CRE CRE Pharmacology & Medications 2 — Questions and Answers
Question 1: A valved holding chamber (spacer) used with an MDI primarily improves therapy by:
- Increasing the total medication dose delivered
- Improving drug deposition in the lower airways (Correct answer)
- Filtering out all large drug particles
- Reducing the frequency of dosing needed
Correct answer: Improving drug deposition in the lower airways
Spacers slow the aerosol cloud, reduce particle velocity, and decrease oropharyngeal deposition, improving lower airway drug delivery.
Question 2: Which inhaled medication requires the patient to rinse their mouth after each use to prevent oral candidiasis?
- Albuterol
- Ipratropium
- Fluticasone (inhaled corticosteroid) (Correct answer)
- Montelukast
Correct answer: Fluticasone (inhaled corticosteroid)
Inhaled corticosteroids deposited in the oropharynx suppress local immunity, promoting Candida overgrowth if the mouth is not rinsed.
Question 3: Long-acting beta-2 agonists (LABAs) carry an FDA black box warning against use as:
- Add-on therapy with an inhaled corticosteroid
- Monotherapy in asthma (Correct answer)
- Maintenance treatment in stable COPD
- Part of a fixed-dose combination inhaler
Correct answer: Monotherapy in asthma
LABA monotherapy in asthma is associated with increased risk of severe asthma-related death, requiring co-administration with an ICS.
Question 4: Which route of medication administration provides the most rapid systemic drug absorption?
- Oral
- Subcutaneous
- Intravenous (Correct answer)
- Intramuscular
Correct answer: Intravenous
Intravenous administration delivers medication directly into systemic circulation, bypassing all absorption barriers and providing the fastest onset.
Question 5: Mucolytics like N-acetylcysteine reduce mucus viscosity primarily by:
- Stimulating cough reflex intensity
- Breaking disulfide bonds in mucoproteins (Correct answer)
- Increasing mucociliary beat frequency
- Suppressing mucus-secreting goblet cells
Correct answer: Breaking disulfide bonds in mucoproteins
N-acetylcysteine cleaves disulfide bonds within mucus glycoproteins, reducing the viscosity and elasticity of airway secretions.
Question 6: Sildenafil is used in pulmonary arterial hypertension because it promotes pulmonary vasodilation by:
- Blocking beta-1 adrenergic receptors
- Inhibiting PDE-5 to increase cGMP levels (Correct answer)
- Activating alpha-2 adrenergic receptors
- Blocking calcium channels in smooth muscle
Correct answer: Inhibiting PDE-5 to increase cGMP levels
Sildenafil inhibits phosphodiesterase-5, preventing cGMP breakdown and sustaining nitric oxide–mediated pulmonary vasodilation.
CRE CRE Pharmacology & Medications 2
A valved holding chamber (spacer) used with an MDI primarily improves therapy by: