NINU Quiz

1) A 12-year-old girl with a childhood history of asthma

complained of cough, dyspnea, and wheezing.

Apply the principle of pharmacological management,

please mention at least two drugs which could
rapidly reverse her bronchoconstriction.
 NINU Quiz

2) a 21 years old male suffers from mild persistent asthma.

Write a full prescription, and specify suitable drugs
for controlling this case/prevent further attacks
 NINU Quiz

3) A 23-year-old woman brought to ER with an acute

exacerbation of asthma that remains unresponsive to initial
treatment with bronchodilators (acute severe asthma).
Apply the principle of pharmacological and
non-pharmacological management
 NINU Quiz

4) a 65-year-old hypertensive asthmatic patient went to an

outpatient clinic as he complained of palpitation. The doctor
added propranolol (beta-blocker), after he took the
medication, he went to the ER with acute severe asthma.
Explain what happened to this patient.

5) 60-year-old asthmatic female complained of pain in knee

joint and she took diclofenac sodium (NSAIDs) to decrease
her pain, then she went to ER with acute severe attack of
asthma.
Explain why this happened to the patient and how to
manage her case?
 NINU Quiz

6) A 4-year-old who has been brought to the emergency

department (ED) by his mother. She immediately tells you he
has a history of BD visits for his asthma.
What can you prescribe for this case ?
 NINU Quiz

Answer 1 :
low-dose ICS-formoterol (combination therapy)
Short acting 32 agonists (SABA)
(Salbutamol/ albuterol-Terbutaline)
Inhaled Muscarinic antagonists
(Ipratopium-Tiotropium)
Methvixanthines
(aminophylline)
Corticosteroids:
low dose ICS (beclomethazone, budesonide, fluticasone)
N.B: Steroids improve the response to $2 agonist

Answer 2:
 NINU Quiz

Answer 3:
Non pharmacological and pharmacological
management:
1)Hospitalization
2)Endotracheal intubation & suction of bronchial secretion.
3)Fluid replacement, correction of acid-base balance,
electrolytes disturbance & dehydration.
4)Oxygen monitoring and therapy.
5)Antibiotics to treat infection.

1)Drug used:
1)High dose ICS- formeterol
2)Salbutamol inhalation and/ or Ipratropium inhalation
3) Plus, Hydrocortisone IV injection.
4)If NO, or MINIMUM response to previous step: Magnesium
sulfate IV
5)If NO, or MINIMUM response to previous three drugs:
Theophylline low dose slow IV infusion.
6)If NO, or MINIMUM response to previous step: ICU-
artificial respiration.
 NINU Quiz

Answer 4 :
● safety concerns have led to guidelines recommending
that beta-blockers should be contraindicated in asthmatic
patients, Airway caliber in people with asthma partly
depends upon the body’s sympathetic drive.
Beta-blockers block this sympathetic drive resulting in
bronchoconstriction.
● The patient should use alternative drug for palpitation like
calcium-channel blocker.

Answer 5: Between 8 - 20% of adult asthmatics experience

bronchospasm following ingestion of aspirin and other
non-steroidal anti-inflammatory drugs (NSAIDs). Other
analgesic should be prescribed to the patient to control her
pain like selective cox-2 inhibitors.
NSAIDS inhibit cyclooxygenase enzyme (COX) and increase
leukotrienes by shifting the pathway to lipoxygenase causing
bronchospasm.Management :
The same as before + leukotrienes inhibitors like :
Zileuton : 5-lipooxygenase inhibitor, decrease LT synthesis
Zafirlukast: LT receptor antagonist.

Answer 6: In children ≤5 years, Short acting β2 agonists

(SABA) As Needed
ICS-Formoterol is ineffective in children less than 5 years