Resp patho and pharmaco Flashcards
which of the following drugs is the most potent bronchodilator?
1. montelukast
2. salmeterol
3. ipratropium
4. theophylline
5. zileuton
salmeterol (beta 2 selective adrenoceptor agonist)
LABA, slow acting
A patient is newly diagnosed to have asthma. which of the following prescriptions is contraindicated?
1. salbutamol
2. salmeterol
3. salmeterol and budesonide
4. budesonide
5. zileuton
B
salbutamol is SABA, fast acting, can be given cause newly diagnosed to have asthma means he just had asthma attack so if u give salbutamol which is fast acting it is ok.
salmeterol is LABA, slow acting but cannot give alone because this is slow acting and is contraindicated in acute asthma , need to be given with inhaled corticosteroid, hence this is contraindicated and option B is the answer
hence salmeterol and budesonide is the ideal treatment
budesonide is anti-inflammatory
recall general rule for beta agonists, LABA must always be given together with inhaled corticosteroid!!!
parents are concerned that a glucocorticoid might impair daughter’s growth and ask for alternative anti-inflammatory. which is not a steroid but can be an effective anti-inflammatory for mild asthma? (2 answers)
1. Zileuton
2. Fluticasone
3. Montelukast
4. Theophylline
answer is A and C
Zileuton is a leukotriene pathway inhibitor, anti-inflammatory
fluticasone is a corticosteroid, first line
Montelukast is also a leukotriene pathway inhibitor, anti-inflammatory
theophylline is a bronchodilator, not anti-inflammatory
this narrows us down to montelukast and zileuton
montelukast only inhibits CysLT receptor, has weak bronchodilator effects
Zileuton does not have bronchodilator effects as it has to be given at low dose. Zileuton only has bronchodilator effects at high dose but high dose not given because it has other adverse effects
what is an additional advantage of montelukast but not zileuton?
A. Montelukast is administered by inhaler and so has fewer systemic adverse effects
B. Montelukast but not zileuton is effective in NSAID exacerbated respiratory disease
C. Montelukast has fever adverse effects
D. Montelukast is a bronchodilator (although a weak one)
D. One difference you need to know between zileuton and montelukast is that montelukast has bronchodilator effects (but weak one) while zileuton has NO bronchodilator effects
both montelukast and zileuton must be given orally and are effective in NSAID exacerbated asthma
montelukast has just as much adverse effects??
Why are leukotriene pathway inhibitors helpful in NSAID exacerbated respiratory disease?
A. Inhibition of COX leads to arachidonic acid overflow to the 5-LOX pathway
B. NSAIDS are agonists at cysteinyl leukotriene receptors
C. NSAIDS activate endogenous cortisol release to trigger Cushing’s syndrome
D. Antagonists at cysteinyl leukotriene receptors suppress prostaglandin synthesis
Ans: A
B is wrong as NSAIDs inhibits cyclooxygenase, Corticosteroids inhibits phospholipase A2
C is wrong as it is corticosteroids that triggers Cushing’s syndrome
D is wrong as montelukast is an antagonist at cysteinyl leukotriene receptors which suppresses Leukotriene synthesis NOT prostaglandin
what are the different histological types of lung cancer?
small cell carcinoma
non-small cell carcinoma which consists of squamous cell carcinoma (most common), adenocarcinoma and others including large cell carcinoma
List 3 paraneoplastic syndromes of lung cancer, with one example for squamous cell carcinoma
For squamous cell lung carcinoma: hypercalcemia
For small cell carcinoma: endocrine disturbances like SIADH, ectopic ACTH secretion, Hypertrophic pulmonary osteoarthropathy
what ipratropium and tiotropium adverse effects will you look out for? (2 ans)
A. dry mouth
B. increased airway secretions
C. urinary retention
D. Hypertension
E. cognitive dysfunction and amnesia
A and C
muscarinic antagonist
inhibits M3 parasympathetic mediated secretion of saliva, hence dry mouth
inhibits parasympathetic mediated contraction of detrusor smooth muscle of bladder hence
what salbutamol adverse effects will you look out for? (more than 1 ans)
1. tachycardia
2. tremor
3. anxiousness
4. hypertension
5. insomnia
salbutamol is a SABA
ans: all 5 of them!
