Question 1

Zafirlukast is a

Accepted Answer

Zafirlukast and montelukast are both leukotriene receptor antagonists and block the inflammatory effects of leukotrienes.Specifically,zafirlukast binds to the cysteinyl leukotriene 1 receptors,with no agonist effect.

Question 2

Singulair can be administered to which of the following patient populations?
1)Adults and adolescents 15 years or older
2)Pediatric patients 6 to 14 years
3)Pediatric patients 2 to 5 years
4)Pediatric patients 12 to 23 months
5)Pediatric patients 6 to 23 months

Accepted Answer

Montelukast is available as a 10-mg tablet,as 4-mg and 5-mg chewable cherry-flavored tablets,and as a 4-mg packet of granules.
Adults and adolescents 15 years or older: One 10-mg tablet daily,taken daily.
Pediatric patients 6 to 14 years: One 5-mg chewable tablet daily,taken daily.
Pediatric patients 2 to 5 years: One 4-mg chewable tablet daily,or one 4-mg packet of oral granules daily.
Pediatric patients 12 to 23 months: One 4-mg packet of oral granules taken every evening.
Pediatric patients 6 to 23 months: One 4-mg packet of oral granules taken daily for allergic rhinitis.

Question 3

Mast cells are

Accepted Answer

Mast cells are connective tissue cells that contain heparin and histamine.Antileukotrienes agents block the inflammatory response in asthma.
Leukotrienes are chemical mediators that cause inflammation.
Mast cell stabilizers are agents used prophylactically to treat the inflammatory response in asthma.

Question 4

Zileuton interacts with which of the following respiratory care drugs?
1)Theophylline
2)Albuterol
3)Warfarin
4)Ipratropium bromide
5)Beclomethasone

Accepted Answer

Zileuton interacts with two important drugs in respiratory care: theophylline and warfarin.It may cause an increase in serum theophylline concentrations and can increase prothrombin time when given concomitantly with warfarin.

Question 5

Leukotrienes exhibit which of the following effects?
1)Increased mucus secretion
2)Inhibition of normal ciliary action
3)Increased airway edema
4)Bronchoconstriction
5)Recruitment of other inflammatory cells into airways

Accepted Answer

Leukotrienes are potent bronchoconstrictors and stimulate other cells to cause airway edema,mucus secretion,ciliary beat inhibition,and recruitment of other inflammatory cells into the airway.

Question 6

What is the clinical indication for use of antileukotriene drug therapy,such as montelukast,in asthma?

Accepted Answer

The following points summarize the current understanding of the role of antileukotriene drug therapy in asthma: •Antileukotriene agents are prophylactic,controller drugs used in persistent asthma,including mild,moderate,and severe states;they are not indicated for acute relief or rescue therapy. •Antileukotrienes can be tried as an alternative to inhaled corticosteroids or cromolynlike agents in mild persistent asthma requiring more than as-needed F1F1F1S1F1F1F10₂ agonists. •Antileukotrienes may not be optimal as monotherapy in persistent asthma. •Antileukotrienes may allow reduction of high-dose inhaled corticosteroids or prevent an increase in the dose of inhaled corticosteroids,and they reduce or prevent the need for oral corticosteroids. •Evidence to date shows these agents as safe and often effective choices in managing a wide range of asthma severity.

Question 7

Cromolyn sodium is effective in preventing bronchospasm by

Accepted Answer

As a mast cell stabilizer,cromolyn sodium works to prevent bronchospasm by inhibiting the degranulation of mast cells,blocking release of the chemical mediators of inflammation.It has no bronchodilatory effects.

Question 8

Which of the following are antileukotriene agents?
1)Zafirlukast
2)Zileuton
3)Cromolyn sodium
4)Montelukast

Accepted Answer

Cromolyn sodium is a mast cell stabilizer,whereas zafirlukast,montelukast,and zileuton are considered antileukotrienes.

Question 9

The general indication for clinical use of nonsteroidal antiasthma agents is

Accepted Answer

The general indication for clinical use of nonsteroidal antiasthma agents is prophylactic management,or control,of mild persistent asthma as put forth in the 2007 National Asthma Education and Prevention Program (NAEPP)Guidelines for the Diagnosis and Management of Asthma.These agents are not designed for short-term control or to reverse active bronchospasm.

Question 10

After a patient begins using cromolyn sodium,how long may it take before clinical improvement in the patient's symptoms is seen?

Accepted Answer

It may take 2 to 4 weeks for improvement in the patient's symptoms,enabling a decrease in concomitant therapy such as bronchodilator or steroid use.

Question 11

The only antileukotriene agent currently approved for use in patients younger than 5 years of age is

Accepted Answer

Montelukast is the only one of the three currently available antileukotriene agents that is approved for use in children younger than 5 years.To date,no safety issues have appeared with pediatric use,and the drug has been proven safe and effective in infants 6 months old.

Question 12

The usual dose of nebulized cromolyn sodium is

Accepted Answer

The usual dose of 20 mg qid (80 mg/day)in some cases can be reduced to a maintenance dose of 40 to 60 mg/day after the patient is stabilized for 1 or 2 months.

Question 13

Nonsteroidal antiasthma drugs are

Accepted Answer

All the drugs described in Chapter 12 are controllers,not relievers,and are used in asthma requiring antiinflammatory drug therapy.

Question 14

Cromolyn sodium is available in what form?

Accepted Answer

Cromolyn sodium is available only as a small volume nebulizer (SVN)formulation.The antileukotriene drugs zafirlukast,montelukast,and zileuton are available in tablet form.

Question 15

Accolate is the brand name for which medication?

Accepted Answer

Accolate is the brand name for zafirlukast.Singulair is the brand name for montelukast,Zyflo is the brand name for zileuton,and Xolair is the brand name for omalizumab.

Question 16

Which of the following nonsteroidal antiasthma agents is formulated as a subcutaneous injection?

Accepted Answer

Xolair is the trade name for omalizumab.It is formulated as a subcutaneous injection every 4 weeks;dose depends on weight and serum IgE level.The other drugs listed are available only for oral administration.

Question 17

Which of the following agents is considered a mast cell stabilizer?

Accepted Answer

Montelukast,zafirlukast,and zileuton all are antileukotriene agents.Cromolyn sodium,also known as Intal,is a mast cell-stabilizing agent used as a prophylactic in the treatment of asthma.Although it may not be used as often in clinical practice today as it was previously,the agent is an alternative in mild persistent asthma.The antiinflammatory mast cell-stabilizing effect of cromolyn has led to uses other than asthma prophylaxis,including the following:
•Allergic rhinitis (nasal solution)
•Mastocytosis,to improve diarrhea,abdominal pain,headaches,nausea,and itching (oral)

Question 18

Which type of asthma is associated with allergic reactions?

Accepted Answer

Extrinsic asthma is dependent on allergy,or atopy,whereas intrinsic asthma shows no evidence of sensitization to common inhaled allergens.

Question 19

Zileuton is administered by

Accepted Answer

Zileuton is marketed as Zyflo in a tablet formulation.

Question 20

The most commonly reported side effect of cromolyn sodium is

Accepted Answer

Nasal congestion may be seen after beginning cromolyn sodium use.Dermatitis,myositis,and gastroenteritis have occurred in a very few patients.

Quiz 12: Nonsteroidal Antiasthma Agents