Asthma: pathogenesis and antiasthmatic therapy MCQs With Answer

Asthma: pathogenesis and antiasthmatic therapy MCQs With Answer

This collection of MCQs is designed specifically for M.Pharm students studying Pharmacotherapeutics I (MPP 102T). It focuses on the pathophysiology of asthma — including immune mechanisms, mediator pathways, and airway remodeling — and on pharmacological interventions from short-acting bronchodilators to advanced biologics. Questions emphasize drug mechanisms, therapeutic indications, adverse effects, pharmacokinetics and clinical decision-making for both acute and chronic management. Use these items to test understanding of molecular targets (β2‑adrenergic receptors, leukotriene pathways, IL‑5/IL‑4 axes), rational drug combinations, and safety considerations such as steroid resistance, CYP interactions, and device selection for inhaled therapies.

Q1. Which of the following best describes the primary intracellular signaling change produced by β2‑adrenergic agonists in airway smooth muscle?

• Increase in intracellular calcium via Gq activation
• Activation of adenylate cyclase and increased cAMP via Gs protein
• Inhibition of guanylate cyclase and decreased cGMP
• Direct opening of potassium channels independent of G proteins

Correct Answer: Activation of adenylate cyclase and increased cAMP via Gs protein

Q2. Airway remodeling in chronic asthma is most directly associated with which mediator produced by structural and inflammatory cells?

• Interferon-gamma (IFN-γ)
• Tumor necrosis factor‑alpha (TNF-α)
• Transforming growth factor‑beta (TGF-β)
• Interleukin‑2 (IL‑2)

Correct Answer: Transforming growth factor‑beta (TGF-β)

Q3. Which pharmacologic class targets leukotriene D4 receptors and is effective for aspirin‑exacerbated respiratory disease and exercise‑induced bronchospasm?

• 5‑lipoxygenase inhibitors (e.g., zileuton)
• Leukotriene receptor antagonists (e.g., montelukast)
• Cyclooxygenase‑2 inhibitors (e.g., celecoxib)
• Phosphodiesterase‑3 inhibitors (e.g., milrinone)

Correct Answer: Leukotriene receptor antagonists (e.g., montelukast)

Q4. Omalizumab exerts its therapeutic effect in allergic asthma by which mechanism?

• Blocking IL‑5 signaling to reduce eosinophils
• Binding circulating IgE and preventing IgE binding to FcεRI on mast cells
• Antagonizing leukotriene receptors on bronchial smooth muscle
• Directly stimulating β2 receptors on airway smooth muscle

Correct Answer: Binding circulating IgE and preventing IgE binding to FcεRI on mast cells

Q5. Which adverse effect is most characteristic of high‑dose inhaled corticosteroid therapy?

• Oropharyngeal candidiasis and dysphonia
• Severe hypokalemia
• Tachycardia due to β1 stimulation
• Renal tubular acidosis

Correct Answer: Oropharyngeal candidiasis and dysphonia

Q6. Theophylline’s bronchodilator action is primarily due to which combination of mechanisms?

• PDE inhibition increasing cAMP and adenosine receptor antagonism
• Direct muscarinic receptor blockade and nitric oxide donation
• Selective β2 receptor agonism and mast cell stabilization
• Inhibition of 5‑lipoxygenase and leukotriene synthesis

Correct Answer: PDE inhibition increasing cAMP and adenosine receptor antagonism

Q7. Which biologic is specifically indicated for severe eosinophilic asthma by targeting the IL‑5 pathway?

• Dupilumab (anti‑IL‑4Rα)
• Omalizumab (anti‑IgE)
• Mepolizumab (anti‑IL‑5)
• Rituximab (anti‑CD20)

Correct Answer: Mepolizumab (anti‑IL‑5)

Q8. A long‑acting muscarinic antagonist used as add‑on maintenance therapy in asthma is:

• Ipratropium bromide
• Tiotropium
• Glycopyrrolate inhaler
• Neostigmine inhalant

Correct Answer: Tiotropium

Q9. Which statement about inhaled long‑acting β2 agonists (LABAs) in asthma management is correct?

• LABA monotherapy is recommended for mild intermittent asthma
• LABAs should always be used together with inhaled corticosteroids for asthma control
• LABAs directly reduce airway inflammation independent of steroids
• LABAs are contraindicated in all patients with cardiovascular disease

Correct Answer: LABAs should always be used together with inhaled corticosteroids for asthma control

Q10. Which biomarker is most useful to assess type-2 airway inflammation and predict response to inhaled corticosteroids?

• Sputum neutrophil percentage
• Exhaled nitric oxide (FeNO)
• Serum C‑reactive protein (CRP)
• Arterial blood lactate

Correct Answer: Exhaled nitric oxide (FeNO)

Q11. Zileuton differs from montelukast in that zileuton:

• Is a cysteinyl leukotriene receptor antagonist
• Inhibits 5‑lipoxygenase and can cause hepatotoxicity
• Acts as a monoclonal antibody against IL‑13
• Directly blocks histamine H1 receptors

Correct Answer: Inhibits 5‑lipoxygenase and can cause hepatotoxicity

Q12. Which pharmacokinetic interaction is important when prescribing theophylline?

• Concurrent rifampicin increases theophylline levels
• Cimetidine decreases theophylline half‑life
• Macrolide antibiotics can raise theophylline plasma concentration by CYP inhibition
• Inducers of CYP1A2 such as ciprofloxacin increase theophylline levels

Correct Answer: Macrolide antibiotics can raise theophylline plasma concentration by CYP inhibition

Q13. Steroid resistance in some asthma patients is most commonly associated with which cellular/molecular mechanism?

• Overexpression of β2 receptors
• Reduced histone deacetylase-2 (HDAC2) activity leading to impaired glucocorticoid transrepression
• Increased expression of glucocorticoid receptor alpha isoform enhancing steroid action
• Excessive leukotriene receptor blockade

Correct Answer: Reduced histone deacetylase-2 (HDAC2) activity leading to impaired glucocorticoid transrepression

Q14. Which inhaler type requires a high inspiratory flow from the patient to achieve optimal drug deposition?

• Metered‑dose inhaler (MDI) without spacer
• Soft mist inhaler
• Dry powder inhaler (DPI)
• Jet nebulizer

Correct Answer: Dry powder inhaler (DPI)

Q15. Dupilumab improves control in some severe asthma patients by blocking which receptor component?

• IL‑5 receptor alpha (IL‑5Rα)
• IL‑4 receptor alpha (IL‑4Rα) thereby inhibiting IL‑4 and IL‑13 signaling
• IgE Fc region on basophils
• TNF receptor 1

Correct Answer: IL‑4 receptor alpha (IL‑4Rα) thereby inhibiting IL‑4 and IL‑13 signaling

Q16. Which clinical feature differentiates an acute severe (status) asthmatic exacerbation requiring immediate nebulized short‑acting bronchodilator therapy?

• Mild wheeze with normal peak expiratory flow (>80% predicted)
• Progressive dyspnea at rest with peak expiratory flow <50% predicted
• Chronic productive cough without dyspnea
• Normal oxygen saturation and no tachypnea

Correct Answer: Progressive dyspnea at rest with peak expiratory flow <50% predicted

Q17. Which effect is a major benefit of inhaled corticosteroids on the airway at the molecular level?

• Direct enzyme inhibition of 5‑lipoxygenase
• Transrepression of NF‑κB and AP‑1 leading to reduced proinflammatory cytokine production
• Activation of adenylyl cyclase to increase cAMP
• Competitive antagonism at muscarinic receptors

Correct Answer: Transrepression of NF‑κB and AP‑1 leading to reduced proinflammatory cytokine production

Q18. In aspirin‑exacerbated respiratory disease (AERD), the pathophysiology primarily involves:

• Excess prostaglandin E2 production leading to bronchospasm
• Inhibition of cyclooxygenase shifting arachidonic acid metabolism toward increased leukotriene synthesis
• Autoimmune destruction of bronchial epithelium
• Viral infection of airway smooth muscle cells

Correct Answer: Inhibition of cyclooxygenase shifting arachidonic acid metabolism toward increased leukotriene synthesis

Q19. Which statement about montelukast is correct?

• It is a 5‑lipoxygenase inhibitor that causes liver enzyme elevation in most patients
• It is a leukotriene receptor antagonist metabolized partially by CYP enzymes and can be used as add‑on therapy in allergic asthma
• It is contraindicated in exercise‑induced bronchospasm
• It acts as a monoclonal antibody against IL‑5

Correct Answer: It is a leukotriene receptor antagonist metabolized partially by CYP enzymes and can be used as add‑on therapy in allergic asthma

Q20. Which is the correct rationale for combining inhaled corticosteroids (ICS) with long‑acting β2 agonists (LABA) in persistent asthma?

• ICS reduce LABA bronchodilator effect but improve mucus clearance
• LABA prevents systemic absorption of ICS
• ICS address airway inflammation while LABA provides sustained bronchodilation; combination reduces asthma morbidity and mitigates LABA monotherapy risk
• Combination therapy is only used to reduce cost and has no pharmacologic synergy

Correct Answer: ICS address airway inflammation while LABA provides sustained bronchodilation; combination reduces asthma morbidity and mitigates LABA monotherapy risk

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