.

A

Answer: Block M3 receptors to reduce bronchoconstriction and mucus production, improving airflow and reducing exacerbations. (2 marks)

215
Q

What are the therapeutic effects of phosphodiesterase-4 inhibitors in COPD?

A

Answer: Reduce airway inflammation by inhibiting PDE4, lowering cytokine release from neutrophils and other inflammatory cells. (2 marks)

216
Q

Explain the narrow therapeutic index of theophylline.

A

Answer: Small differences between therapeutic and toxic plasma levels can cause side effects like dysrhythmias and seizures. (2 marks)

217
Q

List three common side effects of systemic corticosteroids.

A

Answer: Osteoporosis, adrenal suppression, and increased risk of infections. (2 marks)

218
Q

What is the importance of mucolytics in respiratory disease?

A

Answer: Thin mucus by breaking disulfide bonds, aiding clearance in conditions like COPD and cystic fibrosis. (2 marks)

219
Q

SBA: What is the validity period for NHS repeat prescriptions?

A

Answer: Up to one year from the date of issue.

220
Q

SBA: What is required for a prescription from Switzerland to be valid in the UK?

A

Answer: Patient and prescriber details, medication details, prescriber signature, and date of issue.

221
Q

SBA: What is the maximum duration of supply for a POM under an emergency request by a patient?

A

Answer: 30 days, except for items like contraceptives or inhalers.

222
Q

SBA: How long must a pharmacy retain a signed order for the supply of adrenaline autoinjectors to schools?

A

Answer: Two years.

223
Q

SBA: What label wording is mandatory for POMs supplied under emergency conditions?

A

Answer: “Emergency supply.”

224
Q

SBA: Which entity oversees the regulation of wholesale distribution of medicines?

A

Answer: Medicines and Healthcare products Regulatory Agency (MHRA).

225
Q

SBA: What is a Serious Shortage Protocol (SSP)?

A

Answer: A guideline allowing pharmacists to amend prescriptions and supply alternatives during shortages.

226
Q

SBA: Which medication type does not require record-keeping in the POM register?

A

Answer: Oral contraceptives.

227
Q

SBA: For how long must the POM register be retained?

A

Answer: Two years from the date of the last entry.

228
Q

SBA: What is the legal status of faxed prescriptions?

A

Answer: Not legally valid as they are not signed in indelible ink.

229
Q

EMQ: Match the prescription type to its characteristics.

A

NHS repeat prescription: Valid for up to one year.
Private repeat prescription: First dispensing within six months; repeats depend on prescriber instructions.
Military prescription: FMed 296 form; private rules if pharmacy is not contracted by MOD.

230
Q

EMQ: Match the entity to its supply requirements.

A

Schools: Signed order for adrenaline autoinjectors or salbutamol inhalers.
Midwives: Written requisition for midwifery medicines.
Drug treatment services: Supply naloxone under specific NHS or local authority arrangements.

231
Q

EMQ: Match the supply type to its record requirements.

A

Emergency supply to a patient: Reason for supply and “Emergency supply” on the label.
Private prescription: Record in POM register.
Written requisition: Record not legally required but good practice.

232
Q

EMQ: Match the prescriber to the medicines they can request.

A

Optometrist: Signed orders for POMs related to eye care.
Podiatrist: Signed orders for foot-related POMs.
Dentist: Any POM within their competence.

233
Q

EMQ: Match the scenario to the legal guidance.

A

rescribing for family members: Permitted in exceptional circumstances (e.g., life-saving situations).
Supplying based on a faxed prescription: Not legally valid, use professional judgment.
Dispensing and prescribing by the same person: Should remain separate, with documented reasons if combined.

234
Q

What are the requirements for a valid NHS repeat prescription?

A

Answer: Must have “RA” printed, valid for up to one year, signed by the doctor, and linked to repeat dispensing forms marked “RD.” (2 marks)

235
Q

How should private repeat prescriptions be handled?

A

Answer: First dispensing within six months of the date on the prescription; repeats depend on prescriber instructions, e.g., “Repeat x 3” allows four total supplies. (2 marks)

236
Q

What are the record-keeping requirements for emergency supply at a patient’s request?

A

Answer: Record the reason for supply, patient details, medication details, and “Emergency supply” on the label. (2 marks)

237
Q

Describe the protocol for supplying adrenaline autoinjectors to schools.

A

Answer: Requires a signed order containing the school’s name, product details, quantity, purpose, and headteacher’s signature. Retain the order for two years. (2 marks)

238
Q

What is the importance of Serious Shortage Protocols (SSPs)?

A

Answer: Allows pharmacists to amend prescriptions to supply alternative medicines during shortages, improving patient care. (2 marks)

239
Q

What is the inheritance pattern of cystic fibrosis?

A

Answer: Autosomal recessive.

240
Q

What is the most common mutation associated with CF?

A

Answer: ΔF508 mutation.

241
Q

What diagnostic test measures chloride levels in sweat for CF diagnosis?

A

Answer: Sweat test.

242
Q

Which ion transport is primarily affected in CF?

A

Answer: Chloride ion transport.

243
Q

What is the primary cause of death in CF patients?

A

What is the primary cause of death in CF patients?

244
Q

What is the mechanism of action of dornase alfa in CF management?

A

Answer: DNAse enzyme reduces mucus viscosity.

245
Q

What is the most common organism causing lung infections in adult CF patients?

A

Answer: Pseudomonas aeruginosa.

246
Q

What type of diet is recommended for CF patients with pancreatic insufficiency?

A

Answer: High-calorie diet with pancreatic enzyme supplements.

247
Q

What is the function of the CFTR protein?

A

Answer: Chloride ion channel regulating sweat, mucus, and digestive fluids.

248
Q

Why is inhaled hypertonic saline used in CF?

A

Answer: To hydrate mucus and improve clearance.

249
Q

Match the treatment to its therapeutic goal in CF.

A

Dornase alfa: Reduce mucus viscosity.
Hypertonic saline: Hydrate airway mucus.
Antibiotics: Control lung infections.

250
Q

Match the diagnostic tool to its application in CF.

A

Sweat test: Measure chloride levels in sweat.
Heel prick test: Detect common CFTR mutations in newborns.
Nasal potential difference test: Assess ion transport abnormalities.

251
Q

Match the organism to its typical infection stage in CF.

A

Staphylococcus aureus: Childhood.
Haemophilus influenzae: Adolescence.
Pseudomonas aeruginosa: Adulthood.

252
Q

Match the symptom to its underlying cause in CF.

A

Fatty stools: Pancreatic enzyme deficiency.
Chronic cough: Thick, sticky mucus in airways.
Poor growth: Malabsorption of nutrients.

253
Q

Match the gene therapy goal to its target in CF.

A

Gene editing: Correct CFTR mutations.
mRNA therapy: Produce functional CFTR protein.

254
Q

Explain the role of CFTR mutations in CF pathophysiology.

A

Answer: CFTR mutation leads to defective chloride ion transport, causing dehydrated, thick mucus and impaired mucociliary clearance. (2 marks)

255
Q

List two diagnostic methods for CF.

A

Answer: Sweat test and genetic testing for CFTR mutations. (2 marks)

256
Q

What are the main goals of CF management?

A

Answer: Promote mucus clearance, prevent lung infections, provide adequate nutrition, and manage intestinal obstruction. (2 marks)

257
Q

Describe the role of inhaled dornase alfa in CF treatment.

A

Answer: Reduces mucus viscosity by breaking down extracellular DNA. (2 marks)

258
Q

What is the significance of stratifying treatment based on disease severity?

A

Answer: Tailors therapy to improve quality of life and limit exacerbations. (2 marks)

259
Q

What is the validity period for NHS repeat dispensing prescriptions?

A

Answer: Up to one year.

260
Q

What does WDA stand for in wholesale dealing?

A

Answer: Wholesale Distribution Authorisation.

261
Q

What must be included on a school’s signed order for adrenaline autoinjectors?

A

Answer: Name of school, product details, and quantity required.

262
Q

What is the maximum supply duration for emergency supply of a POM at a patient’s request?

A

Answer: 30 days.

263
Q

What wording must appear on the label for emergency supplies?

A

Answer: “Emergency Supply.”

264
Q

Which prescribers can issue prescriptions legally valid in the UK from the EEA or Switzerland?

A

Answer: Approved health professionals from the EEA or Switzerland.

265
Q

Which document must pharmacies maintain for recording private prescription supplies?

A

Answer: POM register.

266
Q

What does an ‘RA’ on an NHS prescription indicate?

A

Answer: Repeat Authorisation.

267
Q

What is the key difference between PSDs and PGDs?

A

Answer: PSDs are patient-specific; PGDs apply to defined groups.

268
Q

What is the purpose of the “Choose Pharmacy EMS Module” in Wales?

A

Answer: To access the Welsh GP Record for relevant medication information.

269
Q

5 EMQ Questions and Answers

A

Match the prescription type to its key feature.
NHS Repeat: Valid for one year.
Private Repeat: Number of repeats indicated on prescription.
Military: Treated as private unless covered by MOD contract.

270
Q

Match the record to its requirement.

A

POM register: Emergency supply records.
Prescription record: Oral contraceptives exempt from keeping.
Signed order: School’s supply of salbutamol inhalers.

271
Q

Match the WDA exemption to the condition.

A

Same legal entity: No WDA required.
For profit: Requires WDA.
For onward wholesale: Prohibited under exemption.

272
Q

Match the supply type to its prescriber.

A

Optometrist: Signed order for POMs within their scope.
Paramedic: Supplied based on requisition for first aid.
Podiatrist: POMs they can administer.

273
Q

Match the prescription requirement to its source.

A

EEA/Swiss prescription: Full prescriber and patient details.
Faxed prescription: Not legally valid.
Repeatable prescription: Supply within 6 months for first dispensing.

274
Q

List the key requirements for private prescriptions.

A

Answer: Patient details, medication details, prescriber’s details, date, and signature. (2 marks)

275
Q

What is the purpose of recording in the POM register?

A

Answer: Maintains audit trail for private prescriptions, emergency supplies, and requisitions. (2 marks)

276
Q

Explain how emergency supply at the patient’s request works.

A

Answer: Pharmacist interviews patient, confirms immediate need and prior prescription, and supplies up to 30 days. (2 marks)

277
Q

What is the role of the MHRA in wholesaling?

A

Answer: Oversees licensing and compliance with GDP standards. (2 marks)

278
Q

Describe the difference between PSDs and PGDs.

A

Answer: PSDs are for named patients; PGDs cover defined patient groups for specific conditions. (2 marks)

279
Q

SBA: What is the primary mechanism of action of short-acting muscarinic antagonists (SAMAs)?

A

Answer: Block M3 receptors to prevent bronchoconstriction.

280
Q

SBA: What functional group in muscarinic antagonists contributes to their lack of CNS penetration?

A

Answer: Quaternary nitrogen.

281
Q

SBA: How does the duration of action differ between SAMAs and LAMAs?

A

Answer: SAMAs act for 3-5 hours, while LAMAs last 12-24 hours.

282
Q

SBA: Which corticosteroid is commonly used for its anti-inflammatory effects in asthma?

A

Answer: Fluticasone.

283
Q

SBA: What is the mechanism of action of mucolytic agents like N-acetylcysteine?

A

Answer: Break disulfide bonds in mucus to reduce viscosity.

284
Q

SBA: What is a potential adverse effect of inhaled corticosteroids?

A

Answer: Oral candidiasis.

285
Q

SBA: What is the pharmacophore of beta-2 agonists required for activity?

A

Answer: Hydroxyl groups on the catechol ring.

286
Q

SBA: What is the structural difference between SABA and LABA molecules?

A

Answer: LABAs have a longer hydrophobic tail, increasing receptor binding duration.

287
Q

SBA: Which drug is an example of a long-acting muscarinic antagonist (LAMA)?

A

Answer: Tiotropium.

288
Q

SBA: What type of reaction is involved in the thiol-disulfide exchange mechanism of mucolytics?

A

Answer: Substitution by a nucleophile.

289
Q

EMQ: Match the drug to its respiratory application.

A

Ipratropium: Short-acting bronchodilator for COPD.
Fluticasone: Long-term anti-inflammatory therapy in asthma.
N-acetylcysteine: Mucolytic to reduce mucus viscosity.

290
Q

EMQ: Match the muscarinic antagonist to its duration of action.

A

Ipratropium: 3-5 hours (SAMA).
Tiotropium: 24 hours (LAMA).
Glycopyrronium: 12 hours (LAMA).

291
Q

EMQ: Match the mechanism to the drug class.

A

Blockade of M3 receptors: Muscarinic antagonists.
Thiol-disulfide exchange: Mucolytics.
Inhibition of phosphodiesterase: Xanthines.

292
Q

EMQ: Match the corticosteroid to its application.

A

Prednisolone: Acute exacerbation of asthma.
Fluticasone: Long-term asthma management.
Ciclesonide: Pro-drug activated in the lungs.

293
Q

EMQ: Match the drug to its adverse effect.

A

Inhaled corticosteroids: Oral candidiasis.
Beta-2 agonists: Tremor.
Muscarinic antagonists: Dry mouth.

294
Q

Describe the role of SAMAs and LAMAs in respiratory management.

A

Answer:
SAMAs (e.g., ipratropium) provide short-term relief by blocking M3 receptors.
LAMAs (e.g., tiotropium) provide prolonged bronchodilation and reduce exacerbations. (2 marks)

295
Q

Explain the mechanism of action of inhaled corticosteroids.

A

Answer: Inhibit inflammatory mediators (e.g., PGE2, leukotrienes) and upregulate beta-2 receptors to enhance bronchodilator response. (2 marks)

296
Q

What structural feature extends the duration of action of LABAs compared to SABAs?

A

Answer: The hydrophobic tail of LABAs binds to receptor anchoring sites, prolonging action. (2 marks)

297
Q

List two mucolytics and their mechanisms of action.

A

Answer:
N-acetylcysteine: Breaks disulfide bonds in mucus.
Carbocysteine: Reduces mucus viscosity. (2 marks)

298
Q

What are the common adverse effects of these respiratory drug classes?

A

Answer:
Inhaled corticosteroids: Oral candidiasis, dysphonia.
Muscarinic antagonists: Dry mouth.
Beta-2 agonists: Tachycardia, tremor. (2 marks)

299
Q

SBA: What is chirality in molecules?

A

Answer: Chirality refers to molecules that are non-superimposable mirror images, typically due to a chiral center bonded to four different groups.

300
Q

SBA: What system is used to assign configurations to chiral centers?

A

Answer: The Cahn-Ingold-Prelog (CIP) priority rules, designating structures as R (rectus) or S (sinister).

301
Q

SBA: What differentiates enantiomers?

A

Answer: How they rotate plane-polarized light and their interaction with chiral environments (e.g., biological receptors).

302
Q

SBA: Which property of enantiomers is identical?

A

Answer: Physical properties like boiling point and solubility (except in chiral environments).

303
Q

SBA: What is the role of polarimetry in chirality?

A

Answer: Measures specific optical rotation to determine enantiomeric purity and excess.

304
Q

SBA: Who first demonstrated the separation of enantiomers?

A

Answer: Louis Pasteur, using sodium ammonium tartrate crystals.

305
Q

SBA: What is racemic resolution?

A

Answer: The process of separating a racemic mixture into its individual enantiomers.

306
Q

SBA: Why is chirality important in drug design?

A

Answer: Receptors and enzymes are chiral, leading to enantiomers having different pharmacological effects.

307
Q

SBA: What is the primary method used in separating enantiomers via chromatography?

A

Answer: Using a chiral stationary phase to differentiate enantiomers by affinity.

308
Q

SBA: How does (S)-Naproxen achieve enantiomeric purity?

A

Answer: Through asymmetric synthesis using a chiral catalyst.

309
Q

EMQ: Match the term to its description.

A

Enantiomer: Non-superimposable mirror images.
Diastereomer: Non-mirror image stereoisomers.
Racemic mixture: 1:1 mixture of two enantiomers.

310
Q

EMQ: Match the technique to its purpose.

A

Polarimetry: Determines specific optical rotation.
Chromatography: Separates enantiomers using a chiral column.
Crystallization: Separates based on solubility differences.

311
Q

EMQ: Match the chiral drug to its clinical significance.

A

Thalidomide: Teratogenic effects linked to chirality.
Ibuprofen: Only the (S)-enantiomer is active.
Propranolol: Both enantiomers contribute to pharmacological effects.

312
Q

EMQ: Match the chiral separation method to its principle.

A

Resolution: Separates racemic mixtures into enantiomers.
Asymmetric synthesis: Directly produces the desired enantiomer.
Chromatography: Exploits differences in chiral interactions.

313
Q

EMQ: Match the stereochemical designation to its feature.

A

R: Clockwise priority arrangement.
S: Counterclockwise priority arrangement.
Racemic: Equal mix of R and S enantiomers.

314
Q

Define chirality and explain its importance in pharmaceuticals.

A

Answer: Chirality refers to molecules with non-superimposable mirror images. It is crucial because biological receptors and enzymes are chiral, affecting drug efficacy and safety. (2 marks)

315
Q

What methods are used to separate enantiomers?

A

Answer: Chromatography (chiral stationary phase), crystallization, and racemic resolution. (2 marks)

316
Q

Describe the role of polarimetry in analyzing chirality.

A

Answer: Measures specific optical rotation to determine enantiomeric purity and excess. (2 marks)

317
Q

List three examples of drugs with significant chiral relevance.

A

Answer:
Thalidomide: Teratogenic effects differ between enantiomers.
Ibuprofen: Only the (S)-enantiomer is active.
Propranolol: Both enantiomers contribute to pharmacological effects. (2 marks)

318
Q

What is asymmetric synthesis, and why is it important?

A

Answer: A method to produce a single enantiomer directly using chiral catalysts, reducing waste and improving drug purity. (2 marks)