Immunology Review Corner

Immunology Review Corner: Chapter 55 of the 6th edition of Middleton’s Allergy Principles and Practice, edited by N. Franklin Adkinson, et al.

Prepared by Dr. Thao N. Tran, Puget Sound Allergy, Asthma and Immunology, and Dr. Karla Lowe, Walter Reed Medical Center.

Chapter 55:  Antileukotriene Therapy in Asthma

1. Which of the following leukotrienes is a potent chemoattractant for both neutrophils and eosinophils?
a. LTB4
b. LTC4
c. LTD4
d. LTE4

2. Primarily which of the following cells produces LTC4?
a. Endothelial cells
b. Neutrophils
c. Airway smooth muscle
d. Mast cells

3. LTD4 and LTC4 have equal affinity for which of the following receptors?
a. BLT1
b. BLT2
c. CysLT1
d. CysLT2

4. Which of the following drugs has the highest binding affinity to the cysLT1 receptor in biologic receptor binding models?
a. Zafirlukast
b. Montelukast
c. Pranlukast
d. Zileuton

5. Zileuton is a:
a. Cysteinyl leukotriene receptor antagonist (cysLTRA)
b. Phospholipase A2 inhibitor
c. 5-Lipoxygenase inhibitor
d. LTC4 synthase inhibitor

6. Which of the following statements about the role of cysLTRAs is most correct?
a. CysLTRAs have been shown to inhibit bronchoconstriction associated with exercise.
b. Treatment with cysLTRAs in chronic asthma decreases blood eosinophils and significantly improves FEV1 (forced expiratory volume at 1 second).
c. Abrupt discontinuation of cysLTRAs results in rebound airway hyperreactivity.
d. The inhibition of aspirin-induced bronchoconstriction by cysLTRAs is independent of the dose of aspirin given.

7. Which of the following statements about intravenous (IV) montelukast is correct?
a. IV montelukast has a lower maximal bronchodilating effect than oral montelukast
b. IV montelukast and inhaled beta-agonist have equivocal but not additive effect on bronchodilation
c. IV montelukast has a more rapid onset of action (bronchodilation) than oral montelukast
d. The IV formulation of montelukast has the same clinical efficacy when administered intramuscularly

8. Liver function test monitoring during the first year of therapy is suggested for which of the following anti-LTs?
a. Zafirlukast
b. Montelukast
c. Pranlukast
d. Zileuton

9. Which of the following agents has the greatest potential for interaction with warfarin?
a. Zafirlukast
b. Montelukast
c. Pranlukast
d. Zileuton

10. Food interferes with the absorption of which of the following anti-LTs?
a. Zafirlukast
b. Montelukast
c. Pranlukast
d. Zileuton


Answers
1. a, page 943
2. d, page 944
3. d, page 944
4. b, page 945
5. c, page 945
6. a, pages 946-947
7. c, page 948
8. d, page 952
9. a, page 952
10. a, page 952