1. Bronchodilation is best accomplished via
A. activation of α1-adrenergic receptors.
B. activation of α2-adrenergic receptors.
C. activation of β1-adrenergic receptors.
D. activation of β2-adrenergic receptors.
E. activation of muscarinic receptors.
2. Which of the following agents is used for treatment of persistent asthma to decrease inflammation, decrease the formation of mucus, and decrease the hyperreactivity of bronchial smooth muscle?
A. Inhaled corticosteroid
B. Systemic corticosteroid
C. Inhaled β2-adrenergic selective agonist
D. Systemic β2-adrenergic selective agonist
E. Systemic phosphodiesterase inhibitor
3. A patient with a history of asthma presents with severe respiratory distress and hypoxemia because of an acute, severe asthma attack. A β-adrenergic receptor agonist is administered immediately by inhalation. A systemic drug is then administered to treat the inflammatory component of the acute asthma. Which of the following was administered?
B. A parenteral corticosteroid
C. Oral theophylline
D. An inhaled corticosteroid
4. A 12-year-old girl is being treated for asthma. The drug treatment has resulted in abdominal discomfort, difficulty sleeping, and a persistent headache. These are common side effects of which agent?
C. Cromolyn sodium
5. Which of the following inhibits acid secretion by direct interaction with the H+-K+–ATPase in the parietal cell?
E. Calcium carbonate
6. Prostaglandins present in the gastric mucosa are believed to
A. increase capillary permeability when aspirin damages the gastric mucosal barrier to ion diffusion.
B. block the binding of acetylcholine on parietal cell muscarinic receptors.
C. inhibit parietal cell hydrochloric acid production.
D. block the entry of calcium into the parietal cell.
E. inhibit gastric bicarbonate secretion.
7. Which of the following is an H2-histamine receptor antagonist?
E. Sodium bicarbonate
8. A 58–year-old woman has rheumatoid arthritis. The patient's symptoms have responded favorably to treatment with a nonsteroidal antiinflammatory agent. To decrease the potential of a gastric ulcer, the patient is instructed to take misoprostol simultaneously with the antiinflammatory agent. What is misoprostol?
A. A prostaglandin E1 analogue that inhibits gastric acid secretion
B. An antacid that decreases the pH of gastric secretions
C. A nonsteroidal antiinflammatory drug–binding agent that prevents absorption in the stomach
D. An H2-histamine receptor blocker that inhibits gastric acid secretion
E. A proton pump inhibitor that inhibits gastric acid secretion
Answers and Explanations
1. D Activation of β2-adrenergic receptors on bronchial smooth muscle produces smooth muscle relaxation and bronchodilation (p. 251).
A α1-adrenergic receptors may be present on the vasculature of the lung and regulate vasoconstriction.
B α2-adrenergic receptors may be found on presynaptic terminals of sympathetic neurons and regulate neurotransmitter release.
C β1-adrenergic receptors are found mainly in the heart. Activation of these receptors causes increased heart rate and force and velocity of contraction.
D Activation of muscarinic cholinergic receptors causes bronchoconstriction.
2. A Decreased inflammation, decreased formation of mucus, and decreased hyperreactivity of bronchial smooth muscle are all effects of corticosteroids. They are administered by inhalation to minimize systemic side effects that would be seen if given systemically (B) (p. 250).
C, D β2 adrenergic receptor selective agonists do not produce these effects, but they do produce bronchodilation.
E Theophylline is a systemic phosphodiesterase inhibitor that mainly produces bronchodilation, but it may also have some antiinflammatory actions. It does not decrease the formation of mucus or decrease hyperreactivity of bronchial smooth muscle.
3. B For acute, severe asthma attacks, parenteral steroids are used (p. 251).
A, C Cromolyn, a mast cell stabilizer, and theophylline, a systemic phosphodiesterase inhibitor, are not used for acute asthma attacks. D Inhaled corticosteroids are used for the chronic treatment of asthma.
E Antibiotics are not effective for treating asthma.
4. E These side effects are produced by theophylline, which is a systemic phosphodiesterase inhibitor (p. 253).
A, D Atropine and ipratropium produce anticholinergic side effects, such as dry mouth, blurred vision, tachycardia, urinary retention, and constipation.
B Beclomethasone may cause throat irritation, dysphonia, oral candidiasis, and growth disturbances in children (rarely).
C Cromolyn sodium, a mast cell stabilizer, has minimal side effects.
5. B Omeprazole inhibits the proton pump (H+-K+–ATPase) of the parietal cells in the stomach, thereby inhibiting gastric acid secretion (p. 259).
A Ursodiol decreases the secretion of cholesterol into bile by reducing cholesterol absorption and suppressing cholesterol synthesis in the liver. It is used to treat cholesterol-containing gallstones.
C Raniitidine is an H2-histamine receptor antagonist that blocks the H2-histamine receptors of parietal cells, thereby inhibiting both basal and stimulated gastric acid secretion.
D Sucralfate forms an ulcer-adherent complex with the protein-aceous exudate at the ulcer site.
E Calcium carbonate is a nonsystemic antacid.
6. C Prostaglandins inhibit parietal cell hydrochloric acid production in the gastric mucosa. They also increase mucus production (p. 262).
7. A Cimetidine is an H2-histamine receptor antagonist that blocks the H2-histamine receptors of parietal cells, thereby inhibiting both basal and stimulated gastric acid secretion (p. 261).
B Ondansetron is an anti-emetic drug that blocks 5-HT3 receptors in the central nervous system and gastrointestinal tract.
C Lactulose is a specialized laxative for chronic liver disease or hepatic coma as it decreases plasma levels of ammonia formed by intestinal bacteria.
D Docusate is a stool softening agent that lowers surface tension and promotes water absorption into feces.
E Sodium bicarbonate is a systemic antacid.
8. A Misoprostol is a prostaglandin derivative that has both cytoprotective and antisecretory actions. It does not act by any of the other listed mechanisms (p. 262).