Pharm Practice Exam 3

Furosemide is the strongest diuretic among the options given. It belongs to a class of drugs called loop diuretics, which work by blocking the reabsorption of sodium and chloride in the kidneys, leading to increased urine production. Furosemide is commonly used to treat conditions such as edema, congestive heart failure, and hypertension, where increased urine output is desired. It has a rapid onset of action and a potent diuretic effect compared to other diuretics like hydrochlorothiazide, spironolactone, and amiloride.

The patient in question 1 is described as having moderate persistent asthma. This stage of asthma is characterized by symptoms occurring daily, nighttime awakenings occurring more than once a week, and the need for short-acting bronchodilator use daily. The patient may also experience limitations in physical activity and lung function tests may show a FEV1 between 60-80% predicted.

Dysphonia is not an adverse effect of methylxanthine. Methylxanthine is a class of drugs that includes caffeine and theophylline, which are known for their stimulant effects on the central nervous system (CNS). These drugs can cause CNS stimulation, leading to increased alertness and wakefulness. They can also cause arrhythmias, or irregular heart rhythms, and convulsions in some cases. However, dysphonia, which refers to difficulty or discomfort in speaking, is not typically associated with the use of methylxanthines.

Propanolol is a non-selective beta blocker because it blocks both beta-1 and beta-2 adrenergic receptors. This means that it affects both the heart and the lungs. Atenolol, metoprolol, and acebutolol are all selective beta blockers, meaning they primarily target the beta-1 receptors in the heart.

The therapeutic range of methylxanthine is 5-15 mg/dL. This range is considered optimal for achieving the desired therapeutic effects of the medication while minimizing the risk of toxicity. Maintaining methylxanthine levels within this range ensures that the drug is effective in treating conditions such as asthma, chronic obstructive pulmonary disease (COPD), and apnea of prematurity, without causing adverse effects. Higher levels may lead to toxicity symptoms like nausea, vomiting, tremors, and seizures, while lower levels may result in inadequate therapeutic response. Therefore, monitoring and adjusting methylxanthine dosages to maintain levels within this range is crucial for optimal patient outcomes.

Infiltration with basophils is associated with asthma because basophils are a type of white blood cell that plays a role in allergic reactions. Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, often triggered by allergens. Basophils release histamine and other chemicals that contribute to the inflammation and constriction of the airways in asthma. Therefore, the presence of basophils in the infiltrate is indicative of the allergic response seen in asthma.

The correct answer is that patients should hold their breath as they count to ten slowly if possible. This is because holding the breath allows the medication to fully reach the lungs and be absorbed effectively. By holding the breath, the patient ensures that the medication has enough time to reach the desired area and have its intended effect. This technique is especially important for patients using an MDI (Metered Dose Inhaler) to ensure optimal delivery of the medication.

Anticholinergics are not included in the current guidelines for asthma. The current guidelines recommend the use of beta-2 agonists, corticosteroids, and leukotriene modifiers for the management of asthma. Anticholinergics, such as ipratropium bromide, are not considered as first-line treatment options for asthma. They may be used in certain cases, such as for acute exacerbations or in combination with other medications, but they are not included in the current guidelines as a standard treatment option for asthma.

Methylxanthines work by inhibiting phosphodiesterase, which prevents the breakdown of cAMP (cyclic adenosine monophosphate). By inhibiting phosphodiesterase, methylxanthines increase the levels of cAMP in smooth muscle cells, leading to smooth muscle relaxation. This relaxation effect helps to open up airways and improve breathing, making methylxanthines commonly used in the treatment of respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD).

The patient's symptoms indicate that his asthma is not well controlled, as they are awakening him multiple times a week. The appropriate treatment in this case would be to add a low dose ICS (inhaled corticosteroid) and a LABA (long-acting beta agonist) to his current SABA (short-acting beta agonist) PRN (as needed) regimen. This combination therapy will help to reduce inflammation and provide long-term control of his asthma symptoms. Considering omalizumab, a biologic medication, may be considered if the patient's symptoms remain uncontrolled even with the addition of low dose ICS and LABA.

If the patient's asthma is well controlled, nighttime awakenings should occur less than twice per week. This means that the patient should not be waking up more than two times per week due to asthma symptoms during the night. If the patient is experiencing nighttime awakenings more frequently, it suggests that their asthma is not well controlled.

Erythromycin is known to decrease the metabolism of theophylline. This is because erythromycin inhibits the activity of the enzyme responsible for metabolizing theophylline in the liver. As a result, theophylline levels in the body can increase, leading to potential adverse effects. Smoking, phenytoin, and oral contraceptives do not have a significant impact on the metabolism of theophylline.

Theophylline and salmeterol are both long-acting Beta-2 agonists, while albuterol and levalbuterol are short-acting Beta-2 agonists. Theophylline is a bronchodilator that works by relaxing the muscles in the airways, but it is not classified as a short-acting Beta-2 agonist. Salmeterol is also a long-acting Beta-2 agonist commonly used for the maintenance treatment of asthma and chronic obstructive pulmonary disease (COPD). Therefore, the correct answer is theophylline and salmeterol.