Asthma
SF is a 3 year old girl who weighs 33 pounds. She is prescribed 0.1 mg/kg albuterol in 2.5 mL of normal saline. How many milliliters of the 0.5% albuterol solution is needed to fill this prescription? (Answer must be numeric; not units or commas; include leading zero when answer is less than 1.)
0.3
ST, a 35 y/o male, is in the hospital for an acute exacerbation of his asthma. Medications Albuterol nebulized treatments PRN Ipratropium nebulized treatments PRN Protonix 40 mg IV daily Aminophylline IV 1,000 mg in 1L of NS at 30 mL/hr How much theophylline will Samuel receive per day? (Answer must be numeric; no units or commas; round final answer to the nearest WHOLE number.)
576
A patient is starting on Singulair. Which of the following are side effects of Singulair? A Headache B Bleeding C Tachycardia D Cough E Purple lung syndrome
A
A patient with moderate asthma enters the pharmacy and asks for a pharmacist's recommendation for headache pain. Choose the safest option: A Acetaminophen B Ibuprofen C Naproxen D Capsaicin cream E Flector patch
A
CM 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
MS 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
Which of the following are possible side effects from the use of an albuterol HFA inhaler? A Nervousness and tremor B Hyperkalemia C Hypoglycemia D Bradycardia E Headache
A
HL 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. HL's personal best is 300 mL. Now she is in the pharmacy and she has selected a peak flow meter to purchase but 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 she takes her medications. B Record the highest number of each day in a log book. C It is best to perform the assessment in a supine position with legs not elevated higher than the lungs. D Coughing during the assessment invalidates the reading. E If the value recorded is < 150 mL, she should go to the hospital immediately, regardless of symptoms.
A,B,D,E
Which of the following medications can increase theophylline levels and possibly result in theophylline toxicity? (Select ALL that apply.) A Ciprofloxacin B Bupropion C Zafirlukast D Ranitidine E Clarithromycin
A,C,E
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.
ABD
AG is a 17 year-old patient with moderate persistent 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
Albuterol comes in all of the following formulations EXCEPT: A Syrup B Injection C Tablet D Nebulizer solution E Metered dose inhaler
B
What is the generic name of Arnuity Ellipta? Answer A Mometasone B Fluticasone C Indacaterol D Aclidinium E Tiotropium
B
JW is well-controlled on his asthma medications which include Flovent HFA 220 mcg BID, Serevent Diskus 1 inhalations BID, and Proventil 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 JW's risk of thrush in the future? (Select ALL that apply. A Mr. Wallach should drink 8 oz of water after taking his medications. B Mr. Wallach should gargle with warm warm and spit out the rinse after using his medications. C Mr. Wallach should purchase a spacer device and use with his Serevent Diskus. D Mr. Wallach should purchase a spacer device and use with his Flovent HFA. E Mr. Wallach should not kiss others as this infection is contagious.
B,D
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, Step 6 asthma should never use oral steroids for maintenance therapy. B Oral steroids can cause many problems, including lowered blood glucose. C Short-term use of prednisone is not associated with decreased bone mineral density. D A brand name is Medrol. E Oral steroids reduce appetite and cause anorexia.
C
CD is a 17 year-old with asthma. She likes to play basketball. Before heading to the court, CD needs to use her albuterol inhaler to help prevent exercise-induced symptoms. Choose the correct statement regarding albuterol: Answer A Albuterol HFA inhalers are damaging to the ozone. B Albuterol is a beta-2 antagonist and is the 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
Pulmicort respules are used primarily in this population group: Answer 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
Which of the following are correct statements regarding Asthmanefrin? A This medication contains the R-isomer of epinephrine. B This medication is available with a prescription. 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.
C
CH 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, one time on Tuesday and one time on Wednesday. It is now Thursday. What would be an appropriate recommendation to make at this time? (Select ALL that apply.) A Take Ventolin 2 inhalations Q4-6H starting today. B Start Serevent Diskus 1 inhalation BID for better symptom control. C Continue to take the Ventolin PRN for acute symptoms. D Start Pulmicort Flexhaler 2 inhalations BID for better symptom control. E Start Singulair 20 mg PO QHS.
C,D
A patient with asthma has been prescribed the Advair Diskus. Which of the following statements is correct? A Advair Diskus contains fluticasone, a long-acting beta-2 agonist. B Advair Diskus contains salmeterol, an inhaled corticosteroid. C Advair Diskus is dosed 1 inhalation once daily. D Advair Diskus treats both airway constriction and inflammation. E Advair Diskus requires shaking before each use.
D
DH has been using prednisone 10 mg PO daily for the past month post discharge from her recent asthma exacerbation. Her physician wants to taper her off the medication. What is the reason corticosteroids must be tapered? Answer 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
RL is a pharmacist in a busy store. CK is a mother who came in with her eight year old daughter. The child had a new prescription for an albuterol inhaler. RL quickly instructed the mother how to use the MDI. When she got home, CK 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 medication. What is the most important thing that RL 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
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
SF 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 The granule packet can be opened 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; the mixture can be stored up to 2 hours.
D...TEASPOON WILL BE OK
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: Answer A This is inappropriate; QVAR HFA is used only for patients needing high dose inhaled corticosterdoid therapy. B This is inappropriate; QVAR HFA should not be used in children due to growth retardation. C This is appropriate; QVAR HFA is a long-acting beta-2 agonist and albuterol is a short-acting beta-2 agonist. D This 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
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: Answer A The patient will require a higher dose of theophylline 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 liver failure. E Theophylline should be dosed on the patient's ideal body weight.
E
SC is a 4 year-old patient with moderate persistent 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 SC's regimen. Which agent can be recommended? Answer A Zileuton B Theophylline C Indacaterol D Zafirlukast E Montelukast
E
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 Ventolin
a
Most metered-dose inhalers need to be shaken well immediately before use. Which metered-dose inhaler does not have to be shaken before use? A QVAR B Symbicort C Pulmicort Flexhaler D Flovent HFA E Asmanex HFA
a
Question NT 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. NT 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
What is the generic name of Xopenex? A Levalbuterol B Tiotropium C Omalizumab D Arformoterol E Mepolizumab
a
Which of the following asthma medications works by blocking interleukin-5 receptors? A Nucala B Xolair C Accolate D Dulera E Theo-24
a
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
Which of the following medications is available as a dry powder inhaler? A Pulmicort Flexhaler B QVAR C Xopenex D Symbicort E Bevespi Aerosphere
a
A patient with severe, persistent asthma has been using prednisone 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 osteoporosis B Elevated blood glucose and diabetes C Poor wound healing D Alopecia E Hearing loss
a,b,c
A patient is started on the Advair Diskus. Which of the following statements are correct regarding Advair Diskus? (Select ALL 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
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 (left-click the mouse to highlight, drag, and order the answer options; ALL options must be used). A Remove the cap from the mouthpiece. B Inspect the mouthpiece for any debris. C Place the mouthpiece on lips and close lips around it. D Press the top of the canister while breathing in deeply and slowly. E Hold breath as long as possible, up to 10 seconds.
as is
Counseling points on the use of Spiriva HandiHaler 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 twice daily.
b
TJ use Spiriva Respimat 2.5 mcg/inhalation. He inhales 5 mcg once daily. If each cartridge contains 60 metered actuations, how long will each cartridge last? A 14 days B 30 days C 45 days D 60 days E 90 days
b
The asthma guidelines recommend that patients with persistent asthma use maintenance medication in order to achieve and maintain control symptoms. Which class of agents is considered first line for maintenance of persistent asthma? Answer A Long-acting bronchodilators B Inhaled corticosteroids C Leukotriene modifiers D Theophylline E Immunomodulators
b
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 in the bronchial tree D Inhibits the enzyme 5-lipoxygenase E Monoclonal antibody that inhibits IgE binding on mast cells and basophils
b
Boris Higgins is taking QVAR 80 mcg 1 inhalation twice daily. Which of the following would be a therapeutic substitute for this medication? A ProAir HFA B Advair HFA C Flovent HFA D Zyflo CR E Dulera
c
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
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 and 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
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
BM is prescribed Advair Diskus for his asthma. Which of the following counseling points should be reviewed with BM about his Advair Diskus medication? (Select ALL that apply.) A Wash the Diskus with a wet cloth weekly. B If he does not feel or taste the medication, take another dose. C This is not a rescue medication for acute asthma attacks. D Rinse the mouth with water and spit after each dose of medication. E Never breathe into the Diskus.
c,d,e
A 70 year old patient has been prescribed Xopenex. Choose the correct statement concerning Xopenex: A Xopenex causes more tachycardia than albuterol. B Xopenex causes fewer headaches than albuterol. C Xopenex is available as a SC injection given weekly. D Xopenex is the R-isomer of albuterol. E Xopenex is the L-isomer of albuterol.
d
A patient has been prescribed beclomethasone for asthma. What is the brand name of beclomethasone when used for asthma? A Beconase B Pulmicort C Asmanex D QVAR E Alvesco
d
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
What are the ingredients in Symbicort? A Salmeterol + fluticasone B Formoterol + fluticasone C Salmeterol + beclomethasone D Formoterol + budesonide E Mometasone + formotero
d
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
A patient is starting on Singulair. Which of the following is a warning associated with the use of Singulair? A Hepatotoxicity B Peripheral neuropathy C Floppy iris syndrome D Bone marrow suppression E Neuropsychiatric events
e
