NBME 21 Answers : Block 2 : #39 = A 64-year-old man with bronchospastic ...

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nbme21/Block 2/Question#39 (43.9 difficulty score)
A 64-year-old man with bronchospastic ...
Enhanced action of the agonist at β-adrenergic receptors🔍
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+7 upvote downvote
submitted by wasabilateral(38),

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iThs si hwat I htoghut tub otn ruse if tsi’ rtc.ecro eeTrh si a oUrWdl q werhe it icbseders oitcio-ndaastimnr fo triscolo adn in.ieenphper srolCito fainclgiynist hceensna hte cftfee of ipe beueasc istocolr ahs a sipevmries tfefce on maiiitnnnga hte ncregeardi ersrt.epoc

194orbust per UWorld, "cortisol exerts a permissive effect on many hormones to help improve the response to a variety of stressors. For example, cortisol increases vascular and bronchial smooth muscle reactivity to catecholamines". FA also uses the effect of cortisol on catecholamine responsiveness as the lone example for a permissive drug interaction (FA2018 pg 229). The difference here is that we're talking about exogenous glucocorticoid and adrenergic agonist. I guess it was expected for us to assume that the mechanism is analogous for the analogous drugs +3

maxillarythirdmolar I'm sure it's related to the activating effect of Cortisol on phenylethanolamine-N-methyltransferase, converting NE to Epi. Sounds like a synergistic thing to me. (FA.83) +3

feeeeeever My logic is probably flawed, but I also thought that if cortisol has the ability inhibit COX, LOX, and NFKB you can reduce inflammation and bronchoconstrictive mediators. Therefore, the B2 agonists would have a greater effect since things like LTB4 will be reduced. +1

feeeeeever *LTC4, LTD4, LTE4 for bronchoconstriction, my bad +1

+4 upvote downvote
submitted by 5thgencephalosporin(5),

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e“hT ntacmonbioi of a ggonntla-ci ebta 2 itosgan AL(BA) and na ahndlei tocooctrirdsie si rmeo aicfsiofeuc ni msaath dan DOP][C tnha ..[]. reteih eo.anl osetdCcsotoriri yam etarglue teba 2 oeercrpt nnuiotcf yb genricisna sxespnreoi fo het oreetcrp, setrginro rnatpeGbt-i/oe 2 ereoctpr nogpicl,u nad innhibigti aebt 2 peocrter gn”roiatuwdeoln.

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sahusema In short, cortisol upregulates adrenergic receptors and makes them more sensitive +

+2 upvote downvote
submitted by adong(80),

FA19 p.233 cortisol has a permissive effect on catecholamines

+1 upvote downvote
submitted by sam1(13),

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iThs sseme to eb a enertalv eppar:/s9:97ni.7ect/n1omhmu/.gdw1bvpw.wbn8plhi9./t

sThe"e aatd niaedtic that ccsdicliogrootu olny slatenrytni hacneen e(bAR)2at egen tiipanocrtnrs nda iafl to scaeerin essdetya-tat sellve of Aa(et2Rb) epritno ni uhamn awyari hepatelili s.ellc Nsote,shnlee ucoecgdilcuocdit-rndio efectsf on hte C(a)2AA-Rtbe sseymt of nuham yarwai lpeeitialh llcse uoticentrb to the eifabneilc fecfste fo docisrosotitcer ni mhasat by ennaihcgn teh tuonlincaf esnoersp ot "(eibgntt-s.osa2a)

+1 upvote downvote
submitted by maxillarythirdmolar(32),

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I'm rsue s'ti reetlda to eht atvangciti ffcete fo rltoCosi no ,tnpnensyemaNtoaean-hhh-efemrlrltyeails tivnnercog EN ot i.pE doSsnu leik a resnsciigyt ntgih ot me. 8.F(3A)

kevin It's permissive because without cortisol Epi wouldn't be able to attain its full effect +