Exam 3 - Random Multiple Choice Flashcards by Rehman Hameed

What type of breath should be used with a dry powder inhaler?

A. Quick and shallow
B. Slow and deep
C. Quick and deep
D. Shallow and slow

C. Quick and deep

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When would you use a LABA as monotherapy in asthma patients?

A. Intermittent
B. Severe
C. Moderate
D. Never

D. Never

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Which of these is a LABA?

A. Fluticasone (Arnuity)
B. Albuterol (Ventolin)
C. Salmeterol (Serevent)
D. Tiotropium (Spiriva)

c. Salmeterol (Serevent)

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What are advantages of a Dry Powder Inhaler

A. Increased experience
B. Less expensive
C. Requires less coordination
D. Uses a propellant

c. Requires less coordination

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Which of these is an environmental risk factor for asthma? (select all that apply)

a. allergen exposure
b. antibiotic exposure
c. exposures to second hand smoke
d. genetic inheritance

a, b, c

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Which symptom frequency would be classified as moderate persistent asthma?

A. Nighttime awakening >1 time/week
B. Nighttime awakening <2 times/month
C. No interference with normal activity
D. SABA use several times a day

a. Nighttime awakening >1 time/week

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Which patient would be considered for a COPD diagnosis? (select all that apply)

A. A child with a history of asthma
B. >40 year old patient with a chronic cough, dyspnea and sputum production
C. A patient with shortness of breath during exercise
D. An adult with a history of smoking >1 pack per day for 10 years

B, D

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Presence of a post bronchodilator FEV1/FVC of <0.7 confirms the presence airflow limitation consistent with COPD

A. True
B. False

A. True

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what state is appropriate for a COPD patient with 2 exacerbations, CAT score of 5 and mMRC of 1?

a. A
b. B
c. C
d. D

c. C

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What COPD staging is appropriate for a patient with 1 exacerbation, CAT score of 15 and an
mMRC of 2?

A. A
B. B
C. C
D. D

B. B

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true or false: initial therapy for a GOLD group C should consist of a LAMA

true

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When should you consider an ICS therapy for a patient living with COPD?

A. Concurrent asthma diagnosis
B. Eosinophils >200
C. History of pneumonia
D. History of Mycobacteria infection

A. Concurrent asthma diagnosis

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Which medication is likely to cause a dry mouth and blurred vision?

A. Albuterol
B. Formoterol
C. Prednisone
D. Tiotropium

D. Tiotropium

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Which medication class when used as monotherapy may result in an increased risk of asthma related death?

A. Ipratropium
B. Levalbuterol
C. Prednisone
D. Salmeterol

d. Salmeterol

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what is the generic name for Pulmicort?

a. Mometasone
b. Beclamethasone
c. Budesonide
d. Fluticasone

c. Budesonide

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How can a patient prevent oral thrush when using an ICS?

A. Do not put tongue on the mouth piece
B. Gargle with listerine after use
C. Only take it at night
D. Wash mouth out with water and spit after use

D. Wash mouth out with water and spit after use

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CS is a 67-year-old man who is being seen for treatment of newly diagnosed chronic obstructive pulmonary disease (COPD). His past medical history is significant for hypertension, diabetes, cirrhosis (Child-Pugh C), and gastroesophageal reflux disease (GERD). Which medication should be avoided in CS?

a. azithromycin
b. Roflumilast
c. Olodaterol
d. Aclidinium

b. Roflumilast

(Roflumilast is hepatically metabolized and is contraindicated in moderate to severe hepatic impairment, like with Child-Pugh B or C)

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BD is a 59-year-old man with chronic obstructive pulmonary disease (COPD), hypertension, and dyslipidemia. He reports to your pharmacy complaining of developing a tremor since starting one of his medications. Which medication is the most likely cause?

A. Ipratropium

B. Tiotropium

C. Fluticasone

D. Prednisone

E. Albuterol

(tremors is a common side effect of beta-agonists. Other common effects include tachycardia and central nervous system stimulation/excitation)

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AJ is a 5-year-old who has been experiencing daytime rhinorrhea, night-time cough that woke him two times this past week, enuresis (involuntary urination) two times in the past months, and has a history of reflux. Which symptom is most likely to warrant a work up for asthma?

a. Rhinorrhea
b. Cough
c. Reflux
d. Enuresis

b. Cough

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Which one of the following medications would be contraindicated with Daliresp?

a. carbamazepine
b. simvastatin
c. clarithromycin
d. fluconazole

a. carbamazepine

(Daliresp is contraindicated for CYP3A4 inducers, such as carbamazepine)

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AZ is a 67-year-old white male who is receiving 32 mg/h of aminophylline in the hospital. He is ready to be changed to oral theophylline. What would the daily dose of theophylline be that would equal 32 mg/h of aminophylline? Aminophylline’s salt factor is 0.8.

a. 614 mg
b. 768 mg
c. 300 mg
d. 900 mg

a. 614 mg

(32 mg/h * 24 hours = 768 mg amionphylline in a daily dose. Multiply by 0.8 to get 614.4)

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CP is a 65-year-old man with chronic obstructive pulmonary disease (COPD), classified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines as patient group C. He is currently using albuterol inhaler as needed (prn), salmeterol inhaler twice a day, and tiotropium inhaler once a day. His COPD is still uncontrolled with frequent symptoms and a recent exacerbation. What recommendations would you make to his medication regimen?

a. add theophylline once daily
b. change salmeterol inhaler to fluticasone/salmeterol combination inhaler scheduled twice a day
c. add an oral corticosteroid once daily
d. change tiotropium inhaler to ipratropium inhaler scheduled four times a day
e. do not make any changes

b. change salmeterol inhaler to fluticasone/salmeterol combination inhaler scheduled twice a day

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Select the formulation of the corticosteroid that should be utilized in maintenance therapy for chronic obstructive pulmonary disease (COPD).

a. IV/injection (methylprednisolone
b. Oral (prednisone
c. Inhalation (fluticasone)
d. nasal (fluticasone)

c. Inhalation (fluticasone)

(inhalation is the preferred formulation/dosage route for maintenance therapy with COPD; this method minimizes adverse reactions; nasal preparations are used for allergic rhinitis)

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PL is a 75-year-old man who has been experiencing increased dyspnea (shortness of breath) for the past month. He was diagnosed with chronic obstructive pulmonary disease (COPD) 3 years ago and has been taking albuterol metered-dose inhaler on an as-needed (prn) basis. He has not had any exacerbations within the past year, and he has a Modified Medical Research Council (mMRC) score of 2. Which of the following is the best choice for changing his medication regimen?

a. add scheduled inhaled tiotropium and continue prn albuterol
b. add scheduled inhaled fluticasone and continue prn albuterol
c. add prn inhaled salmeterol and continue prn albuterol
d. add scheduled oral theophylline and continue prn albuterol
e. no changes are necessary at this time

a. add scheduled inhaled tiotropium and continue prn albuterol

(patient is in group B since he has had 1 or less exacerbation/year and his mMRC is ≥ 2; guidelines recommend adding regular treatment with one or more long-acting bronchodilators; B is incorrect because they haven’t had any exacerbations lately, so no ICS is needed; C is incorrect because salmeterol should be scheduled, not prn)

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Which of the following combinations of inhaled medications can be mixed in a nebulizer and delivered together? a. budesonide and albuterol b. albuterol and ipratropium c. levalbuterol and albuterol d. budesonide and formoterol

b. albuterol and ipratropium (this is DuoNeb)

Which of the following medications should be avoided with the use of albuterol? a. propranolol b. diltiazem c. digoxin d. warfarin

a. propranolol (albuterol should not be used in combination with nonselective beta-blockers due to risk of reduced effectiveness of albuterol; no interactions with the others)

Which of the following medications would NOT be recommended in treating a patient with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD)? a. doxycycline b. prednisone c. Combivent d. Stiolto

d. Stiolto (Stiolto is a LABA/LAMA combo and should not be used to treat an acute exacerbation)

CM is started on fluticasone/salmeterol dry powder inhaler (DPI) 100/50 mcg one puff BID. She returns for a follow-up visit with minimal improvement of symptoms and a forced expiratory volume in 1 second (FEV1) of 70% indicating not well-controlled asthma. After assessing environmental control and medication adherence what additional factor should be addressed prior to stepping up her asthma therapy? a. inhaler technique assessment for slow deep inhale b. albuterol use in the last month c. adherence to morning and evening peak flows d. inhaler technique assessment for forceful deep inhale

d. inhaler technique assessment for forceful deep inhale (DPI's require a forceful deep inhale)

A patient presents with symptoms of shortness of breath, nonproductive cough, and the following spirometry results: prebronchodilator forced expiratory volume in 1 second (FEV1): 69% predicted; post-bronchodilator FEV1: 70% predicted; FEV1/FVC ratio: 0.64. How would you interpret these findings? a. this patient has chronic obstructive pulmonary disease (COPD) with reversible airway obstruction b. this patient has COPD with irreversible airway obstruction c. this patient has asthma with reversible airway obstruction d. this patient does not have asthma since the airway obstruction is irreversible e. this patient does not have COPD or asthma

b. this patient has COPD with irreversible airway obstruction (the predicted prebronchodilator FEV was 69%, the post-bronchodilator FEV was 70%, meaning it didn't change with administration of a bronchodilator)

You are counseling the parents of a 2-year-old child who will be released from the hospital with a new prescription for a medium-dose inhaled corticosteroid. What side effect should you educate the parents about? a. reduced glucose production leading to hypoglycemia b. permanent growth suppression c. intermitted expiratory wheezing d. reduced growth over the first few years but not progressive

d. reduced growth over the first few years but not progressive

You are counseling a 25-year-old woman with asthma who is well-controlled with Advair 250/50 µg one puff bid and albuterol two puffs every 4 to 6 hours prn. She presents a prescription for prenatal vitamin from her initial obstetric appointment. What is the safest medication to recommend for control of her asthma? a. albuterol two puffs qid b. advair 250/50 one puff bid c. alvesco 160 µg one puff daily d. pulmicort 90 mg one puff bid

b. advair 250/50 one puff (In pregnancy when a patient is well-controlled on a current regimen continue treatment. If initiating controller therapy budesonide is the only category B inhaled corticosteroid)

Which one of the following represents a key difference between dry powder inhaler (DPI) and metered-dose inhaler (MDI) devices? a. the rate of inspiration necessary for proper lung deposition b. the need to rinse your mouth out after using them c. the amount of time you are required to hold your breath after inhalation d. the availability of inhaled corticosteroids (ICS)

a. the rate of inspiration necessary for proper lung deposition (need deep, forceful inspiration with a DPI; for an MDI it is a gentle inhalation; should be holding breath 5-10 seconds regardless of device type)

JB is started on fluticasone 220 mcg metred-dose inhaler (MDI) two puffs BID, albuterol MDI two puff q4-6hour prn cough, montelukast 10 mg one tablet at bedtime, and Loratadine 10 mg daily. Patient returns 1 month later with dysphonia and was recently treated for thrush. Which medication is most likely to cause the patient’s current side effects? a. fluticasone b. loratadine c. montelukast d. albuterol

a. fluticasone (The most common side effects of low to medium dose-inhaled corticosteroids are thrush and dysphonia.)

What is the preferred treatment option for a 46-year-old man with the diagnosis of asthma? Current complaints are wheezing in morning that gets better as day progresses. One episode of cough in past month and who has required three courses of oral steroids within the past year. Current forced expiratory volume in 1 second (FEV1) = 55%. a. medium-dosed inhaled corticosteroid (ICS) b. low-dose ICS and long acting β2-agonist (LABA) c. medium-dose ICS and LABA d. theophylline

c. medium-dose ICS and LABA (Patient is exhibiting severe persistent asthma which requires high-dose step four to six combination therapy.)

A 16-year old African American patient is admitted to the hospital for an asthma exacerbation. The patient was prescribed the following medications: Albuterol metered-dose inhaler (MDI) two puffs prn wheezing, Mometasone dry powder inhalation (DPI) one inhalation daily, Fexofenadine 180 mg one tablet daily, and Formoterol DPI one capsule BID. Which has demonstrated an increased risk of death when administered as monotherapy for daily control of asthma? a. albuterol b. mometasone c. fexofenadine d. formoterol

d. formoterol (LABA; it has a black box warning for increased risk of death if used as monotherapy for asthma)

ZH is a 59-year-old with chronic obstructive pulmonary disease (COPD) who was recently prescribed a fluticasone inhaler for COPD. He is concerned about the side effects of inhaled corticosteroids and you conduct inhaler counseling for him. Which of the following is the most likely side effect to be caused by inhaled corticosteroids? a. oral candidiasis b. glucose intolerance c. tachycardia d. immunosuppression e. weight gain

a. oral candidiasis (oral thrush)

What is considered an absolute contraindication to tiotropium? a. bronchospasm b. hypersensitivity reaction c. immunocompromised d. concurrent use with inhaled corticosteroid

b. hypersensitivity reaction

Select the chronic obstructive pulmonary disease (COPD) medications that can be used concurrently in a maintenance regimen for a patient classified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines as patient group C. a. levalbuterol and albuterol b. albuterol and formoterol c. formoterol and salmeterol d. fluticasone and mometasone e. theophylline and aminophylline

b. albuterol and formoterol (albuterol is a SABA, formoterol is a LABA, so they can be used concurrently; A includes two SABAs, C includes two LABAs, D includes two ICSs)

What is the approximate onset of action for levalbuterol metred-dose inhaler (MDI)? a. 2 to 3 minutes b. 5 to 10 minutes c. 30 to 60 minutes d. 4 to 6 hours

b. 5 to 10 minutes (levalbuterol is LABA with onset of about 5 min; might peak at 30 to 60 min; duration is about 4 to 6 hours)

B is a 60-year-old woman recently discharged from the hospital following an exacerbation of her chronic obstructive pulmonary disease (COPD). She was prescribed Advair, Spiriva, and Daliresp. She also has albuterol for as needed (prn) use. She complains of nausea and weight loss when she is picking up her refills and wants to know if one of these medications could be responsible. Which of the medications is most likely to cause these effects? a. Advair (fluticasone/salmeterol) b. Daliresp (roflumilast) c. Spiriva (tiotropium) d. ProAir (albuterol)

b. Daliresp (roflumilast) (most common AEs of roflumilast are GI effects and weight loss; most common AEs of ICS are thrush and hoarseness; most common AEs of LABAs is anxiety; most common AE of tiotropium is dry mouth; most common AEs of albuterol is anxiety and tremor)

The provider calls the pharmacy stating his patient is complaining of increased agitation and abnormal dreams and wants to know if any of the patient’s medications could be causing this side effect. Which medication is most likely contributing to the patient’s behavioral changes? a. Breo Ellipta b. Tiotropium c. Benralizumab d. Montelukast

d. Montelukast

Select the chronic obstructive pulmonary disease (COPD) medication that is a phosphodiesterase inhibitor. a. albuterol b. salmeterol c. ipratropium d. fluticasone e. roflumilast

e. roflumilast

What is the least amount of time that a patient should take Asmanex daily in order to start seeing benefit, symptom improvement? a. 24 hours b. 3 days c. 1 week d. 10 days

c. 1 week (usually takes 2 weeks to 1 month for full effect)

HB is a 72-year-old woman who is being treated for a chronic obstructive pulmonary disease (COPD) exacerbation in the emergency department. She has a past medical history significant for chronic kidney disease (CKD) 4 (glomerular filtration rate [GFR] 20 mL/min), hypertension, and gout. She has been initiated on prednisone 40 mg PO daily, albuterol nebulizations every hour, and supplemental oxygen. It is determined that an antibiotic is also needed. Which of the following antibiotics would be contraindicated in this patient. a. augmentin b. doxycycline c. bactrim d. zithromax

c. bactrim (bactrim is contraindicated in patients with severe renal impairment without the ability to monitor renal function; recommended classes for acute COPD exacerbations are aminopenicillins, tetracyclines, and macrolides)

A patient is currently on albuterol two puffs po q4H PRN and Advair 500 mcg/50 mcg two puffs po BID for asthma, which remains uncontrolled. The provider wants to start zafirlukast 20 mg po BID and asks you to counsel the patient on how to take this medication. Which of the following is the correct administration? a. administer only when having asthma symptoms b. administer with a fatty meal c. administer 1 hour before or 2 hours after meals d. administer with food and a full glass of water

c. administer 1 hour before or 2 hours after meals (food decreases absorption of zafirlukast and should be taken on an empty stomach)

A patient presents to the clinic complaining about using his reliever inhaler 4 times a week and waking up at night due to difficulty breathing over the last 4 weeks. This patient’s asthma is a. well controlled b. partially controlled c. uncontrolled

b. partially controlled

A patient has the following symptoms. Assess the severity of this patient’s asthma: Sx occur daily Nighttime awakenings > once a week SABA use multiple times a day Some limitation with normal activity a. Intermittent b. Persistent-mild c. Persistent-moderate d. Persistent-severe

d. persistent severe (SABA use multiple times per day)

stage this patient's COPD: 1 exacerbation, leading to hospitalization mMRC of 2, CAT of 22 a. A b. B c. C d. D

d. D

Which of the following are appropriate therapies to initiate in a patient with an mMRC of 2, CAT of 22, and 1 exacerbation leading to hospitalization. Select all that apply a. LAMA b. LAMA/LABA c. Bronchodilator d. ICS + LABA

a and b (need an eosinophil count for ICS)

What is the first step in asthma treatment for patients 5 or younger? a. SABA prn b. Daily low dose ICS c. Low dose ICS + formoterol prn

a. SABA prn

which of the following inhalers are combination inhalers? Select all that apply a. Seebri b. Advair c. Pulmicort d. Anoro Ellipta

b. Advair (fluticasone/salmeterol) d. Anoro Ellipta (vilanterol/umeclidinium)

A 14 yo patient with asthma is currently on a daily low dose ICS to control their asthma but finds herself using her SABA 3-4 times a week. What is the next step to treat their asthma? a. High dose ICS + LABA b. Medium dose ICS + LABA c. Add a LABA d. Add a LTRA

c. Add a LABA

Stage this patient's COPD: FEV1/FVC is 0.65 FEV1 is 82% a. mild b. moderate c. severe d. very severe

a. mild

A patient comes to the clinic for a follow up on her COPD complaining of difficulty breathing. She is currently using Salmeterol 50 mcg. What is appropriate to initiate in this patient to improve her symptoms? a. Switch to an ICS b. Add Spiriva Handihaler c. Switch to Advair Diskus d. Switch to Symbicort

b. Add Spiriva Handihaler

histamine is synthesized in a. macrophages b. eosinophils c. mast cells d. basophils e. both c and d

e. both c and d

Mast cell degranulation requires all of the following EXCEPT a. Binding of antigens to IgE antibodies b. Efflux of calcium via calcium release activated channels (CRAC) c. Clustering of FcεR receptors d. Binding of IgE to FcεR receptors

b. Efflux of calcium via calcium release activated channels (should be "influx" not "efflux")

______ are responsible for vasodilation in the ______, while _______ are responsible for it in the _______ a. H2 receptors; endothelium; H1 receptors; smooth muscle b. H3 receptors; smooth muscle; H2 receptors; endothelium c. H4 receptors; endothelium; H2 receptors; smooth muscle d. H2 receptors; smooth muscle; H1 receptors; endothelium

d. H2 receptors; smooth muscle; H1 receptors; endothelium

Which treatment option of AR provides the most complete symptomatic relief? a. Intranasal cromolyn b. Intranasal corticosteroids c. Oral antihistamines d. Intranasal antihistamine

b. Intranasal corticosteroids

Which of the following reactions is matched with its correct phase? a. Antigen binding to IgE; Delayed reaction b. Vascular leakage; Delayed reaction c. TH2 lymphocytes release IL-4; Early reaction d. Mast cells release tryptase; Early reaction

d. Mast cells release tryptase; Early reaction

Which of the following statements regarding asthma is false? a. Goblet cell hyperplasia leads to hypersecretion of mucus b. In asthma patients, the number of ciliated cells and goblet cells increase c. Q576R polymorphism in IL-4α receptor may lead to hypersensitivity to antigen d. IL13 receptors are increased in asthma patients

b. In asthma patients, the number of ciliated cells and goblet cells increase (ciliated cells decrease bc they become goblet cells)

Which of the following receptors is known to be the main contributor to fibrosis in asthma? a. IL 13 b. IL 1 c. Histamine d. Tryptase

a. IL 13

Which of the following does not happen in asthma airway remodeling? a. Mucous hypersecretion b. Basement membrane thickening c. Bronchoconstriction d. Smooth muscle hypertrophy

c. Bronchoconstriction

Which of the following is NOT a first responder in EVALI? a. Granulocytes b. Goblet cells c. Alveolar macrophage d. Neutrophils

b. Goblet cells

Excessively ____ sweat is an early sign of CF. a. Sweet b. Sour c. Bitter d. Salty

d. Salty

Which of the following statements is FALSE regarding β2 receptor agonist? a. Activates Gq b. Increases cAMP concentration c. Leads to bronchial smooth muscle relaxation d. Myosin light chain kinase is phosphorylated as a result of β2 activation

a. Activates Gq (it is Gs)

Which of the following β2 agonists should be used in combination with ICS in asthma patients? a. Albuterol b. Salmeterol c. Levalbuterol d. Terbutaline

b. Salmeterol

Which of the following statements regarding glucocorticoids/inhaled corticosteroid is FALSE? a. It inhibits prostaglandin and leukotriene synthesis b. Increases risk of fungal infection c. Decrease hyperresponsiveness in chronic asthma d. High systemic side effect

d. High systemic side effect (has low systemic side effects)

tiotropium mechanism of action a. Inhibits CysLT1 receptor b. Competitive inhibition of muscarinic receptors in lung c. Prevents degranulation and the release of histamine from mast cells d. Alter gene expression of protein important in inflammatory response e. Reduces free IgE concentration

b. Competitive inhibition of muscarinic receptors in lung (tiotropium is a LAMA, so blocks bronchoconstrictor effects of ACh on M3 and M2 receptors)

beclomethasone mechanism of action a. Inhibits CysLT1 receptor b. Competitive inhibition of muscarinic receptors in lung c. Prevents degranulation and the release of histamine from mast cells d. Alter gene expression of protein important in inflammatory response e. Reduces free IgE concentration

d. Alter gene expression of protein important in inflammatory response

montelukast sodium mechanism of action a. Inhibits CysLT1 receptor b. Competitive inhibition of muscarinic receptors in lung c. Prevents degranulation and the release of histamine from mast cells d. Alter gene expression of protein important in inflammatory response e. Reduces free IgE concentration

a. Inhibits CysLT1 receptor

cromolyn sodium mechanism of action a. Inhibits CysLT1 receptor b. Competitive inhibition of muscarinic receptors in lung c. Prevents degranulation and the release of histamine from mast cells d. Alter gene expression of protein important in inflammatory response e. Reduces free IgE concentration

c. Prevents degranulation and the release of histamine from mast cells (cromolyn is a mast cell stabilizer)

omalizumab mechanism of action a. Inhibits CysLT1 receptor b. Competitive inhibition of muscarinic receptors in lung c. Prevents degranulation and the release of histamine from mast cells d. Alter gene expression of protein important in inflammatory response e. Reduces free IgE concentration

e. Reduces free IgE concentration (omalizumab is anti-IgE)

Which of the following is not a side effect of β2 agonist? a. Skeletal muscle tremor b. Tachycardia c. Seizure d. Palpitation

c. Seizure

which of these medications works by blocking phosphodiesterase and increasing cAMP? a. ProAir HFA b. Theophylline c. Prednisone d. Pulmicort Flexhaler e. Zyrtec D

b. Theophylline (Theophylline is a nonselective phosphodiesterase inhibitor. It causes an inc in cyclic AMP, which promotes the release of epinephrine from adrenal glands. This causes bronchodilation)

Which of the following asthma medications works by blocking interleukin-5 receptors? a. Xolair b. Zafirlukast c. Dulera d. Mepolizumab e. Theophylline

d. Mepolizumab

which of the following statements concerning omalizumab is correct? a. omalizumab is a PDE-5 inhibitor that causes bronchodilation b. omalizumab is indicated for initial therapy in patients who have allergies and mild, persistent asthma c. omalizumab can cause anaphylaxis; the first dose must be administered in a healthcare setting d. omalizumab can be administered intramuscularly at home if an adult or parent has received training e. omalizumab is dosed based on IgG levels and body weight

c. omalizumab can cause anaphylaxis; the first dose must be administered in a healthcare setting

which of the following is the most common cause of COPD? a. alpha-1 antitrypsin deficiency b. smoking c. occupational chemical exposure d. indoor air pollution from cooking fumes e. outdoor air pollution

b. smoking

what is the gold-standard test used to diagnose COPD? a. V/Q scan b. chest X-ray c. peak flow d. spirometry e. bronchoscopy

d. spirometry

what are the active ingredients in Combivent? a. albuterol + aclidinium b. ipratropium + formoterol c. tiotropium + salmeterol d. albuterol + ipratropium e. fluticasone + albuterol

d. albuterol + ipratropium

DK is a 67 YOM who was recently hospitalized for an acute exacerbation of his COPD and pneumonia. He is intubated and has been in the ICU for 1 day. His home medications include Aclidinium 1 inhalation BID, and Nexium OTC as needed. What type of medication was DK taking at home for COPD? a. inhaled ICS b. short-acting muscarinic antagonist c. long-acting beta-2 agonist d. long-acting muscarinic antagonist e. phosphodiesterase-4 inhibitor

d. long-acting muscarinic antagonist (aclidinium, aka Tudorza Pressair is a LAMA)

A 52 YOF with COPD drops off a new prescription for roflumilast at the pharmacy. Which of the following side effects should the pharmacist counsel her on? a. constipation b. flushing c. pruritus d. sedation e. weight loss

e. weight loss

which class of medications has been shown to be the most effective in treating COPD when used on a regular basis? a. short-acting inhaled bronchodilators b. long-acting inhaled bronchodilators c. oral corticosteroids d. theophylline e. leukotriene modifying agents

b. long-acting inhaled bronchodilators

CD is a 25 YOF with asthma whose home medications include Arnuity Ellipta 2 inhalations daily, Proventil HFA 1-2 inhalations Q4-6H PRN, loratadine 10 mg daily and a multivitamin. She states that her symptoms are generally well-controlled but notices that she consistently has difficulty breathing during her aerobics class. What would be the most appropriate treatment change for CD's current complaint? a. switch the Arnuity Ellipta to Flovent Diskus b. take 2 inhalations of Proventil 5-15 minutes before exercise c. discontinue the Arnuity Ellipta; start salmeterol d. add prednisone 10 mg; take two hours prior to exercise e. take 2 inhalations of Arnuity Ellipta 30 minutes before exercise

b. take 2 inhalations of Proventil 5-15 minutes before exercise (CD is experience exercise-induced bronchospasm (EIB). The shortness of breath during exercise can be prevented by taking 2 inhalations from her albuterol inhaler 5-15 minutes before exercise)

Place the instructions for proper use of Combivent Respimat in the correct order. a. open the cap until it snaps fully open b. press the dose release button while taking a slow, deep breath in through the mouth c. hold breath as long as possible, up to 10 seconds d. turn the clear base in the direction of the arrow until it clicks e. exhale full then place the lips around the mouthpiece

d, a, e, b, c (Combivent Respimat is a MDI, but does not need to be shaken prior to use. It is dosed at 1 inhalation QID)

HL has had asthma for a number of years, but is in denial about her disease. At the age of 22 years, she wants to better manage her condition. Her doctor tells her that she has moderate persistent asthma and explains to her how to use a peak flow meter. HL's personal best is 300 mL. Once she gets to the pharmacy, she admits to forgetting the steps for using it. Which of the following statements are correct in counseling HL on the appropriate use of a peak flow meter? (Select all that apply) a. use the peak flow meter in the morning, before taking any asthma medications b. record the highest number of each day in a log book c. for best results, perform the assessment in a supine position d. blow out slow and steady to get as much air exhaled as possible e. if the value recorded is < 150 mL, seek medical help immediately, regardless of symptoms

a, b, e (using a peak flow meter requires the patient to be in a standing (or at least upright) position for best measurement. Patients should blow out as hard and as fast as possible)

how often should the plastic actuator for Atrovent HFA be cleaned? a. every day b. at least weekly c. after every use d. if the inhaler hasn't been used for > 3 days e. every two weeks

b. at least weekly (MDI's, e.g. HFA inhalers, should be cleaned at least weekly by running under warm water and letting it air dry. Only clean the plastic actuator, the metal canister should not get wet)

which inhaler has a window that turns from green to red to indicate a dose was given? a. Umeclidinium/Vilanterol b. Olodaterol c. Tiotropium d. Aclidinium e. Indacaterol/Glycopyrrolate

d. Aclidinium (This is Tudorza Pressair, which has a window that turns from green to red when the patient has inhaled the medication)

A 42 YOF female patient has asthma and prefers 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. IV d. patch e. inhaled

e. inhaled

e. inhaled (inhaled route is preferred in asthma since the medication is delivered directly to the airways of the lungs)

which of the following medications is available as a dry powder inhaler? a. ProAir HFA b. Alvesco c. Breo Ellipta d. Symbicort e. Bevespi Aerosphere

c. Breo Ellipta

Pulmicort Respules are used primarily in this population group: a. patients over the age of 55 years b. adults aged 30-50 years c. children d. patients who have failed theophylline e. patients who have failed leukotriene modifying agents

c. children

which of the following side effects should a patient be counseled on prior to starting arformoterol (Brovana)? a. thrush b. tremors c. hyperkalemia d. drowsiness e. depression

b. tremors (Arformoterol is a LABA. Tremors, nervousness, tachycardia and palpitations are common side effects)

which of the following medications come as a dry powdered inhaler? (Select ALL that apply) a. Combivent Respimat b. Symbicort c. Umeclidinium (Incruse Ellipta) d. Breo Ellipta e. Spiriva Handihaler

c, d, e

SC is a 4 YO patient with moderate persistent asthma. He has been poorly controlled on an albuterol inhaler and a low-dose ICS. The physician wants to add a leukotriene modifier to SC's regimen. Which agent can be recommended? a. Zileuton b. Zafirlukast c. Indacaterol d. Reslizumab e. Montelukast

e. Montelukast (Montelukast is indicated for patients 2+ years of age. Zafirlukast is indicated for patients 5+. Zileuton is indicated for patients 12+. These are the only 3 leukotriene modifiers of the answer choices)

Place the instructions for proper use of an albuterol MDI inhaler in the correct order: a. breathe out fully to expel as much air from the lungs as possible b. shake for 5 seconds c. hold breath for as long as possible, up to 10 seconds d. press the top of the canister while breathing deeply and slowly e. place the mouthpiece into the mouth and close lips around it

b, a, e, d, c

which of the following medications contains a LABA? (Select ALL that apply) a. Spiriva Respimat b. Advair Diskus c. Symbicort d. Combivent Respimat e. Breo Ellipta

b, c, e

JT is a 43 YOM with a history of COPD, for which he currently takes Combivent Respimat and salmeterol. He presents to the clinic today for follow-up after recovering from an exacerbation. His labs show an eosinophil count of 450 cells/uL. What is an appropriate recommendation to make at this time? a. add Atrovent HFA b. add Spiriva Respimat c. change salmeterol to formoterol d. change salmeterol to Advair Diskus e. add prednisone

d. change salmeterol to Advair Diskus (increased levels of eosinophils (> 300 cells/uL) suggest there is inflammation present. An ICS should be added to reduce the inflammation)

which of the following are possible side effects of a ProAir HFA rescue inhaler? (select all that apply) a. tremor b. hypokalemia c. hyperglycemia d. bradycardia e. leukocytosis

a, b, c

which of the following would confirm a diagnosis of COPD? a. Post-bronchodilator increase in FEV1 by > 12% b. Peak expiratory flow rate < 80% of personal best c. FEV1 < 60% predicted based on age d. Post-bronchodilator FEV1/FVC < 0.7 e. No other identifiable cause of symptoms

d. Post-bronchodilator FEV1/FVC < 0.7

What is the most likely side effect from the use of Spiriva? a. urinary retention b. depression c. dry mouth d. constipation e. blurry vision

c. dry mouth (Spiriva can cause anticholinergic side effects, with the most common being dry mouth. Other anticholinergic side effects (e.g. urinary retention) are more likely with over-use of the medication. Dry mouth is more common than blurry vision)

A patient is picking up a new prescription for an ipratropium inhaler and asks the pharmacist how to use it. Which of the following instructions should the pharmacist provide on the appropriate use of this medication? a. there is no need to prime the device before use b. breathe in slowly and deeply while pressing the top of the canister c. breathe out immediately after inhaling d. rinse your mouth after each use e. shake the canister prior to each dose

b. breathe in slowly and deeply while pressing the top of the canister (Ipratropium, aka Atrovent HFA, is an MDI that needs to be primed before the first dose, but it does not need to be shaken)

A 48 year old male with past medical history of hypothyroidism, asthma, and hypertension presents to his PCM with a primary complaint of persistent shortness of breath. He has increased use of his short-acting albuterol MDI to twice daily in response to shortness of breath which has persisted over the last month (not related to infectious illness). He also takes fluticasone propionate 110mcg 2 puffs BID. He also currently takes levothyroxine 100mcg orally daily and lisinopril 20mg daily. Vitals and labs are WNL. His provider wishes to initiate a combination long-acting beta agonist with inhaled corticosteroid combination in one inhaler/diskus. Which of the following contains both of these medications? Select ALL that apply. a. Symbicort b. Breo Ellipta c. Dulera d. Advair HFA e. Arnuity Ellipta

a, b, c, d

A patient is prescribed Advair Diskus for her asthma. Which of the following counseling points should be reviewed? (Select ALL that apply) a. Wash the Diskus with a wet cloth weekly b. If she does not feel or taste the medication, take another dose c. This is not a rescue medication for acute asthma attacks d. Rinse mouth with water and spit after each dose of medication e. Never breathe into the Diskus

c, d, e (Advair Diskus is fluticasone/salmeterol, which is an ICS/LABA combo. Never take an extra dose, even if the patient did not taste or feel the medication. Keep the Diskus dry at all times.)

A 70-year-old patient has been prescribed Xopenex. Choose the CORRECT statement concerning Xopenex: a. Xopenex causes more tachycardia than albuterol b. Xopenex requires more frequent dosing than albuterol c. Xopenex is only available as a nebulizer solution d. Xopenex is the R-isomer of albuterol e. Xopenex is the brand name for indacaterol

d. Xopenex is the R-isomer of albuterol

Most metered-dose inhalers need to be shaken well immediately before use. Which MDI does NOT have to be shaken before each use? a. QVAR Redihaler b. Symbicort c. Xopenex HFA d. Flovent HFA e. Asmanex HFA

a. QVAR Redihaler (QVAR Redihaler, Alvesco and Respimat products are MDIs that don't need to be shaken before use)