Pulm - Pharmacology

Question 1

Besides short-acting beta-2 agonists, what other medication type is useful for quick relief of asthma symptoms (especially for severe cases)?

Answer 1

Anticholinergics

Question 2

What is the preferred medication type for long-term asthma control?

Answer 2

Inhaled corticosteroids

Question 3

Besides inhaled corticosteroids, what other four medication types can be used for long-term asthma control?

Answer 3

Long-acting beta-2 agonists,

oral corticosteroids,

anti-IgE antibodies (e.g. omalizumab),

leukotriene antagonists

Question 4

What are the two first-line medication types you should select from in treating either typical or atypical pneumonia in a patient with no underlying disease?

Answer 4

1. Macrolides
2. Doxycycline

Question 5

What medication type(s) should you select from in treating either typical or atypical pneumonia in a patient with underlying comorbidities (e.g. CHF, diabetes, splenectomy, hospitalization, alcoholism, etc.)?

Answer 5

Fluoroquinolones (respiratory)

Question 6

What medication type(s) should you select from in treating either typical or atypical pneumonia in a patient who has been treated with either macrolides or doxycycline within the past 3 months?

Answer 6

Fluoroquinolones (respiratory)

Question 7

True/False.

First-line agents in treating pneumonia are always antibiotics that act at the cell wall.

Answer 7

False.

Start with macrolides or doxycycline.

Question 8

What is the treatment regimen for tuberculosis (ignore timeframes)?

(5 drugs)

Answer 8

RIPE + streptomycin

(rifampin, isoniazid, pyrazinamide, ethambutol)

Question 9

What is the treatment regimen for infection with MAC (M. avium complex)?

(4 drugs)

Answer 9

Rifabutin, azithromycin, clarithromycin, ethambutol

(RACE)

Question 10

What is the treatment regimen for Hansen’s disease (infection with M. leprae)?

(4 drugs)

Answer 10

Rifampin, dapsone, clofazimine, thalidomide

(RDCT)

Question 11

Because beta-2 agonists can worsen ventilation/perfusion mismatch and worsen hypoxemia by increasing blood flow to poorly ventilated areas of the lung, you must use what first in cases of acute asthma exacerbation?

Answer 11

Oxygen therapy

Question 12

Inhaled corticosteroids have a _________ (rapid/slow) onset of action and have _________ (more/fewer) side effects when compared to oral corticosteroids.

Answer 12

Inhaled corticosteroids have a slow onset of action and have fewer side effects when compared to oral corticosteroids.

Question 13

What negative side effects are associated with lower doses of theophylline?

Answer 13

Mild cortical arousal

+

deferral of fatigue

Question 14

What negative side effects are associated with higher doses of theophylline?

Answer 14

Convulsions,

cardiac arrhythmias,

death

Question 15

True/False.

Beta-2 agonists can be used to increase V/Q matching.

Answer 15

False.

Beta-2 agonists can worsen V/Q mismatch and worsen hypoxemia by increasing blood flow to poorly ventilated areas of the lung.

Question 16

After being activated by cAMP, PKA phosphorylates the following 3 targets to produce the bronchodilator effect:

Answer 16

After being activated by cAMP, PKA phosphorylates the following 3 targets to produce the bronchodilator effect:

MLCK

PI/Ca²⁺

K_Ca channels

Question 17

Why is cromolyn sodium rarely used in asthma management?

Answer 17

Low efficacy

Question 18

Patients with asthma need supplemental oxygen if their pO₂ gets below _____%.

Answer 18

Patients with asthma need supplemental oxygen if their pO₂​ gets below 90%.

Question 19

Oral corticosteroids are only used for asthma management in what two scenarios?

Answer 19

1. Severe asthma
2. In a blocked airway

Question 20

Which leukotriene receptor is preferable due to favorable dosing and fewer side effects (e,g, liver toxicity)?

Answer 20

Montelukast

Question 21

Rescue treatments for asthma are not enough (i.e. control is also needed) if the rescue treatment must be used > ___ times per week.

Answer 21

Rescue treatments for asthma are not enough (i.e. control is also needed) if the rescue treatment must be used > 2 times per week.

Question 22

What is status asthmaticus?

What medication which acts largely at the level of gene transcription should be administered i.v.?

Answer 22

Severe, acute attack that is resistant to short-acting beta agonists;

corticosteroids

Question 23

When should leukotriene receptor antagonists be used as monotherapy for asthma?

Answer 23

Never!

(Increased risk of asthma-related death (poorly understood))

Question 24

Omalizumab (an anti-IgE antibody) has an associated risk of __________.

Answer 24

Omalizumab (an anti-IgE antibody) has an associated risk of anaphylaxis.