Pharmacotherapy of asthma and COPD MCQs With Answer

Introduction:

This quiz collection on “Pharmacotherapy of Asthma and COPD” is designed specifically for M.Pharm Advanced Pharmacology-II students preparing for exams and clinical decision-making. It emphasizes pathophysiology-linked rational therapy, drug mechanisms, comparative pharmacology, adverse effects, monitoring requirements, and inhalation device considerations. Questions range from inhaled bronchodilators and corticosteroids to emerging biologics, oral agents like theophylline and roflumilast, and practical aspects such as drug interactions and dosing rationales. Each item tests deeper understanding needed for therapeutic planning, safe prescribing, and critical appraisal of evidence-based guidelines in obstructive airway disease management.

Q1. Which of the following best describes the mechanism of action of tiotropium in COPD management?

• Long-acting beta2-adrenergic receptor agonist that increases cAMP
• Long-acting muscarinic antagonist that blocks M3 receptors on airway smooth muscle
• Phosphodiesterase-4 inhibitor that reduces pulmonary inflammation
• Leukotriene receptor antagonist that prevents bronchoconstriction

Correct Answer: Long-acting muscarinic antagonist that blocks M3 receptors on airway smooth muscle

Q2. Which statement about inhaled corticosteroids (ICS) in asthma is most accurate?

• ICS are ineffective in reducing airway hyperresponsiveness and should be avoided
• Regular low-to-moderate dose ICS reduce exacerbations and control inflammation; higher doses increase systemic adverse effects
• ICS have no systemic absorption and therefore require no monitoring
• ICS are first-line monotherapy for COPD with proven mortality benefit

Correct Answer: Regular low-to-moderate dose ICS reduce exacerbations and control inflammation; higher doses increase systemic adverse effects

Q3. Which adverse effect is most specifically associated with chronic systemic corticosteroid use in asthma patients?

• Tachycardia and tremor
• Osteoporosis and adrenal suppression
• Nephrotoxicity with progressive renal failure
• Bronchospasm due to paradoxical airway irritation

Correct Answer: Osteoporosis and adrenal suppression

Q4. Roflumilast is indicated in COPD primarily because it:

• Acts as a bronchodilator by stimulating beta2 receptors
• Inhibits PDE4, reducing inflammation and exacerbations in severe COPD with chronic bronchitis
• Is a long-acting antimuscarinic that improves FEV1 immediately
• Neutralizes IgE to prevent allergic exacerbations

Correct Answer: Inhibits PDE4, reducing inflammation and exacerbations in severe COPD with chronic bronchitis

Q5. Which of the following drug interactions is most important to consider with theophylline therapy?

• Concurrent use with beta blockers increases bronchodilation
• Cigarette smoking induces CYP1A2 and increases theophylline clearance, lowering serum levels
• Co-administration with inhaled corticosteroids causes severe hypokalemia
• Concurrent use with montelukast causes life-threatening hypertension

Correct Answer: Cigarette smoking induces CYP1A2 and increases theophylline clearance, lowering serum levels

Q6. Which biologic therapy is correctly matched with its primary target in severe asthma?

• Omalizumab — IL-5 receptor alpha
• Mepolizumab — IL-5 cytokine
• Benralizumab — IgE
• Dupilumab — PDE4 enzyme

Correct Answer: Mepolizumab — IL-5 cytokine

Q7. Why is using a long-acting beta2-agonist (LABA) alone in asthma considered unsafe?

• LABAs cause permanent beta2 receptor upregulation leading to hyperresponsiveness
• LABA monotherapy increases the risk of severe asthma exacerbations and asthma-related death unless combined with an ICS
• LABAs are ineffective in bronchodilation when used alone
• LABA use alone leads to irreversible airway remodeling

Correct Answer: LABA monotherapy increases the risk of severe asthma exacerbations and asthma-related death unless combined with an ICS

Q8. Which inhaler device requires the highest patient inspiratory flow rate for optimal drug delivery?

• Pressurized metered-dose inhaler (pMDI) with spacer
• Dry powder inhaler (DPI)
• Soft mist inhaler
• Ultrasonic jet nebulizer

Correct Answer: Dry powder inhaler (DPI)

Q9. Montelukast’s pharmacologic action in asthma involves:

• Blocking the beta2 receptor to reduce bronchospasm
• Antagonizing the cysteinyl leukotriene receptor CysLT1 to reduce inflammation and bronchoconstriction
• Inhibiting 5-lipoxygenase irreversibly to stop leukotriene synthesis
• Neutralizing circulating IgE antibodies

Correct Answer: Antagonizing the cysteinyl leukotriene receptor CysLT1 to reduce inflammation and bronchoconstriction

Q10. Which monitoring is essential when initiating zileuton therapy for asthma?

• Periodic electrocardiograms (ECGs) to detect QT prolongation
• Liver function tests because of potential hepatotoxicity
• Serum potassium levels because of hypokalemia risk
• Thyroid function tests due to risk of hypothyroidism

Correct Answer: Liver function tests because of potential hepatotoxicity

Q11. In an acute severe asthma exacerbation, which medication provides the most rapid bronchodilation?

• Oral montelukast
• Intravenous aminophylline
• Inhaled short-acting beta2-agonist (SABA) via nebulizer
• Long-acting muscarinic antagonist (LAMA)

Correct Answer: Inhaled short-acting beta2-agonist (SABA) via nebulizer

Q12. Which feature distinguishes benralizumab’s mechanism from mepolizumab in eosinophilic asthma?

• Benralizumab neutralizes IL-4, while mepolizumab blocks IgE
• Benralizumab targets IL-5 receptor alpha and induces antibody-dependent cell-mediated cytotoxicity (ADCC) causing eosinophil depletion
• Mepolizumab induces eosinophil apoptosis via ADCC, while benralizumab binds soluble IL-5
• Benralizumab is an inhaled small molecule, mepolizumab is oral

Correct Answer: Benralizumab targets IL-5 receptor alpha and induces antibody-dependent cell-mediated cytotoxicity (ADCC) causing eosinophil depletion

Q13. Which statement about antibiotic macrolide therapy in COPD prevention is most accurate?

• Long-term macrolide therapy is universally recommended for all COPD patients to prevent exacerbations
• Long-term azithromycin may reduce exacerbation frequency in selected COPD patients but raises concerns of resistance and QT prolongation
• Macrolides have no immunomodulatory effects and only serve as acute antibacterial therapy
• Clarithromycin is preferred for long-term use because it has no cardiac risks

Correct Answer: Long-term azithromycin may reduce exacerbation frequency in selected COPD patients but raises concerns of resistance and QT prolongation

Q14. Which pharmacokinetic property of inhaled corticosteroids most reduces systemic side effects?

• High oral bioavailability and slow hepatic clearance
• High first-pass hepatic metabolism of swallowed fraction and high lung receptor affinity
• Extensive renal excretion of active parent drug
• High systemic distribution volume with prolonged half-life

Correct Answer: High first-pass hepatic metabolism of swallowed fraction and high lung receptor affinity

Q15. Which agent is a selective phosphodiesterase-4 (PDE4) inhibitor and may cause weight loss and psychiatric adverse events?

• Theophylline
• Roflumilast
• Tiotropium
• Montelukast

Correct Answer: Roflumilast

Q16. What is the primary clinical rationale for combining inhaled corticosteroid (ICS) with long-acting beta2-agonist (LABA) in asthma control?

• LABA reduces the systemic side effects of ICS
• ICS prevent tolerance and adverse outcomes associated with LABA while LABA provides sustained bronchodilation, producing synergistic control of symptoms and exacerbations
• Combination therapy only improves device adherence but not clinical outcomes
• ICS and LABA combination is used only for COPD not asthma

Correct Answer: ICS prevent tolerance and adverse outcomes associated with LABA while LABA provides sustained bronchodilation, producing synergistic control of symptoms and exacerbations

Q17. Which of the following is the best marker to guide use of anti-IL5 therapies in severe asthma?

• Elevated serum IgE level regardless of eosinophil count
• High blood eosinophil count and frequent exacerbations despite high-dose ICS
• Positive skin prick test for common aeroallergens only
• Low exhaled nitric oxide (FeNO) levels

Correct Answer: High blood eosinophil count and frequent exacerbations despite high-dose ICS

Q18. Which inhaled bronchodilator class is associated with muscarinic side effects such as dry mouth and urinary retention?

• Beta2-agonists (SABA/LABA)
• Anticholinergics (SAMA/LAMA)
• Leukotriene receptor antagonists
• Phosphodiesterase inhibitors

Correct Answer: Anticholinergics (SAMA/LAMA)

Q19. Which is the most appropriate first-line pharmacologic step for a newly diagnosed patient with mild intermittent asthma?

• Daily high-dose inhaled corticosteroids plus LABA
• As-needed short-acting beta2-agonist (SABA) for symptom relief
• Daily oral corticosteroids to prevent exacerbations
• Immediate initiation of biologic therapy (anti-IgE or anti-IL5)

Correct Answer: As-needed short-acting beta2-agonist (SABA) for symptom relief

Q20. Which statement about oxygen therapy in COPD is correct?

• Long-term oxygen therapy has no impact on survival in hypoxemic COPD patients
• Long-term oxygen therapy improves survival in patients with chronic severe resting hypoxemia (PaO2 ≤55 mmHg or SaO2 ≤88%)
• High-flow oxygen should be given liberally to all COPD exacerbations without monitoring
• Oxygen therapy is contraindicated in COPD due to risk of CO2 retention

Correct Answer: Long-term oxygen therapy improves survival in patients with chronic severe resting hypoxemia (PaO2 ≤55 mmHg or SaO2 ≤88%)

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