Question 1

Explain the reason why theophylline may be contraindicated in patients with existing cardiovascular disease.

Accepted Answer

Caution is necessary in patients with existing cardiovascular disease, since theophylline may cause excessive cardiac stimulation.

Question 2

Implementing a treatment plan that includes cromolyn sodium includes educating the patient on proper use of the medication.The instructions for use are:

Accepted Answer

Cromolyn sodium is a drug that interferes with the antigen-antibody reaction to release mast cell mediators. The drug is taken prophylactically (before allergic exposure) on a daily basis. Cromolyn is also useful in allergic conditions affecting the eyes, nose, and gastrointestinal tract. In the treatment of asthma, cromolyn is administered by oral inhalation three to four times per day.

Question 3

Summarize the preferred therapy for the relief of moderate or persistent asthma.

Accepted Answer

Patients who experience daily asthmatic episodes require daily treatment with low-to-moderate-dose inhaled antiinflammatory corticosteroids and inhaled selective beta-2 adrenergic bronchodilators.

Question 4

Differentiate between the methylxanthine,selective beta-2,and anticholinergic drug agents,and select the drug class that produces mild stimulation of the central nervous system,heart,and kidneys and relaxation of smooth muscle.

Accepted Answer

Methylxanthines produce mild stimulation of the central nervous system, heart, and kidneys. Other physiological actions include relaxation of smooth muscle (bronchodilation) and increased skeletal muscle tone and strength of contractions. Theophylline is the only natural methylxanthine used for its bronchodilating actions.

Question 5

Use the adverse-effect profile of the systemic steroids to determine the statement that is true regarding the use of these steroids in the treatment of asthma.

Accepted Answer

Adverse effects associated with systemic steroid use include fluid retention, muscle wasting, metabolic disturbances, and increased susceptibility to infection.

Question 6

Use the mechanism of action of the corticosteroids to determine the physiologic action that results from their administration.

Accepted Answer

Corticosteroids inhibit the activity of inflammatory cells, the release of inflammatory mediators from mast cells, the production of allergic antibodies, edema, and many other antiinflammatory actions.

Question 7

Describe the proper method of administration of acetylcysteine (Mucosil) to decrease the possibility of irritation and bronchospasm.

Accepted Answer

Acetylcysteine is irritating and can cause bronchospasm. For this reason, a bronchodilator is added to the inhalation mixture. Administration is usually by nebulization, three or four times a day, followed by postural drainage and tracheal suction when necessary.

Question 8

Summarize the role that the autonomic nervous system plays in the development of asthma.

Accepted Answer

Bronchiolar smooth muscle tone and secretion of mucus are normally influenced by the sympathetic and parasympathetic divisions of the autonomic nervous system. Sympathetic stimulation by epinephrine (beta-2 receptor) produces bronchodilation. Parasympathetic activation through the release of acetylcholine produces bronchoconstriction and increased secretion of mucus.

Question 9

Compare the mucolytic and expectorant drug agents,and determine the primary mechanism of action of the mucolytic agents.

Accepted Answer

Mucolytics are chemical agents that liquefy bronchial mucus. Expectorants are drugs that facilitate the removal of thickened mucus secretions from the lungs.

Question 10

Explain the mechanism of action of the anticholinergic drug agents used to treat asthma.

Accepted Answer

By blocking the actions of acetylcholine, anticholinergic drugs produce bronchodilation and also reduce the volume of respiratory secretions. Anticholinergic drugs are not as potent bronchodilators as the beta adrenergic drugs and in asthma are primarily indicated when other bronchodilators are contraindicated or additional bronchodilation is needed

Question 11

A patient complains of hoarseness and changes in his voice.Using your knowledge of steroids and leukotriene inhibitors,you advise the patient that the best way to avoid these adverse effects is to:

Accepted Answer

Steroids increase the incidence of oral infections (usually fungal infections), and they can cause hoarseness and other vocal chord disturbances. The incidence of these adverse effects can be reduced by rinsing the mouth with water after inhalation to minimize the amount of steroid that remains in the oral cavity.

Question 12

Differentiate between the chemical mediators that are formed and released from injured tissue,mast cells,and leukocytes in the respiratory tract,and select the function of histamine as it relates to asthma.

Accepted Answer

In the respiratory tract, histamine causes bronchoconstriction, increased vascular permeability that contributes to mucosal edema, and infiltration of leukocytes, particularly eosinophils.

Question 13

Implementing a treatment plan that includes zileuton (Zyflo) requires monitoring the patient for:

Accepted Answer

Adverse effects of the leukotriene inhibitors include nausea, diarrhea, rash, and headache. One of the more serious adverse effects involves the liver. An abnormal increase in liver enzymes and the development of fever, dark urine, clay-colored stools, or jaundice are signs of liver toxicity and should be reported to the physician.

Question 14

Use the clinical manifestations of asthma and COPD to determine the significant therapeutic aim in treating COPD.

Accepted Answer

The therapeutic aim in COPD is to improve lung function and exercise capacity as much as possible. While bronchoconstriction is not the major symptom of COPD, maximizing respiratory gas exchange is of prime Importance. Mucolytics and expectorants can be used in COPD to liquefy and help remove secretions, but the benefit of these drugs does not appear to be clinically significant.

Question 15

Using the onset of action as the primary factor,determine the preferred therapy for the treatment of the sudden onset of asthma symptoms.

Accepted Answer

Patients who experience less than two asthmatic episodes per week often do not require daily medication. Selective beta-2 adrenergic bronchodilators for oral inhalation that provide immediate onset of action, such as albuterol, can be carried by the patient and used for any sudden onset of symptoms.

Question 16

Identify the symptoms associated with chronic bronchitis.

Accepted Answer

Symptoms of chronic bronchitis include a productive cough, difficulty in breathing, increased respiratory infections, and restriction of physical activity.

Question 17

Caffeine,theophylline,and theobromine are classified as methylxanthines and are found in nature.Methylxanthines can be described as:

Accepted Answer

Caffeine, theophylline, and theobromine are plant compounds found naturally in tea, cocoa, and coffee. These compounds, classified as methylxanthines, produce mild stimulation of the central nervous system, heart, and kidneys. Other physiological actions include relaxation of smooth muscle (bronchodilation) and increased skeletal muscle tone and strength of contraction.

Question 18

Identify the factors that can trigger an asthmatic attack.

Accepted Answer

Allergens, air pollutants, cold air, certain drugs, infections, and exercise are some of the factors that can trigger an asthmatic attack.

Question 19

Identify the physical manifestations associated with emphysema.

Accepted Answer

Individuals with emphysema have difficulty expelling air from the lungs. Respiratory exchange is reduced, and shortness of breath occurs. Irreversible lung damage takes place, forcing the individuals to restrict daily activities.

Question 20

Compare the expectorant and the mucolytic agent,and select the product that is available over the counter without a prescription for the relief of an unproductive cough.

Accepted Answer

The primary action of expectorants is to increase respiratory secretions, which lubricate and help liquefy mucus. The expectorants include salts (ammonium chloride and potassium citrate), ipecac syrup, and guaifenesin. Guaifenesin (Mucinex) is available over the counter and is the most frequently used expectorant for the relief of an unproductive cough.

Quiz 32: Respiratory Pharmacology, treatment of Asthma, and Copd