Fine involuntary shaking of the hands, called a tremor, is a common adverse effect of beta-2 agonist inhalers such as albuterol.
Missing Word
tremor
A tremor results from beta-2 stimulation of skeletal muscle. It is usually mild and often lessens as therapy continues.
Category: Beta-2 Agonists
Question 2
The short-acting beta-2 agonist made of only the active R-isomer of albuterol is levalbuterol.
Missing Word
levalbuterol
Levalbuterol contains only the active form of albuterol. It is used in the same way, to relieve and prevent bronchospasm.
Category: Beta-2 Agonists
Question 3
The short-acting inhaled anticholinergic that is often combined with albuterol to treat acute bronchospasm is ipratropium.
Missing Word
ipratropium
Ipratropium blocks acetylcholine at airway muscarinic receptors. Its bronchodilation adds to that of albuterol, and the two are often given together by inhaler or nebulizer.
Category: Anticholinergic Bronchodilators
Question 4
Tiotropium dry powder comes in a capsule that is placed and pierced in the inhaler device and must never be swallowed.
Missing Word
capsule
The powder in each tiotropium capsule is meant to be inhaled into the lungs. A swallowed capsule does not deliver the drug to the airways.
Category: Anticholinergic Bronchodilators
Question 5
The xanthine bronchodilator that is a salt of theophylline and can be given by IV infusion is aminophylline.
Missing Word
aminophylline
Aminophylline releases theophylline in the body. It shares theophylline's narrow safety margin and adverse effects.
Category: Xanthines
Question 6
Besides opening the airways, theophylline can strengthen contraction of the diaphragm, the main muscle of breathing.
Missing Word
diaphragm
The diaphragm is the dome-shaped muscle that drives inspiration. Better diaphragm contractility is one reason theophylline may help some patients with COPD.
Category: Xanthines
Question 7
The histamine-2 blocker that inhibits liver enzymes and can raise theophylline to toxic levels is cimetidine.
Missing Word
cimetidine
Cimetidine slows the hepatic breakdown of theophylline, so levels rise. Other histamine-2 blockers such as famotidine do not share this interaction to the same degree.
Category: Xanthines
Question 8
The leukotriene receptor antagonist that is taken on an empty stomach, because food lowers its absorption, is zafirlukast.
Missing Word
zafirlukast
Zafirlukast blocks leukotriene receptors, and taking it with a meal markedly reduces how much is absorbed, so doses are timed away from meals. It is also avoided in patients with hepatic impairment.
Category: Leukotriene Modifiers
Question 9
The leukotriene modifier that inhibits the 5-lipoxygenase enzyme rather than blocking leukotriene receptors is zileuton.
Missing Word
zileuton
Zileuton stops leukotrienes from being made, while the other leukotriene modifiers block their receptors. Zileuton can harm the liver, so liver enzymes are monitored.
Category: Leukotriene Modifiers
Question 10
The monoclonal antibody that binds immunoglobulin E and is used for moderate to severe allergic asthma is omalizumab.
Missing Word
omalizumab
Omalizumab lowers free immunoglobulin E so less of it can arm mast cells. It is an add-on maintenance drug with a boxed warning for anaphylaxis.
Category: Mast Cells and Biologics
Question 11
The inhaled corticosteroid that is paired with salmeterol in a combination dry powder inhaler is fluticasone.
Missing Word
fluticasone
Fluticasone combined with salmeterol gives a controller and a long-acting bronchodilator in one device. This pairing meets the rule that a long-acting beta-2 agonist is not used alone in asthma.
Category: Inhaled Corticosteroids
Question 12
The leukotriene receptor antagonist that is approved for seasonal allergic rhinitis as well as asthma is montelukast.
Missing Word
montelukast
Montelukast blocks leukotriene receptors and is approved for asthma, prevention of exercise-induced bronchoconstriction and seasonal allergic rhinitis. Because of its boxed warning for neuropsychiatric events, its use for allergic rhinitis is reserved for patients who cannot use or do not respond to other treatments.
Category: Leukotriene Modifiers
Question 13
The oral corticosteroid that the liver converts to its active form, prednisolone, and that is often given as a short course for asthma flares is prednisone.
Missing Word
prednisone
Prednisone is a prodrug activated in the liver. Short courses reduce severe airway inflammation during exacerbations.
Category: Inhaled Corticosteroids
Question 14
A device that turns liquid medication into a fine mist that the patient breathes through a mouthpiece or mask is a nebulizer.
Missing Word
nebulizer
A nebulizer delivers drug over several minutes of normal breathing. It is useful for young children and for patients too short of breath to use a handheld inhaler.
Category: Inhaler Technique
Question 15
Spraying test puffs into the air before using a new metered-dose inhaler for the first time is called priming.
Missing Word
priming
Priming makes sure the first puff the patient inhales contains a full dose. Inhalers are also primed again if they have not been used for a while, as the label directs.
Category: Inhaler Technique