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Question 1
Correct
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A 20-year-old asthmatic patient's symptoms is deteriorating and patient is moved to the resuscitation area of the Emergency Department. A loading dose of IV aminophylline is administered and her symptoms begin to improve. You are asked to check her theophylline levels after an appropriate time period.How long should you wait before taking her blood sample be taken?
Your Answer: 4-6 hours
Explanation:Plasma theophylline concentration is usually measured five days after starting oral treatment and three days after each dose adjustment. A blood sample to check theophylline concentration should usually be taken after 4-6 hours if an IV dose of aminophylline was given.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 2
Correct
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A 22-year-old presents with acute severe asthma. He takes a drug prescribed by her GP but cannot recall the name and is receiving regular salbutamol nebulisers. His current potassium level is 2.8 mmol/l.Which drug is least likely to have caused his hypokalaemia?
Your Answer: Spironolactone
Explanation:Serious hypokalaemia can occur in severe asthma and the effect can be potentiated by concomitant treatment with theophyllines like aminophylline, corticosteroids, thiazide and loop diuretics, and hypoxia. Plasma-potassium concentration should be monitored in severe asthma.Spironolactone, a potassium-sparing diuretic, is not likely to have contributed to patients hypokalaemia.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 3
Correct
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A patient presents with acute severe asthma. Her initial salbutamol nebulization produced a poor response and you administer another nebuliser with ipratropium bromide added on.Which statement about ipratropium bromide is true?
Your Answer: It can trigger acute closed-angle glaucoma
Explanation:Ipratropium bromide is an antimuscarinic drug. It is used in the management of acute asthma and COPD. It provides short-term relief in chronic asthma. Short-acting β2agonists are preferred and act more quickly.The commonest side effect of ipratropium bromide is dry mouth. Tremor is commonly seen with β2agonists. It can trigger acute closed-angle glaucoma in patients that are susceptible. First-line treatment for moderate asthma attacks is short-acting β2agonists.The BTS guidelines recommend that nebulised ipratropium bromide (0.5 mg 4-6 hourly) be added to β2agonist treatment in patients with a poor initial response to β2agonist therapy or with acute severe or life-threatening asthma.Its duration of action is 3-6 hours, maximum effect occurs 30-60 minutes after use, and bronchodilation can be maintained with three times per day dosing.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 4
Correct
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A 30-year-old patient has a mild exacerbation of his asthma. His steroid inhaler ran out a couple of weeks ago, and he has not replaced it.Which of these statements describes the mechanism of action of corticosteroids in asthma?
Your Answer: Reduction of bronchial inflammation
Explanation:Inhaled corticosteroids suppresses airway inflammation seen in asthma by downregulating pro-inflammatory proteins.They also appear to reverse components of asthma-induced structural changes (airway remodelling), including increased vascularity of the bronchial wall.Corticosteroids reduces the number of inflammatory cells (eosinophils, T lymphocytes, mast cells, and dendritic cells) in the airways.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 5
Correct
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An unrelated medical condition brings a 28-year-old asthmatic man to the Emergency Department. When you look over his meds, you notice that he is taking Theophylline to help with his asthma.Which of the following medicines should you NOT prescribe?
Your Answer: Ciprofloxacin
Explanation:Ciprofloxacin is a cytochrome P450 enzyme inhibitor that raises theophylline levels in the blood. As a result, co-prescribing theophylline should be avoided.The medicines that typically impact theophylline’s half-life and plasma concentration are listed in the table below:Drugs that increase the levels of theophylline in the bloodDrugs that lower theophylline levels in the bloodCalcium channel blockers e.g. VerapamilFluconazoleCimetidineQuinolones, e.g. ciprofloxacinMethotrexateBarbituratesCarbamazepinePhenobarbitalMacrolides, e.g. erythromycinPhenytoin (and fosphenytoin)RifampicinSt. John’s wort
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 6
Correct
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A 42-year-old woman presents with face swelling prominently affecting her upper lip and hands. She has previously been diagnosed with hereditary angioedema.Which of these is the most appropriate management option for this acute attack?
Your Answer: Fresh frozen plasma
Explanation:Hereditary angioedema is inherited as an autosomal dominant disorder and is caused by deficiency of C1 esterase inhibitor, a protein that forms part of the complement system.Attacks can be precipitated by stress and minor surgical procedures. Clinical features of hereditary angioedema include oedema of the skin and mucous membranes commonly affecting the face, tongue and extremities.Angioedema and anaphylaxis due to a deficiency of C1 esterase inhibitor are resistant to adrenaline, steroids and antihistamines. Treatment is with fresh frozen plasma or C1 esterase inhibitor concentrate, which contains C1 esterase inhibitor.Short-term prophylaxis for events that may precipitate angioedema attack is achieved with C1 esterase inhibitor or fresh frozen plasma infusions before the event while long-term prophylaxis can be achieved with antifibrinolytic drugs (tranexamic acid) or androgenic steroids.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 7
Correct
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A patient presents with increased breathlessness and worsening of his chronic cough and. He has a chronic lung disorder and is on long-term oxygen therapy (LTOT).Which of these is an indication for LTOT?
Your Answer: A non-smoker with COPD and a PaO 2 of 7.5 kPa when stable with secondary polycythaemia
Explanation:Long-term administration of oxygen, usually at least 15 hours daily, improves survival in COPD patients who have severe hypoxaemia. Long-term oxygen therapy should be considered in:A non-smoker with COPD and a PaO2<7.3 kPa when stableA non-smoker with COPD and PaO27.3–8 kPa when stable and with secondary polycythaemia, peripheral oedema, or evidence of pulmonary hypertensionSevere chronic asthma with PaO2<7.3 kPa or persistent disabling breathlessnessA patient with Interstitial lung disease with PaO28 kPa with disabling dyspnoeaA patient with cystic fibrosis when PaO2<7.3 kPa or if PaO27.3–8 kPa in the presence of secondary polycythaemia, nocturnal hypoxaemia, pulmonary hypertension, or peripheral oedemaPulmonary hypertension, without parenchymal lung involvement when PaO2<8 kPaNeuromuscular or skeletal disorders, after specialist assessmentObstructive sleep apnoea despite continuous positive airways pressure therapy, after specialist assessmentPulmonary malignancy or other terminal disease with disabling dyspnoeaHeart failure with daytime PaO2<7.3 kPa when breathing air or with nocturnal hypoxaemia
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 8
Correct
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Following a bee sting, a 12-year old boy was transported to resus with symptoms and signs of an anaphylactic reaction. You decide to administer adrenaline IM stat.What is the recommended dose of intramuscular adrenaline?
Your Answer: 0.3 mL of 1:1000
Explanation:Anaphylaxis is a type I hypersensitivity reaction that is severe and life-threatening. It is marked by the fast onset of life-threatening airway and/or circulatory issues, which are generally accompanied by skin and mucosal abnormalities. When an antigen attaches to specific IgE immunoglobulins on mast cells, degranulation and the release of inflammatory mediators takes place (e.g. histamine, prostaglandins, and leukotrienes).The most important medicine for treating anaphylactic responses is adrenaline. It decreases oedema and reverses peripheral vasodilation as an alpha-adrenergic receptor agonist. Its beta-adrenergic effects widen the bronchial airways, enhance the force of cardiac contraction, and inhibit the release of histamine and leukotriene. The first medicine to be given is adrenaline, and the IM route is optimal for most people.In anaphylaxis, age-related dosages of IM adrenaline are:150 mcg (0.15 mL of 1:1000) for a child under 6 years300 mcg (0.3 mL of 1:1000) for a child aged 6 to 12 years 500 mcg (0.5 mL of 1:1000) for children aged 12 and above 500 mcg for adults (0.5 mL of 1:1000)
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 9
Correct
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A 29-year-old man is diagnosed with a severe case of asthma.In the treatment of acute asthma in adults, which of the following is NOT recommended?
Your Answer: Nebulised magnesium
Explanation:There is no evidence to support the use of nebulized magnesium sulphate in the treatment of adults at this time.In adults with acute asthma, the following medication dosages are recommended:By using an oxygen-driven nebuliser, you can get 5 milligrams of salbutamol.500 mcg ipratropium bromide in an oxygen-driven nebuliserOral prednisolone 40-50 mg100 mg hydrocortisone intravenous1.2-2 g magnesium sulphate IV over 20 minutesWhen inhaled treatment is ineffective, intravenous salbutamol (250 mcg IV slowly) may be explored (e.g. a patient receiving bag-mask ventilation).Following senior counsel, current ALS recommendations propose that IV aminophylline be explored in severe or life-threatening asthma. If utilized, a loading dose of 5 mg/kg should be administered over 20 minutes, then a 500-700 mcg/kg/hour infusion should be given. To avoid toxicity, serum theophylline levels should be kept below 20 mcg/ml.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 10
Correct
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A 22-year-old woman comes in with an asthmatic flare. Salbutamol is her only regular medication.What is the dosage per inhalation of a standard metered dose salbutamol inhaler?
Your Answer: 100 micrograms
Explanation:The dose of a conventional metered dose inhaler is 100 micrograms per metered inhalation.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 11
Correct
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A 70-year-old woman presents with exacerbation of her chronic obstructive pulmonary disease (COPD), increased cough, wheeze and chest tightness. On examination, she is tachypnoeic and oxygen saturation is 86%. You plan to administer supplemental oxygen.Which oxygen delivery system is most appropriate to use initially?
Your Answer: Venturi mask
Explanation:In life-threatening emergencies, oxygen should be started immediately otherwise, it should be prescribed like any other drug. The prescription should include a target saturation range.Until blood gases can be measured, initial oxygen should be administered using a controlled concentration of 24% or 28%. The ideal mask is a Venturi mask. The other mask are not ideal for initial use
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 12
Correct
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A 32-year-old asthmatic patient on theophylline as part of her asthma management presents to the Emergency Department with an unrelated medical condition.Which of these drugs should be avoided?
Your Answer: Clarithromycin
Explanation:Macrolide antibiotics (e.g. clarithromycin and erythromycin) are cytochrome P450 enzyme inhibitors. They increase blood levels of theophylline leading to hypokalaemia, and potentially increasing the risk of Torsades de pointes when they are prescribed together. Co-prescription with theophylline should be avoided.Factors that enhance theophylline clearance include cigarette smoking, carbamazepine, phenobarbital, phenytoin, primidone, and rifampin. Medications that inhibit clearance include ethanol, ciprofloxacin, erythromycin, verapamil, propranolol, ticlopidine, tacrine, allopurinol, and cimetidine.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 13
Correct
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You review a 46-year-old woman who has recently been prescribed antibiotics for a urinary tract infection. She suffers from COPD and is currently prescribed salbutamol and Seretide inhalers, and Phyllocontin continus. Since starting the antibiotics, she has been experiencing nausea, vomiting and abdominal pain.Which of the following antibiotics is she MOST LIKELY to have been prescribed for her UTI? Select ONE answer only .
Your Answer: Ciprofloxacin
Explanation:Phyllocontin continus contains aminophylline (a mixture of theophylline and ethylenediamine), a bronchodilator used in the management of COPD and asthma.This patient is exhibiting symptoms of theophylline toxicity, which may have been triggered by the prescription of the antibiotic. Quinolone antibiotics, such as ciprofloxacin and levofloxacin, and macrolide antibiotics, such as erythromycin, increase the plasma concentration of theophyllines and can lead to toxicity.The drugs that commonly affect the half-life and the plasma concentration of theophylline are summarised in the table below:Drugs increasing plasma concentration of theophyllineDrugs decreasing plasma concentration of theophyllineCalcium channel blockers, e.g. VerapamilCimetidineFluconazoleMacrolides, e.g. erythromycinQuinolones, e.g. ciprofloxacinMethotrexateBarbituratesCarbamazepinePhenobarbitolPhenytoin (and fosphenytoin)RifampicinSt. John’s wort
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 14
Correct
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A 22-year-old with a history of brittle asthma is brought to the ED by her partner. She is wheezing and very short of breath and her condition is deteriorating rapidly. Following a series of nebulisations, hydrocortisone and IV magnesium sulphate, she is taken to resus and the intensive care team is called to review her. She is severely hypoxic and confused and a decision is made to intubate her.Which of these drugs is ideal as an induction agent in this patient?
Your Answer: Ketamine
Explanation:Only about 2% of asthma attacks requires intubation and most severe cases are managed with non-invasive ventilation techniques.Though life-saving in the crashing asthmatic, intubation in asthmatic patients is associated with significant morbidity and mortality and is risky. Indications for intubation in asthmatic patients include:Severe hypoxiaAltered mental stateRespiratory or cardiac arrestFailure to respond to medicationsKetamine (1-2 mg/kg) is the preferred induction agent. It has bronchodilatory properties and does not cause hypotension. Propofol poses a risk of hypotension but can also be used.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 15
Correct
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After eating a peanut, a 24-year-old lady develops an anaphylactic reaction.Which of the following should be the first step to manage the situation?
Your Answer: Administer IM adrenaline
Explanation:The most important medicine for treating anaphylactic responses is adrenaline. It decreases oedema and reverses peripheral vasodilation as an alpha-adrenergic receptor agonist. Its beta-adrenergic effects widen the bronchial airways, enhance the force of cardiac contraction, and inhibit the release of histamine and leukotriene. The first medicine to be given is adrenaline, and the IM route is optimal for most people.In anaphylaxis, age-related dosages of IM adrenaline are given:150 mcg (0.15 mL of 1:1000) for children under the age of six 300 mcg (0.3 mL of 1:1000) for a child aged 6 to 12 years 500 mcg (0.5 mL of 1:1000) for children aged 12 and above500 mcg (0.5 mL of 1:1000) for adults
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 16
Incorrect
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A 50-year-old man has recently been on antibiotics for a chest infection. He suffers from COPD and is currently on Seretide inhalers, salbutamol, and Phyllocontin continus. Since commencing the antibiotics, he has developed nausea, vomiting and abdominal pain.Which of the following antibiotics has he MOST LIKELY been on for his chest infection?
Your Answer: Doxycycline
Correct Answer: Erythromycin
Explanation:Phyllocontin continues contains aminophylline, a bronchodilator used in the management of asthma and COPD.The index patient is exhibiting symptoms of theophylline toxicity. This may have been triggered by the antibiotic he took. Macrolide antibiotics, like erythromycin and quinolone antibiotics, like ciprofloxacin and levofloxacin, increases the plasma concentration of theophyllines and can lead to toxicity.Factors that enhance theophylline clearance include cigarette smoking, carbamazepine, phenobarbital, phenytoin, primidone, and rifampin. Medications that inhibit clearance include ethanol, ciprofloxacin, erythromycin, verapamil, propranolol, ticlopidine, tacrine, allopurinol, and cimetidine.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 17
Correct
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A critically ill 48-year-old individual appears with symptoms and signs of an anaphylactic reaction.In an allergic reaction, which of the following is an absolute contraindication to the injection of adrenaline?
Your Answer: None of the other options
Explanation:Even if the following relevant contraindications exist, adrenaline can be given in life-threatening anaphylactic reactions:Coronary artery disease (CAD) Coronary artery disease (CAD) Second stage of labourHypertension that is uncontrolledSevere Ventricular arrhythmias
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 18
Incorrect
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You review a 56-year-old man who has recently been prescribed antibiotics for a chest infection. He suffers from COPD and is currently prescribed salbutamol and Seretide inhalers, and Phyllocontin continus. Since starting the antibiotics, he has been experiencing nausea, vomiting and abdominal pain.Which of the following antibiotics is he MOST LIKELY to have been prescribed for his chest infection? Select ONE answer only .
Your Answer: Amoxicillin
Correct Answer: Levofloxacin
Explanation:Phyllocontin continus contains aminophylline (a mixture of theophylline and ethylenediamine), a bronchodilator used in the management of COPD and asthma.This patient is exhibiting symptoms of theophylline toxicity, which may have been triggered by the prescription of the antibiotic. Quinolone antibiotics, such as ciprofloxacin and levofloxacin, and macrolide antibiotics, such as erythromycin, increase the plasma concentration of theophyllines and can lead to toxicity.The drugs that commonly affect the half-life and the plasma concentration of theophylline are summarised in the table below:Drugs increasing plasma concentration of theophyllineDrugs decreasing plasma concentration of theophyllineCalcium channel blockers, e.g. VerapamilCimetidineFluconazoleMacrolides, e.g. erythromycinQuinolones, e.g. ciprofloxacinMethotrexateBarbituratesCarbamazepinePhenobarbitolPhenytoin (and fosphenytoin)RifampicinSt. John’s wort
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 19
Incorrect
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A patient presents with an acute severe asthma attack. Following a poor response to his initial salbutamol nebuliser, you administer a further nebuliser that this time also contains ipratropium bromide.After what time period would you expect the maximum effect of the ipratropium bromide to occur? Select ONE answer only.
Your Answer: Less than 5 minutes
Correct Answer: 30 -60 minutes
Explanation:Ipratropium bromide is an antimuscarinic drug used in the management of acute asthma and COPD. It can provide short-term relief in chronic asthma, but short-acting β2agonists act more quickly and are preferred.The BTS guidelines recommend that nebulised ipratropium bromide (0.5 mg 4-6 hourly) can be added to β2agonist treatment for patients with acute severe or life-threatening asthma or those with a poor initial response to β2 agonist therapy.The aerosol inhalation of ipratropium can be used for short-term relief in mild chronic obstructive pulmonary disease in patients who are not already using a long-acting antimuscarinic drug (e.g. tiotropium).Its maximum effect occurs 30-60 minutes after use; its duration of action is 3-6 hours, and bronchodilation can usually be maintained with treatment three times per day.The commonest side effect of ipratropium bromide is dry mouth. It can also trigger acute closed-angle glaucoma in susceptible patients. Tremor is commonly seen with β2agonists but not with antimuscarinics. Ipratropium bromide should be used with caution in: Men with prostatic hyperplasia and bladder-outflow obstruction (worsened urinary retention has been reported in elderly men), People with chronic kidney disease (CKD) stages 3 and above (because of the risk of drug toxicity), People with angle-closure glaucoma (nebulised mist of antimuscarinic drugs can precipitate or worsen acute angle-closure glaucoma)
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 20
Correct
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A 50-year-old woman has an anaphylactic reaction following accidental ingestion peanuts at a restaurant. She is a known hypertensive on atenolol 50 mg daily and BP is well controlled. She is also on amlodipine 5 mg daily. Two doses of IM adrenaline has been given without improvement.Which medication may prove helpful in this patient?
Your Answer: IM Glucagon
Explanation:Resistant to the effects of adrenaline in anaphylaxis is seen in patients taking beta-blockers.Glucagon can be used to overcome the effects of the beta-blockade if initial doses of adrenaline are unsuccessful in patients taking beta-blockers.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 21
Incorrect
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A 25-year-old female arrives at the emergency room with a severe case of asthma. When she doesn't seem to be improving after initial treatment, you decide to start an aminophylline infusion.From the options below, which is Aminophylline's main mechanism of action?
Your Answer: Beta receptor agonism
Correct Answer: Phosphodiesterase inhibition
Explanation:Theophylline and Ethylenediamine are combined in a 2:1 ratio to form Aminophylline. Its solubility is improved by the addition of Ethylenediamine. It has a lower potency and a shorter duration of action than Theophylline.It is used to treat the following conditions: Heart failureIt is used to treat the following conditions: COPDBradycardiasAminophylline has the following properties:Phosphodiesterase inhibitor that increases intracellular cAMP and relaxes smooth muscle in the bronchial airways and pulmonary blood vessels.Mast cell stabilization is achieved by using a non-selective adenosine receptor antagonist.It has slight positive inotropic and chronotropic effects, increasing cardiac output and decreasing systemic vascular resistance, lowering arterial blood pressure. It has been used historically in the treatment of refractory heart failure and is indicated by the current ALS guidelines as a substitute treatment for bradycardia. The daily oral dose for adults is 900 mg, divided into 2-3 doses. For severe asthma or COPD, a loading dosage of 5 mg/kg over 10-20 minutes is given, followed by a continuous infusion of 0.5 mg/kg/hour. The therapeutic range is small (10-20 microgram/ml), hence assessments of aminophylline plasma concentrations are useful during long-term treatment.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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Question 22
Incorrect
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A 28-year-old asthmatic patient is seen in the Emergency Department following an acute exacerbation. His symptoms start to improve when your consultant gives him a high dose of IV aminophylline.Which of the following is correct mechanism of action of aminophylline ?
Your Answer: Muscarinic receptor antagonism
Correct Answer: Inhibition of phosphodiesterase
Explanation:Aminophylline has the following properties:Phosphodiesterase inhibitor that increases intracellular cAMP and relaxes smooth muscle in the bronchial airways and pulmonary blood vessels.Mast cell stabilization is achieved by using a non-selective adenosine receptor antagonist.
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This question is part of the following fields:
- Pharmacology
- Respiratory Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
