NSG 533
EXAM 3
Advanced Pharmacology
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 3 Comprehensive Study Guide
,Table of Contents
NSG 533 Exam 3 ................................................................................ 2
NSG 533 Exam 3 ............................................................................. 26
NSG 533 Exam 3 Focused Study Guide .............................. 49
NSG 533 Exam 3
Question 1
A 28-year-old patient with moderate persistent asthma is prescribed an inhaled
corticosteroid (ICS). Which of the following best describes the mechanism of action
of ICS?
A) Stimulate beta-2 adrenergic receptors causing bronchodilation
B) Inhibit acetylcholine on muscarinic receptors to prevent bronchoconstriction
C) Potent anti-inflammatory agents that decrease airway inflammation, attenuate airway
hyper-responsiveness, and minimize mucus production
D) Block leukotriene receptors to reduce bronchoconstriction
Correct Answer: C
Rationale: Inhaled corticosteroids (ICS) such as fluticasone, budesonide, beclomethasone,
and ciclesonide are the most potent anti-inflammatory agents for asthma. They work by
decreasing airway inflammation, attenuating airway hyper-responsiveness, and minimizing
mucus production and secretions. They also improve the actions of beta-agonists and target
the lungs directly. Option A describes LABA mechanism, Option B describes LAMA
mechanism, and Option D describes LTRA mechanism.
Question 2
Which of the following are examples of inhaled corticosteroids? (Select All That Apply)
,A) Fluticasone
B) Salmeterol
C) Budesonide
D) Tiotropium
E) Beclomethasone
F) Ciclesonide
Correct Answers: A, C, E, F
Rationale: Fluticasone, budesonide, beclomethasone, and ciclesonide are all inhaled
corticosteroids. Salmeterol (Option B) is a long-acting beta agonist (LABA), and tiotropium
(Option D) is a long-acting muscarinic antagonist (LAMA). It is critical to distinguish
between drug classes for safe prescribing.
Question 3
A patient with asthma not adequately controlled on an inhaled corticosteroid alone
is prescribed a long-acting beta agonist (LABA) as add-on therapy. What is the
primary mechanism of action of LABA?
A) Inhibit 5-lipoxygenase to reduce leukotriene production
B) Stimulate beta-2 adrenergic receptors in the lungs, resulting in relaxation of bronchial
smooth muscle (bronchodilation)
C) Block muscarinic receptors to prevent cholinergic bronchoconstriction
D) Stabilize mast cell membranes to prevent degranulation
Correct Answer: B
Rationale: Long-acting beta agonists (LABA) such as salmeterol and vilanterol work by
stimulating beta-2 adrenergic receptors in the lungs, resulting in relaxation of bronchial
smooth muscle (bronchodilation). Benefits include improved pulmonary function, more
symptom-free days, and decreased need for short-acting beta agonists (SABA). LABA
should NEVER be used as monotherapy for asthma—must always be combined with
ICS. Option A describes LTRA, Option C describes LAMA, and Option D describes
cromolyn/mast cell stabilizers.
Question 4
Which of the following are benefits of adding a long-acting beta agonist (LABA) to
inhaled corticosteroid therapy in asthma? (Select All That Apply)
,A) Improved pulmonary function
B) More symptom-free days
C) Decreased need for short-acting beta agonists (SABA)
D) Reduced airway inflammation independent of ICS
E) Replacement for inhaled corticosteroids
Correct Answers: A, B, C
Rationale: LABA add-on therapy to ICS provides improved pulmonary function, more
symptom-free days, and decreased need for SABA rescue inhalers. However, LABA does
NOT reduce airway inflammation independently (Option D)—that is the role of ICS. Most
importantly, LABA should NEVER replace ICS (Option E) due to safety concerns; LABA
monotherapy increases risk of asthma-related death.
Question 5
A patient with COPD is started on tiotropium. Which mechanism of action correctly
describes this medication?
A) Stimulates beta-2 receptors to increase cAMP and cause bronchodilation
B) Inhibits effects of acetylcholine on muscarinic receptors, protecting against cholinergic-
mediated bronchoconstriction
C) Blocks leukotriene D4 receptors to reduce inflammation
D) Inhibits phosphodiesterase to increase cAMP levels
Correct Answer: B
Rationale: Tiotropium is a long-acting muscarinic antagonist (LAMA). It inhibits the effects
of acetylcholine on muscarinic receptors, protecting against cholinergic-mediated
bronchoconstriction. This is particularly useful in COPD where cholinergic tone is
increased. Option A describes beta-agonists, Option C describes LTRA (montelukast), and
Option D describes phosphodiesterase inhibitors like roflumilast.
Question 6
A patient newly started on tiotropium reports dry mouth and difficulty urinating. The nurse
practitioner should recognize these as:
A) Signs of an allergic reaction requiring immediate discontinuation
B) Expected antimuscarinic side effects that may improve with continued use
C) Indications that the dose is too high
D) Symptoms unrelated to the medication
,Correct Answer: B
Rationale: Tiotropium and other LAMAs may cause dry mouth, urinary retention, and
headache due to their antimuscarinic (anticholinergic) properties. These are expected side
effects. Dry mouth is the most common and often improves over time. Urinary retention
requires monitoring, especially in patients with benign prostatic hyperplasia (BPH). These
are not typically reasons for immediate discontinuation unless severe.
Question 7
Which of the following statements about leukotriene receptor antagonists (LTRA) is
CORRECT?
A) They are bronchodilators that work by stimulating beta-2 receptors
B) They are anti-inflammatories that inhibit 5-lipoxygenase or antagonize leukotriene D4
effects
C) They block muscarinic receptors to prevent bronchoconstriction
D) They are the most potent anti-inflammatory agents for asthma
Correct Answer: B
Rationale: Leukotriene receptor antagonists (LTRA) such as montelukast are anti-
inflammatories that either inhibit 5-lipoxygenase or completely antagonize the effect of
leukotriene D4. They improve forced expiratory volume (FEV), decrease symptoms, SABA
use, and exacerbations. However, they can cause neuropsychiatric events (suicidal
ideation, depression, agitation), which requires patient counseling and monitoring. Option
A describes LABA, Option C describes LAMA, and Option D describes ICS.
Question 8
A parent reports that their 10-year-old child on montelukast has become
increasingly irritable and anxious. What is the most appropriate action?
A) Reassure the parent that these are normal childhood behaviors
B) Discontinue montelukast immediately and consider alternative asthma therapy
C) Increase the dose of montelukast
D) Add a benzodiazepine for anxiety
Correct Answer: B
Rationale: Montelukast and other LTRAs carry an FDA black box warning for
neuropsychiatric events including suicidal ideation, depression, agitation, irritability, and
,anxiety. Any reported neuropsychiatric symptoms warrant discontinuation of the
medication and consideration of alternative asthma therapy (typically ICS or ICS/LABA).
This is a patient safety priority.
Question 9
A patient experiencing an acute asthma exacerbation presents to the emergency
department. Which medication class is the FIRST-LINE treatment for reversing acute
airway obstruction?
A) Inhaled corticosteroids
B) Long-acting beta agonists
C) Short-acting beta agonists (SABA)
D) Leukotriene receptor antagonists
Correct Answer: C
Rationale: Short-acting beta agonists (SABA) such as albuterol and levalbuterol are first-
line for acute asthma exacerbations. They reverse acute airway inflammation and
bronchoconstriction, increase mucociliary clearance, and stabilize mast cell membranes.
Side effects include tremors, tachycardia, and hypokalemia. ICS (Option A) are for
maintenance, LABA (Option B) are for chronic control, and LTRA (Option D) are for
maintenance/prevention.
Question 10
A patient using albuterol reports hand tremors and a racing heart. The nurse practitioner
should explain that these are:
A) Signs of an overdose requiring emergency treatment
B) Common beta-2 agonist side effects due to stimulation of beta receptors
C) Indications to switch to a different class of medication
D) Symptoms that will worsen over time and require discontinuation
Correct Answer: B
Rationale: Tremors, tachycardia, and hypokalemia are common side effects of SABA
therapy due to beta-2 adrenergic receptor stimulation. These effects are typically dose-
related and transient. Patients should be counseled that tremors and palpitations are
expected but should be monitored. Frequent SABA use (>2 days/week) indicates poor
asthma control and warrants step-up therapy, not just side effect management.
,Question 11
Which of the following statements about inhaled corticosteroids (ICS) is TRUE
regarding their role in asthma management?
A) ICS are used only for acute asthma exacerbations
B) ICS are the most potent anti-inflammatory agents and improve the actions of beta-
agonists
C) ICS can replace beta-agonists in all asthma patients
D) ICS are less effective than leukotriene receptor antagonists for inflammation
Correct Answer: B
Rationale: ICS are the most potent anti-inflammatory agents for asthma. They decrease
airway inflammation, attenuate airway hyper-responsiveness, minimize mucus production
and secretions, and improve the actions of beta-agonists while targeting the lungs directly.
They are maintenance medications, NOT for acute rescue (Option A). They do NOT replace
beta-agonists (Option C)—both are needed for different purposes. ICS are MORE effective
than LTRA (Option D) for inflammation.
Question 12
Which of the following are risk factors that may precipitate an asthma attack? (Select
All That Apply)
A) Uncontrolled asthma symptoms
B) Frequent use of SABA
C) Inadequate ICS therapy
D) FEV1 >80% predicted
E) Psychological or financial problems
F) Smoking or allergy exposure
G) Obesity
H) History of intubation
I) One or more exacerbations in the past year
Correct Answers: A, B, C, E, F, G, H, I
Rationale: Risk factors for asthma exacerbation include: uncontrolled asthma symptoms,
frequent SABA use, inadequate ICS therapy, low FEV1 (<60% predicted)—NOT >80%
(Option D is incorrect), psychological/financial problems, smoking or allergy exposure,
,obesity, allergen exposure, pregnancy, history of intubation, and one or more exacerbations
in the past year. Low FEV1 indicates poor control and higher risk.
Question 13
A patient with asthma has been well-controlled on a maintenance regimen for 2
months with no symptoms. The patient asks about reducing their medication. What
is the most appropriate response?
A) Step down therapy can be initiated now since the patient feels well
B) Step down therapy should not be considered until at least 3 months of controlled
symptoms
C) Medications should never be reduced once asthma is controlled
D) All medications can be stopped immediately
Correct Answer: B
Rationale: Step-down therapy for asthma can be initiated once a patient is controlled on a
maintenance regimen for 3 months with no symptoms. This 3-month period ensures
sustained control before reducing therapy. Step-down too early risks loss of control.
However, maintaining high-dose therapy indefinitely (Option C) is not appropriate and
increases side effect risk. Never stop all medications abruptly (Option D).
Question 14
A patient with asthma and hypertension requires a beta-blocker for cardiac
protection. Which beta-blocker would be the SAFEST choice?
A) Propranolol
B) Nadolol
C) Atenolol
D) Timolol
Correct Answer: C
Rationale: Cardioselective beta-1 blockers such as atenolol and metoprolol are NOT
absolute contraindications in asthma. Non-selective beta-blockers (propranolol, nadolol,
timolol) block both beta-1 and beta-2 receptors and can cause bronchoconstriction and are
contraindicated in asthma. Beta-1 selective agents have less effect on bronchial beta-2
receptors but still require caution and monitoring in asthmatic patients.
, Question 15
Which of the following best describes the mechanism of action of beta-agonists?
A) Inhibit phosphodiesterase to increase cGMP
B) Stimulate adenylyl cyclase to increase formation of cyclic adenosine monophosphate
(cAMP), causing smooth muscle relaxation
C) Block muscarinic receptors to prevent acetylcholine binding
D) Inhibit the release of inflammatory mediators from mast cells
Correct Answer: B
Rationale: Beta-agonists cause smooth muscle relaxation by stimulating adenylyl cyclase to
increase formation of cyclic adenosine monophosphate (cAMP). Increased cAMP leads to
bronchial smooth muscle relaxation (bronchodilation). This is the fundamental mechanism
for both SABA and LABA. Option A describes phosphodiesterase inhibitors, Option C
describes anticholinergics, and Option D describes mast cell stabilizers.
Question 16
A patient who smokes heavily is prescribed theophylline for asthma. How will
smoking likely affect theophylline dosing requirements?
A) Smoking will decrease theophylline metabolism, requiring lower doses
B) Smoking will increase theophylline metabolism, requiring higher doses
C) Smoking has no effect on theophylline metabolism
D) Smoking will increase theophylline toxicity risk
Correct Answer: B
Rationale: Chemicals in tobacco smoke induce hepatic cytochrome P450 enzymes
(particularly CYP1A2), which increases theophylline metabolism and clearance. Therefore,
smokers typically require higher theophylline doses to achieve therapeutic levels. When a
patient quits smoking, theophylline levels may rise, and dose reduction may be necessary to
prevent toxicity. Theophylline has a narrow therapeutic index, so monitoring is essential.
Question 17
A patient started on lisinopril for hypertension reports a dry, hacking cough. What is
the most appropriate recommendation?
A) Discontinue lisinopril and switch to an angiotensin receptor blocker (ARB)
B) Add an antitussive medication
EXAM 3
Advanced Pharmacology
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 3 Comprehensive Study Guide
,Table of Contents
NSG 533 Exam 3 ................................................................................ 2
NSG 533 Exam 3 ............................................................................. 26
NSG 533 Exam 3 Focused Study Guide .............................. 49
NSG 533 Exam 3
Question 1
A 28-year-old patient with moderate persistent asthma is prescribed an inhaled
corticosteroid (ICS). Which of the following best describes the mechanism of action
of ICS?
A) Stimulate beta-2 adrenergic receptors causing bronchodilation
B) Inhibit acetylcholine on muscarinic receptors to prevent bronchoconstriction
C) Potent anti-inflammatory agents that decrease airway inflammation, attenuate airway
hyper-responsiveness, and minimize mucus production
D) Block leukotriene receptors to reduce bronchoconstriction
Correct Answer: C
Rationale: Inhaled corticosteroids (ICS) such as fluticasone, budesonide, beclomethasone,
and ciclesonide are the most potent anti-inflammatory agents for asthma. They work by
decreasing airway inflammation, attenuating airway hyper-responsiveness, and minimizing
mucus production and secretions. They also improve the actions of beta-agonists and target
the lungs directly. Option A describes LABA mechanism, Option B describes LAMA
mechanism, and Option D describes LTRA mechanism.
Question 2
Which of the following are examples of inhaled corticosteroids? (Select All That Apply)
,A) Fluticasone
B) Salmeterol
C) Budesonide
D) Tiotropium
E) Beclomethasone
F) Ciclesonide
Correct Answers: A, C, E, F
Rationale: Fluticasone, budesonide, beclomethasone, and ciclesonide are all inhaled
corticosteroids. Salmeterol (Option B) is a long-acting beta agonist (LABA), and tiotropium
(Option D) is a long-acting muscarinic antagonist (LAMA). It is critical to distinguish
between drug classes for safe prescribing.
Question 3
A patient with asthma not adequately controlled on an inhaled corticosteroid alone
is prescribed a long-acting beta agonist (LABA) as add-on therapy. What is the
primary mechanism of action of LABA?
A) Inhibit 5-lipoxygenase to reduce leukotriene production
B) Stimulate beta-2 adrenergic receptors in the lungs, resulting in relaxation of bronchial
smooth muscle (bronchodilation)
C) Block muscarinic receptors to prevent cholinergic bronchoconstriction
D) Stabilize mast cell membranes to prevent degranulation
Correct Answer: B
Rationale: Long-acting beta agonists (LABA) such as salmeterol and vilanterol work by
stimulating beta-2 adrenergic receptors in the lungs, resulting in relaxation of bronchial
smooth muscle (bronchodilation). Benefits include improved pulmonary function, more
symptom-free days, and decreased need for short-acting beta agonists (SABA). LABA
should NEVER be used as monotherapy for asthma—must always be combined with
ICS. Option A describes LTRA, Option C describes LAMA, and Option D describes
cromolyn/mast cell stabilizers.
Question 4
Which of the following are benefits of adding a long-acting beta agonist (LABA) to
inhaled corticosteroid therapy in asthma? (Select All That Apply)
,A) Improved pulmonary function
B) More symptom-free days
C) Decreased need for short-acting beta agonists (SABA)
D) Reduced airway inflammation independent of ICS
E) Replacement for inhaled corticosteroids
Correct Answers: A, B, C
Rationale: LABA add-on therapy to ICS provides improved pulmonary function, more
symptom-free days, and decreased need for SABA rescue inhalers. However, LABA does
NOT reduce airway inflammation independently (Option D)—that is the role of ICS. Most
importantly, LABA should NEVER replace ICS (Option E) due to safety concerns; LABA
monotherapy increases risk of asthma-related death.
Question 5
A patient with COPD is started on tiotropium. Which mechanism of action correctly
describes this medication?
A) Stimulates beta-2 receptors to increase cAMP and cause bronchodilation
B) Inhibits effects of acetylcholine on muscarinic receptors, protecting against cholinergic-
mediated bronchoconstriction
C) Blocks leukotriene D4 receptors to reduce inflammation
D) Inhibits phosphodiesterase to increase cAMP levels
Correct Answer: B
Rationale: Tiotropium is a long-acting muscarinic antagonist (LAMA). It inhibits the effects
of acetylcholine on muscarinic receptors, protecting against cholinergic-mediated
bronchoconstriction. This is particularly useful in COPD where cholinergic tone is
increased. Option A describes beta-agonists, Option C describes LTRA (montelukast), and
Option D describes phosphodiesterase inhibitors like roflumilast.
Question 6
A patient newly started on tiotropium reports dry mouth and difficulty urinating. The nurse
practitioner should recognize these as:
A) Signs of an allergic reaction requiring immediate discontinuation
B) Expected antimuscarinic side effects that may improve with continued use
C) Indications that the dose is too high
D) Symptoms unrelated to the medication
,Correct Answer: B
Rationale: Tiotropium and other LAMAs may cause dry mouth, urinary retention, and
headache due to their antimuscarinic (anticholinergic) properties. These are expected side
effects. Dry mouth is the most common and often improves over time. Urinary retention
requires monitoring, especially in patients with benign prostatic hyperplasia (BPH). These
are not typically reasons for immediate discontinuation unless severe.
Question 7
Which of the following statements about leukotriene receptor antagonists (LTRA) is
CORRECT?
A) They are bronchodilators that work by stimulating beta-2 receptors
B) They are anti-inflammatories that inhibit 5-lipoxygenase or antagonize leukotriene D4
effects
C) They block muscarinic receptors to prevent bronchoconstriction
D) They are the most potent anti-inflammatory agents for asthma
Correct Answer: B
Rationale: Leukotriene receptor antagonists (LTRA) such as montelukast are anti-
inflammatories that either inhibit 5-lipoxygenase or completely antagonize the effect of
leukotriene D4. They improve forced expiratory volume (FEV), decrease symptoms, SABA
use, and exacerbations. However, they can cause neuropsychiatric events (suicidal
ideation, depression, agitation), which requires patient counseling and monitoring. Option
A describes LABA, Option C describes LAMA, and Option D describes ICS.
Question 8
A parent reports that their 10-year-old child on montelukast has become
increasingly irritable and anxious. What is the most appropriate action?
A) Reassure the parent that these are normal childhood behaviors
B) Discontinue montelukast immediately and consider alternative asthma therapy
C) Increase the dose of montelukast
D) Add a benzodiazepine for anxiety
Correct Answer: B
Rationale: Montelukast and other LTRAs carry an FDA black box warning for
neuropsychiatric events including suicidal ideation, depression, agitation, irritability, and
,anxiety. Any reported neuropsychiatric symptoms warrant discontinuation of the
medication and consideration of alternative asthma therapy (typically ICS or ICS/LABA).
This is a patient safety priority.
Question 9
A patient experiencing an acute asthma exacerbation presents to the emergency
department. Which medication class is the FIRST-LINE treatment for reversing acute
airway obstruction?
A) Inhaled corticosteroids
B) Long-acting beta agonists
C) Short-acting beta agonists (SABA)
D) Leukotriene receptor antagonists
Correct Answer: C
Rationale: Short-acting beta agonists (SABA) such as albuterol and levalbuterol are first-
line for acute asthma exacerbations. They reverse acute airway inflammation and
bronchoconstriction, increase mucociliary clearance, and stabilize mast cell membranes.
Side effects include tremors, tachycardia, and hypokalemia. ICS (Option A) are for
maintenance, LABA (Option B) are for chronic control, and LTRA (Option D) are for
maintenance/prevention.
Question 10
A patient using albuterol reports hand tremors and a racing heart. The nurse practitioner
should explain that these are:
A) Signs of an overdose requiring emergency treatment
B) Common beta-2 agonist side effects due to stimulation of beta receptors
C) Indications to switch to a different class of medication
D) Symptoms that will worsen over time and require discontinuation
Correct Answer: B
Rationale: Tremors, tachycardia, and hypokalemia are common side effects of SABA
therapy due to beta-2 adrenergic receptor stimulation. These effects are typically dose-
related and transient. Patients should be counseled that tremors and palpitations are
expected but should be monitored. Frequent SABA use (>2 days/week) indicates poor
asthma control and warrants step-up therapy, not just side effect management.
,Question 11
Which of the following statements about inhaled corticosteroids (ICS) is TRUE
regarding their role in asthma management?
A) ICS are used only for acute asthma exacerbations
B) ICS are the most potent anti-inflammatory agents and improve the actions of beta-
agonists
C) ICS can replace beta-agonists in all asthma patients
D) ICS are less effective than leukotriene receptor antagonists for inflammation
Correct Answer: B
Rationale: ICS are the most potent anti-inflammatory agents for asthma. They decrease
airway inflammation, attenuate airway hyper-responsiveness, minimize mucus production
and secretions, and improve the actions of beta-agonists while targeting the lungs directly.
They are maintenance medications, NOT for acute rescue (Option A). They do NOT replace
beta-agonists (Option C)—both are needed for different purposes. ICS are MORE effective
than LTRA (Option D) for inflammation.
Question 12
Which of the following are risk factors that may precipitate an asthma attack? (Select
All That Apply)
A) Uncontrolled asthma symptoms
B) Frequent use of SABA
C) Inadequate ICS therapy
D) FEV1 >80% predicted
E) Psychological or financial problems
F) Smoking or allergy exposure
G) Obesity
H) History of intubation
I) One or more exacerbations in the past year
Correct Answers: A, B, C, E, F, G, H, I
Rationale: Risk factors for asthma exacerbation include: uncontrolled asthma symptoms,
frequent SABA use, inadequate ICS therapy, low FEV1 (<60% predicted)—NOT >80%
(Option D is incorrect), psychological/financial problems, smoking or allergy exposure,
,obesity, allergen exposure, pregnancy, history of intubation, and one or more exacerbations
in the past year. Low FEV1 indicates poor control and higher risk.
Question 13
A patient with asthma has been well-controlled on a maintenance regimen for 2
months with no symptoms. The patient asks about reducing their medication. What
is the most appropriate response?
A) Step down therapy can be initiated now since the patient feels well
B) Step down therapy should not be considered until at least 3 months of controlled
symptoms
C) Medications should never be reduced once asthma is controlled
D) All medications can be stopped immediately
Correct Answer: B
Rationale: Step-down therapy for asthma can be initiated once a patient is controlled on a
maintenance regimen for 3 months with no symptoms. This 3-month period ensures
sustained control before reducing therapy. Step-down too early risks loss of control.
However, maintaining high-dose therapy indefinitely (Option C) is not appropriate and
increases side effect risk. Never stop all medications abruptly (Option D).
Question 14
A patient with asthma and hypertension requires a beta-blocker for cardiac
protection. Which beta-blocker would be the SAFEST choice?
A) Propranolol
B) Nadolol
C) Atenolol
D) Timolol
Correct Answer: C
Rationale: Cardioselective beta-1 blockers such as atenolol and metoprolol are NOT
absolute contraindications in asthma. Non-selective beta-blockers (propranolol, nadolol,
timolol) block both beta-1 and beta-2 receptors and can cause bronchoconstriction and are
contraindicated in asthma. Beta-1 selective agents have less effect on bronchial beta-2
receptors but still require caution and monitoring in asthmatic patients.
, Question 15
Which of the following best describes the mechanism of action of beta-agonists?
A) Inhibit phosphodiesterase to increase cGMP
B) Stimulate adenylyl cyclase to increase formation of cyclic adenosine monophosphate
(cAMP), causing smooth muscle relaxation
C) Block muscarinic receptors to prevent acetylcholine binding
D) Inhibit the release of inflammatory mediators from mast cells
Correct Answer: B
Rationale: Beta-agonists cause smooth muscle relaxation by stimulating adenylyl cyclase to
increase formation of cyclic adenosine monophosphate (cAMP). Increased cAMP leads to
bronchial smooth muscle relaxation (bronchodilation). This is the fundamental mechanism
for both SABA and LABA. Option A describes phosphodiesterase inhibitors, Option C
describes anticholinergics, and Option D describes mast cell stabilizers.
Question 16
A patient who smokes heavily is prescribed theophylline for asthma. How will
smoking likely affect theophylline dosing requirements?
A) Smoking will decrease theophylline metabolism, requiring lower doses
B) Smoking will increase theophylline metabolism, requiring higher doses
C) Smoking has no effect on theophylline metabolism
D) Smoking will increase theophylline toxicity risk
Correct Answer: B
Rationale: Chemicals in tobacco smoke induce hepatic cytochrome P450 enzymes
(particularly CYP1A2), which increases theophylline metabolism and clearance. Therefore,
smokers typically require higher theophylline doses to achieve therapeutic levels. When a
patient quits smoking, theophylline levels may rise, and dose reduction may be necessary to
prevent toxicity. Theophylline has a narrow therapeutic index, so monitoring is essential.
Question 17
A patient started on lisinopril for hypertension reports a dry, hacking cough. What is
the most appropriate recommendation?
A) Discontinue lisinopril and switch to an angiotensin receptor blocker (ARB)
B) Add an antitussive medication
