Immunology Review Corner

Prepared by Dr. Thao N. Tran, Stony Brook University Hospital- SUNY, and Dr. Karla Lowe, Walter Reed Medical Center.

Chapter 49:  Beta-Adrenergic Agonists

1. Terbutaline is a:
a. Short-acting non-selective beta-agonist
b. Complete agonist for the beta-adrenergic receptors
c. Short-acting selective beta-agonist that produces a similar degree of bronchodilation as albuterol
d. Long-acting beta-agonist

2. Which of the following statements about formoterol is correct?
a. When given orally, formoterol has prolonged bronchodilator action over 12 hours
b. After inhalation, formoterol onset of action is similar to that of albuterol
c. When given orally, formoterol is a non-selective beta2-agonist
d. Formoterol and salmeterol are both long-acting selective beta2-agonists with similar onset and duration of action

3. The following aerosolized beta-agonist is best described by the onset of 75% of maximum bronchodilation within 5 minutes, peak bronchodilation after 4 hours, and duration of bronchodilation greater than 12 hours?
a. Metaproterenol
b. Terbutaline
c. Salmeterol
d. Formoterol

4. Which of the following statements about the delivery of medication from a jet nebulizer is correct?
a. Jet nebulizer is a more efficient delivery system than the metered-dose inhaler (MDI)
b. The delivery rate of medication varies over a sevenfold range among commercially available nebulizers.
c. In a typical jet nebulizer, approximately 75% of a 2-ml volume leaves the nebulization chamber
d. More bronchodilation is produced from the same beta-agonist dose when delivered by a pressure-driven nebulizer than by a fluorocarbon-propelled MDI

5. With excellent MDI technique, how much of the dose can be deposited in the lungs?
a. 2-5%
b. 6-10%
c. 12-14%
d. 20-25%

6. In addition to relaxation of bronchial smooth muscle, other actions of beta2-adrenergic agonists include:
a. Increasing the microvascular permeability
b. Excitation of cholinergic neurotransmission
c. Preventing the translocation of the glucocorticoid receptor into the nucleus
d. Increasing mucociliary clearance

7. Which of the following is decreased on bronchoalveolar lavage (BAL) examination after 4-8 weeks of regular treatment with salmeterol?
a. Total number of cells
b. Activation markers on lymphocytes
c. Eosinophil cationic protein levels
d. Number of eosinophils

8. Which of the following is a side effect of beta2-adrenergic therapy?
a. Prolonged QTc interval
b. Stimulation of gastric acid secretion
c. Hypoglycemia
d. Hyperkalemia

9. Which of the following is correct about subsensitivity (or tolerance) to beta-agonist?
a. Subsensitivity has only been observed in the use of non-selective beta-agonists
b. Subsensitivity to beta-agonist has a greater affect on the duration of action than the peak affect of the drug
c. There is strong evidence that chronic use of long-acting beta-agonists will blunt the response to short-acting beta-agonists
d. With chronic administration, subsensitivity to formoterol develops much more rapidly and often than salmeterol

10. For beta-agonists, as a whole, increased use is associated with an increased risk of death. At what level of use does the risk of death begin to rise?
a. 0.4 canisters per month
b. 1.4 canisters per month
c. 2.4 canisters per month
d. 3.4 canisters per month

Answers:
1. c, page 804
2. b, page 805
3. d, page 806
4. b, page 806
5. c, page 807
6. d, page 808
7. c, page 808
8. a, page 809
9. b, page 810
10. b, page 813