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

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

(A) Direct stimulation of cardiac contractile force

(B) Tachycardia

(C) Bronchodilation

(D) Postural hypotension

(E) Throbbing headache

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.

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?

(A) Diuretic effect

(B) Positive inotropic effect

(C) Skeletal muscle tremor

(D) Smooth muscle relaxation

(E) Tachycardia

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.

A 19-year-old college student has well-controlled asthma but on reporting to the college health clinic, complains of a sore throat. On examination, he has typical signs of thrush, a fungal infection with Candida albicans. The asthma controller medication most likely to be associated with Candida infection is:

(A) Albuterol by aerosol

(B) Beclomethasone by aerosol

(C) Ipratropium by inhaler

(D) Prednisone by mouth

(E) Theophylline in long-acting oral form

Chronic oral corticosteroids, eg, prednisone, have important toxicities (see Chapter 39). However, they are unlikely to cause oral fungal infection. In contrast, topical, inhaled steroids, eg, beclomethasone, are associated with this adverse effect because the inhalation route results in high concentrations in the oropharynx. The answer is B.

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.

Which of the following drugs can be used by nebulizer for a prompt direct bronchodilator effect in severe, acute asthma?

(A) Albuterol

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