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Chapter 24: Pulmonary Pharmacology

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A 20-year-old woman has occasional asthma symptoms during the winter when she goes snowshoeing. The medication of choice to relieve her asthma symptoms is inhaled

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a. albuterol.

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b. salmeterol.

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c. tiotropium bromide.

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d. iloprost.

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e. budesonide.

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Answer is a. To relieve occasional asthma symptoms such as those induced by cold air and exercise, the medication of choice is a short-acting β2 agonist (eg, albuterol) delivered by inhalation.

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A 54-year-old man who had occupational exposure to asbestos has developed COPD and emphysema. The medication of choice to improve his breathing is inhaled

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a. albuterol.

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b. salmeterol.

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c. tiotropium bromide.

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d. iloprost.

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e. budesonide.

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Answer is c. In COPD, inhaled anticholinergic drugs such as tiotropium are the bronchodilators of choice in most patients. Clinical studies have shown that long-term use of tiotropium improves lung function and health status, and reduces exacerbations and all-cause mortality, although there is no effect on disease progression.

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An asthma patient with persistent asthma is prescribed a combination inhaler, budesonide/formoterol (SYMBICORT). The mechanisms of action of the 2 drugs in this formulation are

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a. a long-acting β2 adrenergic agonist and an anticholinergic.

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b. a corticosteroid and a phosphodiesterase inhibitor.

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c. an endothelin receptor antagonist and a prostacyclin receptor agonist.

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d. a long-acting β2 adrenergic agonist and a corticosteroid.

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e. a corticosteroid and an anticholinergic.

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Answer is d. Budesonide is an ICS that has beneficial anti-inflammatory effects in asthma, and formoterol is a LABA that has bronchodilator and bronchoprotective effects. These agents have both complementary and synergistic effects in patients with persistent asthma. The combination inhaler is more convenient for patients, simplifies therapy, and improves compliance with ICS because the patients perceive clinical benefit. In addition, delivering the 2 drugs in the same inhaler ensures they are delivered simultaneously to the same cells in the airways, allowing the beneficial molecular interactions between LABA and corticosteroids to occur.

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The mechanistic rationale for using sildenafil to treat PAH is that it

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a. increases cGMP synthesis in pulmonary artery smooth muscle.

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