Marc Imhotep Cray, M.D.

Drugs Acting on the Respiratory System Review Test Answers And Explantions

1. The answer is D. This is a fairly classical presentation of asthma, which should be confirmed with further pulmonary testing. Mild persistent asthma can be treated several ways (Table 9-1), but inhaled glucocorticoids are very effective. Oral prednisone has many side effects, especially in a young person. Omalizumab is for patients who are refractory to other treatments. Antihistamines such as diphenhydramine are poorly effective in asthma, and theophylline is only moderately effective. 2. The answer is B. Zileuton is a leukotriene synthesis inhibitor that can cause increases in hepatic enzymes and altered liver function. It decreases the rate of heparin metabolism, leaving patients prone to easy bruising. Zafirlukast and albuterol are antiasthmatic agents but do not alter liver enzymes. Aspirin might cause bleeding disorders, but the low dose this patient is taking is unlikely to be responsible for the liver enzyme abnormalities. 3. The answer is C. The patient's asthma is worsening, especially in response to exercise or increased allergen exposure and the excessive of short-acting 2-agonists requires a change in medication. The best choice would be a long-acting 2-agonist like salmeterol. Oral glucocorticoids have many adverse effects, zileuton and nedocromil are unlikely to be sufficiently efficacious in the worsening asthma. 4. The answer is B. The metabolism of theophylline depends on age; the half-life of the drug in children is much shorter than in adults. The methylxanthines are all well absorbed and are metabolized in the liver. 5. Which of the following statements correctly describes the action of theophylline? 5. The answer is B. Theophylline may have several mechanisms of action, but its adenosinereceptor antagonist activity and the inhibition of phosphodiesterase are the best understood. 6. The answer is D. Opioids act centrally to decrease the sensitivity of the cough center; they also decrease propulsion in the bowel. 7. The answer is B. Ipratropium is an ACh-receptor antagonist; it is poorly absorbed, so most of its effect is in the lung. It does not cross the bloodbrain barrier and does not block mediator release or H1-receptors. 8. The answer is B. By inhibiting 5-lipoxygenase, zileuton reduces leukotriene biosynthesis; it does not inhibit (and in fact it might increase) prostaglandin synthesis.

Drugs Acting on the Respiratory System Review Test Answers And Explantions