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Chapter 20: Drugs Used in Asthma & Chronic Obstructive Pulmonary Disease

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One effect that theophylline, nitroglycerin, isoproterenol, and histamine have in common is

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(A) Direct stimulation of cardiac contractile force

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(B) Tachycardia

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(C) Bronchodilation

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(D) Postural hypotension

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(E) Throbbing headache

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Theophylline does not ordinarily cause headache or postural hypotension. Nitroglycerin does not cause direct cardiac stimulation but does evoke a compensatory sympathetic reflex. Histamine does not cause bronchodilation. The answer is B.

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A 23-year-old woman is using an albuterol inhaler for frequent acute episodes of asthma and complains of symptoms that she ascribes to the albuterol. Which of the following is not a recognized action of albuterol?

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(A) Diuretic effect

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(B) Positive inotropic effect

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(C) Skeletal muscle tremor

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(D) Smooth muscle relaxation

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(E) Tachycardia

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Albuterol is a β2-selective receptor agonist, but in moderate to high doses it produces β1 cardiac effects as well as β2-mediated smooth and skeletal muscle effects. It does not cause diuresis. The answer is A.

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A 10-year-old child has severe asthma and was hospitalized 5 times between the ages of 7 and 9. He is now receiving outpatient medications that have greatly reduced the frequency of severe attacks. Which of the following is most likely to have adverse effects when used daily over long periods for severe asthma?

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(A) Albuterol by aerosol

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(B) Beclomethasone by aerosol

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(C) Ipratropium by inhaler

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(D) Prednisone by mouth

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(E) Theophylline in long-acting oral form

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Chronic systemic corticosteroids have important toxicities (see Chapter 39). If oral corticosteroids must be used, alternate-day therapy is preferred because it interferes less with normal growth and metabolism in children. The answer is D.

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A 16-year-old patient is in the emergency department receiving nasal oxygen. She has a heart rate of 125 bpm, a respiratory rate of 40 breaths/min, and a peak expiratory flow <50% of the predicted value. Wheezing and rales are audible without a stethoscope.

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Which of the following drugs does not have a direct bronchodilator effect?

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(A) Epinephrine

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(B) Terbutaline

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(C) Prednisone

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