Exam 3: NSG533/ NSG 533 (Latest 2024/ 2025) Advanced Pharmacology Complete Review| Questions and Verified Answers| 100% Correct| Grade A

Exam 3: NSG533/ NSG 533 (Latest 2024/ 2025) Advanced Pharmacology Complete Review| Questions and Verified Answers| 100% Correct| Grade A Q: Long-acting Inhaled B2-agonists Answer: -Provide 12-24 hours of bronchodilation after single dose -Useful for nocturnal symptoms -Chronic treatment for asthma as ADD-ON therapy for patients not controlled on low-medium dose of ICS -Helps reduce ICS amount necessary for control *-Not to be used a monotherapy (risk for severe attack)* -Salmeterol dosed BID -Available as single agent or as fixed-ratio combo product with ICS -Formoterol and vilanterol only available as combo product with ICS -Combo products may increase adherence Q: Leukotriene Receptor Antagonists Answer: -Anti-inflammatory medications that competitively antagonize the effects of leukotriene D4 as montelukast does -Improve FEV, decrease asthma symptoms and SABA use and decrease asthma attacks -Less effective than ICS -Beneficial for asthma patients with allergic rhinitis, aspirin sensitivity, exercise-induced bronchospasm -SE: sleep disorders, aggressive behavior, suicidal thoughts Q: Tiotropium (long acting muscarinic antagonist) Answer: -Onset of action 30 minutes, duration 24 hours -For uncontrolled asthma already taking ICS or ICS + LABA combination -Decreases severe exacerbations, improves lung function, steroid sparing -SE (all muscarinic antagonists): blurred vision, dry mouth, urinary retention Q: Inhaled Corticosteroids Answer: -Preferred for therapy for all forms of persistent asthma in all age groups -Decrease airway inflammation, attenuate airway hyperresponsiveness, minimize mucus production and secretion, improve response to B2-agonists -All equally effective in equipotent doses -Flat-dose response curve, doubling dose has little effect. Smokers do need higher doses though 2 weeks of therapy needed for significant clinical effects Q: ICS side effects Answer: Oral candidiasis, cough, dysphoniaRinse mouth with water after, use MDI with VHC, decrease dose to reduce hoarseness Systemic absorption occurs via pulmonary and oral routes -SE: adrenal suppression, decreased BMD, skin thinning, cataracts, easy bruising (all with more likely with higher ICS dose)Risk of pneumonia increases with ICS use Q: ICS drug interactions Answer: potent inhibitors of CYP3A4 (ritonavir, itraconazole, ketoconazole) administered with high doses can cause Cushing syndrome and adrenal insufficiency-40% of patients don't respond to therapy may be related to GLCC11 gene variant in some patients Q: Leukotriene Receptor Antagonists (LTRAs) Answer: -Anti-inflammatory medications that competitively antagonize the effects of leukotriene D4 as montelukast does -Improve FEV, decrease asthma symptoms and SABA use and decrease asthma attacks -Less effective than ICS -Beneficial for asthma patients with allergic rhinitis, aspirin sensitivity, exercise-induced bronchospasm -SE: sleep disorders, aggressive behavior, suicidal thoughts Q: What is theophylline's current place in therapy (Asthma / COPD) and why has it fallen out of favor ? Answer: Consider the many drug-drug, drug disease interactions: -Ranitidine, josamycin, midecamycin, amoxycillin, tetracycline, cephalexin, cefaclor, orciprenaline, metoprolol, antacids, medroxyprogesterone acetete, metoclopramide, and metronidazole, oral contraceptives, allopurinol, benzos, ciprofloxacin, erythromycin, levothyroxine, methotrexate, phenytoin, St. John's wort -Does not address underlying inflammation -Relatively weak bronchodilator -Narrow therapeutic window Q: Anti-Interleukin-5 Receptor Monoclonal Antibodies Answer: -Mepolizumab, reslizumab, benralizumab IL-5 triggers cascade of inflammation by activating eosinophils -This medication blocks the trigger F -or patients with eosinophilic asthma decreases attacks and decreases need for oral corticosteroids -Mepolizumab, benralizumab SubQ injection -Reslizumab IV q4weeks -SE: nasopharyngitis, headache, formation of positive anti-drug antibodies, worsening asthma or URIs, anaphylactic risk, immunosuppression/infection risk Q: marcolides (asthma) Answer: New evidence shows azithromycin 500 mg PO TID/week for 48 weeks decreases asthma attacks and improves QOL for adults with asthma not controlled by ICS and LABA Q: Asthma step 1 Answer: no controller, as needed SABA only have asthma symptoms or need SABA 2x/month, no waking at night, no risk factors for attacks, no attacks in past year Q: Asthma step 4 Answer: Medium/high dose ICS/LABA + SABA PRN Troublesome asthma symptoms most days or waking due to asthma once a week or more Q: Asthma step 2 low-dose ICS +SABA PRN -Infrequent asthma symptoms but patient has more than 1 risk factor for attack