Respiratory Drugs and Autacoids Flashcards by Venice Camille Patricio

Formoterol is also used as a reliever due to its short onset of action and longer duration of ___ hours

12 hours

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R-isomer of albuterol used in children with asthma

Levalbuterol

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Beta-agonist that inhibits uterine contractions to prevent premature labor

Terbutaline

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Which of the following ultra-LABA may be used as monotherapy for treatment if COPD?
A. Indacaterol
B. Olodaterol
C. Vilanterol
D. Bambuterol
E. AOTA

E. AOTA
-may be used as monotherapy with COPD but needs to be in combi with ICS for Asthma

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Which of the following cannot be used in acute exacerbation?
A. Salbutamol
B. Metaproterenol
C. Salmeterol
D. Pirbuterol
E. Levalbuterol

C. Salmeterol

LABA with 20 min duration

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This is a unique LABA that has a longer duration of action but same onset as SABA; hence, it may be used as a controller and a reliever medication.

Formoterol

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This is used largely for treatment of the acute vasodilation and bronchospasm of anaphylaxis, but it can cause tachycardia, arrhythmia, and worsening of angina pectoris as it is an alpha and beta agonist

Epinephrine

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This sympathomimetic has an oral activity and more pronounced central effects and lower potency compared to EPI

Ephedrine (longer duration rin)

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T/F:
Tolerance does not develop with Methylxanthines, but it elicits adverse CNS effects; hence, it’s an add-on treatment only

True

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T/F:
Theophylline is commonly used in pediatrics and not with COPD

False:
- not in pediatrics since it has narrow Therapeutic Index, but it is seen more on COPD

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Which of the following is FALSE of Theophylline?
A. Slowest rates of clearance occur in infants and neonates
B. Blood levels need to be monitored when used
C. Aminophylline is the commonly used preparation for therapeutic purposes
D. Superior effects than corticosteroids

D. its inferior to corticosteroids

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This xanthine-derived drug is used in intermittent claudication as it decreases the blood viscosity

Pentoxifylline

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Which of the following is not an MOA of Theophylline?
A. Inhibits PDE3 for the relaxation of airway
B. Inhibits histone deacetylation
C. Inhibits receptors for adenosine
D. Inhibits PDE4 to prevent release of cytokines and chemokines

B. should be enhanced histone deacetylation for activation of inflammatory gene transcription

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Which of the following is not a sign of Theophylline toxicity?
A. Hypertension
B. GI Distress
C. Insomnia
D. Tremors
E. Arrhythmia

A. should be hypotension

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Which of the following is a low concentration CV effect of Theophylline?
A. Increased catecholamine release
B. Enhanced histone deacetylation
C. Inhibits receptors for adenosine in SNS nerves
D. Inhibits PDE decreasing calcium influx
E. Both A and C

E. Both A and C

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What is the GI effect of Theophylline?

Stimulate Gastric acid and digestive enzyme secretion

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Which of the following is an effect of Theophylline?
A. Increased tubular sodium reabsorption and decreased GRF
B. Inhibit antigen-induced release of histamine from lung tissue
C. Decreased GI secretion
D. Negative chronotropy and inotropy

B. inhibits Histamine, weak diuretic, stimulates GI secretions and positive chronotropy and inotropy

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Earliest sign of Theophylline toxicity is

Nausea and vomiting

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The selective quaternary ammonium derivative of atropine used as an add-on therapy for patients having severe asthma attacks

Ipratropium bromide

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Which of the following are not true of Ipratropium bromide?
A. Minimally crosses the nasal and gastrointestinal membranes and the blood-brain barrier
B. Results to greater bronchoconstriction with less toxicity
C. Useful in COPD patients who are unresponsive to beta-2 agonists
D. Not used in long-term asthma treatment
E. Given throughout and after duration of asthma attack

E. Ipratropium bromide is only given is severe asthmatic patients about 48-72 hours, and bronchodilation and anti-inflammatory effects suggest discontinuation

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Which of the following is NOT true of Tiotropium bromide?
A. It’s a long-acting muscarinic antagonist
B. it’s taken by inhalation
C. May be used by asthma only patients
D. Maintenance therapy for patients with COPD and overlapping asthma
E. NOTA

C. it is NOT recommended for patients with asthma only

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These are the inhibitory proteins synthesized as corticosteroids block all pathways of eicosanoid synthesis

annoxins or lipocortins

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Which of the following is the most important action of corticosteroids in asthma?
A. Contraction of engorged vessels in the bronchial mucosa
B. Potentiation of the effects of beta-receptor agonists
C. Inhibition of infiltration of airways by lymphocytes, eosinophils, and mast cells
D. Reduce bronchial hyperactivity

all are effects of Corticosteroids

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Which of the following surface-active corticosteroids are for local aerosol administration, considered safe and for long-term use?
A. Beclomethasone
B. Budesonide
C. Fluticasone
D. AOTA

D. AOTA

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Which of the following are given via IV for Status asthmaticus patients? A. Methylprednisolone B. Prednisone C. Prednisolone D. Fluticasone

A. Methylprednisolone and Hydrocortisone

Which inhaled corticosteroid is associated with less frequent oral candidiasis? A. Flunisolide B. Ciclesonide C. Triamcinolone D. Mometasone E. NOTA

B. Ciclesonide - prodrug activated by bronchial esterases

Drug for Biologic therapy that binds to IgE on sensitized mast cells and prevents activation by asthma triggers and subsequent release of inflammatory mediators

Omalizumab

Medications used for the prophylaxis of mild to moderate persistent asthma

Mast cell stabilizers or chromones

A prototype drug used to reduce symptoms of allergic rhino-conjunctivitis

Cromolyn (Disodium Cromoglycans)

Which of the following is not a feature of Cromolyn? A. used for Systemic mastocytosis B. for management of Hay Fever C. readily absorbed in the systemic circulation D. requires 4-6 weeks trial to determine efficacy

C. Cromolyn (Disodium Cromoglycate) is poorly absorbed into the systemic circulation and havelittle toxicity mild adverse effect

What is the most important clinical effect of Omalizumab?

Reduction in the frequency and severity of asthma exacerbations, while enabling a reduction in cortocosteroid requirements.

Which asthma medication has been proven effective as a treatment for chronic recurrent urticaria and for peanut allergy

Omalizumab

True or False: The first injection of Omalizumab can be done at home

False: it should be done in a hospital setting There can be anaphylaxis or severe form of allergy despite being an anti-allergy medication. Remember: This is a monoclonal antibody. It can elicit an immune response.

True or False: A 12 year-olf girl may be prescribed with Omalizumab if she has IgE levels of 250 IU and is able to afford treatment

False: should be around 400 IU

Which of the following is NOT a side effect of Omalizumab? A. Malignancy B. URTI C. Viral infections D. Sinusitis E. Hypotension

E. Hypotension

There is a need for screening for chronic infections the hepatitis B and TB in patients being prescribed with: A. Cromolyn B. Theophylline C. Omalizumab D. Zileuton E. Ipatropium bromide

C. Omalizumab

Anti-thymic stromal lymphopoietin drug for non-eosiniphilic type of asthma

Tezepelumab

Add-on Anti-Interleukin-4 Receptor a drug for severe eosinophilic or Type 2 asthma

Dupilumab

Which among the Anti-IL-5 monoclonal antibody works on Isotype humanized IgG4?

Reslizumab

Which drugs are no longer part of the management for asthmatic patients based on 2022 GINA Guidelines? A. Mast cell stabilizers B. Lipoxygenase inhibitors C. COX inhibitors D. Leukotriene antagonists E. Inhaled corticosteroids

B. Mast cell stabilizers

True or False: Using two or more canisters of an inhaler is a marker for increased risk of asthma fatality.

True

True or False: For patients with severe asthma attacks, inhalation of a β-receptor agonist is as effective as subcutaneous injection of epinephrine.

False: that's for mild Severe attacks require treatment with oxygen, frequent or continuous administration of aerosolized albuterol, and systemic treatment with prednisone or methylprednisolone (0.5 mg/kg every 6–12 hours).

Which is NOT true of COPD? A. COPD may involve both airways and alveoli B. It has better response to ICS therapy than Asthma C. Like asthma, it results to reduction in maximum expiratory flow D. Manifests neutriphilic infiltration E. Preventable disease, and cannot be fully reversed with treatment once developed

B. should be "it has poor response to ICS therapy"

Which drug combination is used for the relief of COPD symptoms?

SABA inhalation (especially for acute exacerbation) and Anticholinergic

Which type of antimuscarinic drug may potentially cause vagal-induced bronchoconstrition?

Short-acting Muscarinic Antagonists

Which of the following is not a Long-acting antimuscarinic used for COPD? A. Oxitropium B. Tiotropium C. Glycopyrollate D. Umeclinidinium E. Aclidinium

A. Oxitropium is a SAMA

True or False: The use of Theophylline require frequent monitoring of levels paticularly in adult COPD patients as clearance decrease with age.

True

Salmeterol, when combined with this drug, produces a greater improvement in FEV1 and breathlessness than when taken alone.

Theophylline

These are anti-inflammatory agents for COPD that were found to reduce exacerbations over 1 year when administered

Antibiotics (azithromycin and erythromycin)

These drugs were recently included in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2021 as its principal action is to reduce inflammation by inhibiting the breakdown of intracellular cyclic AMP

PDE4 inhibitors

Which of the following is not true of Rofumilast? A. It's a PDE4 inhibitor B. It's a once daily oral medication with direct bronchodilator activity C. It reduces moderate and severe exacerbations treated with systemic corticosteroids in patients with Chronic Bronchitis D. It has greater beneficial effects in patients with a prior history of hospitalization for an acute exacerbation E. It requires precautions in patients with depression

B. it induces indirect activity

The drug of choice in acute asthmatic brochospasm

Albuterol

This is a drug similar to albuterol and is also available as oral drug

Terbutaline

Which of the following may manifest cardiac effects when administered for asthma? A. Epinephrine B. Isoproterenol C. Formeterol D. Both A and B

D. Isoproterenol = powerful

Which of the following is a management for Hay fever? A. Cromolyn B. Fluticasone C. Theophylline D. Both A and B

D. Both A and B

Leukotriene Antagonists effective in preventing exercise-induced asthma and aspirin-induced bronchospastic attack

Zafirlukast Montelukast

An asthma patient reducing predisone dosage and taking LTD4 antagonist manifested systemic vasculitis accompanied by worsening asthma, pulmonary infiltrates, and eosinophilia. What is this drug? A. Montelukast B. Theophylline C. Cromolyn D. Omalizumab E. Dupilumab

A. Montelukast (LTD4 antagonist like Zafirlukast) - Churg-Strauss syndrome is a disorder marked by blood vessel inflammation. This inflammation can restrict blood flow to organs and tissues, sometimes permanently damaging them. This condition is also known as eosinophilic granulomatosis with polyangiitis (EGPA)

A patient had a history of Nedocromil medications. Which of the following is not true of this drug? A. It's a prophylactic anti-inflammatory agent via INHALATION B. Administered shortly BEFORE exercise or inevitable exposure to allergens C. Effect is mediated by inhibition of various SODIUM channels reponsible for secretion and cellular activation of MAST Cells D. Has NO DIRECT bronchodilator action but inhibits bronchospasm via mast cell degranulation

C. Inhibition of various DELAYED CHLORIDE CHANNELS

Which of the following is known to increase skeletal muscle strength helpful for the diaphragms of COPD patients? A. Cromolyn B. LAMA C. Theophylline D. PD4 inhibitors E. Roflumilast

C. Theophylline

Drug that inhibits 5-lipoxygenase decreasing the biosynthesis of leukotrienes but has been associated with LFT abnormalities

Zileuton - inhibits lipozygenase - orally active - prevents exercise- and antigen-induced bronchospasm - associated with liver toxicities (Liver function test abnormalities) - for adult patients only

Route of administration of Omalizumab

Parenteral (subQ injections)

Interleukins blocked by Dupilumab

IL-4 and IL-13

This is known as "anti-inflammatory reliever" for asthma that reduces the risk of severe exacerbation for adults and adolescents

low dose ICS-formeterol - reduces the risk of severe exacerbation compared with SABA relievers

Storage cells of histamine

→ Mast cells, mainly in lungs, skin & GIT mucosa as an inactive complex → Platelets & basophilic leukocytes in CNS → Enterochromaffin-like (ECL) cells of the stomach

Firstline of treatment for allergic rhinitis

Antihistamine

Most important receptor for histamine for in lines the smooth muscles and is also present in the endothelial tract

H1 - used for allergic rhinitis and skin conditions

H receptors found in myenteric plexus

H3: presynaptic autoreceptors and heteroreceptors

H receptors for Eosinophils, Neutrophils and CD4 T cells

True or False: In humans, mast cells in skin and basophils have a negative feedback control mechanism mediated by H2 receptors, but lungs mast cells do not

True

Which is not true of histamine? A. It inhibits the release of lysosome contents B. It inhibits T- and B-lymphocyte function via H1 and H3 receptors C. Causes leakage of plasma-containing mediators of acute inflammation and antibodies D. Causes local vasodilation

B. These actions are mediated by H2 or H4 receptors

Structures of the H1 and H2 receptors differ significantly; Each appear to be more closely related to: _______ and _______ respectively

H1 - Muscarinic H2 - 5-HT1

Which drug is an agonist at H4 and an antagonist or inverse agonist at H3 receptors

Clobenpropit

Activation of which Gs H receptor may couple to Gq?

H2 receptor

Activation of which H receptor is very important chemotactic effects on eosinophils and mast cells?

H4 receptors - found mainly in leukocytes

Interaction of mast cells with ______ antibodies and allergens will bring about the release of inflammatory mediators such as histamine which causes wheal formation

IgG

True or False? Manifestations of wheal and flare reaction is also seen in the lining of the respiratory tract

True Manifestations of wheal and flare reaction is also seen in the lining of the respiratory tract particularly, the nose

Bronchoconstriction via Histamine is mediated by which receptor?

H1 - Smooth muscle - Endothelium - Brain

Diarrhea due to Histamine stimulation is mediated by which receptors?

H2 - in gastric parietal cells - contraction of intestinal smooth muscle - secretion of gastric pepsin and intrinsic factor

Which H2-blocking drug (H3 antagonist also) has ab analgesic effects comparable to that produced by opioids?

Burimamide

DOC: Anaphylactic Shock

Epinephrine

Which of the following is not a Beta receptor activity of Epi? A. Pulmonary bronchodilation B. Increased Myocardial contractility C. Suppress release of leukotrienes D. Decrease mucosal edema

D. is for alpha receptor activity Alpha receptor activity ▪ Decrease mucosal edema (like laryngeal edema) ▪ Decrease peripheral vasodilation and vascular permeability

These are known as Selectively Acting H1 receptor antagonists

2nd generation drugs

Which newer generation of anti-histamine has a less sedating property compared to others?

Bilastine

Anti-histamine that has significant acute suppressant effect on antipsychotic drugs-associated extrapyramidal symptoms

Diphenhydramine

Many first-generation agents, especially those of the ethanolamine have significant _______-like effect on peripheral muscarinic receptors

Atropine-like

Antihistamines especially those in the _______ subgroup may cause orthostatic hypotension to susceptible individuals

phenothiazine

A first-generation potent H1-blocking agent that notably blocks serotinin and resembles phenothiazine AH

Cyproheptadine

These are first-gen H1-antagonist that are actually more potent than procaine as local anesthetics

Diphenhydramine and promethazine

Which of the following are not a quality of of 2nd generation antihistamines? A. Anti-inflammatory action B. P-glycoprotein transporter inhibitor C. Anti-muscarinic effect D. Less-lipid soluble E. Less sedation

C. exhibited especially by ethanolamines

Which of the following is not an effect of first-gen H1-antagonist? A. Serotonin-blocking action B. Anti-nausea C. Benefit for non-allergic rhinorrhea D. Anti-inflammatory E. Local anesthesia

D. Anti-inflammatory

These are the second-line drugs after glucocorticoids for Hay fever or allergic rhinitis

H1 antagonist nasal spray

Drug of choice for urticaria

H1 antagonists

This may be precipitated by histamine release maintained by peptide kinins that are not affected by antihistaminic agents

Angioedema

Which among the drugs below reduces awareness of itching in atopic dermatitis? A. Diphenhydramine B. Cyproheptadine C. Roflumilast D. Fluticasone

A. Diphenhydramine

True or False? With the used of antihhistamines in atopic dermatitis, clinical effectiveness of one group may diminish with continued use and switching to another group may restore drug effectiveness.

True

Which of the following is effective in preventing motion sickness? A. Scopolamine B. Diphenhydramine C. Promethazine D. Piperazine E. AOTA

AOTA Greatest: diphenhydramine and promethazine Significant activity and less sedating: piperazines (meclizine and cyclizine) Buclizine, hydroxyzine and meclizine are indicated less for allergies rather are used for motion sickness

Both scopolamine and the H1 antagonists are more effective in preventing motion sickness when combined with:

ephedrine or amphetamine

Several large prospective studies disclosed NO increase in the incidence of birth defects with the use of Doxylamine, thereby justifying the reintroduction of a similar product:

Diclegis

These constitute the most common undesirable actions of H1-antagonists

Sedation and anticholinergic action

These antihistamines are no longer marketed as they are cardiotoxic and may induce cardiac arrhythmia or lethal ventricular arrhythmias

Astemizole and Terfenadine (occurs in combination with ketoconazole, itraconazole, or macrolide antibiotics)

A patient underwent V. arrhythmia upon taking doses of an antibiotic. History determined that patient was also taking one of the following antihistamines: A. Fexofenadine B. Cetirizine C. Astemizole D. Desloratadine E. Promethazine

C. Astemizole and Terfenadine when used with drugs that are inhibit its metabolism by CYP3A4 such as ketoconazole, itraconazole, or macrolide antibiotics may be cardiotoxic

The mechanism of toxicity of Terfenasine as Astemizole involves:

blockade of the HERG (IKr) potassium channels in the heart

Which of the following is not a second generation H1-antagonist? A. Azelastine B. Olopatadine C. Acrivastine D. Azatadine E. Fexofenadine

D. Azatadine

This first-generation alkylamine is a common component of OTC “cold” medication

Chlorpheniramine

What is the cardiotoxic effects of first-generation anti-histamine

prolongs QTC

Duration of action of first-gen H1 antagonist

4-8 hours

True or False: Second-generation H1-antagonists exhbits no tolerance

True

Which histamine-selective ligands are of value in sleep disorders, narcolepsy, obesity, and cognitive and psychiatric disorders.

This is an inverse H3-receptor agonist, has been shown to reduce sleep cycles in mutant mice and in humans with narcolepsy

Tiprolisant