Exam 3 - Random Multiple Choice

Question 1

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

Answer 1

C. Quick and deep

Question 2

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

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

Answer 2

D. Never

Question 3

Which of these is a LABA?

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

Answer 3

c. Salmeterol (Serevent)

Question 4

What are advantages of a Dry Powder Inhaler

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

Answer 4

c. Requires less coordination

Question 5

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

Answer 5

a, b, c

Question 6

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

Answer 6

a. Nighttime awakening >1 time/week

Question 7

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

Answer 7

B, D

Question 8

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

A. True
B. False

Answer 8

A. True

Question 9

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

Answer 9

c. C

Question 10

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

Answer 10

B. B

Question 11

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

Answer 11

true

Question 12

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

Answer 12

A. Concurrent asthma diagnosis

Question 13

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

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

Answer 13

D. Tiotropium

Question 14

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

Answer 14

d. Salmeterol

Question 15

what is the generic name for Pulmicort?

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

Answer 15

c. Budesonide

Question 16

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

Answer 16

D. Wash mouth out with water and spit after use

Question 17

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

Answer 17

b. Roflumilast

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

Question 18

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

Answer 18

E. Albuterol

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

Question 19

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

Answer 19

b. Cough

Question 20

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

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

Answer 20

a. carbamazepine

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

Question 21

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

Answer 21

a. 614 mg

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

Question 22

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

Answer 22

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

Question 23

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)

Answer 23

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)

Question 24

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

Answer 24

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)

Question 25

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

Answer 25

b. albuterol and ipratropium

(this is DuoNeb)

Question 26

Which of the following medications should be avoided with the use of albuterol?

a. propranolol
b. diltiazem
c. digoxin
d. warfarin

Answer 26

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)

Question 27

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

Answer 27

d. Stiolto

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

Question 28

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

Answer 28

d. inhaler technique assessment for forceful deep inhale

(DPI’s require a forceful deep inhale)

Question 29

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

Answer 29

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)

Question 30

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

Answer 30

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

Question 31

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

Answer 31

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)

Question 32

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)

Answer 32

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)

Question 33

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

Answer 33

a. fluticasone

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

Question 34

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

Answer 34

c. medium-dose ICS and LABA

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

Question 35

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

Answer 35

d. formoterol

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

Question 36

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

Answer 36

a. oral candidiasis

(oral thrush)

Question 37

What is considered an absolute contraindication to tiotropium?

a. bronchospasm
b. hypersensitivity reaction
c. immunocompromised
d. concurrent use with inhaled corticosteroid

Answer 37

b. hypersensitivity reaction

Question 38

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

Answer 38

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)

Question 39

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

Answer 39

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)

Question 40

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)

Answer 40

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)

Question 41

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

Answer 41

d. Montelukast

Question 42

Select the chronic obstructive pulmonary disease (COPD) medication that is a phosphodiesterase inhibitor.

a. albuterol
b. salmeterol
c. ipratropium
d. fluticasone
e. roflumilast

Answer 42

e. roflumilast

Question 43

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

Answer 43

c. 1 week

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

Question 44

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

Answer 44

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)

Question 45

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

Answer 45

c. administer 1 hour before or 2 hours after meals

(food decreases absorption of zafirlukast and should be taken on an empty stomach)

Question 46

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

Answer 46

b. partially controlled

Question 47

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

Answer 47

d. persistent severe

(SABA use multiple times per day)

Question 48

stage this patient’s COPD:
1 exacerbation, leading to hospitalization
mMRC of 2, CAT of 22

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

Answer 48

d. D

Question 49

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

Answer 49

a and b

(need an eosinophil count for ICS)

Question 50

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

Answer 50

a. SABA prn

Question 51

which of the following inhalers are combination inhalers? Select all that apply

a. Seebri
b. Advair
c. Pulmicort
d. Anoro Ellipta

Answer 51

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

Question 52

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

Answer 52

c. Add a LABA

Question 53

Stage this patient’s COPD:
FEV1/FVC is 0.65
FEV1 is 82%

a. mild
b. moderate
c. severe
d. very severe

Answer 53

a. mild

Question 54

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

Answer 54

b. Add Spiriva Handihaler

Question 55

histamine is synthesized in

a. macrophages
b. eosinophils
c. mast cells
d. basophils
e. both c and d

Answer 55

e. both c and d

Question 56

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

Answer 56

b. Efflux of calcium via calcium release activated channels

(should be “influx” not “efflux”)

Question 57

______ 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

Answer 57

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

Question 58

Which treatment option of AR provides the most complete symptomatic relief?

a. Intranasal cromolyn
b. Intranasal corticosteroids
c. Oral antihistamines
d. Intranasal antihistamine

Answer 58

b. Intranasal corticosteroids

Question 59

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

Answer 59

d. Mast cells release tryptase; Early reaction

Question 60

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

Answer 60

b. In asthma patients, the number of ciliated cells and goblet cells increase

(ciliated cells decrease bc they become goblet cells)

Question 61

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

Answer 61

a. IL 13

Question 62

Which of the following does not happen in asthma airway remodeling?

a. Mucous hypersecretion
b. Basement membrane thickening
c. Bronchoconstriction
d. Smooth muscle hypertrophy

Answer 62

c. Bronchoconstriction

Question 63

Which of the following is NOT a first responder in EVALI?

a. Granulocytes
b. Goblet cells
c. Alveolar macrophage
d. Neutrophils

Answer 63

b. Goblet cells

Question 64

Excessively ____ sweat is an early sign of CF.

a. Sweet
b. Sour
c. Bitter
d. Salty

Answer 64

d. Salty

Question 65

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

Answer 65

a. Activates Gq

(it is Gs)

Question 66

Which of the following β2 agonists should be used in combination with ICS in asthma patients?

a. Albuterol
b. Salmeterol
c. Levalbuterol
d. Terbutaline

Answer 66

b. Salmeterol

Question 67

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

Answer 67

d. High systemic side effect

(has low systemic side effects)

Question 68

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

Answer 68

b. Competitive inhibition of muscarinic receptors in lung

(tiotropium is a LAMA, so blocks bronchoconstrictor effects of ACh on M3 and M2 receptors)

Question 69

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

Answer 69

d. Alter gene expression of protein important in inflammatory response

Question 70

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

Answer 70

a. Inhibits CysLT1 receptor

Question 71

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

Answer 71

c. Prevents degranulation and the release of histamine from mast cells

(cromolyn is a mast cell stabilizer)

Question 72

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

Answer 72

e. Reduces free IgE concentration

(omalizumab is anti-IgE)

Question 73

Which of the following is not a side effect of β2 agonist?

a. Skeletal muscle tremor
b. Tachycardia
c. Seizure
d. Palpitation

Answer 73

c. Seizure

Question 74

which of these medications works by blocking phosphodiesterase and increasing cAMP?

a. ProAir HFA
b. Theophylline
c. Prednisone
d. Pulmicort Flexhaler
e. Zyrtec D

Answer 74

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)

Question 75

Which of the following asthma medications works by blocking interleukin-5 receptors?

a. Xolair
b. Zafirlukast
c. Dulera
d. Mepolizumab
e. Theophylline

Answer 75

d. Mepolizumab

Question 76

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

Answer 76

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

Question 77

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

Answer 77

b. smoking

Question 78

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

Answer 78

d. spirometry

Question 79

what are the active ingredients in Combivent?

a. albuterol + aclidinium
b. ipratropium + formoterol
c. tiotropium + salmeterol
d. albuterol + ipratropium
e. fluticasone + albuterol

Answer 79

d. albuterol + ipratropium

Question 80

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

Answer 80

d. long-acting muscarinic antagonist

(aclidinium, aka Tudorza Pressair is a LAMA)

Question 81

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

Answer 81

e. weight loss

Question 82

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

Answer 82

b. long-acting inhaled bronchodilators

Question 83

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

Answer 83

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)

Question 84

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

Answer 84

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)

Question 85

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

Answer 85

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)

Question 86

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

Answer 86

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)

Question 87

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

Answer 87

d. Aclidinium

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

Question 88

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

Answer 88

e. inhaled

Question 89

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

Answer 89

e. inhaled

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

Question 90

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

Answer 90

c. Breo Ellipta

Question 91

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

Answer 91

c. children

Question 92

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

Answer 92

b. tremors

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

Question 93

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

Answer 93

c, d, e

Question 94

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

Answer 94

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)

Question 95

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

Answer 95

b, a, e, d, c

Question 96

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

Answer 96

b, c, e

Question 97

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

Answer 97

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)

Question 98

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

Answer 98

a, b, c

Question 99

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

Answer 99

d. Post-bronchodilator FEV1/FVC < 0.7

Question 100

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

Answer 100

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)

Question 101

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

Answer 101

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)

Question 102

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

Answer 102

a, b, c, d

Question 103

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

Answer 103

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.)

Question 104

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

Answer 104

d. Xopenex is the R-isomer of albuterol

Question 105

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

Answer 105

a. QVAR Redihaler

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