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Exam l 2 : l NU641/ l NU l 641 l (NEW l 2025/ l
2026 l Update) l Advanced l Clinical l
Pharmacology l Guide| l Questions l & l
Answers| l Grade l A| l 100% l Correct l
(Verified l Solutions)- l Regis
QUESTION
Leukotrienel modifiers Answer: Leukotrienel receptorl antagoinistsl (LTRAs)l andl 5 l lipoxygenasael pathwayl inhibitorsl developedl basedl onl thel theoryl thatl cysteinyll leukotrienesl playl al significantl rolel inl thel chronicl inflammationl associatedl withl asthmal andl allergy
l Thisl causesl airwayl ededmal smoothl musclel constriction,l andl cellularl changesl associatedl withl thel inflammatoryl process
Originallyl al lotl ofl excitementl whenl thesel camel tol thel marketl butl nowl actuallyl onlyl typicallyl usedl asl secondl line
Canl bel orall whichl mightl helpl withl compliance
QUESTION
Leukotrienel modifiersl PK Answer:
- leukotienel receptorl antagonistsl =l zafirlukast,l montelukast
- 5 l lipoxygenasel pathwayl inhibitors=l zileuton
- typicallyl welll absorbed,l 3 - 5 l hrl halfl lie
- extensivel hepaticl metabolism,l cautionl forl liverl disease
QUESTION
Leukotrienel modifersl precautions Answer:
- avoidl zileutonl inl severel liverl diease ***dol notl usel forl primaryl treatmentl ofl anl acutel asthmal attackl (longerl terml affects)
- chewablel montelukastl containsl phenylalanine-l don'tl takel ifl youl havel PKU
- cautionl ifl systemicl corticosteroidl dosel isl reducedl orl substitutedl canl leadl tol eosinophilia,l vascularl rash,l worseningl pulm,l cardiacl complicationsl andl neuropathy
- reportsl ofl neuropsychiatricl events Zileuton=l pregl c LTRASl generally=l pregl b Zafirlukastl goodl forl kidsl agel 5+,l Montelukastl >l 12 l m Leukotrinel modifiersl s/e
- zileutonl rare=l hepaticl injury Drugl interactions:l increasel theophyllinel levelsl sol mustl decreasel theophyllinel dose Canl increasel PTl withl Warfarin
QUESTION
LTRA'sl clinicall usel andl ptl education Answer:
- treatmentl ofl CHRONICl ASTHMA
- montelukast=l preventl ofl exercisel inducedl bronchoconstrictionl inl agel >15,l allergicl rhinitisl >6l months
- mustl bel takenl dailyl evenl ifl symptoml free-l notl forl acutel episodes,l mustl continuel bronchodilatorl inhaledl forl acutel episodesl ofl bronchospasm
QUESTION
Inhaledl corticosteroidsl (ICS) Answer:
- beclomethasone,l triamcinolone,l budesonidel (Pulmicort),l fluticasonel (Flovent)
- PD:l suppressesl airwayl inflammationl byl activatingl anti-inflaml genes,l switchingl offl inflammatoryl genel expressionl andl inhibitingl inflammatoryl cells
l reductionl inl thel severityl ofl asthmal symptoms,l increasedl peakl flowl readings,l andl decreasedl airwayl hyperl responsiveness
- inl general,l safel andl welll toleratedl forl childrenl andl adults
- corticosteroidsl canl alsol bel usedl intranasallyl forl allergicl rhinitis
QUESTION
- rinsel mouth,l usel peakl flowl monitor,l quitl smoking,l spacers,l mouthl rinse,l avoidl environementall triggers,l avoidl infectionsl whenl possible
QUESTION
Dryl vsl meteredl dose Answer: Dryl powderl inhaler=l onlyl appropriatel ifl thel patientl canl makel al forcefull andl deepl inhalation Meteredl dosel inhaler=l (andl tol al lesserl extentl softl mistl inhalers)l requirel coordinationl betweenl devicel triggeringl andl inhalationl andl patientl canl inhalel slowlyl andl deeplyl froml thel device-l ifl therel isl doubtl considerl addingl al spacer
QUESTION
reviewl inhalerl thingl inl moodle Answer:
QUESTION
Asthmal pathophysiology Answer:
- chronicl inflammationl disorderl ofl thel airways
- airwayl inflammationl presentl evenl betweenl flareupsl andl canl significantlyl alterl lungl function
- recurrentl episodesl ofl wheezing,l breathlessnessl andl chestl tightness
- airflowl obstructionl isl reversible LOOKl ATl GINAl GUIDELINES
QUESTION
Asthma-l howl tol determinel treatment?l Andl goals Answer:
- 4 l classesl ofl severity
l needl forl medicationl tol relievel symptomsl (howl muchl rescuel medication)
l nightimel symptoms
l lungl function
exacerbation Goals Improvel impairmentl (preventl chronicl symptoms,l reducel thel usel ofl inhaledl shortl actingl betal agonists,l maintainl normall orl nearl normall pulmonaryl function,l maintainl normall activityl levels,l meetl patient/l familyl expectationsl ofl asthmal care) Reducel riskl (preventl recurrentl exacerbationsl andl minimizel EDl visitsl andl hospitalizations,l preventl lossl ofl lungl function,l providel optimall therapyl withl minimall sidel effects)
QUESTION
Asthmal classification Answer:
- preferredl relieverl alll steps:l asl neededl lowl dosel ICS-formoteroll orl SABA Stepl 1=l intermiediate
- symptomsl lessl thanl twicel al week
- asymptomaticl betweenl exacerbations
- preferredl controller:
l asl neededl lowl dosel ICS-formoteroll (preferred)l orl lowl dosel ICSl takenl wheneverl SABAl isl taken
- patientsl havel symptosl whenl exposedl tol triggersl (URI,l allergens,l chemicals)
- exercisel inducedl canl bel mildl intermittent
- needl annuall ful shot Stepl 2:l mildl persistent Symptomsl >twicel al week,l <daily Exacerbationsl mayl effectl activity
- controller:l withl onel longl terml controll medicationl daily
lowl dosel ICSl (-formoterol)l orl lowl dosel ICSl arel thel mainstayl forl alll ages
leukotrienel modifier/theophyllinel arel alternatives
- usel betal agonistsl asl needed,l ifl usingl morel thanl 2 l daysl perl weekl thenl stepl upl therapy Stepl 3:l moderatel persistent Dailyl symptoms,l exacerbationsl affectl normall activities
- treatl withl mediuml dose-inhaledl corticosteroidsl orl lowl dosel inhaledl steroidsl plusl LABA
- alternative:l mediuml dosel inhaledl steroidl plusl leukotrienel receptorl modifierl orl theophylline
- mayl usel shortl actingl betal agonistl PRN
- exacerbationsl mayl requirel orall corticosteroids Stepl 4:l severel persistent Somel degreel ofl symptomsl alll thel time,l limitedl physicall activity
l ptsl atl riskl ofl asthmal attacksl include:l previousl severel exacerbationsl requiringl intubationl orl ICUl admission,l 2 l orl morel hospitalizationsl orl 3 l EDl visitsl inl thel pastl year,l usel ofl 2 l orel morel shortl actingl betal agonistl inhalersl inl thel pastl month,l worseningl asthma
QUESTION
Asthmal inl preg Answer:
- poorl controlledl asthmal canl leadl tol lowl birthl weight,l increasedl prenatall morbidityl andl prematurity *****-inhaledl betal agonistsl drugl ofl choicel duringl pregl (albuterol)l ,l inhaledl corticosteroidsl arel thel longl terml drugl ofl choicel (budesonidel hasl mostl data)
QUESTION
Pediatricl asthma Answer:
- l Nol LABAl lessl thanl 4 l yo Controller
- l Stepl 1:l lowl dosel ICSl takenl wheneverl SABAl taken,l orl dailyl lowl ICS
- l Stepl 2:l dailyl lowl dosel ICSl orl leukotrienel receptorl antagonistl (LTRA)l [preferredl options]l orl lowl dosel ICSl wheneverl SABAl taken
- l Stepl 3:l lowl dosel ICS-LABAl orl mediuml dosel ICDl [preferredl optionsl ]orl lowl dosel ICSl +l LTRA
- l Stepl 4:l mediuml dosel ICS-l LABAl (preferred)l orl highl dosel ICS-LABAl orl addl onl tirporiuml orl addl onl LTRA
- l Stepl 5:l specialist Reliver
- asl neededl shortl actingl betal agonists
QUESTION
Pedl asthmal considerations Answer:
- usel auerochamberl withl maskl forl infantsl andl youngl kids,l usel spacersl forl alll kids,l canl usel neb
- secondl inhalerl atl school
QUESTION
Asthmal inl olderl adults Answer:
- determinel ifl symptomsl arel reversiblel (asthma)l orl notl (COPD)
- meds:l increasedl sidel effects,l interactionsl (e.l g.l betal blockers)
QUESTION
Asthmal outcomes Answer:
- optimall outcomesl isl beingl ablel tol dol activitiesl ofl dailyl livingl withl minimall asthmal symptoms
- referl tol asthmal specialistl if:
difficultiesl achievingl orl maintingl control
l immunosuppressivel therapyl isl beingl considered
l anyl adultl thatl requiresl stepl 4 l therapyl orl al childl whol requiresl stepl 3 l therapy
QUESTION
Asthmal variants Answer: Seasonall allergies
- startl longl terml controll medsl >1l monthl beforel allergyl seasonl starts Coughl variantl asthmal (mainl sxl nonl productivel cough)
- triall bronchodilator,l samel stepwisel management Exercisel inducedl asthmal (EIA)
- commonl ofl mostl asthmatics Treatment=l shortl actingl betal agonistl 15 l minl beforel exercisel (2- 3 l hours),l salmeteroll lastsl 10 - 12 l hoursl (cannotl usel ifl usingl asl LTCl med?)
- maskl orl scarfl overl mouthl ifl coldl induced
- leukotrienel modifierl mayl helpl (10-15%l ofl people)
Patho:l conditionl ofl chronicl airflowl limitationl thatl isl notl fullyl reversible Includes:l chronicl bronchitis,l emphysemal (pinkl puffers),l asthmaticl bronchitisl (bluel bloaters) Diseasel progression:l respiratoryl musclel fatigue,l ventilatoryl disorders,l cardiovascularl compromisel andl poorl qualityl ofl life
QUESTION
COPDl clinicall indicators Answer:
- dyspneal thatl progressesl overl time,l worsel withl exercise,l andl persistent
- recurrentl wheeze
- chronicl cough:l mayl bel intremittentl andl unproductivel (especiallyl inl am)
- recurrentl URI Riskl factors:l smoking,l smokel froml cookingl andl heatingl fuels,l occupationall dustl vapors,l genetics,l lowl birthl weight,l prematurityl etc Diagnosisl madel withl spirometry
QUESTION
GOTl withl COPD Answer:
- reducel symptoms,l improvel exercisel tolerance,l improvel healthl status,l preventl diseasel progression,l preventl andl treatl exaserbations,l reducel mortality
QUESTION
GOLDl guidelines Answer:
- Groupl A:l lessl symptomatic,l lowl riskl ofl futurel exacerbations
mmrcl gradel 0 l orl 1 l [dyspneal scale=l SOBl withl strenuousl exercise,l SOBl walkingl upl hilll orl walkingl fast],l Catl scorel <
l LAMAl e.l gl tiotropium(Spiriva)l +l SABAl e.l g.l albuteroll (proair)
zerol tol onel exascerbationl perl yearl withoutl hospitalization
- Groupl B:l morel symptomatic,l lowl riskl ofl futurel exacerbations
mmrcl gradel >2l [l 2=l walkl slowerl thanl ppll bcl I'ml SOBl orl havel tol stopl becausel SOB,l 3=l Il havel tol stopl forl breathl afterl walingl 100 l metersl orl more,l 4=l Il aml tool SOBl tol leavel thel house,l dressingl makesl mel SOB]l orl CATl scorel >
zerol tol onel exacerbationl perl yearl withoutl hospitalization
LAMA+l LABA******l e.l g.l tiotropium+olodateroll (stiolto)l +l SABAl egl albuterol
- Groupl E:l highl riskl ofl futurel exacerbations
l >2l exacerationsl perl yearl orl >1l hospitalizationl forl exacerbations
l Groupl E:l - >LAMA+l LABA******l e.l g.l tiotropium+olodateroll (stiolto)l +l SABAl egl albuteroll [WHENl NOl HOSPITALIZATIONSl ORl EOSINOPHILSl >300]
l ICS+l LAMA+l LABAl E.l G.l Fluticasone-umeclidinium-vilanteroll (Trelegy)l +l SABA
QUESTION
LOOKl ATl MEDl LISTl EXAMPLES Answer:
QUESTION
COPDl exacerbationsl OPl management Answer:
- shortl actingl betal 1 l agonistl (albuterol)l withl orl withoutl shortl actingl muscarinicl antagonistl (ipratropium)
- systemicl corticosteroids:l smalll butl beneficiall effectl withl al reductionl ofl release
l predl 40mg/dayl forl 5 - 14 l days
- antibiotics
indicatedl forl outpatientsl whol havel moderatel tol severel COPDl exacerbationl (iel increasel inl >2l ofl 3 l cardinall symptoms:l dypsnea,l sputuml volume/l viscosityl orl sputuml purulence)
l nol riskl factorsl forl poorl outcomes:l macrolidel (azithromycin)l orl secondl orl thirdl genl cephealosporinl (cefdinirl orl cefpodoxime)
l riskl factorsl forl poorl outcomes:l amoxicillin/l clavulanatel orl respiratoryl fluoroquinolonel (levofloxacin,l moxiflocaxin)
l riskl factorsl forl poorl outcomel andl riskl forl pseudomonasl infection:l ciprofloxacin
- oxygen:l prescribedl whenl ptsl havel arteriall hypoxemia,l titratedl tol keepl SaO2l >90%
- monitoring:l spirometryl annuallyl orl morel frequentlyl ifl symptomsl worsen,l referl tol specialist:l moderatel orl severel COPD,l severel exacerbationsl orl rapidl progression,l agel <40,l weightl loss
QUESTION
5 l A'sl ofl quitting Answer: Ask:l forl everyl patientl atl everyl clinicl visit,l askl tobaccol usel statusl andl documentl it Advise:l stronglyl urgel alll tobaccol usersl tol quitl inl al clear,l strong,l personalizedl manner Assess:l determinel willingnessl andl rationalel ofl patient'sl desirel tol quit Assist:l providel aidl forl ptsl tol quit Arrange:l schedulel followl upl contact,l eitherl inl personl orl byl telephone
QUESTION
Smokingl cessationl treatment Answer:
- managedl byl combinationl ofl behaviorall andl pharmacologicl treatments
pharmacotherapyl isl startedl eitherl beforel orl onl thel quitl datel dependingl onl thel medl selected
- GOT:l completel discontinuationl ofl tobacco Agentl options: Vareniclinel (chantix):l nicotinel receptorl partiall agonist,l tobaccol freel byl 12 l weeks Nicotinel replacementl therapy:l graduall controlledl reductionl ofl nicotinel tol avoidl withdrawll symptoms Bupropion:l tobaccol freel byl 7 - 12 l weeks
QUESTION
Nicotinel receptorl partiall agonists Answer: Vareniclinel (chantix) PD:l partiall agonistl ofl nicotinicl acetylcholinel (naCh)l receptorsl (manyl many.l .l .l .l )l tol dimmishl nicotinel cravingsl andl withdrawll symptoms,l reducesl thel pharmacologicl rewardl ofl nicotinel inl casesl wherel al patientl relapsesl andl usesl tobacco,l alsol bindsl withl serotoninl receptors Precautions:l patientsl withl psychiatricl illness DDI:l alc ADR:l nausea,l insomnia,l abnormall dreamsl (vivid,l unsual,l strange),l headache,l skinl rash
Startl 1 - 2 l weeksl beforel quite,l upl tol 5 l weeksl before Advantages:l duall action-relievesl nicotinel withdrawll andl blocksl rewardl froml smoking,l orall pill Disadvantages:l reducedl dosel inl severel renall insufficiency,l avoidl inl ptsl withl unstablel psycl orl historyl ofl suicidall ideationl orl PTSD,l monitorl forl neuropsycl issues
QUESTION
Nicotinel replacementl therapy Answer: OTCl drugs Patch-nicotrol,l nicoderm,l habitrol
- 14mgl forl 10 l cigsl daily,l 21mgl forl 10+l cigs
- Dailyl patches,l rotatel applicationl site,l taperingl dosel notl required
- ADR:l skinl irriation,l insomnia,l vividl dreams
- Advantages:l steadyl nicl dose,l easiestl nicotinel productl tol use
- Disadvantages:l cannotl alterl nicl levell withl cravings,l isl removedl beforel bed,l takesl atl leastl 30 - 3 l ohursl afterl reapplicationl tol reachl effectivel levels Gum-l Nicorette
- 2mgl ifl firstl cigl isl >30l minl afterl waking,l 4mgl ifl <30l min
- Admin:l 1 l piecel perl hoursl asl needed,l nol morel thanl 1 l anl hour,l nol foodl orl drinkl withl use
- ADR:l mouthl irritation,l jawl soreness,l heartburn,l hiccuprs,l orl nausea
- Advantages:l userl controlsl nicl dose,l orall substitutel forl cigarettes
- Dis:l unpleasantl taste,l canl damagel dentall work,l difficultl forl denturel wearers,l 'chewl andl park' Lozenge-l commit
- 2mgl ifl firstl cig>l 30 l minl afterl waking,l 4mgl ifl <30l min
- Admin:l maxl 20 l lozengesl daily,l 1 l everyl 1 - 2 l hours
- ADR:l mouthl irritation,l hiccuprs,l heartburn,l nausea
- l Advantages:l userl controll doses,l orall subl forl cig,l betterl withl dentall work
- Dis:l unpleasantl taste Prescription Nasall spray-l Nicotroll NS
- 1 l sprayl tol eachl nostrill everyl 1 - 2 l hoursl asl needed,l maxl 10 l spraysl perl house,l 80 l perl day
- ADR:l nasall andl throatl irritation,l rhinitis,l sneezing,l coughl orl tearyl eyes
- advantages:l userl controlsl nic,l ***mostl rapidl deliveryl ofl nicotinel amongl nicotinel replacementl products
- disadvantages:l locall irritationl tol nasall mucosal isl difficultl forl manyl tol toleratel Inhaler-l Nicotrol
QUESTION
smokingl cessation:l monitoringl andl patientl education Answer: monitoring:l withdrawll symptoms-l cravings,l nervousness,l irritability,l impatientence,l hostility,l labilel mood,l difficutlyl concentrating,l restlesness,l anxiety patientl ed:l properl dosing,l removel patchl atl appropriatel times,l properl dosingl ofl guml andl inhaler
QUESTION
Vareniclinel (Chantix)l mayl bel prescribedl forl tobaccol cessation.l Instructionsl tol al patientl whol isl startingl vareniclinel include: A.l Thel maximuml timel vareniclinel canl bel usedl isl 12 l weeks B.l Nauseal isl al signl ofl vareniclinel toxicityl andl shouldl bel reportedl tol thel provider C.l Itl canl bel usedl safelyl withl alcohol D.l Neuropsychiatricl symptomsl mayl occur Answer: d
QUESTION
Transdermall nicotinel replacementl (thel patch)l isl anl effectivel choicel inl tobaccol cessationl because: A.l Thel patchl providesl al steadyl levell ofl nicotinel withoutl reinforcingl orall aspectsl ofl smoking.l B.l Therel isl thel abilityl tol "finel tune"l thel amountl ofl nicotinel thatl isl deliveredl tol thel patientl atl anyl onel time.l C.l Therel isl lessl ofl al probleml withl nicotinel toxicityl thanl withl otherl formsl ofl nicotinel replacement.l Transdermall nicotinel isl saferl inl pregnancy.l Answer: a
QUESTION
tuberculosis Answer:
- infectiousl diseasel causedl byl tl tuberculosis,l slowl growing
- TBl isl inhaledl intol thel alvelousl andl spreadsl froml lungs
- infectionl isl spreadl almostl exclusivelyl byl aerosolizationl ofl contaminedl lungl secretions
- resistancel isl al growingl problem l - aquiredl resisteancel tol TBl medicationsl stemsl froml inadequatel orl inappropriatel prescribedl treatmentl regimensl orl froml patientl noncompliance
- multil drugl resistancel isl becomingl al problem
QUESTION
TBl goalsl ofl treatment Answer:
- accuratel diagnosis:l screeningl vial PPDl orl antiferon-TBl serum,l CXRl ifl needed
- completionl ofl thel recommendedl therapy
- effectivel treatmentl tol treatl ptl andl preventl transmission
- Americanl Thoracicl Societyl goal:l reducel transmissionl overall,l erradicatel persisitingl bacilli,l preventl relapsel afterl completingl therapyl andl preventingl drugl resistance
QUESTION
TBl rationall drugl therapy Answer: riskl stratification highl risk:l childrenl <4l yo,l HIV/AIDs,l transplantl patients,l foreignl bornl patients drugl therapyl principles:l
- treatmentl regimenl mustl containl multiplel drugsl tol whichl thel organismsl arel suspectiple
- thel drugsl mustl bel takenl regularly
- drugl therapyl mustl continuel forl al sufficentl periodl ofl time twol phasesl ofl treatment
- initiationl phasel forl firstl 2 l months
- continuationl phasel lastsl 4 - 7 l months
whatl dol partsl ofl thel endocrinel systeml do? Answer: hypothalamus=l controll center thyroid=l metabolism parathyroid=l bloodl calcium adrenal=l steroids,l catacolamine gonad=l estrogen thyropropinl releasel hormone->l TSH GnRH->l FSH,l LH growthl hormonel releasingl hormone->l GHl (somatropin) prolactinl releasingl hormone->l prolactin pancrease exocrine:l trypsinogen,l chymotropysin,l amylase,l lipasel endocrine:l insulin,l glucagon adrenal:l cortisol,l aldosterone,l estrogens,l androgens
QUESTION
pancreaticl enzymes Answer: uses:l cysticl fibrosisl andl pancreatitisl (helpl withl digestion)l withl al goall ofl minimizingl steatorrheal andl keepl goodl nutritionall status,l bonel statesl havel obstrucionl ofl pancrease PD:l inactivatedl byl pHl valuesl <4,l dol notl crushl orl chewl (effectsl inl jejunum/l duodenum)l onlyl Viokasel notl entericl coatedl (mustl bel onl PPI)
- drugl mustl bel takenl immediatlyl beforel orl withl meall PK:l pancrelipasel madel froml pork,l cowl orl vegtablel source ADRs:l skinl irriationl onl contact,l rashesl GI:l stomatitis,l nausea highl doses:l hyperuricosuria,l hyperuricemial DOl NOTl NEEDl TOl GIVEl IFl NPO,l alsol itl isl importantl tol synchronizel withl gastricl emptingl takel withl orl beforel meal
QUESTION
panrealipsase Answer: agel andl weightl based eachl drugl isl specifiedl inl lipase,l protease,l andl amlyasel unites,l drugsl arel prescribedl inl unitsl ofl kgl basedl onl lipasel
admin:l don'tl chew,l crush,l drinkl withl water,l avoidl leavingl inl mouth,l entericl coatedl formulationl shouldl notl bel mixedl withl alkalinel foodsl priorl tol ingestion thisl populationl typicallyl toleratesl smallerl meals
QUESTION
Patientsl withl cysticl fibrosisl arel oftenl prescribedl enzymel replacementl forl pancreaticl secretions.l Eachl replacementl drugl hasl lipase,l protease,l andl amylasel components,l butl thel drugl isl prescribedl inl unitsl of: A.l Lipase B.l Protease C.l Amylase D.l Pancreatin Answer: a
QUESTION
Differentl brandsl ofl pancreaticl enzymel replacementl drugsl are: A.l Bioequivalent B.l Aboutl thel samel inl costl perl unitl ofl lipasel acrossl brands C.l Ablel tol bel interchangedl betweenl genericl andl brand-namel productsl tol reducel cost D.l Nonel ofl thel above Answer: b
QUESTION
insulinl clinicall pearls Answer:
- eachl 15gml CHOl servingl raisesl BGl ~l 50mg/dL
- 1 l unitl bolusl ofl insulinl lowersl glucosel 20 - 60 l mg/dL Typel Il DM
- initiall dosel ofl insulinl 0 .l 2 - 0 .l 6 l units/kg/dayl inl dividedl doses
- averagel maintenaincel insulinl dosesl arel 0 .l 4 - 1 .l 2U/kgl inl body/weight/l daily
- splitl basall insulinl needsl andl bolusl insulinl needsl evenlyl 50%l each
