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🏠7. Respiratory System

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Question Bank

1
What is a Metered-Dose Inhaler (pMDI)?
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pressurized inhaler that propels drugs from canister with the aid of a propellant

2
What is the purpose of a Spacer Chamber in inhalation therapy?
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To increase the percentage of drug inhaled into the lower airways, especially useful in children.

3
What are Dry Powder Inhalers typically used for?
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used for drugs given every day, especially for peptides and proteins like insulin

4
What is the difference between a metered-dose inhaler and a dry-powder inhaler?
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MDI: delivers aerosolized drug to the lungs DPI: delivers powdered medications to the lungs

5
How does a nebulizer work?
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changes liquid drug to mist delivers to the lungs over a period of time (between 10-20 minutes)

6
What is the preferred route of inhalation for medication delivery?
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Inhalation route with small particle size

7
What percentage of inhaled medication is absorbed by the lungs?
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10%–20%

8
What is the oral route of administration?
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Generally reserved for patients unable to use inhalers.

9
What is the parenteral route of administration?
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IV mainly for severely ill patients due to fast onset and inability to absorb drugs from the GI tract

10
parasympathetic innervation in the tracheobronchial tree?
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Bronchoconstriction

11
Sympathetic innervation in the tracheobronchial tree?
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Bronchodilation

12
What are the two zones of the tracheobronchial tree?
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Conducting Zone and Respiratory Zone

13
what respiratory structures are in the conducting zone
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trachea, bronchi, bronchioles, terminal bronchioles

14
what respiratory structures are in the respiratory zone
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respiratory bronchioles, alveolar ducts, alveolar sacs

15
What is the definition of asthma?
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Chronic inflammatory disorder caused by excessive airway hyperresponsiveness in response to triggers

16
What is the role of Ach in asthma?
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• Ach binds to airway muscarinic receptors • triggers smooth muscle contraction and mucus secretion

17
What happens in the early phase of asthma
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• allergen triggers IgE-mediated mast cell degranulation • histamine release • bronchospasm, vasodilation, wheezing, airway inflammation

18
What happens in the later phase of asthma
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• activated lymphocytes, release cytokines • recruit other proinflammatory cells • airway hyperresponsive, edema, mucus secretion

19
What is the mechanism of extrinsic (allergic) asthma?
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Type I hypersensitivity reaction

20
How is acute asthma divided into phases?
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Early phase: histamine derived, bronchoconstriction and edema Late phase: inflammatory mediator derived, mucus secretion

21
What is the epidemiology of intrinsic asthma?
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More frequent in adults, occurring after the age of 30 years.

22
What is the mechanism of intrinsic asthma?
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Due to nonallergic causes.

23
What are the triggers of intrinsic asthma?
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Smoking, chronic bronchitis, respiratory infections, air pollutants, cold air, and exercise.

24
What are the classifications of asthma
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• mild intermittent • mild persistent • moderate persistant • severe persistant

25
occurrence of mild intermittent asthma?
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Symptoms less than twice a week

26
Classification for asthma with symptoms between once a day and twice a week?
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Mild persistent

27
What are the three main categories of asthma management as shown in the slide?
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• Bronchodilators • Anti-inflammatory • Inflammation pathway Leukotriene modifiers

28
What are the types of Anti-inflammatory Meds?
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Steroids Biologics: Anti-IgE Anti-IL-5 Prophylatic Lipoxygenase inhibitor Leukotriene antagonists Phosphodiesterase inhibitors

29
What are the three therapeutic goals of asthma therapy?
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1. Decrease intensity and frequency of asthma 2. prevent asthma exacerbation 3. minimize limitations in daily activity

30
What does the Global Initiative for Asthma (GINA) recommend for asthma patients?
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patients should receive treatment with long-term controller and reliever meds

31
What are bronchodilators?
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Meds that relax the muscles in the airways, making it easier to breathe

32
What are the types of bronchodilators?
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• Short-acting β2-adrenoceptor agonists (SABAs) • Long-acting β2-adrenoceptor agonists (LABAs) • Muscarinic Antagonists • Methylxanthines

33
β2 agonists MOA
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activate β2 adrenergic receptors, ↑ cAMP levels → ↓ calcium availability → bronchodilation

34
What are some examples of SABAs?
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Albuterol Levalbuterol

35
onset and duration of Short-acting β2-adrenoceptor agonists?
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fast onset of action (1-5 min) short duration (4-6 hours)

36
Onset and duration of LABAs
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onset: slower duration: 12 hours

37
What are some examples of LABAs?
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Salmeterol Formoterol

38
Muscarinc Antagonist meds
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Ipratropium Tiotropium

39
Muscarinic Antagonist MOA
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Competitive antagonist for Ach-mediated bronchoconstriction at M3 receptors ↓ mucus secretion

40
What are the main types of controller medications for anti-inflammatory agents?
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Examples include corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs)

41
Methylxanthines medication
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theophylline

42
Methylxanthines: Theophylline MOA
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poorly understood PDE inhibitor → ↑ cAMP → ↓ calcium → bronchodilator effect

43
Steroid drugs
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Beclomethasone Fluticasone Budesonide

44
Steroid MOA
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• inhibit phospholipase A2 → inhibit arachidonic acid + products • ↓ inflammatory cells and ↓ mucus production • suppress airway inflammation; not a cure

45
Biologics: Anti-IgE drug
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Omalizumab

46
Biologics: Anti-IgE MOA
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blocks binding of IgE to mast cells → Prevents degranulation → ↓ eosinophils + inflammatory mediators

47
Biologics: Anti-IL-5 Drug
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Benralizumab

48
Biologics: Anti-IL-5 Drug
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block IL 5 action → reduce the inflammatory response

49
Prophylatic Drug
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Cromolyn

50
Cromolyn MOA
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stabilize mast cells → inhibits degranulation + release of histamine

51
Lipoxygenase inhibitor drug
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Zileuton

52
Lipoxygenase inhibitor MOA
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Selective inhibitor of 5- lipoxygenase → prevents conversion of arachidonic acid to leukotrienes

53
Leukotriene antagonist drugs
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Montelukast Zafrilukast

54
Leukotriene antagonist MOA
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blocks leukotriene receptors → prevent response to leukotriene mediators

55
Treatment strategy for Well Controlled asthma
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1. Low dose ICS/LABA, PRN 2. low dose ICS daily Reliever: SABA

56
Treatment strategy for partly controlled asthma
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3. low dose ICS/LABA daily Reliever: SABA

57
Treatment strategy for poorly controlled asthma
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4. medium dose ICS/LABA, daily 5. High dose: ICS/LABA daily + LAMA, + biologics Reliever: SABA

58
Treatment strategy • low COPD • few symptoms
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SABA, SAMA, LABA, LAMA choose one

59
Treatment strategy • low COPD • more symptoms
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LABA or LAMA

60
Treatment strategy • high COPD • few symptoms
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LAMA

61
Treatment strategy • high COPD • more symptoms
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LAMA or LAMA + LABA or LABA + ICS

62
Phosphodiesterase inhibitor med
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Roflumilast tablet

63
Phosphodiesterase inhibitors MOA
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inhibit PDE4 → accumulation of cAMP

64
Antihistamine drugs
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Cetirizine Loratadine

65
Antihistamine MOA
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2nd Gen compete w/ histamine for receptor binding sites

66
α-adrenergic agonists meds
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Pseudoephedrine Oxymetazoline

67
α-adrenergic agonists MOA
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Stimulates α-adrenergic receptors in nasal arterioles → local vasoconstriction

68
What are some examples of intranasal corticosteroids?
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Fluticasone triamcinolone

69
What are the side effects of opioids in patients with asthma?
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Bronchospasm due to histamine release

70
What are the side effects of opioids and sedatives?
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Respiratory depression

71
What side effect can anticholinergic agents cause?
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Mild xerostomia

72
Mechanism of aspirin induced asthma
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Aspirin inhibits COX1 → prevents prostaglandin production → more leukotrienes (inflam. mediators) → smooth muscle contraction