Over-the-Counter Expectants Overview
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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?

    <p>Formoterol</p> Signup and view all the answers

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

    <p>Reduced receptor availability</p> Signup and view all the answers

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

    <p>Acute asthma attacks</p> Signup and view all the answers

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

    <p>Chronic respiratory infections</p> Signup and view all the answers

    What is a characteristic symptom of chronic asthma?

    <p>Coughing particularly at night</p> Signup and view all the answers

    What is the primary action of guaifenesin as an expectorant?

    <p>Increases bronchial fluid secretion</p> Signup and view all the answers

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

    <p>Guaifenesin</p> Signup and view all the answers

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

    <p>Antihistamines</p> Signup and view all the answers

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

    <p>Wheezing that is fully responsive to bronchodilators</p> Signup and view all the answers

    What is the primary characteristic of bronchial asthma?

    <p>Chronic inflammatory disorder of the airways</p> Signup and view all the answers

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

    <p>Frequent exposure to allergic stimuli</p> Signup and view all the answers

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

    <p>Stress-induced bronchoconstriction</p> Signup and view all the answers

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

    <p>It is a consequence of chronic inflammation.</p> Signup and view all the answers

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

    <p>Interferon</p> Signup and view all the answers

    What is commonly noted about patients with severe asthma?

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

    What symptoms are most commonly associated with asthma?

    <p>Wheezing, breathlessness, chest tightness, and coughing</p> Signup and view all the answers

    Which of the following statements about asthma is incorrect?

    <p>Asthma is an acute disorder.</p> Signup and view all the answers

    Theophylline belongs to which category of asthma medications?

    <p>Xanthines</p> Signup and view all the answers

    What role do inflammatory cytokines play in asthma?

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

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

    <p>250 mg over 15 minutes</p> Signup and view all the answers

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

    <p>Immediate release tablets of 500 mg</p> Signup and view all the answers

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

    <p>Caffeine is the agent of choice</p> Signup and view all the answers

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

    <p>Irritability</p> Signup and view all the answers

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

    <p>To enhance absorption of ergotamine</p> Signup and view all the answers

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

    <p>Palpitations</p> Signup and view all the answers

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

    <p>It helps alleviate respiratory distress</p> Signup and view all the answers

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

    <p>Convulsions</p> Signup and view all the answers

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

    <p>Cardiac arrest</p> Signup and view all the answers

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

    <p>Patients with severe cardiac disease</p> Signup and view all the answers

    Which drug interaction can lead to increased toxicity of methylxanthines?

    <p>Enzyme inhibitors</p> Signup and view all the answers

    In which situation is the administration of Aminophylline contraindicated?

    <p>Peptic ulcer</p> Signup and view all the answers

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

    <p>Anorexia</p> Signup and view all the answers

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

    <p>15 minutes</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

    Increased mucus secretion in asthma is easy to expel.

    <p>False</p> Signup and view all the answers

    Patients with chronic asthma typically experience symptoms only during daytime.

    <p>False</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

    Bronchodilator therapy is ineffective during an acute asthma attack.

    <p>False</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

    Xanthines are classified as muscarinic receptor blockers in asthma management.

    <p>False</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

    Atropium is effective when used alone for bronchial dilation.

    <p>False</p> Signup and view all the answers

    Xanthines inhibit adenosine A receptors leading to CNS stimulation.

    <p>True</p> Signup and view all the answers

    Methylxanthines are exclusively classified as synthetic compounds.

    <p>False</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

    Aminophylline can be safely administered to patients with peptic ulcers.

    <p>False</p> Signup and view all the answers

    Theophylline decreases mediator release from mast cells.

    <p>True</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

    Phosphodiesterase enzyme inhibition by xanthines leads to decreased cAMP levels.

    <p>False</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

    Aminophylline is a salt of caffeine.

    <p>False</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

    Xanthines enhance cardiac contractility through the action of PDE3.

    <p>True</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

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

    <p>True</p> 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.

    <p>False</p> Signup and view all the answers

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

    <p>True</p> Signup and view all the answers

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

    <p>False</p> Signup and view all the answers

    How might chronic asthma affect the airflow in patients?

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

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

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

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

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

    Describe how stimulation of bronchial β2 receptors leads to bronchodilatation.

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

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

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

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

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

    What potential psychological impact does asthma have on patients?

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

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

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

    How does the management of asthma utilize bronchodilators?

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

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

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

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

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

    How does airway edema contribute to asthma symptoms?

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

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

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

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

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

    What is the role of xanthines in reducing bronchoconstriction?

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

    Describe how xanthines affect the central nervous system.

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

    What synergistic effect results from combining ipratropium with β2 agonists?

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

    What impact do xanthines have on mast cell mediator release?

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

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

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

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

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

    What types of xanthines are classified as natural and semisynthetic?

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

    What cardiovascular effects are associated with the use of xanthines?

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

    Explain why ipratropium is preferred over atropine for bronchodilation.

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

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

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

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

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

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

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

    What is the primary mechanism through which atropine induces bronchodilation?

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

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

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

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

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

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

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

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

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

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

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

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

    <p>Neonatal apnea syndrome.</p> Signup and view all the answers

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

    <p>Irritability, headache, insomnia, nervousness, and convulsions.</p> Signup and view all the answers

    How does caffeine assist in the treatment of migraine?

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

    What cardiovascular side effects may occur with aminophylline use?

    <p>Palpitations, tachycardia, and arrhythmias.</p> Signup and view all the answers

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

    <p>It can cause syncope or cardiac arrest.</p> Signup and view all the answers

    What potential consequence arises from the prolonged use of aminophylline?

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

    Ipra atropium is not sufficient alone for ______.

    <p>bronchodilation</p> Signup and view all the answers

    Xanthines are adenosine A receptor ______ leading to bronchodiilatation.

    <p>antagonists</p> Signup and view all the answers

    Caffeine is an example of a ______ xanthine.

    <p>natural</p> Signup and view all the answers

    Aminophylline must be given by slow ______.

    <p>i.v.</p> Signup and view all the answers

    Xanthines lead to increased AV ______.

    <p>conduction</p> Signup and view all the answers

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

    <p>cardiac arrest</p> Signup and view all the answers

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

    <p>cAMP</p> Signup and view all the answers

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

    <p>methylxanthines</p> Signup and view all the answers

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

    <p>CNS</p> Signup and view all the answers

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

    <p>cardiac</p> Signup and view all the answers

    Methylxanthines such as aminophylline are considered ______.

    <p>semisynthetic</p> Signup and view all the answers

    Gastrointestinal toxicity due to Aminophylline can include ______.

    <p>nausea</p> Signup and view all the answers

    Xanthines can block the bronchoconstrictor effect of ______.

    <p>adenosine</p> Signup and view all the answers

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

    <p>3-4</p> Signup and view all the answers

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

    <p>12</p> Signup and view all the answers

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

    <p>peptic</p> Signup and view all the answers

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

    <p>cAMP</p> Signup and view all the answers

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

    <p>inhalation</p> Signup and view all the answers

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

    <p>arrhythmia</p> Signup and view all the answers

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

    <p>potassium</p> Signup and view all the answers

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

    <p>unopposed β2</p> Signup and view all the answers

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

    <p>muscarinic</p> Signup and view all the answers

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

    <p>urine</p> Signup and view all the answers

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

    <p>sedation</p> Signup and view all the answers

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

    <p>expel</p> Signup and view all the answers

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

    <p>BBB</p> Signup and view all the answers

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

    <p>dryness</p> Signup and view all the answers

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

    <p>secretions</p> 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.

    <p>syncope</p> Signup and view all the answers

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

    <p>asthma</p> Signup and view all the answers

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

    <p>neonatal</p> Signup and view all the answers

    Caffeine is known to reverse CNS ______.

    <p>depression</p> Signup and view all the answers

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

    <p>vasoconstriction</p> Signup and view all the answers

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

    <p>insomnia</p> Signup and view all the answers

    Acute pulmonary edema is due to acute left sided ______.

    <p>heart failure</p> Signup and view all the answers

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

    <p>bronchodilation</p> Signup and view all the answers

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

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

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

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

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

    <p>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</p> Signup and view all the answers

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

    <p>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</p> Signup and view all the answers

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

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

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

    <p>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</p> Signup and view all the answers

    Match the following xanthines with their classification:

    <p>Caffeine = Natural Theophylline = Natural Aminophylline = Semisynthetic Theobromine = Natural</p> Signup and view all the answers

    Match the following effects of xanthines with their mechanism:

    <p>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</p> Signup and view all the answers

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

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

    Match the following roles of adenosine antagonists with their effects:

    <p>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</p> Signup and view all the answers

    Match the following xanthines with their specific examples:

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

    Match the following pharmacological actions with their descriptions:

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

    Match the following compounds with their typical pharmacological effects:

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

    Match the following therapeutic uses with their corresponding xanthine:

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

    Match the following asthma symptoms with their descriptions:

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

    Match the following types of asthma with their characteristics:

    <p>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</p> Signup and view all the answers

    Match the following groups of bronchodilator drugs with their classifications:

    <p>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</p> Signup and view all the answers

    Match the following predisposing factors with their categories:

    <p>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</p> Signup and view all the answers

    Match the following asthma management strategies with their descriptions:

    <p>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</p> Signup and view all the answers

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

    <p>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</p> Signup and view all the answers

    Match the following bronchial muscle responses to their effects:

    <p>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</p> Signup and view all the answers

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

    <p>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</p> Signup and view all the answers

    Match the following therapeutic uses with their respective substances:

    <p>Aminophylline = Acute pulmonary edema Caffeine = Neonatal apnea syndrome</p> Signup and view all the answers

    Match the following adverse effects with their corresponding systems:

    <p>CNS = Headache and nervousness CVS = Arrhythmias</p> Signup and view all the answers

    Match the following administration routes with their dosage forms:

    <p>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</p> Signup and view all the answers

    Match the following conditions with their main effects:

    <p>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</p> Signup and view all the answers

    Match the following CNS uses with their potential outcomes:

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

    Match the following intravenous administration precautions with their specific conditions:

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

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

    <p>Aminophylline = Headache Caffeine = Tachycardia</p> Signup and view all the answers

    Match the following therapeutic roles with their associated outcomes:

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

    Match the following drugs with their characteristics:

    <p>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</p> Signup and view all the answers

    Match the following adverse effects with their corresponding drug:

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

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

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

    Match the following statements to the correct drug:

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

    Match the following characteristics to their drug usages:

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

    Match the following side effects with their classifications:

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

    Match the following properties to the right drug:

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

    Match the following impacts to their corresponding action:

    <p>Ipratropium = Potentially fewer overall complications Atropine = Increases side effects including dryness Both drugs = Affect airway smooth muscle</p> 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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    Description

    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.

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