NSG5003 ALREADY FINAL TEST 2026
QUESTIONS WITH CORRECT
ANSWERS GRADED A+
◍ ATP.
Answer: Functions as energy-transferring molecule
◍ Short Acting Beta 2 Agonists (SABA).
Answer: ExamplesAlbuterolLevalbuterolMechanism of ActionStimulate
β2-adrenergic receptors in bronchial smooth muscleIncrease cAMP, Cause
rapid bronchodilationAdverse
EffectsTremorTachycardiaPalpitationsHypokalemiaNervousnessDrug
InteractionsBeta blockers may reduce bronchodilationMAO inhibitors /
TCAs increase cardiovascular effectsContraindications / CautionsSevere
cardiac diseaseTachyarrhythmiasMonitoringSymptom reliefFrequency of
rescue inhaler useHeart ratePatient CounselingUsed for acute symptoms
onlyIf needed >2 days/week, asthma may be poorly controlledProper inhaler
technique is essential
◍ Short-Acting Muscarinic Antagonists (SAMA).
Answer: ExampleIpratropiumMechanismBlocks muscarinic
receptorsPrevents acetylcholine-mediated bronchoconstrictionAdverse
EffectsDry mouthBitter tasteBlurred vision (if aerosol contacts eyes)Drug
InteractionsAdditive effects with other
anticholinergicsContraindicationsHypersensitivity to atropine
derivativesMonitoringImprovement in airflowPatient CounselingOften used
with SABA in exacerbations
◍ Oxidative phosphorylation.
Answer: occurs in mitochondria; mechanism by which energy is produced
from carbs, fats, & proteins
,◍ Atrophy.
Answer: decrease in cellular size
◍ Hypertophy.
Answer: increase in cellular size by increased work demand or hormonal
situation
◍ Inhaled Corticosteroids (ICS).
Answer: ExamplesBudesonideFluticasoneBeclomethasoneMometasoneMechanismSu
airway inflammationReduce cytokines and inflammatory cellsICS are
considered the most effective controller therapy for asthma.Adverse
EffectsOral candidiasisDysphoniaThroat irritationHigh-dose systemic
effects:Adrenal suppressionOsteoporosisGrowth suppression (rare)Drug
InteractionsCYP3A4 inhibitors (ketoconazole, ritonavir) may increase
systemic steroid exposureContraindicationsUntreated systemic
infectionMonitoringSymptom controlExacerbation frequencyLung function
(FEV1)Patient CounselingRinse mouth after useUse daily even if
asymptomaticNot for acute attacks
◍ Long-Acting Beta-2 Agonists (LABA).
Answer: ExamplesSalmeterolFormoterolMechanismLong-acting
bronchodilation via β2 receptorsImportant LABAs must be used with
inhaled corticosteroids in asthma due to increased risk of severe
exacerbations if used alone.NEVER alone Adverse
EffectsTachycardiaTremorHeadacheDrug InteractionsBeta blockersMAO
inhibitorsContraindicationsLABA monotherapy in
asthmaMonitoringAsthma controlExacerbation frequencyPatient
CounselingDo not use aloneUsed for maintenance therapy (COPD)
◍ Hyperplasia.
Answer: increase cellular number by increased cellular division
◍ Dysplasia.
Answer: abnormal change in size, shape, & organization of mature tissue
cells
,◍ Metaplasia.
Answer: reversible replacement of one mature cell type by another less
mature cell type
◍ Cell Injury.
Answer: caused by hypoxia
◍ Leukotriene Receptor Antagonists (LTRA).
Answer: ExampleMontelukastMechanismBlock leukotriene receptors →
reduce bronchoconstriction and inflammationAdverse
EffectsHeadacheNeuropsychiatric effects (rare)Drug InteractionsFew
clinically significantContraindicationsHypersensitivityMonitoringSymptom
controlPatient CounselingTaken once dailyUseful in exercise-induced
asthma and allergic asthma
◍ Long-Acting Muscarinic Antagonists (LAMA).
Answer: Often considered 1st line bronchodilator in
COPDExampleTiotropiumUmeclidiniumGlycopyrrolateMechanismBlocks
M3 receptors → bronchodilationPrevent acetylcholine-mediated
bronchoconstrictionAdverse EffectsDry mouthUrinary retentionconstipation
ContraindicationsNarrow-angle glaucomaBPH (use
caution)MonitoringLung functionexacerbation frequencyPatient
CounselingUsed as add-on therapy in uncontrolled asthma for patients not
controlled with ICS/LABAUse once daily Report difficulty urinating
◍ Free Radicals.
Answer: can cause lipid peroxidation or destruction of unsaturated fatty
acids, alterations of proteins, & alterations in DNA
◍ Methylxanthines.
Answer: ExampleTheophyllineMechanismInhibits phosphodiesterase → ↑
cAMP → bronchodilationMay have mild anti-inflammatory effectsWhy it
fell out of favorNarrow therapeutic indexMany drug interactionsFrequent
adverse effectsAdverse EffectsNauseaVomitingArrhythmiasSeizuresDrug
InteractionsCiprofloxacinMacrolidesSmoking increases
, clearanceMonitoringSerum theophylline levels
◍ Theophylline current place in therapy.
Answer: Second- or third-line therapyRarely used for asthma or
COPDConsidered only when other therapies are unavailable or
ineffectiveWhy Theophylline Has Fallen Out of FavorNarrow Therapeutic
IndexSmall difference between therapeutic and toxic levelsSignificant
Adverse EffectsNausea and
vomitingTremorTachycardiaArrhythmiasSeizures (severe
toxicity)Numerous Drug-Drug InteractionsExamples:Macrolide
antibioticsFluoroquinolonesCimetidineMany CYP450
inhibitorsDrug-Disease InteractionsLiver diseaseHeart diseaseSeizure
disordersOther FactorsSmoking increases theophylline metabolism,
requiring dose adjustments
◍ Biologic Agents Asthma.
Answer: ExamplesOmalizumab
(anti-IgE)MepolizumabReslizumabBenralizumab (anti-IL-5)Dupilumab
(anti-IL-4 receptor)MechanismTarget IgE or eosinophilic pathwaysUsed for
severe asthma not controlled with standard therapy.Target specific
inflammatory pathways involved in severe asthmaAdverse EffectsInjection
site reactionsAnaphylaxis (rare)MonitoringAsthma exacerbationsEosinophil
levels
◍ Apoptosis.
Answer: cell death from programmed, selective self destruction
◍ Phosphodiesterase-4 Inhibitors.
Answer: xampleRoflumilastMechanismInhibits PDE-4Reduces
inflammatory mediator releasePlace in TherapySevere COPD with chronic
bronchitis and frequent exacerbationsAdverse EffectsWeight
lossNauseaInsomniaPsychiatric symptomsMonitoringWeightMood
changesPatient CounselingReport depression or weight loss
◍ Necrosis.
Answer: sum of changes after local cell death & includes inflammation &
QUESTIONS WITH CORRECT
ANSWERS GRADED A+
◍ ATP.
Answer: Functions as energy-transferring molecule
◍ Short Acting Beta 2 Agonists (SABA).
Answer: ExamplesAlbuterolLevalbuterolMechanism of ActionStimulate
β2-adrenergic receptors in bronchial smooth muscleIncrease cAMP, Cause
rapid bronchodilationAdverse
EffectsTremorTachycardiaPalpitationsHypokalemiaNervousnessDrug
InteractionsBeta blockers may reduce bronchodilationMAO inhibitors /
TCAs increase cardiovascular effectsContraindications / CautionsSevere
cardiac diseaseTachyarrhythmiasMonitoringSymptom reliefFrequency of
rescue inhaler useHeart ratePatient CounselingUsed for acute symptoms
onlyIf needed >2 days/week, asthma may be poorly controlledProper inhaler
technique is essential
◍ Short-Acting Muscarinic Antagonists (SAMA).
Answer: ExampleIpratropiumMechanismBlocks muscarinic
receptorsPrevents acetylcholine-mediated bronchoconstrictionAdverse
EffectsDry mouthBitter tasteBlurred vision (if aerosol contacts eyes)Drug
InteractionsAdditive effects with other
anticholinergicsContraindicationsHypersensitivity to atropine
derivativesMonitoringImprovement in airflowPatient CounselingOften used
with SABA in exacerbations
◍ Oxidative phosphorylation.
Answer: occurs in mitochondria; mechanism by which energy is produced
from carbs, fats, & proteins
,◍ Atrophy.
Answer: decrease in cellular size
◍ Hypertophy.
Answer: increase in cellular size by increased work demand or hormonal
situation
◍ Inhaled Corticosteroids (ICS).
Answer: ExamplesBudesonideFluticasoneBeclomethasoneMometasoneMechanismSu
airway inflammationReduce cytokines and inflammatory cellsICS are
considered the most effective controller therapy for asthma.Adverse
EffectsOral candidiasisDysphoniaThroat irritationHigh-dose systemic
effects:Adrenal suppressionOsteoporosisGrowth suppression (rare)Drug
InteractionsCYP3A4 inhibitors (ketoconazole, ritonavir) may increase
systemic steroid exposureContraindicationsUntreated systemic
infectionMonitoringSymptom controlExacerbation frequencyLung function
(FEV1)Patient CounselingRinse mouth after useUse daily even if
asymptomaticNot for acute attacks
◍ Long-Acting Beta-2 Agonists (LABA).
Answer: ExamplesSalmeterolFormoterolMechanismLong-acting
bronchodilation via β2 receptorsImportant LABAs must be used with
inhaled corticosteroids in asthma due to increased risk of severe
exacerbations if used alone.NEVER alone Adverse
EffectsTachycardiaTremorHeadacheDrug InteractionsBeta blockersMAO
inhibitorsContraindicationsLABA monotherapy in
asthmaMonitoringAsthma controlExacerbation frequencyPatient
CounselingDo not use aloneUsed for maintenance therapy (COPD)
◍ Hyperplasia.
Answer: increase cellular number by increased cellular division
◍ Dysplasia.
Answer: abnormal change in size, shape, & organization of mature tissue
cells
,◍ Metaplasia.
Answer: reversible replacement of one mature cell type by another less
mature cell type
◍ Cell Injury.
Answer: caused by hypoxia
◍ Leukotriene Receptor Antagonists (LTRA).
Answer: ExampleMontelukastMechanismBlock leukotriene receptors →
reduce bronchoconstriction and inflammationAdverse
EffectsHeadacheNeuropsychiatric effects (rare)Drug InteractionsFew
clinically significantContraindicationsHypersensitivityMonitoringSymptom
controlPatient CounselingTaken once dailyUseful in exercise-induced
asthma and allergic asthma
◍ Long-Acting Muscarinic Antagonists (LAMA).
Answer: Often considered 1st line bronchodilator in
COPDExampleTiotropiumUmeclidiniumGlycopyrrolateMechanismBlocks
M3 receptors → bronchodilationPrevent acetylcholine-mediated
bronchoconstrictionAdverse EffectsDry mouthUrinary retentionconstipation
ContraindicationsNarrow-angle glaucomaBPH (use
caution)MonitoringLung functionexacerbation frequencyPatient
CounselingUsed as add-on therapy in uncontrolled asthma for patients not
controlled with ICS/LABAUse once daily Report difficulty urinating
◍ Free Radicals.
Answer: can cause lipid peroxidation or destruction of unsaturated fatty
acids, alterations of proteins, & alterations in DNA
◍ Methylxanthines.
Answer: ExampleTheophyllineMechanismInhibits phosphodiesterase → ↑
cAMP → bronchodilationMay have mild anti-inflammatory effectsWhy it
fell out of favorNarrow therapeutic indexMany drug interactionsFrequent
adverse effectsAdverse EffectsNauseaVomitingArrhythmiasSeizuresDrug
InteractionsCiprofloxacinMacrolidesSmoking increases
, clearanceMonitoringSerum theophylline levels
◍ Theophylline current place in therapy.
Answer: Second- or third-line therapyRarely used for asthma or
COPDConsidered only when other therapies are unavailable or
ineffectiveWhy Theophylline Has Fallen Out of FavorNarrow Therapeutic
IndexSmall difference between therapeutic and toxic levelsSignificant
Adverse EffectsNausea and
vomitingTremorTachycardiaArrhythmiasSeizures (severe
toxicity)Numerous Drug-Drug InteractionsExamples:Macrolide
antibioticsFluoroquinolonesCimetidineMany CYP450
inhibitorsDrug-Disease InteractionsLiver diseaseHeart diseaseSeizure
disordersOther FactorsSmoking increases theophylline metabolism,
requiring dose adjustments
◍ Biologic Agents Asthma.
Answer: ExamplesOmalizumab
(anti-IgE)MepolizumabReslizumabBenralizumab (anti-IL-5)Dupilumab
(anti-IL-4 receptor)MechanismTarget IgE or eosinophilic pathwaysUsed for
severe asthma not controlled with standard therapy.Target specific
inflammatory pathways involved in severe asthmaAdverse EffectsInjection
site reactionsAnaphylaxis (rare)MonitoringAsthma exacerbationsEosinophil
levels
◍ Apoptosis.
Answer: cell death from programmed, selective self destruction
◍ Phosphodiesterase-4 Inhibitors.
Answer: xampleRoflumilastMechanismInhibits PDE-4Reduces
inflammatory mediator releasePlace in TherapySevere COPD with chronic
bronchitis and frequent exacerbationsAdverse EffectsWeight
lossNauseaInsomniaPsychiatric symptomsMonitoringWeightMood
changesPatient CounselingReport depression or weight loss
◍ Necrosis.
Answer: sum of changes after local cell death & includes inflammation &
