Over-the-Counter Expectants Overview

Questions and Answers

What is the primary mechanism of action for selective β2 agonists in bronchodilation?

Inhibition of bronchial β2 receptors

Stimulation of bronchial α1 receptors

Increase of cAMP levels (correct)

Decrease of bronchial smooth muscle contractility

Which of the following adverse effects is specifically associated with the use of β2 agonists?

Hypokalemia due to potassium shifting (correct)

Gastrointestinal upset leading to diarrhea

Increased mucous production in the airways

Hypertension due to vasoconstriction

What is a significant difference in administration between short-acting and long-acting β2 agonists?

Long-acting agents have a duration of 2 hours.

Short-acting is always administered orally.

Long-acting is preferred for acute asthma attacks.

Short-acting agents are given by inhalation or i.v. infusion. (correct)

Which of the following β2 agonists has the longest duration of action?

Formoterol Signup and view all the answers

What could lead to tolerance when using β2 agonists for an extended period?

Reduced receptor availability Signup and view all the answers

During which condition are β2 agonists typically administered for the quickest effect?

Acute asthma attacks Signup and view all the answers

Which factor is the most important predisposing factor for chronic asthma?

Chronic respiratory infections Signup and view all the answers

What is a characteristic symptom of chronic asthma?

Coughing particularly at night Signup and view all the answers

What is the primary action of guaifenesin as an expectorant?

Increases bronchial fluid secretion Signup and view all the answers

Which of the following is NOT considered effective as an expectorant based on traditional remedies?

Guaifenesin Signup and view all the answers

Which of the following is NOT a type of bronchodilator used in asthma management?

Antihistamines Signup and view all the answers

In acute severe asthma, which symptom is least likely to be observed?

Wheezing that is fully responsive to bronchodilators Signup and view all the answers

What is the primary characteristic of bronchial asthma?

Chronic inflammatory disorder of the airways Signup and view all the answers

What is a common trigger for the inflammation seen in asthma?

Frequent exposure to allergic stimuli Signup and view all the answers

Which of the following explains a possible exacerbation of asthma due to psychological factors?

Stress-induced bronchoconstriction Signup and view all the answers

Which of the following statements about airway smooth muscle hypertrophy is true?

It is a consequence of chronic inflammation. Signup and view all the answers

Which of the following is NOT a cytokine typically associated with asthma inflammation?

Interferon Signup and view all the answers

What is commonly noted about patients with severe asthma?

They can only say a few words with each breath. Signup and view all the answers

What symptoms are most commonly associated with asthma?

Wheezing, breathlessness, chest tightness, and coughing Signup and view all the answers

Which of the following statements about asthma is incorrect?

Asthma is an acute disorder. Signup and view all the answers

Theophylline belongs to which category of asthma medications?

Xanthines Signup and view all the answers

What role do inflammatory cytokines play in asthma?

They facilitate the infiltration of inflammatory cells in the bronchial wall. Signup and view all the answers

What is a recommended intravenous dosage for aminophylline in the treatment of acute severe asthma?

250 mg over 15 minutes Signup and view all the answers

In chronic bronchial asthma, which of the following is NOT an appropriate form of theophylline administration?

Immediate release tablets of 500 mg Signup and view all the answers

What effect does caffeine have in the context of neonatal apnea syndrome?

Caffeine is the agent of choice Signup and view all the answers

Which of the following side effects is associated with central nervous system (CNS) use of aminophylline?

Irritability Signup and view all the answers

What is the main therapeutic use of caffeine in the treatment of migraine?

To enhance absorption of ergotamine Signup and view all the answers

Which of the following correctly describes a cardiovascular side effect of caffeine?

Palpitations Signup and view all the answers

What therapeutic role does aminophylline play in acute pulmonary edema due to acute left-sided heart failure?

It helps alleviate respiratory distress Signup and view all the answers

What is a potential side effect of CNS use of caffeine for delaying physical and mental fatigue?

Convulsions Signup and view all the answers

What is a potential consequence of rapid intravenous injection of Aminophylline?

Cardiac arrest Signup and view all the answers

Which of the following groups should Aminophylline be used with caution?

Patients with severe cardiac disease Signup and view all the answers

Which drug interaction can lead to increased toxicity of methylxanthines?

Enzyme inhibitors Signup and view all the answers

In which situation is the administration of Aminophylline contraindicated?

Peptic ulcer Signup and view all the answers

What could be a symptom of gastrointestinal toxicity due to Aminophylline?

Anorexia Signup and view all the answers

What is the recommended duration for the slow intravenous administration of Aminophylline?

15 minutes Signup and view all the answers

Stimulation of bronchial β2 receptors leads to a decrease in cAMP, resulting in bronchodilatation.

False Signup and view all the answers

Selective β2 agonists can cause hypokalemia due to the shifting of potassium from blood into cells.

True Signup and view all the answers

Tachycardia and arrhythmia from β2 agonists are solely due to direct activation of cardiac β1 receptors.

False Signup and view all the answers

Long acting β2 agonists are typically administered intravenously to manage chronic asthma.

False Signup and view all the answers

Tolerance can develop with prolonged use of β2 agonists, necessitating a temporary cessation of the drug.

True Signup and view all the answers

Salbutamol and terbutaline are classified as long acting β2 agonists with a duration of 12 hours.

False Signup and view all the answers

Hypertrophy of airway smooth muscle is a common consequence of chronic asthma.

True Signup and view all the answers

Increased mucus secretion in asthma is easy to expel.

False Signup and view all the answers

Patients with chronic asthma typically experience symptoms only during daytime.

False Signup and view all the answers

Acute severe asthma can lead to symptoms such as cyanosis and severe dyspnea.

True Signup and view all the answers

Bronchodilator therapy is ineffective during an acute asthma attack.

False Signup and view all the answers

Psychological factors are involved in 40% of patients with asthma.

True Signup and view all the answers

Xanthines are classified as muscarinic receptor blockers in asthma management.

False Signup and view all the answers

A family history of allergy is a significant predisposing factor for asthma.

True Signup and view all the answers

Atropium is effective when used alone for bronchial dilation.

False Signup and view all the answers

Xanthines inhibit adenosine A receptors leading to CNS stimulation.

True Signup and view all the answers

Methylxanthines are exclusively classified as synthetic compounds.

False Signup and view all the answers

Rapid intravenous injection of Aminophylline can cause hypotension and cardiac arrest.

True Signup and view all the answers

Caffeine can lead to bronchoconstriction by activating the effects of adenosine.

False Signup and view all the answers

Aminophylline can be safely administered to patients with peptic ulcers.

False Signup and view all the answers

Theophylline decreases mediator release from mast cells.

True Signup and view all the answers

The use of enzyme inducers like smoking reduces the serum levels of methylxanthines.

True Signup and view all the answers

Aminophylline must be administered over at least 30 minutes to avoid sudden syncope.

False Signup and view all the answers

Phosphodiesterase enzyme inhibition by xanthines leads to decreased cAMP levels.

False Signup and view all the answers

Elderly patients require caution when receiving Aminophylline due to potential adverse effects.

True Signup and view all the answers

Aminophylline is a salt of caffeine.

False Signup and view all the answers

Cimetidine and erythromycin can interact with Aminophylline, leading to decreased methylxanthine toxicity.

False Signup and view all the answers

Xanthines enhance cardiac contractility through the action of PDE3.

True Signup and view all the answers

Atropine is a selective M3 blocker that is preferred for treating asthma due to its minimal side effects.

False Signup and view all the answers

Ipratropium bromide can cross the blood-brain barrier and may cause CNS side effects such as sedation.

False Signup and view all the answers

Excessive dryness of bronchial secretions is a side effect associated with the use of atropine in airway management.

True Signup and view all the answers

Ipratropium bromide is utilized in bronchodilation due to its selective action on M3 receptors only.

True Signup and view all the answers

The primary reason ipratropium is preferred over atropine is its ability to cause less urinary retention.

True Signup and view all the answers

Atropine is a preferred option for treatment of asthma due to its ability to create bronchodilation through opposed β2 action.

False Signup and view all the answers

The central nervous system (CNS) side effects caused by ipratropium bromide are relatively minimal compared to atropine.

True Signup and view all the answers

Ipratropium bromide is a tertiary ammonium compound, making it capable of crossing the blood-brain barrier.

False Signup and view all the answers

How might chronic asthma affect the airflow in patients?

Chronic asthma can lead to airway smooth muscle hypertrophy, causing narrowed airways and restricted airflow. Signup and view all the answers

What role do genetic factors play in the predisposition to asthma?

Genetic factors can increase the likelihood of developing asthma in families with a history of allergies. Signup and view all the answers

Describe the significance of mucus secretion in the context of asthma.

In asthma, increased mucus secretion can obstruct airways, making it difficult for patients to expel it effectively. Signup and view all the answers

Describe how stimulation of bronchial β2 receptors leads to bronchodilatation.

Stimulation of bronchial β2 receptors increases cAMP levels, resulting in smooth muscle relaxation and bronchodilatation. Signup and view all the answers

What are the common symptoms experienced by patients during an acute severe asthma attack?

Common symptoms include severe dyspnea, inspiratory wheezing, and cyanosis, with patients struggling to speak. Signup and view all the answers

What are the primary adverse effects of β2 agonists related to cardiac health?

The primary adverse effects are tachycardia and arrhythmia, which can occur due to hypotension and direct activation of cardiac β1 receptors. Signup and view all the answers

What potential psychological impact does asthma have on patients?

Asthma can involve psychological factors in about 40% of patients, potentially exacerbating their condition. Signup and view all the answers

Explain the difference in duration between short-acting and long-acting β2 agonists in asthma management.

Short-acting β2 agonists have a duration of 3-4 hours, while long-acting β2 agonists last about 12 hours. Signup and view all the answers

How does the management of asthma utilize bronchodilators?

Bronchodilators, such as β-adrenergic agonists, are used to relax airway muscles, facilitating easier airflow. Signup and view all the answers

What are xanthines, and how are they used in asthma management?

Xanthines, like theophylline, are bronchodilator medications that help relax the muscles around the airways. Signup and view all the answers

In what form of asthma are long-acting β2 agonists typically administered, and what is their route?

Long-acting β2 agonists are typically administered in chronic asthma, either orally or by inhalation. Signup and view all the answers

How does airway edema contribute to asthma symptoms?

Airway edema results in swelling of the respiratory mucosa, leading to congestion and difficulty in breathing. Signup and view all the answers

What physiological changes can lead to hypokalemia in patients using β2 agonists?

Hypokalemia can occur due to the shift of potassium from the blood into cells as a result of β2 agonist therapy. Signup and view all the answers

Why is the development of tolerance a concern with prolonged use of β2 agonists?

Tolerance can lead to reduced effectiveness of the drug, sometimes requiring temporary cessation to regain response. Signup and view all the answers

What is the role of xanthines in reducing bronchoconstriction?

Xanthines act as adenosine A receptor antagonists, leading to bronchodiilatation by blocking the broncchoconstrictor effect of adenosine. Signup and view all the answers

Describe how xanthines affect the central nervous system.

Xanthines stimulate the CNS by blocking the inhibitory effects of adenosine, resulting in increased alertness. Signup and view all the answers

What synergistic effect results from combining ipratropium with β2 agonists?

The combination enhances bronchodilation more effectively than ipratropium alone, maximizing therapeutic outcomes. Signup and view all the answers

What impact do xanthines have on mast cell mediator release?

Xanthines lead to decreased mediator release from mast cells, which is beneficial in reducing inflammation. Signup and view all the answers

Explain the effect of phosphodiesterase (PDE) inhibition by xanthines.

Inhibiting PDE enzymes increases cAMP and cGMP levels, resulting in enhanced bronchodilation and cardiac contractility. Signup and view all the answers

How does caffeine function as a bronchodilator in neonatal apnea syndrome?

Caffeine acts as a xanthine, stimulating respiration and promoting airway opening through its bronchodilator properties. Signup and view all the answers

What types of xanthines are classified as natural and semisynthetic?

Natural xanthines include caffeine and theophylline, while semisynthetic xanthines include aminophylline. Signup and view all the answers

What cardiovascular effects are associated with the use of xanthines?

Xanthines can increase cardiac contractility and may lead to arrhythmogenic actions due to enhanced cAMP levels. Signup and view all the answers

Explain why ipratropium is preferred over atropine for bronchodilation.

Ipratropium is more selective as a muscarinic blocker and does not cross the BBB, which minimizes CNS side effects. Signup and view all the answers

What are the main side effects associated with the use of atropine as a muscarinic antagonist?

The main side effects include dry mouth, urine retention, and CNS effects such as sedation. Signup and view all the answers

Why is the excessive dryness of bronchial secretions a concern when using muscarinic antagonists?

Excessive dryness makes it difficult to expel bronchial secretions, potentially leading to airway obstruction. Signup and view all the answers

Discuss the significance of ipratropium being a quaternary ammonium compound in its pharmacological use.

Being a quaternary ammonium compound, ipratropium is less likely to cross the BBB, reducing potential CNS side effects. Signup and view all the answers

What is the primary mechanism through which atropine induces bronchodilation?

Atropine blocks M3 receptors in the airway smooth muscle, leading to bronchodilation via unopposed β2 action. Signup and view all the answers

How do the CNS side effects of atropine differ from those of ipratropium?

Atropine can cause sedation due to its ability to cross the BBB, whereas ipratropium does not typically cause such effects. Signup and view all the answers

In what way does the selectivity of ipratropium impact its clinical use compared to atropine?

Ipratropium's selectivity reduces the likelihood of undesirable side effects associated with non-selective muscarinic antagonism. Signup and view all the answers

What are the implications of muscarinic antagonist side effects for patient management in respiratory diseases?

Understanding these side effects is crucial for preventing complications such as difficulties in mucus clearance and sedation. Signup and view all the answers

What is the recommended intravenous dosage for aminophylline in the treatment of acute severe asthma?

250 mg i.v. infused slowly over at least 15 minutes. Signup and view all the answers

In chronic bronchial asthma, what are the forms of theophylline administration mentioned?

Sustained release tablets of theophylline (100-300 mg/day) or rectal suppositories of aminophylline. Signup and view all the answers

What condition is particularly treated with caffeine as the agent of choice?

Neonatal apnea syndrome. Signup and view all the answers

What are some central nervous system side effects of aminophylline use?

Irritability, headache, insomnia, nervousness, and convulsions. Signup and view all the answers

How does caffeine assist in the treatment of migraine?

Caffeine, combined with ergotamine, increases vasoconstriction of cerebral blood vessels. Signup and view all the answers

What cardiovascular side effects may occur with aminophylline use?

Palpitations, tachycardia, and arrhythmias. Signup and view all the answers

What is a notable adverse effect associated with the sudden rapid intravenous injection of aminophylline?

It can cause syncope or cardiac arrest. Signup and view all the answers

What potential consequence arises from the prolonged use of aminophylline?

Tolerance may develop, leading to reduced effectiveness of the drug. Signup and view all the answers

Ipra atropium is not sufficient alone for ______.

bronchodilation Signup and view all the answers

Xanthines are adenosine A receptor ______ leading to bronchodiilatation.

antagonists Signup and view all the answers

Caffeine is an example of a ______ xanthine.

natural Signup and view all the answers

Aminophylline must be given by slow ______.

i.v. Signup and view all the answers

Xanthines lead to increased AV ______.

conduction Signup and view all the answers

One common side effect of rapid intravenous injection of Aminophylline is ______.

cardiac arrest Signup and view all the answers

The inhibition of phosphodiesterase enzyme (PDE4) leads to increased levels of ______.

cAMP Signup and view all the answers

Enzyme inhibitors like cimetidine can increase the serum levels of ______.

methylxanthines Signup and view all the answers

Inhibition of the inhibitory effect of adenosine on the CNS leads to ______ stimulation.

CNS Signup and view all the answers

The use of Aminophylline should be approached with caution in patients with severe ______ disease.

cardiac Signup and view all the answers

Methylxanthines such as aminophylline are considered ______.

semisynthetic Signup and view all the answers

Gastrointestinal toxicity due to Aminophylline can include ______.

nausea Signup and view all the answers

Xanthines can block the bronchoconstrictor effect of ______.

adenosine Signup and view all the answers

Short acting β2 agonists such as salbutamol and terbutaline have a duration of action of ___ hours.

3-4 Signup and view all the answers

Long acting β2 agonists, like salmeterol, typically have a duration of ___ hours.

12 Signup and view all the answers

Aminophylline should not be given to patients with a ______ ulcer.

peptic Signup and view all the answers

Stimulation of bronchial β2 receptors leads to an increase in ___, resulting in bronchodilatation.

cAMP Signup and view all the answers

In patients with acute asthma, short acting β2 agonists are administered by ___ or intravenous infusion.

inhalation Signup and view all the answers

Adverse effects of β2 agonists can include tachycardia and ___ due to reflex from hypotension.

arrhythmia Signup and view all the answers

Hypokalemia from β2 agonists occurs due to the shift of ___ from blood into cells.

potassium Signup and view all the answers

Atropine blocks M3 receptors in the airway leading to bronchodilatation through _____ action.

unopposed β2 Signup and view all the answers

Ipratropium is more preferred than atropine because it is a more selective _____ blocker.

muscarinic Signup and view all the answers

Atropine is a non-selective M3 blocker leading to many side effects such as dry mouth and _____ retention.

urine Signup and view all the answers

Ipratropium can cross the BBB and causes CNS side effects such as _____.

sedation Signup and view all the answers

Excessive dryness of bronchial secretions makes it difficult to _____ them.

expel Signup and view all the answers

Ipratropium is a quaternary ammonium compound that can't cross the _____.

BBB Signup and view all the answers

A notable side effect of non-selective M3 blockers is excessive _____ of bronchial secretions.

dryness Signup and view all the answers

Ipratropium is used instead of atropine primarily because it does not cause excessive dryness of bronchial _____.

secretions Signup and view all the answers

In acute severe asthma, aminophylline may be given by slow i.v. infusion of 250 mg to avoid ______ or cardiac arrest.

syncope Signup and view all the answers

Sustained release tablets of theophylline can be administered for chronic bronchial ______.

asthma Signup and view all the answers

Caffeine is used in the treatment of ______ apnea syndrome as the agent of choice.

neonatal Signup and view all the answers

Caffeine is known to reverse CNS ______.

depression Signup and view all the answers

Ergotamine is combined with caffeine to increase ______ of cerebral blood vessels.

vasoconstriction Signup and view all the answers

Adverse effects of CNS use of caffeine may include irritability, headache, and ______.

insomnia Signup and view all the answers

Acute pulmonary edema is due to acute left sided ______.

heart failure Signup and view all the answers

The primary action of aminophylline in treating severe asthma is its ability to cause ______.

bronchodilation Signup and view all the answers

Match the following selective β2 agonists with their respective duration of action:

Salbutamol = Short acting (3-4 hours) Salmeterol = Long acting (12 hours) Terbutaline = Short acting (3-4 hours) Formoterol = Long acting (12 hours) Signup and view all the answers

Match the adverse effects with their corresponding causes related to β2 agonists:

Tachycardia = Reflex from hypotension Tremors = Direct activation of skeletal muscle Hypokalemia = Shift of potassium from blood to cells Tolerance = Prolonged use of the drug Signup and view all the answers

Match the following β2 agonists with their usual routes of administration:

Salbutamol = Inhalation or iv infusion for acute asthma Salmeterol = Orally or by inhalation for chronic asthma Terbutaline = Inhalation for acute asthma Formoterol = Orally for chronic asthma Signup and view all the answers

Match the mechanism of action of β2 agonists with the corresponding outcomes:

Stimulation of β2 receptors = Increased cAMP Inhibition of mast cell degranulation = Decreased histamine release Reduction of airway inflammation = Decreased bronchial wall edema Bronchodilation = Increased airway diameter Signup and view all the answers

Match the following medication actions with their effects in asthma treatment:

Isoprenaline = Bronchodilation Adrenaline = Vasodilation of skeletal muscle blood vessels Ephedrine = Bronchodilation and increased heart rate Selective β2 agonists = Reduced bronchial inflammation Signup and view all the answers

Match the following concepts with their respective descriptions regarding β2 agonists:

Short acting β2 agonists = Used in acute asthma therapy Long acting β2 agonists = Used in chronic asthma management Adverse effects = Can include tachycardia and tremors Administration route = Inhalation for acute episodes Signup and view all the answers

Match the following xanthines with their classification:

Caffeine = Natural Theophylline = Natural Aminophylline = Semisynthetic Theobromine = Natural Signup and view all the answers

Match the following effects of xanthines with their mechanism:

Bronchodilatation = Block bronchoconstrictor effect of adenosine CNS stimulation = Block inhibitory effect of adenosine on the CNS Decreased mediator release = From mast cells Increased AV conduction = Due to inhibition of phosphodiesterase Signup and view all the answers

Match the following effects with their corresponding phosphodiesterase (PDE) enzyme:

Bronchodilatation = PDE4 Increased cardiac contractility = PDE3 Cerebral vasoconstriction = PDE3 Peripheral vasodilation = PDE4 Signup and view all the answers

Match the following roles of adenosine antagonists with their effects:

CNS stimulation = Inhibition of adenosine Bronchodilatation = Antagonism at A receptors Mast cell mediator release = Decrease in release from mast cells AV conduction acceleration = Increased conduction due to PDE inhibition Signup and view all the answers

Match the following xanthines with their specific examples:

Caffeine = General stimulant Theobromine = Found in chocolate Theophylline = Used in asthma treatment Aminophylline = Salt of theophylline Signup and view all the answers

Match the following pharmacological actions with their descriptions:

Bronchodilatation = Reduces airway resistance CNS stimulation = Enhances alertness and wakefulness Vasodilation = Improves blood flow through vessels Mast cell stabilization = Decrease in allergic response Signup and view all the answers

Match the following compounds with their typical pharmacological effects:

Caffeine = Respiratory stimulant in apnea Theophylline = Used to treat asthma Aminophylline = Acute pulmonary edema treatment Theobromine = Diuretic effect Signup and view all the answers

Match the following therapeutic uses with their corresponding xanthine:

Caffeine = Migraine treatment Theophylline = Chronic obstructive pulmonary disease Aminophylline = Acute asthma exacerbations Theobromine = Heart health support Signup and view all the answers

Match the following asthma symptoms with their descriptions:

Dyspnea = Difficulty in breathing Chest tightness = Feeling of pressure in the chest Coughing = Commonly occurs at night Wheezing = High-pitched sound during expiration Signup and view all the answers

Match the following types of asthma with their characteristics:

Chronic asthma = Persistent symptoms and may require continuous treatment Acute severe asthma = Characterized by severe dyspnea and response issues to treatment Mild intermittent asthma = Symptoms require no medications or occasional short-acting inhalers Refractory asthma = Asthma that does not respond well to standard treatments Signup and view all the answers

Match the following groups of bronchodilator drugs with their classifications:

β-adrenergic agonists = Stimulate β-receptors to induce bronchodilation Muscarinic receptor blockers = Inhibit acetylcholine to cause bronchodilation Xanthines = Increase cAMP levels to relax bronchial smooth muscle Short-acting β-agonists = Provide rapid relief from bronchospasm Signup and view all the answers

Match the following predisposing factors with their categories:

Recurrence of respiratory infection = Environmental factor Genetic factors = Family history of allergies Psychological factors = Contributing to 40% of cases Airway smooth muscle hypertrophy = Biological response to chronic asthma Signup and view all the answers

Match the following asthma management strategies with their descriptions:

Use of bronchodilators = Relieves airway constriction Mucus clearance techniques = Facilitates expulsion of thick secretions Inhaled corticosteroids = Reduces inflammation in the airways Leukotriene modifiers = Target specific inflammatory pathways Signup and view all the answers

Match the following characteristics of asthma presentations with their intensity levels:

Mild symptoms = Intermittent and typically manageable Moderate symptoms = Contact physician for management adjustments Severe symptoms = Emergency care often necessary Recovering acute symptoms = Gradual improvement following intervention Signup and view all the answers

Match the following bronchial muscle responses to their effects:

Bronchospasm = Constriction of air passages Airway edema = Swelling of the airway lining Mucus accumulation = Excess mucus obstructing airflow Smooth muscle hypertrophy = Thickening of airway walls over time Signup and view all the answers

Match the following terms related to asthmatic conditions with their definitions:

Hypertrophy of airway smooth muscle = Increased muscle mass in airways due to chronic inflammation Increased mucus secretion = Overproduction of mucus that hinders airflow Cyanosis = Bluish skin due to lack of oxygen Expiratory wheezing = Audible noise during breathing out indicating airflow obstruction Signup and view all the answers

Match the following therapeutic uses with their respective substances:

Aminophylline = Acute pulmonary edema Caffeine = Neonatal apnea syndrome Signup and view all the answers

Match the following adverse effects with their corresponding systems:

CNS = Headache and nervousness CVS = Arrhythmias Signup and view all the answers

Match the following administration routes with their dosage forms:

Slow i.v. infusion = 250 mg for Aminophylline Sustained release tablets = 100-300 mg for Theophylline Rectal suppository = Aminophylline for chronic bronchial asthma i.v. infusion = 0.7 mg/kg/h for maintenance Signup and view all the answers

Match the following conditions with their main effects:

Acute severe asthma = May lead to syncope or cardiac arrest Chronic bronchial asthma = Sustained release of Theophylline Neonatal apnea syndrome = Caffeine is agent of choice Acute pulmonary edema = Due to acute left-sided heart failure Signup and view all the answers

Match the following CNS uses with their potential outcomes:

Caffeine = Reversal of CNS depression Caffeine + Ergotamine = Increased VC of cerebral blood vessels Signup and view all the answers

Match the following intravenous administration precautions with their specific conditions:

Aminophylline = Care with patients showing arrhythmias Theophylline = Dosed as sustained release for chronic conditions Caffeine = Used cautiously in CNS depression Signup and view all the answers

Match the following side effects with the substances associated with them:

Aminophylline = Headache Caffeine = Tachycardia Signup and view all the answers

Match the following therapeutic roles with their associated outcomes:

Aminophylline = Improves airflow in acute asthma Caffeine = Emergency treatment for apnea Theophylline = Chronic management in asthma patients Signup and view all the answers

Match the following drugs with their characteristics:

Ipratropium = Does not cross the blood-brain barrier Atropine = Non-selective M3 blocker causing significant side effects Both Ipratropium and Atropine = Can cause CNS side effects Signup and view all the answers

Match the following adverse effects with their corresponding drug:

Atropine = Difficulty expelling bronchial secretions Ipratropium = Reduced dryness of bronchial secretions Both drugs = Can lead to sedation through CNS effects Signup and view all the answers

Match the following effects with the respective action of the drugs:

Ipratropium = Preferred for treatment of asthma Atropine = Blocks M3 receptors leading to bronchodilation Signup and view all the answers

Match the following statements to the correct drug:

Atropine = Can cause excessive dryness of bronchial secretions Ipratropium = More selective than Atropine Signup and view all the answers

Match the following characteristics to their drug usages:

Ipratropium = Minimizes CNS side effects Atropine = Used more for its non-selective effects Signup and view all the answers

Match the following side effects with their classifications:

Dry mouth = Common with Atropine Urine retention = Common with Atropine CNS sedation = Possible with both Atropine and Ipratropium Excessive dryness = Specifically associated with Atropine Signup and view all the answers

Match the following properties to the right drug:

Ipratropium = Preferred for fewer side effects Atropine = Requires caution due to side effects Signup and view all the answers

Match the following impacts to their corresponding action:

Ipratropium = Potentially fewer overall complications Atropine = Increases side effects including dryness Both drugs = Affect airway smooth muscle Signup and view all the answers

Study Notes

Guaifenesin

Widely used over-the-counter (OTC) expectorant.
Increases bronchial fluid secretion.

Other Expectorants

Traditional expectorants include ammonium chloride and tincture of ipecac.
Efficacy of many OTC cough mixtures is considered doubtful, especially at typical dosages.

Bronchial Asthma

Chronic inflammatory disorder of airways causing airflow obstruction.
Symptoms include wheezing, breathlessness, chest tightness, and coughing.
Pathogenesis involves frequent exposure to allergens leading to inflammatory cell infiltration.

Predisposing Factors for Asthma

Respiratory infections are the most significant trigger.
Genetic factors may contribute to asthma, particularly in families with allergic histories.
Psychological factors impact 40% of asthmatics.

Clinical Presentation of Chronic Asthma

Symptoms range from mild intermittent requiring minimal treatment to severe cases necessitating multiple medications.
Acute severe asthma can lead to uncontrolled inflammation, airway edema, and severe bronchospasm.
Patients may experience significant difficulty breathing, cyanosis, and can only speak a few words at a time.

Management of Asthma

Bronchodilators

Three main classes: β-adrenergic agonists, muscarinic receptor blockers (like ipratropium), and xanthines (such as theophylline).

β-Adrenergic Agonists

Non-selective agonists: adrenaline, isoprenaline, and ephedrine (rarely used).
Selective β2 agonists:
- Short-acting (e.g., salbutamol; duration 3-4 hours).
- Long-acting (e.g., salmeterol; duration 12 hours).

Mechanism of Action

Stimulation of bronchial β2 receptors increases cAMP, leading to bronchodilation and reduced histamine release.

Administration

Short-acting β2 agonists used in acute asthma via inhalation or intravenous infusion.
Long-acting β2 agonists are taken orally or by inhalation for chronic asthma.

Adverse Effects

Possible tachycardia and arrhythmias due to hypotension or loss of selectivity at high doses.
Tremors and nervousness may occur.
Tolerance can develop with prolonged use, leading to potential hypokalemia.

Therapeutic Uses of Xanthines

Acute severe asthma: aminophylline via slow intravenous infusion.
Chronic asthma: sustained release theophylline tablets or rectal aminophylline.

Central Nervous System (CNS) Uses

Reverses CNS depression and delays physical/mental fatigue (e.g., caffeine).
Used in migraines and neonatal apnea syndrome.

Cardiovascular System (CVS) Uses

Addresses acute pulmonary edema from left-sided heart failure.

Precautions

Administer aminophylline slowly to avoid sudden cardiac complications.
Monitor for interactions with enzyme inhibitors or in patients with pre-existing conditions.

Asthma and Its Characteristics

Hypertrophy of airway smooth muscle contributes to airway obstruction.
Excessive mucus secretion leads to difficulty in mucus expulsion.
Congestion and edema of the respiratory mucosa may occur.

Predisposing Factors

Recurring respiratory infections: Most significant risk factor for asthma.
Genetic factors: Family history of asthma and allergies increases risk.
Psychological factors: Present in 40% of asthmatic patients.

Clinical Presentation of Asthma

Chronic asthma: Characterized by dyspnea, chest tightness, nighttime coughing, and expiratory wheezing.
Symptom variability: Patients may experience mild intermittent symptoms or severe symptoms needing multiple medications.

Acute Severe Asthma

Can escalate to uncontrolled inflammation, airway edema, mucus accumulation, and severe bronchospasm.
Symptoms include severe dyspnea, inspiratory wheezing, cyanosis, and limited ability to speak.

Management of Asthma

Bronchodilators: Key medications used to treat asthma.

β-Adrenergic Agonists

Divided into three groups: non-selective, selective β2 agonists, and muscarinic receptor blockers.
Selective β2 agonists:
- Short-acting: Salbutamol, terbutaline, fenoterol (3-4 hours duration).
- Long-acting: Salmeterol, formoterol (12 hours duration).
Mechanism of action: Stimulating bronchial β2 receptors increases cAMP, leading to bronchodilation and reduced inflammation.
Administration: Short-acting for acute asthma via inhalation or IV; long-acting for chronic asthma orally or via inhalation.
Adverse effects: Tachycardia, arrhythmia, tremors, tolerance development, hypokalemia.

Muscarinic Antagonists

Ipratropium bromide: Blocks M3 receptors, leading to bronchodilation but is not the first choice in treating asthma.
More selective than atropine; does not cross the blood-brain barrier, reducing CNS side effects.
Often combined with β2 agonists for synergistic effect.

Methylxanthines

Classification: Include natural (caffeine, theophylline) and semi-synthetic forms (aminophylline).
Mechanism of action: Adenosine A receptor antagonists leading to bronchodilation and CNS stimulation.
Inhibit phosphodiesterase enzymes, increasing cAMP and affecting cardiac contractility.
Precautions: Slow IV administration to avoid complications; caution in patients with cardiac/renal diseases.

Drug Interactions

Enzyme inhibitors: Increase serum levels of methylxanthines, risking toxicity.
Enzyme inducers: Decrease levels and reduce effectiveness of methylxanthines.

Asthma Overview

Chronic asthma leads to hypertrophy of airway smooth muscle and increased mucus secretion, causing difficulty in expelling mucus.
Congestion and edema of the respiratory mucosa affect airflow and breathing.

Predisposing Factors

Recurrent respiratory infections: Major contributing factor to asthma development.
Genetic factors: Asthma has a familial component, commonly seen in individuals with a history of allergies.
Psychological factors: Present in about 40% of asthmatics, potentially influencing the severity of symptoms.

Clinical Presentation

Chronic asthma symptoms: Include dyspnea, chest tightness, cough (often at night), and expiratory wheezing.
Patients exhibit varying degrees of symptom severity, from mild to severe, requiring either little to no medication or multiple treatments.

Acute Severe Asthma

Uncontrolled asthma can escalate into an acute phase characterized by inflammation, airway edema, mucus accumulation, and severe bronchospasm resistant to bronchodilators.
Symptoms include severe dyspnea, inspiratory wheezing, cyanosis, and limited verbal communication due to breathlessness.

Management of Asthma

Treatment involves bronchodilators classified into three groups:
- β-adrenergic agonists
- Muscarinic receptor blockers (e.g., ipratropium)
- Xanthines (e.g., theophylline)

β-adrenergic Agonists

Classification:
- Non-selective (e.g., adrenaline, ephedrine) rarely used.
- Selective β2 agonists:
  - Short-acting: Salbutamol (3-4 hours), Terbutaline, Fenoterol.
  - Long-acting: Salmeterol, Formoterol (12 hours).
Mechanism: Stimulate bronchial β2 receptors, increasing cAMP, leading to bronchodilation and reduced bronchial inflammation.
Administration:
- Short-acting for acute asthma via inhalation or IV.
- Long-acting for chronic asthma orally or via inhalation.
Adverse Effects: Tachycardia, arrhythmias, tremors, tolerance, and hypokalemia due to potassium shifts.

Muscarinic Antagonists: Ipratropium Bromide

Blocks M3 receptors in airway smooth muscle for bronchodilation; however, not used solely for asthma treatment due to side effects (dry mouth, urine retention).
More selective and less central nervous system effects than atropine.

Methylxanthines

Classification:
- Natural (e.g., caffeine, theophylline) and semisynthetic (e.g., aminophylline).
Mechanism: Adenosine receptor antagonism leads to bronchodilation, CNS stimulation, decreased mediator release from mast cells, and increased AV conduction.
Therapeutic Uses:
- Severe asthma: Aminophylline IV infusion for acute attacks.
- Chronic asthma: Sustained-release theophylline tablets or rectal suppositories.

CNS and CVS Uses of Methylxanthines

CNS: Reverses depression, delays fatigue, treats migraines, and neonatal apnea.
CVS: Used in acute pulmonary edema due to heart failure.

Adverse Effects of Methylxanthines

CNS: Irritability, headaches, insomnia, nervousness, and convulsions.
CVS: Palpitations, tachycardia, and arrhythmias.

Bronchodilators

Adrenaline, isoprenaline, and ephedrine are rarely used as bronchodilators.
Selective β2 agonists are categorized into short-acting (e.g., salbutamol, terbutaline, fenoterol) with a duration of 3-4 hours and long-acting (e.g., salmeterol, formoterol) with a duration of 12 hours.

Mechanism of Action

Stimulation of bronchial β2 receptors increases cAMP levels, leading to bronchodilation.
β2 receptor stimulation in mast cells decreases histamine release.
Reduces bronchial inflammation and wall edema.

Administration

Short-acting β2 agonists are typically administered via inhalation or intravenous infusion for acute asthma.
Long-acting β2 agonists are given orally or by inhalation for chronic asthma.

Adverse Effects

Common side effects include tachycardia and arrhythmias due to reflex hypotension and direct activation of cardiac β1 receptors at high doses.
Tremors and nervousness can occur.
Tolerance may develop with prolonged use, necessitating a temporary cessation of the drug.
Hypokalemia results from potassium shift from blood to cells.

Muscarinic Antagonists

Ipratropium bromide is a non-selective M3 blocker which leads to bronchodilation.
Side effects include dry mouth, urine retention, increased sedation, and excessive dryness of bronchial secretions.
Ipratropium is preferred over atropine: it is a more selective muscarinic blocker, a quaternary ammonium compound unable to cross the blood-brain barrier, and does not excessively dry bronchial secretions.
Commonly combined with β2 agonists for a synergistic effect.

Methylxanthines

Classifications include natural (caffeine, theophylline, theobromine) and semi-synthetic (aminophylline, a salt of theophylline).
Mechanism involves antagonizing adenosine A receptors, leading to bronchodilation, CNS stimulation, reduced mediator release from mast cells, and increased AV conduction.
Inhibition of phosphodiesterase enzymes (PDE3 and PDE4) results in bronchodilation, increased cardiac contractility, smooth muscle relaxation, and diuresis.

Therapeutic Uses

Acute severe asthma: aminophylline can be administered via slow intravenous infusion (250 mg at least over 15 minutes) followed by maintenance infusion (0.7 mg/kg/h).
Chronic bronchial asthma: sustained-release theophylline tablets (100-300 mg/day) or rectal suppositories of aminophylline can be used.
CNS applications include reversing CNS depression, delaying fatigue (caffeine), and treating migraines (caffeine with ergotamine).
Neonatal apnea syndrome: caffeine is the preferred treatment.
CVS applications involve treating acute pulmonary edema due to left-sided heart failure.

Adverse Effects of Methylxanthines

CNS: irritability, headache, insomnia, nervousness, and convulsions.
CVS: palpitations, tachycardia, and arrhythmias; rapid IV injection can cause hypotension and syncope.
GIT: nausea, anorexia, increased acidity, and activation of peptic ulcers.

Precautions

Aminophylline should be administered slowly (at least over 15 minutes).
Caution is required in patients with severe cardiac disease, hypoxemia, renal and hepatic conditions, and in elderly or neonate populations.
Avoid use in patients with peptic ulcers.

Drug Interactions

Co-administration with enzyme inhibitors (e.g., cimetidine, erythromycin) may increase serum levels of methylxanthines, posing a risk for toxicity.
Enzyme inducers (e.g., smoking, rifampin) may decrease serum levels and effectiveness of these drugs.

Asthma Overview

Chronic asthma leads to hypertrophy of airway smooth muscle and increased mucus secretion, causing difficulty in expelling mucus.
Congestion and edema of the respiratory mucosa affect airflow and breathing.

Predisposing Factors

Recurrent respiratory infections: Major contributing factor to asthma development.
Genetic factors: Asthma has a familial component, commonly seen in individuals with a history of allergies.
Psychological factors: Present in about 40% of asthmatics, potentially influencing the severity of symptoms.

Clinical Presentation

Chronic asthma symptoms: Include dyspnea, chest tightness, cough (often at night), and expiratory wheezing.
Patients exhibit varying degrees of symptom severity, from mild to severe, requiring either little to no medication or multiple treatments.

Acute Severe Asthma

Uncontrolled asthma can escalate into an acute phase characterized by inflammation, airway edema, mucus accumulation, and severe bronchospasm resistant to bronchodilators.
Symptoms include severe dyspnea, inspiratory wheezing, cyanosis, and limited verbal communication due to breathlessness.

Management of Asthma

Treatment involves bronchodilators classified into three groups:
- β-adrenergic agonists
- Muscarinic receptor blockers (e.g., ipratropium)
- Xanthines (e.g., theophylline)

β-adrenergic Agonists

Classification:
- Non-selective (e.g., adrenaline, ephedrine) rarely used.
- Selective β2 agonists:
  - Short-acting: Salbutamol (3-4 hours), Terbutaline, Fenoterol.
  - Long-acting: Salmeterol, Formoterol (12 hours).
Mechanism: Stimulate bronchial β2 receptors, increasing cAMP, leading to bronchodilation and reduced bronchial inflammation.
Administration:
- Short-acting for acute asthma via inhalation or IV.
- Long-acting for chronic asthma orally or via inhalation.
Adverse Effects: Tachycardia, arrhythmias, tremors, tolerance, and hypokalemia due to potassium shifts.

Muscarinic Antagonists: Ipratropium Bromide

Blocks M3 receptors in airway smooth muscle for bronchodilation; however, not used solely for asthma treatment due to side effects (dry mouth, urine retention).
More selective and less central nervous system effects than atropine.

Methylxanthines

Classification:
- Natural (e.g., caffeine, theophylline) and semisynthetic (e.g., aminophylline).
Mechanism: Adenosine receptor antagonism leads to bronchodilation, CNS stimulation, decreased mediator release from mast cells, and increased AV conduction.
Therapeutic Uses:
- Severe asthma: Aminophylline IV infusion for acute attacks.
- Chronic asthma: Sustained-release theophylline tablets or rectal suppositories.

CNS and CVS Uses of Methylxanthines

CNS: Reverses depression, delays fatigue, treats migraines, and neonatal apnea.
CVS: Used in acute pulmonary edema due to heart failure.

Adverse Effects of Methylxanthines

CNS: Irritability, headaches, insomnia, nervousness, and convulsions.
CVS: Palpitations, tachycardia, and arrhythmias.

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This quiz covers the essential information about a common over-the-counter expectorant, guaifenesin, and contrasts it with other traditional expectorants found in various cough mixtures. Understand the mechanisms by which these expectorants work and their relevance in treating coughs effectively.