Exam 1 Medication Quiz

True or False

Anticholinergics may be as effective as or even superior to B2 agonists in the treatment of asthma

False

Brand name inhaler to correct medication combination

Combivent, Duoneb

albuterol/ipratropium

Brand name inhaler to correct medication combination

Dulera

mometasone/formeterol

Brand name inhaler to correct medication combination

Symbicort

Budesonide/Formoterol

Brand name inhaler to correct medication combination

Stiolto Respimat

Olodaterol/Tiotropium

Brand name inhaler to correct medication combination

Anoro Ellipta

Umeclidinium/Vilanterol

Brand name inhaler to correct medication combination

Bevespi Aerosphere

Formoterol/Glycopyrrolate

Brand name inhaler to correct medication combination

Advair Diskus/HFA

Fluticasone propionate/salmeterol

Brand name inhaler to correct medication combination

Trelegy Ellipta

Fluticasone furoate/umeclidinium/vilanterol

Cromolyn

Prevents bronchoconstriction but has no direct bronchodilatory action and are ineffective once bronchoconstriction has occurred

Leukotriene inhibitors

Small bronchodilatory effect in some asthmatic patients and appears to prevent bronchoconstriction

Corticosteroids

Although gradually improving airway obstruction, these medications have no direct effect on contraction of airway smooth muscle and are not therefore considered to be bronchodilators

Beta-2 adrenergic agonists

Treatment of choice in asthma because they are most effective bronchodilators and have minimal side effects when used correctly

Anticholinergics

Competitive antagonist of endogenous ACh at muscarinic receptors resulting in bronchodilation and reduced tracheobronchial mucus secretion

Methylxanthines

In additions to its bronchodilator action, these medications also nonselectively inhibit PDE, inhibit adenosine receptors, inhibit IL-10 release, promote apoptosis in eosinophils, and reduce expression of inflammatory genes in asthma and COPD

Methylprednisolone

Available for oral and IV use

Prednisolone

Commercially available as a tab, ODT, and oral soln/syrup

Prednisone

Most commonly used oral steroid

Tachycardia and palpitations

Reflex cardiac stimulatoin secondary to peripheral vasodilation, from direct stimulation of atrial B2 receptors and possibly also from stimulation of myocardial B1 receptors as the doses of B2 agonist are increased

Hypokalemia

B2 receptor stimulation of potassium entry into skeletal muscle, which may be secondary to a rise in insulin secretion

Ventilation-perfusion V/Q mismatch

Pulmonary vasodilation in blood vessel previously constricted by hypoxia results in the shunting of blood to poorly ventilated areas and a fall in arterial oxygen tension

Muscle tremor

Stimulation of B2 receptors in skeletal muscle. It may be more troublesome with elderly patients and so is a more frequent problem in patients with COPD

Arnuity Ellipta

Fluticason furoate

Incruse Ellipta

Umeclidinium

Breo Ellipta

Vilanterol/Fluticasone furoate

Histamine

A chemical mediator released from mast cells

Asthma

Characterized by shortness of breath and wheezing

Bronchodilator

A drug that relaxes bronchial smooth muscle and dilates the lower respiratory passages

Mucolytic

A drug that liquifies bronchial secretions

COPD

A disease in which patients have difficulty expelling air from the lungs. Characterized, in part, by destruction of the walls of alveoli

Inhaled anticholinergics are a mainstay of COPD therapy. Which of the following medications are inhaled anticholinergics? SELECT ALL THAT APPLY

Glycopyrrolate

Spiriva

Atrovent

The only drug class that provides immediate relief of an acute asthmatic attack?

Beta adrenergics

Which of the following corticosteroids is commercially available as a nebulized solution?

Budesonide

Which of the following statements supports inhalation as the preferred mode of delivery of many drugs with direct effect on airways? (select all that apply)

Inhalation route can reduce systemic side effects of many medications

Lower doses can be used to achieve therapeutic effect

Several medications have greater therapeutic efficacy when given by the inhaled route

Which of the following statements is true of IV or nebulized magnesium sulfate? Select all that apply.

Improves lung function when added to nebulized B2 agonist

Side effects include flushing and nausea but are usually minor

Appears to act as a bronchodilator and may reduce cytosolic Ca2+ concentrations in airway smooth muscle cells

Which of the following statements is true regarding roflumilast? Select all that apply

Approved fro patients with COPD with severe disease (FEV1 <50% predicted, frequent exacerbations, and chronic bronchitis)

The relatively weak efficacy is due to dose limitations as a result of side effects, particularly diarrhea, headaches, and nausea

Oral PDE4 inhibitor

Which of the following SABAs are commercially available as oral dosage forms? (Select all that apply)

Albuterol

Terbutaline

What are the components of the brand produce 'Symbicort’? Select all that apply

Formoterol

Budesonide

The bronchodilator drug that would provide the longest duration of action is

Vilanterol

What are the medication components of Advair HFA?

fluticasone/salmeterol

Name the three main classes of bronchodilators that are in current clinical use. (separate by commas)

anticholinergics, Beta-2 agonists, methylxanthines

These two corticosteroids are prodrugs activated by esterases in the respiratory tract to the active principle form (separate by commas)

beclomethasone dipropionate, ciclesonide

Combivent is a combination product of which two medications?

albuterol, ipratropium

__ provides bronchodilation and bronchoprotection for more than 12 hours because it has a bulky substitution in the aliphatic chain and has moderate lipophilicity, which appears to keep the drug in the membrane close to the receptor, so it behaves as a slow-release drug

formoterol

List 3 local side effects of ICSs

cough, dysphonia, thrush

List all of the LAMAs

aclidinium, glycopyrrolate, tiotropium, umeclidinium, revefenacin

List two once-daily beta-2 agonists that have duration of actions more than 24 hours

olodaterol, vilanterol

LAMAs cause dryness of the ___ in 10%-15% of patients, but this usually disappears during continued therapy. __ retention is occasionally seen in elderly patients.

mouth, urinary

Omalizumab is a medication used in asthma that blocks ___ antibodies

IgE

Oral steroids are usually given as a single dose in the ___ because this coincides with the normal diurnal increase in plasma cortisol and produces less adrenal suppression

morning

Continuous treatment with a B2-agonist often leads to ___, which may be due to ___ of the receptor. __ may serve to prevent the development of B2-agonist tolerance in airway smooth muscle and prevent and reverse the fall in pulmonary B receptor density

tachyphylaxis, downregulation, corticosteroids

List two SABAs with commercially available MDIs

albuterol, levalbuterol

What is the mechanism of action of Singulair?

Leukotriene inhibitor

What is the MOA of Spiriva?

Muscarinic antagonist

__binds to all muscarinic receptor subtypes but dissociates slowly from _ and _ receptors, giving it a degree of kinetic receptor selectivity for these receptors compared with _ receptors from which it dissociates more rapidly.

tiotropium, M3, M1, M2

What is the generic name of Xopenex?

Levalbuterol

True or False

Albuterol is a racemic mixture of active R- and inactive S- isomers

True

Dupixent (dupilumab) is now indicated to treat certain subtypes of both asthma and COPD via (albeit an unknown) anti-inflammatory mechanism of action. Which targets are suspected to be of help? Select all that apply

IL-4

IL-13

Albuterol is commonly used as a rescue inhaler in patients with asthma and COPD and is available by itself in a number of different inhaled device types. Which ones? Select all that apply.

DPI

MDI

Nebulizer

Brand name Ohtuvayre or ensifentrine, is a new nebulized medication indicated to treat patients with COPD via an inhibitory MOA. What are its targets? Select all that apply

phosphodiesterase 4

phosphodiesterase 3