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Dr. Keshv PART 2 Exam 2 RESPIR

Total questions: 70

Worksheet time: 6hrs 16mins

Name
Class
Date
1.

Which of the following statements are TRUE about THEOPHYLLINE? Select all that apply

a)

Ciprofloxacin and Cimetidine will inhibit metabolism because of CYP1A2

b)

it has anti-inflammatory effects

c)

Narrow therapeutic index

d)

Its adverse effects include: tachycardia, insomnia, arrhythmias, seizures

e)

Inhibition of inflammation due to neutrophils (COPD)

2.

Which of the following statements are TRUE about Roflumilast? Select all that apply

a)

Once daily oral tablet

b)

PDE4 Inhibitor

c)

Inhibition of inflammation due to neutrophils (COPD)

d)

Adverse effects: headache, insomnia

e)

Narrow therapeutic index

3.

Which of the following are TRUE about Leukotrienes? Select all that apply

a)

Stimulate mucus secretion by epithelial cells

b)

Bronchoconstriction (1000 x histamine); LTD4

c)

Recruit eosinophils

d)

Overall contribute to inflammation in asthma

e)

Bind to unique receptor (CysLTR); G-coupled receptor

4.

What becomes the source for the production of both Leukotrienes and PGD2 (Prostaglandins) ?

a)

Cysteinyl Leukotrienes

b)

Arachidonic Acid

c)

Lipoxygenases

d)

Cyclooxygenases

5.

Which of the following drugs will inhibit lipoxygenase enzyme, tries to reduce the amount of leukotrienes, Inhibit airway muscle contraction AND INHIBIT EOSINOPHILIA ?

a)

Montelukast

b)

Zileuton (Zyflo CR)

c)

Zafirlukast

d)

Theophylline

6.

Which of the following are considered Cysteinyl Leukotrienes? Select all that apply

a)

LTB4

b)

LTC4

c)

LTD4

d)

LTE4

7.

Which of the following Cysteinyl Leukotrienes is the most potent/significant?

a)

LTB4

b)

LTC4

c)

LTD4

d)

LTE4

8.

Which of the following is the intermediate in the production of Leukotrienes?

a)

LTA4

b)

LTB4

c)

LTC4

d)

LTD4

e)

LTE4

9.

Which of the following is TRUE about potentially drug interactions in Zileuton (Zyflo CR)?

a)

By inhibiting CYP1A2, 2C9, 3A4 it DECREASES Warfarin, Theophylline and Propranolol levels.

b)

By inhibiting CYP1A2, 2C9, 3A4 it INCREASES Warfarin, Theophylline and Propranolol levels.

c)

By inhibiting CYP1A2, 2C9, 3A4 there is no effect in Warfarin, Theophylline and Propranolol levels.

d)

By inhibiting CYP1A2, 2C9, 3A4 it decreases only Warfarin and Propranolol levels.

10.

Which of the following are the adverse effects of Zileuton (Zyflo CR)? Select all that apply

a)

Sinusitis

b)

headache

c)

pharyngolaryngeal pain

d)

arrhythmias

e)

tachycardia

11.

Which of the following are Leukotriene Receptor Antagonists (LRA)?

a)

Zafirlukast (Accolate) = BID

b)

Montelukast (Singulair) = QD

c)

Block CysLTR (prevent LT binding)

d)

useful for allergies

e)

Inhibit inflammation

12.

 

Which of the following are Leukotriene Receptor Antagonists (LRA) adverse effects (Singular, Zafirlukast)?

a)

Mood disorders

b)

Well tolerated

c)

GI disturbances, headache

d)

Suicidal thougths

e)

oropharyngeal pain

13.

Which of the following Leukotriene Receptor Antagonists (LRA) has a shorter half life, poor absorption when taken with food and NOT RECOMMENDED FOR VERY YOUNG KIDS?

a)

Zafirlukast

b)

Montelukast

14.

Which of the following are the disadvantages of Zafirlukast? Select all that apply

a)

shorter half life than Montelukast

b)

longer half life than Montelukast

c)

Drug-drug interactions (inhibits CYP2C9, raises warfarin levels

d)

Not recommended in young kids

e)

poor absorption with food

15.

Which of the following are considered immune effects with Cortisol and Glucocorticoids (anti-inflammatories)? Select all that apply

a)

Decreased number of circulating leukocytes

b)

Increased number of circulating leukocytes

c)

Decreased production of proinflammatory cytokines

d)

Decreased expression of enzymes needed for PG & LT production

e)

In allergic asthma, decrease in eosinophil count correlates with favorable outcome

16.

Which of the following is TRUE regarding the chronic use of Glucocorticoids including HIGH doses?

a)

it helps HPA to maintain its optimal function

b)

suppresses HPA

c)

more effective and less adverse effects

d)

it can cause better functioning of the HPA

17.

Which of the following symptoms occur with the sudden withdrawal of Glucocorticoids? Select all that apply

a)

hypertension

b)

weakness, fatigue

c)

aches/pains

d)

hypotension

e)

hyperglycemia

18.

Which of the following are TRUE regarding the “burst” treatment for acute asthma? Select all that apply

a)

treatment 9-12 days

b)

treatment 3-5 days

c)

treatment for 2 weeks

d)

taper rquired

e)

not tapering required

19.

Which of the following is the preferred parenteral glucocorticoid because its faster onset, regardless of its greater mineralocorticoid effects.

a)

Prednisone

b)

Methylprednisolone

c)

Prednisolone

d)

Hydrocortisone

20.

Which of the following are the adverse affects of systemic Glucocorticoids? Select all that apply

a)

Mood swings, irritability

b)

Hyperglycemia

c)

Insomnia

d)

Weight gain because increased appetite, GI irritation

e)

Hypertension

21.

What is the main goal of Inhaled Glucocorticoids in Asthma? Select all that apply

a)

to be used in acute patients and maximize systemic exposure

b)

to be used chronically and minimize systemic exposure

c)

for systemic exposure

d)

have high affinity for GCC and less affinity for MCC

e)

rapid systemic inactivation

22.

Which of the following ICS (Inhaled Corticosteroids) in Asthma have greater first pass metabolism and lower oral bioavailability? Select all that apply

a)

Budesonide

b)

Fluticasone

c)

Mometasone

d)

Ciclesonide

23.

Which of the following ICS is prodrug activated by pulmonary esterases?

a)

Budesonide

b)

Ciclesonide

c)

Fluticasone

d)

Mometasone

24.

How long does it take for ICS to have full effects?

a)

same day

b)

3-5 days

c)

7-10 days

d)

next day

25.

Which of the following are the effects of ICS? Select all that apply

a)

Reduced hyperresponsiveness of airways

b)

Increased expression of b2 receptors in the lungs so the airways are more sensitive to SABA and LABA

c)

Takes 7-10 days to be fully effective

d)

Reduction of inflammation in lungs

e)

Increase inflammation in lungs

26.

Which of the following are the most common adverse effect of ICS in Asthma? Select all that apply

a)

Dysphonia (loss of voice)

b)

Oropharyngeal candidiasis (thrush)

c)

Lupus erythematosus

d)

Gynecomastia

27.

What recommendation should be given to a patient using an Inhaled Corticosteroid in Asthma (ICS)?

a)

Eat some food immediately

b)

Rinse mouth after inhalation instead of swallowing

c)

Chew a gum for the bad taste of the drug

d)

Use mint to degrade the taste particles of the drug

28.

Which of the following are TRUE regarding this image? Select all that apply

a)

Increased GCC activity and Decreased MCC

b)

Prednisolone

c)

It has longer duration than Hydrocortisone

d)

It has shorter duration than Hydrocortisone

e)

Prednisone

29.

Which of the following is inactive and not suitable for patients with hepatic insufficiency?

a)

Prednisolone

b)

Prednisone

c)

Hydrocortisone

d)

Methylprednisolone

30.

Which of the following Glucocorticoids is a PRODRUG?

a)

Methylprednisolone

b)

Prednisone

c)

Prednisolone

d)

Hydrocortisone

31.

Which of the following statements is TRUE about this image? Select all that apply

a)

11-keto, prodrug not suitable for patients with hepatic insufficiency

b)

1-dehydro double bond flattens the ring and increase MCC

c)

carbon 6-methyl increase MCC activity

d)

carbon 6-methyl increase GCC activity and doesn't change activity for MCC

e)

Methylprednisolone

32.

Which of the following are TRUE about Glucocorticoids structures? Select all that apply

a)

must have a ketone at group 3

b)

21 carbons

c)

must have a ketone at group 5

d)

unsaturated (double bond) bond between carbon 4-5.

e)

must have a hydroxyl group at carbon 11

33.

Another way to see it

a)

Yes

b)

No

34.

Which of the following is true about Cl group?

a)

decreases MCC activity

b)

increases both GCC & MCC activity

c)

increased only GCC activity

35.

Which of the following is true about the Methyl group in Carbon 16?

a)

increased only GCC activity

b)

increases both GCC & MCC activity

c)

decreases MCC activity

36.

Which of the following is true about the blue arrow?

a)

6-α-methyl substitution decreases MCC activity

b)

6-α-methyl substitution increased only GCC activity

c)

6-α-methyl substitution increases both GCC & MCC activity

37.

Which of the following statements is TRUE about those the two red arrows?

a)

Anytime you have a group at 9’ position, you will decrease GCC at 16’

b)

Anytime you have a group at 9’ position, you will increase MCC at 16’

c)

Anytime you have a group at 9’ position, you must also have a group decreasing MCC activity at 16’

d)

Anytime you have a group at 9’ position, you will increase GCC activity group at 16’

38.

Which of the following is TRUE regarding this image? Select all that apply

a)

Red arrow = Ester at C-17 enhances GCC activity; this ester is shielded from esterase

b)

Blue arrow = Ester at C-21 makes it a prodrug

c)

Beclomethasone dipropionate (Beclovent)

d)

Beclomethasone monopropionate (active)

39.

Which of the following is TRUE about this image? Select all that apply

a)

Increased lipophilicity helps better penetration of lung tissue

b)

acetal group enhance GCC activity and suppress MCC activity but the MCC ratio is high

c)

Increased hydrophilicity helps better penetration of lung tissue

d)

acetal group suppress both GCC and MCC activity

40.

Summary of the different activities within the number of carbons. Photomemory. I have set up 10 minutes so you can practice drawing it.

Fluticasone Propionate is NOT a prodrug.

a)

Yes

b)

No

41.

Which of the following structures represent a prodrug?

a)
b)
c)
d)
e)
42.

Ciclesonide is a prodrug that is activated preferentially by which of the following?

a)

lung amidases

b)

lung esterases

c)

lung aminases

d)

lung etherases

43.

Understand this!

a)

Yes

b)

No

44.

Which of the following is TRUE about biologic products (zumab) ? Select all that apply

a)

these drugs can cause tiredness and fatigue on the day of the injection

b)

all can trigger injection site reactions and systemic allergic reactions

c)

these drugs are well tolerated with no reactions

d)

these drugs cause hyperactivity

45.

Which of the following causes the B cell to switch from producing IgG to IgE?

a)

IL-5

b)

IL-4

c)

IL-13

46.

Which of the following will increase the number of Esoinophils?

a)

IL-4

b)

IL-5

c)

IL-13

47.

Which of the following is involved in the activation of different cells like eosinophils and mast cells?

a)

IL-13

b)

IL-4

c)

IL-5

48.

Which of the following is TRUE about Omalizumab (Xolair)? Select all that apply

a)

Prevents binding of IgE to mast cells

b)

Humanized monoclonal antibody against IgE

c)

Anaphylaxis (Black Box Warning)

d)

Prevents hypersensitivity driven by IgE

49.

Which of the following has a black box warning for Anaphylaxis (can happen within 24 hour of any dose ?

a)

Mepolizumab (Nucala)

b)

Omalizumab (Xolair)

c)

Reslizumab (Cinqair)

d)

Benralizumab (Fasenra)

e)

DUPIXENT® (Dupilumab)

50.

Which of the following drugs binds to IL-5 preventing recruitment of Eosinophils for the treatment of eosinophilic asthma? Select all that apply

a)

Reslizumab (Cinqair)

b)

Mepolizumab (Nucala)

c)

Omalizumab (Xolair)

d)

Benralizumab (Fasenra)

51.

Which of the following adverse effects are caused by Reslizumab (Cinqair)? Select all that apply

a)

cough

b)

pain in the throat (oropharyngeal)

c)

headache

d)

anaphylaxis

e)

nasopharyngeal dryness/pain

52.

Which of the following adverse effects is caused by Benralizumab (Fasenra)?

a)

oropharyngeal pain, cough

b)

nasopharyngeal dryness/pain

c)

anaphylaxis

d)

headache

53.

Which of the following drugs is a humanized monoclonal antibody AGAINST IL-5 RECEPTOR targeting the cells for destruction (by NK cells)?

a)

Mepolizumab (Nucala)

b)

Omalizumab (Xolair)

c)

Reslizumab (Cinqair)

d)

Benralizumab (Fasenra)

e)

DUPIXENT® (Dupilumab)

54.

Which of the following drugs is a human monoclonal antibody against IL-4 receptors for Atopic dermatitis and Asthma?

a)

Benralizumab (Fasenra)

b)

DUPIXENT® (Dupilumab)

c)

Reslizumab (Cinqair)

d)

Mepolizumab (Nucala)

e)

Omalizumab (Xolair)

55.

Which of the following biological drugs has a side effect for Conjunctivitis and keratitis?

a)

Benralizumab (Fasenra)

b)

Reslizumab (Cinqair)

c)

DUPIXENT® (Dupilumab)

d)

Mepolizumab (Nucala)

e)

Omalizumab (Xolair)

56.

Which of the following side effects is caused by DUPIXENT® (Dupilumab)?

a)

Nasopharyngeal dryness/pain

b)

Conjunctivitis, keratitis

c)

Oropharyngeal pain

d)

Headache

e)

Anaphylaxis

57.

Which of the following statements is TRUE about the mechanism of DUPIXENT® (Dupilumab)?

a)

Prevents IL-5 from acting and blocking IL-4 receptor activation , decreasing IgE and inflammation.

b)

Prevents IL-5 from acting and blocking IL-5 receptor activation , decreasing IgE and inflammation

c)

Prevents IL-13 from acting and blocking IL-5 receptor activation , decreasing IgE and inflammation.

d)

Prevents IL-4 from acting and blocking IL-13 receptor activation , decreasing IgE and inflammation.

58.

Which of the following regions secrete the catecholamines (epinephrine, norepinephrine, dopamine)?

a)

Medulla (inner region)

b)

Cortex (outer region)

59.

Arachidonic acid is released upon hydrolysis of membrane phospholipids by which of the following?

a)

Cyclooxygenase A2

b)

Phospholipase A2

(PLA2)

c)

LTD4

d)

LTC4

e)

LTE4

60.

Know this

a)

Yes

b)

No

61.

Which of the following is/are the findings in atopy? Select all that apply

a)

Increase Th1 count

b)

Increased IgE titer

c)

Increased in Th2 count

d)

Increased cytotoxic T-cell count

e)

Eosinophilia

62.

Which of the following maintains surface of mast cells?

a)

SCF

b)

ECP

c)

CCL11

d)

IL-4

e)

IL-5

63.

Which of the following attracts Eosinophils?

a)

SCF

b)

CCL11

c)

ECF

d)

IL-4

e)

IL-5

64.

Which of the following is characteristic/are characteristics of COPD that differentiate it from Asthma? Select all that apply

a)

IgE mediated inflammation

b)

inflammation resistant to corticosteroid treatment

c)

Hyperresponsive airways

d)

Presence of neutrophils and cytotoxic T cells

e)

Inflammation damage to alveolar walls and lung parenchyma

65.

What are the beneficial effects of Beta 2 agonists? Select all that apply

a)

Decreased plasma exudation

b)

Mast cell stabilization

c)

Bronchodilation

d)

Increase in ciliary activity

e)

Reduce adhesin of bacteria to epithelium

66.

Know this BETA 2 AGONIST SIGNALING PATHWAY

a)

Yes

b)

No

67.

Know this Muscarinic Receptor Pathway Signaling !!!

a)

Yes

b)

No

68.

This structure is ? Select all that apply

a)

LABA

b)

Vilanterol

c)

Formeterol

d)

SABA

e)

LAMA

69.

Which image has the longest duration of action?

a)

A

b)

B

c)

C

70.

Which of the following are effects of CORTICOSTEROIDS? Select all that apply

a)

Redistribution of fat from limbs to trunk and face

b)

Gluconeogenesis

c)

Decreased osteoblasts

d)

Decreased fibroblasts and collagen

e)

Loss of muscle mass

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