Some COPD medications are formulated as a capsule, which is then inserted into a device for inhalation. Patients need to be counseled that these capsules are not meant to be taken by mouth, but inhaled. Select all the COPD medications which come as a capsule meant for inhalation:
A. Spiriva HandiHaler
B. Combivent Respimat
C. Tudorza Pressair
D. Foradil Aerolizer
E. Arcapta Neohaler
A, D, E.
Gerald has COPD. What are some goals of therapy that should be followed when treating COPD?
A. Use as many medications as possible to prevent the progression of COPD.
B. Give oxygen therapy for any patient wanting to halt the progression of disease.
C. Short-acting inhaled bronchodilators are more effective and more convenient than treatment with long-acting agents.
D. Combining bronchodilators of different pharmacologic classes may improve efficacy and decrease the risk of side effects.
E. Oral or inhaled corticosteroid use is recommended in all patients with COPD.
Frederick is a patient newly diagnosed with COPD. In order to determine appropriate therapy, what factors are considered in assessing the severity of his COPD? (Select ALL that apply.)
A. Current symptoms
C. Degree of airflow limitation
D. Exacerbation history
A, C, D, E.
Which of the following medications come as a dry powder inhaler? (Select ALL that apply.)
A. Combivent Respimat
Which of the following medications are long-acting anticholinergics? (Select ALL that apply.)
B. Combivent Respimat
What is the generic name for Arcapta?
D. The generic name for Arcapta is indacaterol.
arformoterol (Brovana): R-isomer of formoterol
What is the primary cause of COPD?
A. Alpha-1 antitrypsin deficiency
C. Occupational chemical exposure
D. Indoor air pollution from cooking fumes
E. Outdoor air pollution
B. The major risk factor for developing COPD is smoking. Other conditions which can cause COPD are alpha-1 antitrypsin deficiency, occupational dusts and chemicals (chemical agents and fumes), and indoor and outdoor air pollution. Patients must be counseled to stop smoking. Anyone with COPD should be assisted with measures to stop smoking.
Which of the following medications are in Symbicort?
A. Mometasone + formoterol
B. Fluticasone + salmeterol
C. Budesonide + formoterol
D. Budesonide + salmeterol
E. Beclomethasone + formoterol
C. Symbicort contains budesonide + formoterol.
Which of the following statements regarding olodaterol is false?
A. The brand name is Striverdi Respimat
B. It is a long-acting anticholinergic
C. The device must be discarded 3 months from the date it was inserted or when there are no doses left
D. Olodaterol is dosed 2 inhalations daily
E. Olodaterol is contraindicated as monotherapy in treatment of asthma
Which class of drugs have been shown to be most effective as monotherapy in treating COPD when used on a regular basis?
A. Short-acting inhaled bronchodilators
B. Long-acting inhaler bronchodilators
C. Oral corticosteroids
D. Inhaled corticosteroids
E. PDE-4 inhibitors
Which patient counseling point is incorrect in regards to cleaning the inhalation devices?
A. Atrovent HFA and Arcapta do not require routine cleaning.
B. Combivent Respimat should be cleaned weekly.
C. Spiriva Handihaler should be cleaned as needed.
D. Tudorza Pressair should not be cleaned with water.
E. Tudorza Pressair and Breo Ellipta do not require routine cleaning.
A. Atrovent HFA needs to be cleaned at least once a week.
What are patient counseling points regarding the use of Combivent Respimat? (Select ALL that apply.)
A. The most common side effects include upper respiratory tract infections, cough and dry mouth
B. To take an inhalation, turn the base, open the cap, and press the dose-release button
C. Shake the inhaler prior to taking an inhalation
D. The Combivent Respimat does not need to be primed prior to use
E. Take 2 inhalations QID
A, B. The dose is 1 inhalation QID, Combivent Respimat needs to be primed prior to use and then again if the inhaler has not been used for more than 3 days.
Incruse Ellipta is a and Breo Ellipta is a .
A. Short-acting anticholinergic, long-acting anticholinergic
B. Short-acting anticholinergic, long-acting beta-2 agonist
C. Long-acting beta-2 agonist, long-acting anticholinergic
D. Long-acting anticholinergic, long-acting beta-2 agonist
E. Long-acting beta-2 agonist, short-acting anticholinergic
A patient is prescribed Advair. Which of the following are correct statements regarding Advair? (Select ALL that apply.)
A. Advair Diskus is not indicated for COPD.
B. Advair Diskus should be used with a spacer device to decrease the risk of thrush.
C. Advair Diskus should be taken 1 inhalation BID.
D. Advair contains flunisolide + salmeterol.
E. Advair improves lung function and breathing in COPD.
Peter is a 72 year-old male who has COPD with chronic bronchitis and emphysema. He was a long-term smoker (1.5 pack per day x 35 years), but has not smoked for years. Fortunately, he does not require oxygen therapy. He is having trouble managing his many medications, including the four-time daily dose of Atrovent. The physician has switched his Atrovent toSpiriva. Choose the correct statement regarding Spiriva:
A. Spiriva is dosed in a metered dose inhaler (MDI).
B. Spiriva contains ipratropium; an anticholinergic medication.
C. Spiriva is a long-acting beta-2 agonist.
D. Spiriva comes as capsules which are inhaled with the HandiHaler device.
E. Spiriva is dosed 1 puff twice per day after breakfast and dinner.
D. Spiriva is dosed once daily, using the Handihaler device. It is important that patients understand not to swallow the capsules.
What is the most likely side effect from the use of Spiriva?
A. Urinary retention
C. Dry mouth
E. Blurry vision
C. Spiriva can cause anticholinergic side effects but the most common one is dry mouth. There is more dry mouth with Spirivathan with Atrovent.
Which of the following is the correct generic name for Tudorza?
C. The generic name for Tudorza is aclidinium.
vilanterol/fluticasone (Breo Ellipta)
Breo Ellipta should be discarded how long after the removal from the foil tray if not used sooner?
A. 4 weeks
B. 6 weeks
C. 2 months
D. 3 months
E. 4 months
B. Breo Ellipta should be discarded 6 weeks after removal from the foil tray if not used sooner.
Which inhalers will make a sound upon inhalation? (Select ALL that apply.)
A. Combivent Respimat
B. Spiriva HandiHaler
C. Tudorza Pressair
D. Breo Ellipta
B, C, E. When from inhaling the Spiriva HandiHaler, the patient should hear the Spiriva capsule vibrate or rattle. When inhaling from the Arcapta Neohaler, the patient should hear a whirring sound. Tudorza Pressair will make a "click" sounds upon inhalation.
Which vaccines should COPD patients receive (if no contraindications are present)?
A. Influenza, meningococcal
B. Influenza, pneumococcal
C. Pneumococcal, meningococcal
D. Pneumococcal, varicella
E. Hepatitis, meningococcal
Which of the following statements are correct regarding Daliresp? (Select ALL that apply.)
A. It is used for mild COPD due to modest benefit.
B. It is a phosphodiesterase 4 inhibitor.
C. It can cause diarrhea, weight loss, nausea and depression.
D. The generic name is indacaterol.
E. It is contraindicated in severe renal impairment.
B, C. Roflumilast (Daliresp) is a phosphodiesterase 4 inhibitor. It is contraindicated in moderate-severe liver impairment.
Duc is started on Combivent. What are the ingredients in Combivent?
A. Albuterol + aclidinium
B. Ipratropium + formoterol
C. Tiotropium + salmeterol
D. Albuterol + ipratropium
E. Fluticasone + albuterol
D. Combivent contains albuterol + ipratropium.
Which of the following patient counseling points is false regarding Atrovent HFA?
A. To prime, spray twice away from the face. Prime again if it has been over 3 days since last use.
B. Breathe in sharply through the mouth wile pressing the top of the canister all the way down to inhale the medication.
C. Hold breathe for as long as possible, preferably 10 seconds.
D. If another inhalation is needed, wait at least 15 seconds.
E. Rinse Atrovent mouthpiece weekly.
B. The patient should be advised to breathe in slowly and deeply while inhaling the medication.
Which drugs require patients to rinse their mouth with water after use and spit? (Select ALL that apply.)
A. Advair Diskus
B. Breo Ellipta
C. Atrovent HFA
E. Spiriva HandiHaler
A, B, D. Advair Diskus, Breo Ellipta, and Symbicort all contain steroids which require patients to rinse their mouth and spit to reduce risk of oral candidiasis.