Bronchial asthma is a medical condition that causes the airway path of the lungs to swell and narrow. due to this swelling, the air path produces excess mucus making it hard to breathe, which results in coughing, short breath, and wheezing. The disease is chronic and interferes with daily work. In this article, we will discuss some questions which are mainly related to the pharmacology of bronchial asthma. So here we discuss the Bronchial Asthma Test which is actually are the Pharmacology MCQ Test with Answer of Bronchial Asthma.
Which of the following drugs can be administered by subcutaneous route?*
Ans. (b) Terbutaline (Ref: Katzung 12/e p344)
All four drugs i.e. albuterol (salbutamol), terbutaline, metaproterenol, and pirbuterol are available as a metered-dose inhaler
Salbutamol and terbutaline are also available in tablet forms
Only terbutaline is available as a subcutaneous injection. This route is indicated only for severe asthma requiring emergency treatment when aerosolized therapy is not available or has been ineffective.
Mechanism of action of theophylline in bronchial asthma is: *
(a) Phosphodiesterase 4 inhibition
(c) Anticholinergic action
(d) Inhibition of mucociliary clearance
Ans. (a) Phosphodiesterase 4 inhibition (Ref: Katzung 11/e p345)
Theophylline is used in bronchial asthma. Its mechanism of action is:
• Inhibition of phosphodiesterases particularly PDE-4.
• Antagonism of adenosine receptors.
• Enhancement of histone deacetylation. Acetylation of histone is required for activation of inflammatory gene transcription.
By inhibiting this process, low-dose theophylline may restore responsiveness to corticosteroids.
To prevent exercise-induced bronchial asthma drug used is: *
Ans. (a) Sodium cromoglycate (Ref: Katzung 10/e p325; KDT 6/e p223)
Mast cell stabilizers like cromoglycate and nedocromil are used to prevent exercise-induced asthma. However, corticosteroids
are preferred for this indication.
Which of the following drugs is useful in acute severe asthma? *
Ans. (a) Magnesium sulfate (Ref: Harrison 17/e p1605)
Magnesium sulfate by i.v. or inhalational route has been used for the treatment of acute severe asthma. All other drugs mentioned in the options are used for prophylaxis of asthma.
All of the following statements about theophylline are correct EXCEPT: *
(a) Increase in dose is required in cardiopulmonary disease
(c) Increase in dose is required in smokers
(d) Inhibits phosphodiesterase
Ans. (a) An increase in dose is required in cardiopulmonary disease (Ref: KDT 6/e p220, 221)
• Theophylline is a methylxanthine derivative. It acts by inhibiting the metabolism of cAMP through inhibition of the enzymes, phosphodiesterase-III and IV. The resulting increase in cAMP is responsible for bronchodilation.
Dose reduction is required in
Patients with CHF,
Patients of pneumonia,
• Hepatic insufficiency
• With enzyme inhibitors like ciprofloxacin, cimetidine
The dose should be increased in
• Concomitant administration of enzyme inducers like
rifampicin and phenobarbitone
Which of the following drugs is the fastest acting inhaled bronchodilator? *
What is the most appropriate place in therapy for long-acting beta-agonists? *
c. In combination with ICS
d. In combination with cromolyn
Long-acting beta-agonists are suitable for prophylaxis of asthma but if given alone tolerance may develop due to downregulation of beta 2 receptors. But if they are given in combination with ICS tolerance to beta 2 agonist does not develop.
Which of the following b2 agonists is given by inhalation, and is suitable for both terminating acute asthma attacks as well as for twice-daily prophylaxis? *
Classification of beta-agonists
epinephrine – isoprenaline, ephedrine
Selective beta 2 – agonists (Preferable).
Short-acting and Fast-acting: Salbutamol (albuterol) and Terbutaline
Salmeterol: 12 hours action and slow acting
Formoterol: 12 hours action faster onset
Bambuterol: Slow but 24 hours of action.
Inhibition of 5-lipoxygenase is useful in: *
1. MT is a 10-year-old boy who is brought into the Tulane Emergency Department by his parents. Their chief complaint is that MT has been constantly coughing and having trouble breathing for the past 3 days. MT recently recovered from an upper respiratory infection and has had multiple bouts of bronchitis in the past year. His physical exam reveals moderate to severe respiratory distress with bilateral expiratory wheezing. His respiratory rate is 32/min, BP=120/83 mm Hg, heart rate = 135/min, temperature 37.8 C. HIs pO2 is 93%. What drug should be given to MT to rapidly relieve his symptoms? *
C. ipratropium by nebulizer (with oxygen)
D. levalbuterol by nebulizer (with oxygen)
Ans- D – levalbuterol by nebulizer (with oxygen)
Inhaled short-acting beta-2 agonists (SABAs) are drugs of choice for producing a rapid relief from bronchoconstriction.
Note: nebulized medications are frequently given along with oxygen. If his pO2 was less than 90%, oxygen should actually be given first to prevent a beta-2-induced ventilation/perfusion mismatch. However, this patient’s pO2 was 93%.
MTs’ clinical status does not improve despite aggressive conventional therapy with a short-acting beta-2 agonist and systemic corticosteroids. He is admitted to the hospital, and placed in the intensive care unit. It is decided to try a trial dose of theophylline, which has a narrow therapeutic window of 5-15 ug/ml. What toxic side effects should you be looking for if MT’s theophylline levels become too high? *
D. seizures & arrhythmias
Ans: D seizures & arrhythmias
Too much cAMP effect centrally can cause seizures, and too much cAMP effect in heart tissue can cause arrhythmias.
CW is a 14-year-old boy who is escorted by his father to the local hospital Emergency Department after developing an anaphylactic-like reaction including severe urticaria and bronchoconstriction. The drug of choice for treating CW’s condition is: *
Epinephrine is a treatment of choice for anaphylactic reactions. Epinephrine can be given rapidly, and it produces rapid responses to cause beta-2 mediated bronchodilation, alpha-mediated pressor effects to support blood pressure (which can be lowered by histamine release), reduced mucosal edema in the upper airway, and reduced release of inflammatory mediators by mast cells & basophils.
Julie is a 27-year-old veterinarian who has been struggling with allergies caused by exposure to cat dander. Her current drug regimen of daily fluticasone and salmeterol (Advair ®) has not been sufficient to control her symptoms of severe persistent asthma. Considering her occupation, what additional form of prophylactic treatment would be the best choice to add to her therapy, and would require treatment only once or twice a month? *
A. beclomethasone (QVAR ®)
This drug is indicated for patients exposed to perennial allergens. It requires once or twice a month s.c. injection, and is relatively expensive. However, considering her occupation, and that she is already taking an ICS + LABA combination for prophylaxis, there are few other effective options available.
A 55-year-old female who is taking propranolol for the management of a cardiovascular disease experiences an acute asthmatic attack. Which of the following drugs would you prescribe to attenuate this asthmatic attack? *
Ans. (d) Ipratropium bromide
Inhaled β2 agonists are the agents of choice for the termination of an acute attack of bronchial asthma. However, as the patient is
receiving β-blockers, treatment with β2 agonists will be ineffective (receptors are already blocked). Therefore, other bronchodilators
like anticholinergic agents (ipratropium) or methylxanthines (theophylline) will be useful in such a case.
A 28-year-old man has been newly diagnosed with asthma. He has never been admitted to the hospital with an asthma exacerbation and experiences symptoms once or twice a week. You discuss the treatment options with him. His peak expiratory flow reading is currently 85 percent of the normal predicted value expected for his age and height. Which of the following is the most appropriate first step in treatment? *
A. Short-acting beta-2 agonist inhaler
B. Long-acting beta-2 agonist inhaler
C. Low-dose steroid inhaler
D. Leukotriene receptor antagonists
E. High-dose steroid inhaler
The British Thoracic Society has introduced a five-step approach in the management of chronic asthma (2008 guidelines). Step 1: The use of short-acting beta-2 agonists in mild intermittent asthma. Step 2: If the patient is using beta-2 agonists three times a week or more or is symptomatic or has required oral corticosteroids in the last two years, then regular preventer
therapy is required with an inhaled steroid (C) (e.g. 400 μg beclomethasone inhaler twice a day). The dose of steroid inhaler should be titrated according to disease severity. Step 3: Add-on therapy is usually instituted if the patient is symptomatic despite being on steroid inhalers. Long-acting beta-2 agonists (B) (e.g. salmeterol) can be used and the dose of steroid inhaler can be increased (E) if there is still poor asthma control. Step 4: If
control remains inadequate despite additions used in step 3, the use of leukotriene receptor antagonists (D) (e.g. montelukast), theophylline, or slow-release beta-2 agonist tablets is advised. Step 5: If control remains poor, then the addition of oral low dose steroids can be used. This patient has been newly diagnosed and coupled with the fact that he experiences symptoms once or twice, at most, a week, puts him into the mild intermittent asthma category. Thus the introduction of short-acting beta-2 agonists (A) is the most appropriate answer here.
A 58-year-old man is admitted with a mild exacerbation of asthma. He suffers from hypertension which is controlled with medication. He was given 5 mg salbutamol and 500 μg ipratropium nebulizers, on route to the hospital, by paramedics and has received ‘back to back’ salbutamol 5 mg nebulizers since admission to accident and emergency. The patient was then sent to the acute medical unit where he was given regular nebulizers along with his regular antihypertension medication. Before he was discharged, his serum potassium reading was 2.9. Select, from the list below, the drug which is most likely to have caused the hypokalaemia. *
C The correct answer here is salbutamol (C). Regular nebulized salbutamol is commonly associated with hypokalaemia.
Ipratropium is not documented to cause electrolyte disturbances.
Ramipril (B) is reported to causes hyperkalemia rather than hypokalaemia.
Amlodipine (D) and paracetamol (E) are also not known to cause hypokalaemia.
This patient will require potassium supplementation either via intravenous infusion or oral administration.
In a patient of chronic asthma on treatment with theophylline, which of the following should not be used to treat his upper respiratory tract infection? *
Smoking and enzyme inducers (phenytoin, phenobarbitone, rifampicin, etc.) decrease the plasma levels of theophylline, therefore require an increase in dose.
On the other hand, drugs like ciprofloxacin, erythromycin, and cimetidine are powerful microsomal enzyme inhibitors, predisposing to the toxicity of theophylline.
Mechanism of actions of montelukast is: *
(a) Competitive antagonist of leukotriene receptors
(b) Inhibits alpha receptor
(c) Beta receptor agonist
(d) Non-competitive inhibitor of leukotriene synthesis
Select the correct statement regarding the use of inhaled glucocorticoids in bronchial asthma: *
(a) They are used for acute attacks of asthma
(b) They have high systemic activity
(c) They are superior to b2 agonists in symptom control
(d) Oral candidiasis can occur as a side effect
A 34 years old man with a long history of asthma is referred to a pulmonologist. The physician decides to prescribe zileuton. The mechanism of action of this drug is to:
(a) Antagonize leukotriene D4 receptor
(b) Inhibits 5-lipoxygenase
(c) Inhibit phosphodiesterases
(d) Stimulate beta2 receptors
Bronchial Asthma Test
Bronchial Asthma Test
Bronchial Asthma Test
Bronchial Asthma Test
Bronchial Asthma Test