45. Asthma Flashcards Preview

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Flashcards in 45. Asthma Deck (52):
1

A 70 year old patient has been prescribed Xopenex. Choose the correct statement concerning Xopenex:

A. Xopenex causes less tachycardia than albuterol.
B. Xopenex causes fewer headaches than albuterol.
C. Xopenex causes less nervousness than albuterol.
D. Xopenex is the R-isomer of albuterol.
E. Xopenex is the L-isomer of albuterol.

D. Xopenex is the R-isomer of the beta-2 adrenergic agonist albuterol. Like albuterol, it is available in a metered-dose inhaler (Xopenex HFA) and for use in a nebulizer. The frequency of systemic effects (tachycardia, headache, nervousness) is reported to be similar to albuterol.

2

A patient with asthma has been prescribed the Advair Diskus. Which of the following statements is correct?

A. Advair contains fluticasone, a long-acting beta-2 agonist.
B. Advair contains salmeterol, an inhaled corticosteroid.
C. Advair Diskus is dosed 1 inhalation once daily.
D. Advair treats both airway constriction and inflammation.
E. Advair Diskus must be used within 2 months of opening the foil pouch.

D. Advair contains salmeterol, a long-acting beta-2 agonist (which opens the airways) and fluticasone, an inhaled corticosteroid (which reduces inflammation). The mechanisms of action were reversed in the question. The correct dose forAdvair Diskus is 1 inhalation twice daily.

3

Madison is a four year-old girl with asthma. She will receive montelukast. Select the correct dose for a four year-old child.

A. A 4 mg chewable tablet taken once daily in the evening
B. A 5 mg chewable tablet taken once daily in the evening
C. A 5 mg chewable tablet taken BID
D. A 10 mg chewable tablet taken once daily in the evening
E. A 10 mg chewable tablet taken BID

A. The montelukast dosage for pediatric patients 2-5 years of age is one 4-mg chewable tablet or one packet of 4-mg oral granules taken in the evening.

1-5 yo: 4mg QPM

6-14: 5mg QPM

15+: 10mg QPM

4

What is the sweetener used in the montelukast chewable tablets?

A. Sorbitol
B. Honey
C. Splenda
D. Phenylalanine
E. Sucrose

D. Phenylalanine is commonly used to sweeten chewable drugs; it cannot be used in patients with phenylketonuria (PKU).

5

Lilly is a 15 year-old girl with asthma. She uses a steroid inhaler daily and has an albuterol inhaler that she uses before she runs track. Track meets can be long and sometimes last several hours. Lilly's albuterol inhaler ran out at the last meet and she became short of breath. Choose an appropriate recommendation that would provide longer-acting relief for Lilly to use prior to a track meet:

A. She can use Aerospan HFA instead of the short-acting beta agonist.
B. She can use Foradil instead of the short-acting beta agonist.
C. She can use Proventil instead of the short-acting beta agonist.
D. She can use theophylline instead of the short-acting beta agonist.
E. She can use Accolate instead of the short-acting beta agonist.

B. An albuterol inhalation lasts about 2-3 hours. If the patient requires a longer duration of action, long-acting beta-2 agonists can be used. She would still need to be dispensed an albuterol inhaler for "rescue" therapy.

Foradil (formoterol)

Accolate (zafirlukast)

6

A patient has been prescribed beclomethasone for asthma. What is the brand name of beclomethasone when used for asthma?

A. Beconase
B. Vancenase
C. Asmanex
D. QVAR
E. Nasonex

D. The brand name of beclomethasone for asthma is QVAR.

7

A patient with mild, intermittent asthma has been prescribed an albuterol MDI. Counsel the patient on the correct use of the device. Place the instructions for proper MDI technique below in the correct order (click and drag each statement into the proper order below). 

A. Remove the dust cap from the inhaler.
B. Inspect the mouthpiece for any debris.
C. Place the mouthpiece on your lips and close your lips around it.
D. Press the top of the canister while you are breathing in deeply and slowly.
E. Hold your breath as long as you can, up to 10 seconds.
 

A, B, C, D, E.

8

A patient is starting on Singulair. What is a warning associated with the use of Singulair? 

A. Hepatotoxicity
B. Peripheral neuropathy
C. Floppy iris syndrome
D. Bone marrow suppression
E. Behavior and mood changes

E. A serious warning involves behavior and mood-related changes have been reported: agitation including aggressive behavior or hostility, bad or vivid dreams, depression, disorientation (confusion), feeling anxious and hallucinations. This warning was added in 2009 and applies to all the leukotriene modifiers.

9

Which of the following steroids has the greatest antiinflammatory potency?

A. Fludrocortisone
B. Prednisone
C. Betamethasone
D. Triamcinolone
E. Cortisone

C. Bethamethasone and dexamethasone have the greatest antiinflammatory potency.

10

Raffi is a pharmacist in a busy store. Cheryl is a mother who came in with her eight year old daughter. The child had a new prescription for an albuterol inhaler. Raffi quickly instructed the mother how to use the MDI. When the mother got home, she had no idea how to instruct her daughter properly. The child, like many patients, had poor technique and did not obtain proper relief from the medicine. What is the most important thing that Raffi should have done to ensure that the parent and child understood how to use the inhaler?

A. Have the mother repeat back the instructions to him in a slow and deliberate manner.
B. The pharmacist should have repeated the instructions twice and asked the mother if she understood everything that was explained.
C. The pharmacist should have given the mother written instructions.
D. The pharmacist should have demonstrated how to use the inhaler and then watched the patient demonstrate proper technique.
E. The pharmacist should have had the technician, who may have had more time, demonstrate proper technique to the mother.

D. Delivery device instructions should be provided by demonstration. The only way to know for sure if the patient absorbed the information is to have them demonstrate proper use.

11

What is the therapeutic range for theophylline?

A. 1-5 mcg/mL
B. 2-10 mcg/mL
C. 5-15 mcg/mL
D. 10-20 mcg/mL
E. 50-100 mcg/mL

C. The therapeutic range for theophylline is 5-15 mcg/mL.

12

A patient with severe, persistent asthma has had an acute exacerbation. The physician has prescribed a short course of oral prednisone. Choose the correct statement:

A. Patients with severe asthma should always use inhaled, not oral steroids.
B. Oral steroids can cause many problems, including lowered blood glucose.
C. Prednisone is a prodrug of prednisolone.
D. A brand name is Medrol.
E. Oral steroids reduce appetite and cause anorexia.

C. Oral steroids, used chronically, have many adverse effects. The risk depends on the dose and duration (higher dose and longer duration will cause more problems). Oral steroids can increase blood pressure and increase appetite causing weight gain.

13

A 42 year-old female patient has been diagnosed with asthma. She only likes taking medication that comes in a pill for easy administration. Which of the following routes is preferred for drug therapy when treating asthma?

A. Oral
B. Buccal
C. Intravenous
D. Patch
E. Inhaled

E. The inhaled route is preferred in asthma since the disease is in the airways of the lungs.

14

Which of the following medications can increase theophylline levels and possibly result in theophylline toxicity? (Select ALLthat apply.)

A. Ciprofloxacin
B. Bupropion
C. Zafirlukast
D. Ranitidine
E. Clarithromycin

A, C, E.

15

Counseling points on the use of the Foradil should include the following: 

A. The capsules should be swallowed whole; do not crush or chew the caspule.
B. Leave the capsule sealed in the blister foil until just before use.
C. This medication can be used to treat an acute attack.
D. The capsules must be stored in the refrigerator by the patient.
E. This medication is dosed once daily.

B. Foradil is used in the aerolizer and not swallowed whole. It is used for maintenance therapy; not an acute asthma attack.

Foradil (formoterol)

16

A patient has been prescribed fluticasone for asthma. What is the brand name of fluticasone when used for asthma?

A. Aerospan
B. Flonase
C. Flomax
D. Flovent
E. Pulmicort

D. Be very careful with the steroids used for asthma and those used for allergic rhinitis as they are same generic drug name but different brand names and delivery devices.

17

Which of the following medications is a dry powder inhaler? 

A. Pulmicort Flexhaler
B. QVAR
C. Xopenex
D. Symbicort
E. Accuneb

A. Pulmicort Flexhaler is a dry powder inhaler.

Pulmicort (budesonide)

18

Dawn has been using prednisone 10 mg PO daily for the past month post discharge from her recent asthma exacerbation.  Her doctor wants to taper her off the medication.  What is the reason corticosteroids must be tapered?

A. They can cause rebound hypertension if stopped abruptly.
B. They can cause psychological dependence and withdrawal symptoms if stopped abruptly.
C. They can cause seizures to occur if stopped abruptly.
D. They can cause hypothalamic pituitary adrenal axis suppression.
E. They can cause bizarre, psychiatric behavior if stopped abruptly.

D. Corticosteroids need to be tapered due to hypothalamic pituitary adrenal axis suppression.

19

What is the correct dose of Advair HFA?

A. 1 inhalation once daily.
B. 1 inhalation BID.
C. 2 inhalations once daily.
D. 2 inhalations BID.
E. Take PRN.

D. Advair HFA is 2 inhalations twice daily.

20

Heather has had asthma for a number of years and has been in denial about her disease. At the age of 22 years, she wants to better manage her condition. Her doctor tells her that she is a Step 4 asthmatic and explains to her how to use a peak flow meter. Heather's personal best number is 300. Now Heather is in the pharmacy and she has selected a peak flow meter to purchase but admits to forgetting the steps in using it. Which of the following statements are correct in counseling Heather on the appropriate use of a peak flow meter? (Select ALL that apply.)

A. Do the peak flow meter assessment in the morning, before you take your medications.
B. Perform one assessment (3 readings) per day and record the highest number of the assessment in a log book.
C. It is best to perform the assessment in a supine position with the legs not elevated higher than the lungs.
D. Coughing during the assessment invalidates the reading.
E. If the value recorded is less than 150, she should go to the hospital immediately, regardless of symptoms.

A, B, D, E.

Values below 50% of personal best, patients should go to hospital.

21

Johnny is prescribed Advair Diskus for his asthma. Which of the following counseling points should be reviewed with Johnny about his Advair Diskus medication? (Select ALL that apply.)

A. Wash the Diskus with a wet cloth weekly.
B. If you do not feel or taste the medication, take another dose.
C. This is not a rescue medication for acute asthma attacks.
D. Rinse your mouth with water after your dose of medication.
E. Never breathe into the Diskus.

C, D, E. Never take an extra dose, even if the patient did not taste or feel the medicine. Keep the Diskus dry at all times.

22

Caleb is a 16 year-old teenager who has asthma and his only medication is Ventolin. He has been using his Ventolin inhaler for acute symptoms. When asked how many times he has used his Ventolin, he states he used it twice on Sunday, 1 time on Tuesday and 1 time on Wednesday. It is now Thursday. What would be appropriate recommendations to make at this time? (Select ALL that apply.)

A. Take Ventolin 2 puffs Q4-6H starting today.
B. Start him on a Serevent Diskus 1 inhalation BID for better symptom control.
C. Continue to take the Ventolin PRN for acute symptoms.
D. Start him on Pulmicort Flexhaler 2 inhalations BID for better symptom control.
E. Start him on Singulair 10 mg QHS.

C, D.

Starts as intermittent, then persistent (mild, moderate, severe)

Step 1: SABA prn indicated at all Steps

Step 2: Low dose ICS

Step 3: Low dose ICS + LABA or medium dose ICS

Step 4: Medium dose ICS + LABA

Step 5: High dose ICS + LABA, omalizumab indicated here

Step 6: High dose ICS + LABA + PO steroids, omalizumab indicated here

If patient uses rescue inhaler >2 times per week, then you should step up.

23

Rank the following oral corticosteroids in order of their anti-inflammatory potency (least potent = 1 to most potent = 5).  Drag and drop the choices into the correct order.

A. Cortisone
B. Hydrocortisone
C. Prednisone
D. Methylprednisolone
E. Dexamethasone
 

A, B, C, D, E.

cortisone 25 = hydrocortisone 20 = methylprednisolone/triamcinolone 4 = prednisone/prednisolone 5 = betamethasone 0.6 = dexamethasone 0.75

24

What is the generic name of Arnuity Ellipta?

A. Mometasone
B. Fluticasone
C. Indacaterol
D. Aclidinium
E. Tiotropiu

B. Arnuity Ellipta is the brand name of fluticasone furoate.

25

Which of the following medication classes has a boxed warning regarding an increased risk of asthma-related deaths when used as monotherapy?

A. Long-acting beta-2 agonists
B. Leukotriene modifiers
C. Theophylline
D. Short-acting beta-2 agonists
E. Inhaled corticosteroids

A. Long-acting beta-2 agonists have a boxed warning regarding the increased risk of asthma-related deaths when used as monotherapy.

26

Sammy is a 4 year-old patient with moderate asthma. He has been poorly controlled on an albuterol inhaler and a low-dose inhaled corticosteroid. The physician wants to add a leukotriene modifier to Sammy's regimen. Which agent can be recommended?

A. Zileuton
B. Theophylline
C. Indacaterol
D. Zafirlukast
E. Montelukast

E. Two leukotriene receptor blockers are indicated for use in children with asthma. Montelukast is indicated for patients at least one year old and zafirlukast is indicated for patients 5 years and older.

27

Which of the following statements concerning omalizumab is correct?

A. Omalizumab is a mast-cell stabilizer.
B. Omalizumab can be used as initial therapy in patients who have allergies & severe, persistent asthma.
C. Omalizumab can cause anaphylaxis.
D. Omalizumab can be administered at home in a nebulizer if an adult or parent has received training.
E. Omalizumab is dosed based on IgG levels and body weight.

C. Omalizumab is a monoclonal antibody that prevents binding of IgE to the high-affinity receptors on basophils and mast cells. Omalizumab is used as adjunctive therapy for patients 12 years and older who have allergies and severe, persistent asthma. Clinicians who administer omalizumab should be prepared and equipped to identify and treat anaphylaxis.

omalizumab (Xolair): SQ dose based on IgE and body weight

28

A 55 year-old male patient has continuous asthma symptoms, even with high dose inhaled corticosteroid therapy. He also has NYHA Class III heart failure. The physician will initiate theophylline. Choose the correct statement: 

A. The patient will require a higher dose of theophylline than most due to his heart failure.
B. The patient will have to limit the amount of protein in his diet to < 5% of total calories.
C. The therapeutic range of theophylline is 2-10 mcg/mL.
D. Signs of theophylline toxicity include vomiting, ventricular tachycardias, and seizures.
E. Theophylline should be dosed on the patient's actual body weight.

D. Heart failure increases theophylline levels; therefore, the patient will require a lower dose of theophylline. Although high-protein diets can decrease levels, patients should not limit the amount of protein consumed.

29

A patient with severe, persistent asthma has had an acute exacerbation. The physician has prescribed a short course of oral prednisone. Short-term side effects that can occur from the use of oral steroids include: 

A. Cushingoid symptoms
B. Peptic ulcers
C. Glaucoma
D. Irritable or anxious behavior
E. Decreased blood pressure

D.

30

A patient has been prescribed mometasone for asthma. What is the brand name of mometasone when used for asthma?

A. QVAR
B. Nasonex
C. Aerospan
D. Alvesco
E. Asmanex

E. The brand name of mometasone for asthma is Asmanex.

Alvesco (ciclesonide)

31

Carla is an eleven year-old girl with asthma. The physician wants to give her montelukast, but is not sure of the correct dose. Choose the correct dose of montelukast for an eleven year-old child:

A. A 5 mg chewable tablet taken once daily in the evening.
B. A 5 mg chewable tablet taken BID.
C. A 10 mg chewable tablet taken once daily in the evening.
D. A 10 mg chewable tablet taken BID.
E. A 4 mg packet of granules mixed with milk taken in the morning.

A. Montelukast comes in an oral tablet, chewable tablet and oral granules. The different formulations make it easy to use in children. When used for asthma, the medicine is dosed once daily in the evening.

1-5: 4mg QPM

6-14: 5mg QPM

15+: 10mg QPM

32

A patient is starting on Singulair. Which of the following are side effects of Singulair?

A. Headache and upper respiratory tract infections
B. Bleeding and bruising
C. Tachycardia and cough
D. Dermal thinning and tachyphylaxis
E. Purple lung syndrome

A. The most common side effects of Singulair include headache, dizziness, upper respiratory infection, pharyngitis, stomach pain, sinusitis and others.

33

Sammy is an 18 month old boy who has been prescribed montelukast granules. Counsel the parents on how to administer the granules to their son:

A. Mix with 4 oz of applesauce and administer within 24 hours.
B. You can open the granule packet up to 8 hours prior to use.
C. Mix with one tablespoon of warm water.
D. Mix with a spoonful of cool, mashed carrots and administer within minutes.
E. Mix with a tablespoon of breast milk or formula and mixture can be stored up to 2 hours.

D. Instruct parents using the granules not to open the granule packet until they are ready to use it since granules mixed with foods or liquids cannot be stored. The granules can be mixed with 1 teaspoonful (5 mL) of baby formula or breast milk, or a spoonful of applesauce, mashed carrots, rice, or ice cream. Whatever the medicine is mixed with must be cold or at room temperature. Instruct the parents not to mix the granules with extra amounts of milk or food; they need to make sure the entire dose has been consumed. Administer the mixutre immediately (within 15 minutes).

34

Which of the following are correct statements regarding Asthmanefrin? (Select ALL that apply.)

A. This medication contains the R-isomer of epinephrine.
B. This medication is available OTC.
C. This medication is not preferred in patients with asthma.
D. This medication can cause more thrush than others on the market.
E. This medication is preferred in patients with cardiac disease.

B, C. Asthmanefrin is a racemic mixture of epinephrine that is available OTC. Since it is not beta-2 selective, it is not preferred as a SABA in asthma.

35

The asthma guidelines recommend that patients with persistent asthma use a long-term control medication to be taken daily in order to achieve and maintain control of persistent asthma symptoms. Which class of agents is considered the best course of therapy for persistent asthma symptom control?

A. Long-acting bronchodilators
B. Inhaled corticosteroids
C. Leukotriene modifiers
D. Theophylline
E. Immunomodulators

B.

Starts as intermittent, then persistent (mild, moderate, severe)

Step 1: SABA prn indicated at all Steps

Step 2: Low dose ICS

Step 3: Low dose ICS + LABA or medium dose ICS

Step 4: Medium dose ICS + LABA

Step 5: High dose ICS + LABA, omalizumab indicated here

Step 6: High dose ICS + LABA + PO steroids, omalizumab indicated here

If patient uses rescue inhaler >2 times per week, then you should step up.

36

What is the generic name of Xopenex?

A. Levalbuterol
B. Tiotropium
C. Omalizumab
D. Arformoterol
E. Indacaterol

A. The generic name of Xopenex is levalbuterol.

37

Which of the following medications can decrease theophylline levels? (Select ALL that apply.)

A. Allopurinol
B. Citalopram
C. Carbamazepine
D. Primidone
E. Quinidine

C, D.

38

Which of the following are possible side effects from the use of an albuterol HFA inhaler? (Select ALL that apply.)

A. Nervousness, tremor, and palpitations
B. Hyperkalemia
C. Hypoglycemia
D. Bradycardia
E. Throat dryness or irriitation, cough

A, E. The major side effects include nervousness, tremor, shakiness, mouth/throat dryness or irritation, cough, lightheadedness, trouble sleeping, tachycardia, hyperglycemia and others. If albuterol is over-used or not used correctly, the medicine could be systemically absorbed and hypokalemia could result.

39

Pulmicort respules are used primarily in this population group:

A. Seniors
B. Adults between 30 and 50 years old
C. Children
D. Patients who have failed theophylline
E. Patients who have failed luekotriene modifying agents

C. Pulmicort respules are used mainly in children.

Because it's a suspension for nebulization.

40

Jason is well-controlled on his asthma medications which include Flovent HFA 220 mcg BID, Foradil 1 capsule BID, andProventil HFA PRN symptoms. He is picking up his refills and asks if anything can help with his sore throat. When inspected, the pharmacist recognizes the throat is sore due to thrush. What are some counseling points the pharmacist can provide that will help reduce Jason's thrush? (Select ALL that apply.)

A. Jason should drink 8 oz of water after taking his medications.
B. Jason should gargle with warm warm and spit out the rinse after using his medications.
C. Jason should purchase a spacer device and use with his Foradil.
D. Jason should purchase a spacer device and use with his Flovent HFA.
E. Jason should not kiss others as this infection is contagious.

B, D. Thrush is a side effect of his Flovent.

41

Cassandra is a 17 year-old with asthma. She likes to play basketball. Before heading to the court, Cassandra needs to use her albuterol inhaler to help prevent exercise-induced symptoms. Choose the correct statement regarding albuterol:

A. Albuterol HFA inhalers are damaging to the ozone.
B. Albuterol is a beta-2 antagonist and is preferred treatment for exercise-induced symptoms.
C. A brand name for albuterol is Ventolin.
D. She should be using an inhaled corticosteroid for prevention of exercise-induced symptoms.
E. Only an inhaled formulation of albuterol is available in the U.S.

C. Albuterol inhalers are short-acting beta-2 adrenergic agonists taken as needed for rapid, short-term relief of asthma symptoms or to prevent an asthma attack. Albuterol comes in aerosols for oral inhalation, oral tablets, oral solution and syrups. HFA inhalers have replaced CFC inhalers because HFA inhalers do not damage the ozone.

42

What is the mechanism of action of Theo-24?

A. Binds to beta-2 receptors and causes relaxation of bronchial smooth muscle
B. Blocks phosphodiesterase, increasing cAMP and releasing epinephrine from the adrenal cells
C. Depresses migration of polymorphonuclear leukocytes and inhibits inflammation
D. Inhibits the enzyme 5-lipoxygenase
E. Monoclonal antibody that inhibits IgE binding on mast cells and basophils

B. This is the mechanism of theophylline, or Theo-24.

43

JS is being treated in the hospital for an acute asthma exacerbation with dexamethasone 3 mg IV BID. The physician would like to transition this patient to an equipotent dose of prednisone. What is the equipotent daily dose of prednisone?

A. 60 mg
B. 50 mg
C. 40 mg
D. 30 mg
E. 66.7 mg

C.

cortisone 25 = hydrocortisone 20 = methylprednisolone/triamcinolone 4 = prednisone/prednisolone 5 = betamethasone 0.6 = dexamethasone 0.75

44

Alexa is a 17 year-old patient with moderate asthma. The physician is considering adding zileuton. Unlike the other agents in its class, zileuton has a risk for which of the following toxicities?

A. Hypersensitivity reactions, with trouble breathing
B. Hepatotoxicity
C. Acute renal failure
D. Demyelinating disease
E. Hemolytic anemia

B. Zileuton can cause liver toxicity; liver enzymes must be monitored each month for the first 3 months, then every 2-3 months for the rest of the year, and periodically thereafter.

45

A 12 year-old male patient has a new prescription for QVAR HFA. Previously, the patient had been using only an albuterol inhaler. He has been using the albuterol inhaler 3-4 times per week. Choose the correct statement:

A. This is inappropriate; QVAR HFA is used only for patients needing high dose ICS therapy.
B. This is inappropriate; QVAR HFA should not be used in children due to growth retardation.
C. This is inappropriate; QVAR HFA is in the same drug class as albuterol.
DThis is inappropriate; this patient is having an asthma exacerbation and should go to the hospital.
E. This is appropriate; QVAR HFA is considered a first line agent per the asthma guidelines.

E. Inhaled corticosteroids, like QVAR HFA, are first line therapy for anyone with persistent asthma as demonstrated in this case.

46

A patient is started on the Advair Diskus. Which of the following statements are correct regarding Advair Diskus? (SelectALL that apply.)

A. This medication comes with a dose counter.
B. Advair Diskus is dosed 2 inhalations BID.
C. The dose of the corticosteroid stays the same while the dose of the beta-2 agonist varies in the different product strengths.
D. This medication should not be used with a spacer device.
E. Always use the Diskus in a level, flat position.

A, D, E. Advair Diskus is dosed 1 inhalation BID. Since it is a dry powder inhaler, it cannot be used with a spacer device.

47

Which of the following statements are correct regarding Pulmicort respules? (Select ALL that apply.)

A. Pulmicort respules are given via nebulization.
B. The generic name is budesonide.
C. Pulmicort respules leave a metallic taste in the mouth.
D. Pulmicort respules can be used as first-line therapy.
E. Pulmicort respules need to be refrigerated.

A, B, D. Pulmicort respules are stored at room temperature. Shake well before using.

48

A patient with severe, persistent asthma has been using prednisone 10-20 mg daily for at least three years. Which side effects are likely to be due to long-term prednisione use? (Select ALL that apply.)

A. Reduced bone density and possible osteoporosis
B. Elevated blood glucose and possible diabetes
C. Poor wound healing
D. Anorexia
E. Hearing loss

A, B, C.

49

A patient has developed oral thrush. Which medication is most likely to have contributed to this condition?

A. QVAR
B. Singulair
C. Xopenex
D. Spiriva
E. Zyflo

A. Corticosteroids, such as QVAR, can cause oral thrush.

50

What are the ingredients in Symbicort?

A. Salmeterol + fluticasone
B. Formoterol + fluticasone
C. Salmeterol + beclomethasone
D. Formoterol + budesonide
E. Mometasone + formoterol

D. Symbicort is formoterol + budesonide.

51

A patient with moderate asthma enters the pharmacy and asks for your recommendation for headache pain. Choose the safest option:

A. Acetaminophen
B. Ibuprofen
C. Naproxen
D. Capsaicin cream
E. Flector patch

A. NSAIDs (aspirin, ibuprofen, naproxen, diclofenac) and non-selective beta blockers and selective beta blockers at high (non-selective) doses may worsen asthma symptoms.

52

Natalie is a 12 year-old with asthma. She uses Flovent. She has no other medications and has not had any asthma symptoms since she started Flovent two years ago. Natalie is wondering if she still needs an albuterol inhaler for her asthma. The pharmacist should respond:

A. Yes; all patients with asthma should have a short-acting beta-2 agonist.
B. No; she has not had any acute symptoms for at least 12 months.
C. No; she has not had any acute symptoms for at least 18 months.
D. No; she has not had any acute symptoms for at least 24 months.
E. No; she should have a long-acting beta-2 agonist for rescue symptoms.

A. No matter what stage/step of asthma is present, all patients must have a short-acting beta-2 agonist like albuterol for acute relief ("rescue") of symptoms.

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