1.
Drug treatment for asthma and COPD aim to do all of the following except:
Correct Answer
A. Cure asthma/COPD
Explanation
Drug treatment for asthma and COPD aims to relieve/prevent bronchoconstriction, inhibit airway inflammation, prevent airway remodeling, and manage asthma/COPD. However, it does not aim to cure asthma/COPD. Asthma and COPD are chronic conditions that currently do not have a known cure. The goal of drug treatment is to control symptoms, improve lung function, and prevent exacerbations, but it cannot completely eliminate the underlying condition.
2.
Stimulation of beta-2 sympathetic receptors can alleviate bronchoconstriction. Drugs that stimulate these receptors are called all of the following except:
Correct Answer
E. AlpHa-1 antagonists
Explanation
Alpha-1 antagonists are not drugs that stimulate beta-2 sympathetic receptors. Alpha-1 antagonists work by blocking the alpha-1 adrenergic receptors, which are involved in vasoconstriction. They are used to treat conditions like high blood pressure. On the other hand, sympathomimetics, adrenergics, and beta-2 agonists are all terms used to describe drugs that stimulate the beta-2 sympathetic receptors. Catecholamines are a type of sympathomimetic drug that includes substances like epinephrine and norepinephrine.
3.
Beta-adrenergic stimulation by agonists stimulate AC to increase cAMP. The increase in cAMP correctly affects which of the following pathways?
Correct Answer
B. PKA inhibiting MLCK
Explanation
Beta-adrenergic stimulation by agonists increases the production of cyclic adenosine monophosphate (cAMP). In this case, the increase in cAMP leads to the activation of protein kinase A (PKA). PKA then inhibits myosin light chain kinase (MLCK), which is responsible for the phosphorylation of myosin light chain (MLC). By inhibiting MLCK, PKA prevents the phosphorylation of MLC and thereby inhibits smooth muscle contraction. This explains why the correct answer is PKA inhibiting MLCK.
4.
The binding of cAMP to the regulatory subunits of PKA liberate 2 catalytic subunits. What is the mechanism of action of these catalytic subunits?
Correct Answer
B. pHospHorylation of MLCK to inhibit airway muscles
Explanation
The catalytic subunits of PKA phosphorylate MLCK (Myosin Light Chain Kinase) to inhibit airway muscles. MLCK is responsible for phosphorylating myosin, which leads to muscle contraction. By phosphorylating MLCK, the catalytic subunits of PKA inhibit its activity, preventing the phosphorylation of myosin and ultimately leading to muscle relaxation. This mechanism of action is important in regulating airway smooth muscle tone and controlling bronchial constriction.
5.
Primarily, beta-2 adrenergic agonist alleviate bronchoconstriction. Additional potential benefits include all of the following except:
Correct Answer
E. All of the above are additional benefits of beta-2-agonists
Explanation
Beta-2 adrenergic agonists primarily alleviate bronchoconstriction. In addition to this, they have several additional benefits. They can reduce plasma exudation, increase ciliary action, stabilize mast cells, and reduce bacterial adherence to epithelial cells. Therefore, all of the given options are actually additional benefits of beta-2 agonists.
6.
Which of the following pairs are the NON-selective beta-2-agonists?
Correct Answer
C. EpHedrine and isoproterenol
Explanation
Ephedrine and isoproterenol are the non-selective beta-2-agonists because they bind to both beta-1 and beta-2 adrenergic receptors. Albuterol and pirbuterol are selective beta-2-agonists, as they primarily target the beta-2 adrenergic receptors. Salmeterol and formoterol are also selective beta-2-agonists commonly used as long-acting bronchodilators for asthma and chronic obstructive pulmonary disease (COPD).
7.
Beta-2-agonists, can be administered in all of the following mechanisms of action except:
Correct Answer
E. All of the above are routes of administration of beta-2-agonists
Explanation
All of the options listed in the question are routes of administration for beta-2-agonists. This means that beta-2-agonists can be administered through inhalation solutions, long-acting oral agents, intravenous agents, and inhaled dry powders. Therefore, the correct answer is that all of the above are routes of administration of beta-2-agonists.
8.
True or False: When using intravenous formulations of beta-2-agonists, a smaller dose is necessary compared to inhaled formulations.
Correct Answer
B. False
Explanation
When using intravenous formulations of beta-2-agonists, a larger dose is necessary compared to inhaled formulations. This is because intravenous administration bypasses the lungs and delivers the medication directly into the bloodstream, requiring a higher dose to achieve the desired effect.
9.
Side effects of beta-2-agonists include all of the following except:
Correct Answer
D. Bradycardia
Explanation
Beta-2-agonists are medications that relax the muscles in the airways, making it easier to breathe. They are commonly used to treat conditions such as asthma and chronic obstructive pulmonary disease (COPD). One of the side effects of beta-2-agonists is tremors, which are involuntary shaking movements. Headaches can also occur as a side effect. Tachycardia, or a rapid heart rate, is another potential side effect. However, bradycardia, which is a slow heart rate, is not typically associated with beta-2-agonists. Hypertension, or high blood pressure, can also occur as a side effect.
10.
Levalbuterol is the r-enantiomer of the racemic mixture of albuterol. This formulation is thought to exhibit _____ selectivity of the ____ receptor, contributing to fewer side effects.
Correct Answer
D. Higher; B2
Explanation
Levalbuterol is the R-enantiomer of albuterol, which means it is a specific form of the drug that has a higher affinity for the B2 receptor. This higher selectivity for the B2 receptor leads to fewer side effects compared to the racemic mixture of albuterol. Therefore, the correct answer is "higher; B2."
11.
Long acting beta agonists have a unique structural feature that make them long-acting. What is this unique structural feature?
Correct Answer
C. Long hydropHobic carbon tails
Explanation
Long acting beta agonists (LABAs) have a unique structural feature of long hydrophobic carbon tails. This feature allows them to bind tightly to the beta-adrenergic receptors in the lungs, resulting in a prolonged duration of action. The hydrophobic nature of the carbon tails allows LABAs to remain in the lipid-rich cell membrane for an extended period, leading to sustained activation of the receptors and a longer-lasting bronchodilator effect. The other options, such as hydrophilic OH groups, highly water soluble nitrogen atom, and hydrophobic phenolic rings, may have their own roles in drug activity but do not specifically contribute to the long-acting property of LABAs.
12.
The S.M.A.R.T exhibited asthma related deaths due to Salmeterol. Which one of the following reason is NOT attributed to these asthma related deaths?
Correct Answer
D. Salmeterol causes more sides effects, tachycardia and muscle tremor, that lead to death
Explanation
The correct answer is "Salmeterol causes more side effects, tachycardia and muscle tremor, that lead to death." This is because the question asks for the reason that is NOT attributed to the asthma-related deaths. The other options provided in the question are all valid reasons that can contribute to asthma-related deaths caused by Salmeterol.
13.
Which one of the following pairs are INCORRECTLY matched side effects and the receptors that cause them?
Correct Answer
C. Palpitations: beta 2 receptors
Explanation
Palpitations are the sensation of a rapid or irregular heartbeat. Beta 2 receptors are primarily found in the smooth muscle of the bronchioles and blood vessels. While beta 2 receptors can cause relaxation of smooth muscles, they are not directly responsible for palpitations. Palpitations are more commonly associated with the activation of beta 1 receptors, which are located in the heart. These receptors increase heart rate and can lead to palpitations. Therefore, the pairing of palpitations with beta 2 receptors is incorrect.
14.
Anticholinergics exhibit all of the following actions except:
Correct Answer
E. All of the above are actions of anticholinergics
Explanation
Anticholinergics exhibit all of the listed actions, including decreasing vagal tone, decreasing transmission of airway ganglion, decreasing mucus production, and decreasing neurokinin release and inflammation. Therefore, the correct answer is that all of the above are actions of anticholinergics.
15.
Anticholinergics act by antagonizing muscarinic acetylcholine receptors which ultimately ____ the Ca++ concentration and this ________ stimulation of MLCK.
Correct Answer
D. Decrease; decrease
Explanation
Anticholinergics act by blocking muscarinic acetylcholine receptors, which leads to a decrease in intracellular calcium concentration. This decrease in calcium concentration ultimately results in a decrease in stimulation of MLCK (myosin light chain kinase).
16.
Anticholinergics are thought to be especially useful in the management of _____ than it is at managing _____ because it blocks muscarinic receptors on bronchial smooth muscle, prevents muscle contraction, decreases mucus production versus allows bronchodilation.
Correct Answer
A. COPD; asthma
Explanation
Anticholinergics are believed to be more effective in managing COPD than asthma because they block muscarinic receptors on bronchial smooth muscle, preventing muscle contraction and reducing mucus production. This helps to alleviate the symptoms of COPD, such as bronchoconstriction and excessive mucus production. In asthma, on the other hand, bronchodilation is needed to relieve symptoms, which anticholinergics do not provide as effectively. Therefore, anticholinergics are considered more beneficial in the management of COPD compared to asthma.
17.
Anticholinergics have a unique structural feature that is responsible for its minimum systemic effects. What is this unique structural feature?
Correct Answer
D. Quaternary ammonium
Explanation
Quaternary ammonium is the unique structural feature of anticholinergics that is responsible for its minimum systemic effects. This feature refers to a positively charged nitrogen atom bonded to four alkyl or aryl groups. This structural arrangement allows the anticholinergic to have limited penetration into the central nervous system, reducing the risk of side effects such as sedation or confusion.
18.
Tiotropium is considered a more potent agent than ipratropium for which of the following TWO reasons?
Correct Answer(s)
B. Tighter binding
D. Slower dissociation from M3
Explanation
Tiotropium is considered a more potent agent than ipratropium because it has tighter binding to the target receptor (M3) and slower dissociation from it. This means that tiotropium stays bound to the receptor for a longer time, leading to a more prolonged and effective action. The tighter binding and slower dissociation contribute to the increased potency of tiotropium compared to ipratropium.
19.
Methylxanthines like theophylline inhibit MLCK via which of the following mechanisms?
Correct Answer
C. Prevent the breakdown of cAMP
Explanation
Methylxanthines like theophylline prevent the breakdown of cAMP. cAMP is a secondary messenger that plays a crucial role in various cellular processes, including the regulation of MLCK (myosin light chain kinase). By inhibiting the breakdown of cAMP, methylxanthines increase the levels of cAMP in the cell, leading to the inhibition of MLCK. MLCK is responsible for the phosphorylation of myosin, which is necessary for muscle contraction. Therefore, by preventing the breakdown of cAMP, methylxanthines indirectly inhibit MLCK and ultimately relax smooth muscles.
20.
Additional asthma/COPD benefits of methylxanthines include all of the following EXCEPT:
Correct Answer
C. Inhibition of PKA
Explanation
Methylxanthines have several additional benefits for asthma/COPD, including being an antagonist of adenosine, inhibiting the secretion of inflammatory mediators, and strengthening the diaphragm. However, they do not inhibit PKA (protein kinase A), which is a key enzyme involved in many cellular processes. Therefore, the correct answer is "Inhibition of PKA."
21.
Theophylline and aminophylline have very narrow therapeutic windows. Which of the following ranges of serum concentrations would you expect a patient to exhibit minor side effects such as N&V, nervousness, and insomnia?
Correct Answer
C. 15-25 mcg/ml
Explanation
Theophylline and aminophylline have very narrow therapeutic windows, meaning that the range of serum concentrations at which they are effective is very close to the range at which they can cause side effects. In this case, a patient would be expected to exhibit minor side effects such as N&V, nervousness, and insomnia at serum concentrations of 15-25 mcg/ml. This range is higher than the previous options, indicating that a higher concentration of the drug is needed to cause these side effects.
22.
Roflumilast and cilomilast are PDE inhibitors of which of the following specific isoform?
Correct Answer
B. PDE4
Explanation
Roflumilast and cilomilast are specific phosphodiesterase 4 (PDE4) inhibitors. PDE4 is an isoform of phosphodiesterase enzyme that is involved in the breakdown of cyclic adenosine monophosphate (cAMP) in the cells. By inhibiting PDE4, roflumilast and cilomilast increase the levels of cAMP, which can have anti-inflammatory effects. Therefore, the correct answer is PDE4.
23.
Hormone synthesis in the adrenal cortex starts with _____, which is dependent on the ______ enzymes for transport into the inner mitochondrial membrane.
Correct Answer
D. Cholesterol; StAR
Explanation
The correct answer is Cholesterol; StAR. Hormone synthesis in the adrenal cortex begins with cholesterol, which is transported into the inner mitochondrial membrane with the help of the StAR (Steroidogenic Acute Regulatory) protein. StAR plays a crucial role in the transfer of cholesterol from the outer to the inner mitochondrial membrane, where it is converted into pregnenolone, the precursor for various adrenal hormones.
24.
Diurnal production of cortisol exhibits all of the following patterns EXCEPT:
Correct Answer
C. Decreases with caffeine and exercise
Explanation
Cortisol is a hormone that follows a diurnal pattern, meaning its production varies throughout the day. It typically rises in the morning, with its peak occurring around 8 AM. This aligns with the natural sleep-wake cycles of the body. Additionally, cortisol production can be triggered by bursts throughout the day in response to stress or other stimuli. However, cortisol levels do not decrease with caffeine and exercise. In fact, both caffeine and exercise can stimulate cortisol production. Therefore, the correct answer is "decreases with caffeine and exercise."
25.
Treatment with exogenous glucocorticoids present a risk in changing the body's regulatory processes of making its own endogenous cortisol. Which of the following pairs are TWO properly matched treatment and effect?
Correct Answer(s)
A. Sustained elevation = induced hypertropHy
D. Prolonged exposure = induced atropHy
Explanation
Exogenous glucocorticoids are synthetic forms of cortisol that are used as medications to reduce inflammation and suppress the immune system. Sustained elevation of exogenous glucocorticoids can lead to induced hypertrophy, which refers to an increase in the size of cells or tissues. This is because glucocorticoids can stimulate protein synthesis and promote the growth of muscle fibers. On the other hand, prolonged exposure to exogenous glucocorticoids can lead to induced atrophy, which refers to a decrease in the size of cells or tissues. This is because glucocorticoids can inhibit protein synthesis and promote the breakdown of muscle fibers.
26.
Cortisol's anti-inflammatory effects are due to inhibition of which of the following TWO enzymes?
Correct Answer(s)
A. PLA2
C. PGH2 synthase (COX 1 and 2)
Explanation
Cortisol's anti-inflammatory effects are due to the inhibition of two enzymes: PLA2 and PGH2 synthase (COX 1 and 2). PLA2 is an enzyme that releases arachidonic acid from cell membranes, which is a precursor for the production of inflammatory mediators. By inhibiting PLA2, cortisol reduces the availability of arachidonic acid and subsequently decreases the production of inflammatory mediators. PGH2 synthase, also known as cyclooxygenase (COX), is responsible for the synthesis of prostaglandins, which are potent mediators of inflammation. Cortisol inhibits both COX 1 and COX 2, further reducing the production of inflammatory prostaglandins.
27.
Inhaled corticosteroids for the long-term treatment of COPD and asthma exhibit all of the following desired features EXCEPT:
Correct Answer
E. All of the above are desired features of ICS'
Explanation
The correct answer states that all of the mentioned features are desired in inhaled corticosteroids (ICS) for the long-term treatment of COPD and asthma. This means that ICS should have a high affinity for the glucocorticoid receptor, minimal systemic absorption, high serum protein binding, and rapid systemic inactivation. These features are desired because they allow for targeted delivery to the lungs, reducing the risk of systemic side effects and maximizing the therapeutic effects of the medication.
28.
Which of the following is an adverse effect of ICS that patients can minimize with proper inhaler use and education?
Correct Answer
C. OropHaryngeal candidiasis
Explanation
Oropharyngeal candidiasis is a fungal infection that can occur in the mouth and throat as a side effect of using inhaled corticosteroids (ICS). It is characterized by white patches or lesions in the mouth and can cause discomfort and difficulty swallowing. However, with proper inhaler use and education, patients can minimize the risk of developing this side effect. This may include rinsing the mouth after each use of the inhaler and using a spacer device to ensure the medication is delivered directly to the lungs and not deposited in the mouth.
29.
Studies using human and mouse cys-LT receptors proved which of the following leukotriene ligands to be the most important in the use of leukotriene inhibitors to treat asthma?
Correct Answer
C. LTD4
Explanation
Studies using human and mouse cys-LT receptors have shown that LTD4 is the most important leukotriene ligand in the use of leukotriene inhibitors to treat asthma. This suggests that blocking LTD4 specifically can be more effective in managing asthma symptoms compared to blocking other leukotriene ligands such as LTB4, LTC4, or LTE4. The answer also indicates that leukotriene inhibitors do not block these ligands with the same affinity, further emphasizing the significance of targeting LTD4 specifically.
30.
Montelukast and zafirlukast are two leukotriene inhibitors that block cysteinyl receptor, CysTR1 for the LTD4 ligand. What kind of receptor is the cysteinyl receptor and what ion does the inhibition affect that prevent muscle contraction and eosinophil chemotaxis?
Correct Answer
B. G-coupled protein receptor; Ca++
Explanation
The cysteinyl receptor is a G-coupled protein receptor, and the inhibition affects the ion Ca++. This inhibition of Ca++ prevents muscle contraction and eosinophil chemotaxis.
31.
Omalizumab (Zolair) is a unique treatment of asthma that uses humanized monoclonal antibodies to target against _______ and the most worrisome side effect of this drug is _______.
Correct Answer
D. IgE: anapHylaxis
Explanation
Omalizumab (Zolair) is a unique treatment of asthma that uses humanized monoclonal antibodies to target against IgE, which is an immunoglobulin involved in allergic reactions. The most worrisome side effect of this drug is anaphylaxis, a severe and potentially life-threatening allergic reaction.
32.
Allergic rhinitis, or hay fever is an inflammatory process of the mucus membranes of the eyes, nose, and throat. These IgE mediated activation of mast cell are carried out by what primary and second mediators?
Correct Answer
C. Primary: Histamine, Secondary: Leukotriene
Explanation
Allergic rhinitis, or hay fever, is caused by an inflammatory response triggered by the activation of mast cells. Histamine is a primary mediator released by mast cells during this process, causing symptoms such as itching, sneezing, and nasal congestion. Leukotrienes are secondary mediators that are also released by mast cells and contribute to the inflammatory response, leading to symptoms such as nasal congestion and inflammation. Therefore, the correct answer is Primary: Histamine, Secondary: Leukotriene.
33.
The mast cell degranulation pathway versus the mast cell eicosanoid synthesis pathway share all the following steps EXCEPT:
Correct Answer
D. Syk activated the PLC-gamma, cleaving PIP2 into IP3 and DAG
Explanation
The mast cell degranulation pathway and the mast cell eicosanoid synthesis pathway share all the steps mentioned in the options except for Syk activating the PLC-gamma, cleaving PIP2 into IP3 and DAG.
34.
H1 receptor antagonists that have a side effect profile that includes: short half lives and crossing of the blood-brain barrier would most likely describe which generation of anti-histamines?
Correct Answer
A. 1st generation
Explanation
First-generation H1 receptor antagonists are known to have a side effect profile that includes short half-lives and the ability to cross the blood-brain barrier. This means that these anti-histamines are quickly metabolized and eliminated from the body, and they are also able to enter the brain, which can lead to sedation and other central nervous system effects. Therefore, the given answer correctly identifies the side effect profile associated with first-generation anti-histamines.
35.
Oral decongestants, like pseudoephedrine can be classified under which mechanism of action?
Correct Answer
C. AlpHa-1 adrenergic receptor agonist
Explanation
Oral decongestants, like pseudoephedrine, work by stimulating alpha-1 adrenergic receptors. This stimulation causes vasoconstriction, which reduces swelling in the nasal passages and helps to relieve congestion. Muscarinic acetylcholine receptor antagonists, glucocorticoid receptor agonists, and H1 histamine receptor agonists do not accurately describe the mechanism of action of decongestants.
36.
Clinical trials have shown R112, a ______ inhibitor, to be effective in allergic rhinitis by blocking the mast cell activation pathway.
Correct Answer
A. Syk
Explanation
R112 is shown to be effective in allergic rhinitis by blocking the mast cell activation pathway. This suggests that R112 is an inhibitor of Syk, as Syk is a key protein involved in mast cell activation. By inhibiting Syk, R112 can prevent mast cell activation and subsequently reduce the symptoms of allergic rhinitis.