Asthma

While completing a medication reconciliation at the clinic for SM, the pharmacist notices that his albuterol inhaler is the Ventolin HFA brand that contains 60 inhalations per canister. Based on his current usage (about 6 puffs on 4 days/week), how many weeks will his inhaler last? (Round answer to the nearest TENTH).

2.5 weeks 6 puffs x 4 days = 24 puffs per week 60 total puffs / 24 puffs per week = 2.5 weeks

What is the therapeutic range for Theophylline?

5-15 mpg/mL

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 mg ST will receive 576 mg of theophylline (1 mg/mL x 30 mL/hr x 24 hrs = 720 mg of aminophylline; aminophylline contains 80% theophylline; 720 mg x 0.8 = 576 mg of theophylline).

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) A 4 mg chewable tablet taken once daily in the evening Adults: 10 mg daily in the evening Age 6-14 years: 5 mg daily Age 1-5 years: 4 mg daily Montelukast comes in an oral tablet, chewable tablet and oral granules. The different formulations make it easy to use in children.

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: A) Albuterol is preferred for exercise-induced bronchospasm; she should take her dose 5-15 minutes before exercise. B) An alternative option for exercise-induced bronchospasm is Serevent Diskus scheduled twice daily. C) A brand name for albuterol is Perforomist. D) She should be using an inhaled corticosteroid for prevention of exercise-induced symptoms. E) Patients with asthma should not exercise as this is a known trigger for asthma symptoms.

A) Albuterol is preferred for exercise-induced bronchospasm; she should take her dose 5-15 minutes before exercise. Albuterol inhalers are preferred for exercise-induced bronchospasm. LABAs can be used as an alternative 30-minutes prior to exercise, as long as they are not taken daily.

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) Ciprofloxacin C) Zafirlukast E) Clarithromycin

Which of the following medication classes has a boxed warning regarding an increased risk of asthma-related deaths when used as monotherapy? A) Long-acting beta-2 agonists B) Leukotriene modifiers C) Theophylline D) Short-acting beta-2 agonists E) Inhaled corticosteroids

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

Which of the following side effects may LY be experiencing from excessive use of ProAir HFA inhaler? (Select ALL that apply.) A) Nervousness and anxiety B) Hypokalemia C) Hyperglycemia D) Bradycardia E) Headache

A) Nervousness and anxiety B) Hypokalemia C) Hyperglycemia The major side effects of inhaled beta-2 agonists include nervousness, tremor, shakiness, cough, tachycardia, hyperglycemia and hypokalemia.

Which medication is most likely contributing to the HEENT (few white plaques on the tongue and inner cheeks) finding on the physical exam? A) Pulmicort B) Zyrtec D C) ProAir D) Theophylline E) Ibuprofen

A) Pulmicort (Budesonide) Inhaled corticosteroids, such as Pulmicort Flexhaler, can cause oral thrush.

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) Xopenex HFA D) Flovent HFA E) Asmanex HFA

A) QVAR QVAR and Alvesco are MDIs that do not need to be shaken before use.

A patient is started on the ProAir RespiClick. Which of the following statements are correct regarding ProAir RespiClick? (Select ALL that apply.) A) This medication contains a rescue drug, albuterol. B) The device should be shaken before the dose is administered. C) This medication contains a propellant (e.g., HFA). D) This medication should not be used with a spacer device. E) The dose should be administered with a quick and forceful inhalation.

A) This medication contains a rescue drug, albuterol. D) This medication should not be used with a spacer device. E) The dose should be administered with a quick and forceful inhalation. RespiClick inhalers are DPIs. They have a similar shape to an MDI but they should not be shaken and the dose should be administered with a quick, forceful inhalation.

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 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, go to the hospital immediately, regardless of symptoms.

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. E) If the value recorded is < 150 mL, go to the hospital immediately, regardless of symptoms. Using a peak flow meter requires the patient to be in a standing (or at least in an upright) position for the best measurement. Patients should blow out as hard and as fast as possible.

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 3 months. C) No; she has not had any acute symptoms for at least 6 months. D) No; she has not had any acute symptoms for at least 12 months. E) Yes; she should stop her Flovent inhaler instead.

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

TJ uses 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) 30 days The patient takes 2 inhalations once daily, therefore each cartridge will last 30 days.

JW is well-controlled on his asthma medications which include Flovent HFA 220 mcg 2 inhalations BID, Serevent Diskus 1 inhalations BID, and Proventil HFA 1-2 inhalations Q4-6H 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) JW should drink 8 oz of water after taking his medications. B) JW should gargle with warm water and spit out the rinse after using his medications. C) JW should purchase a spacer device and use it with his Serevent Diskus. D) JW should purchase a spacer device and use it with his Flovent HFA. E) JW should not kiss others as this infection is contagious.

B) JW should gargle with warm water and spit out the rinse after using his medications. D) JW should purchase a spacer device and use it with his Flovent HFA. Thrush is a side effect of his Flovent that can be decreased by using a spacer. Common brand names for OTC spacer devices include OptiChamber and AeroChamber.

Which medication on LY's profile 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 increase in cyclic adenosine monophosphate which promotes release of epinephrine from adrenal cells. This causes bronchodilation.

ProAir HFA 2 inhalations Q6H PRN (last two refill dates: 6/3, 7/29) How often, on average, is LY using her ProAir HFA inhaler based on the refill history? A) < 2 inhalations per week B) 2 inhalations per day C) 3-4 inhalations per day D) 4-6 inhalations per day E) 6-8 inhalations per day

C) 3-4 inhalations per day Most albuterol inhalers, including ProAir HFA, contain 200 inhalations per canister. Based on the refill history, LY used one inhaler in 56 days (number of days between June 3rd and July 29th). 200 inhalations/56 days = 3.6 inhalations/day (which falls in the range of 3-4).

Which of the following vaccination recommendations is appropriate for LY? A) Annual influenza vaccine and Pneumovax 23 after age 65. B) Annual influenza vaccine, Prevnar 13 now, and Pneumovax 23 after age 65. C) Annual influenza vaccine, Pneumovax 23 now, and a second dose of Pneumovax 23 after age 65. D) Annual influenza vaccine, Prevnar 13 now, and Pneumovax 23 in 12 months. E) Annual influenza vaccine, Prevnar 13 now, Pneumovax 23 in 12 months, and a second dose of Pneumovax 23 after age 65.

C) Annual influenza vaccine, Pneumovax 23 now, and a second dose of Pneumovax 23 after age 65.

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 Ellipta = DPI

Which of the following medications can decrease theophylline levels? (Select ALL that apply.) A) Allopurinol B) Citalopram C) Carbamazepine D) Primidone E) Quinidine

C) Carbamazepine D) Primidone Carbamazepine and primidone can increase the metabolism of theophylline, therefore, decreasing levels of theophylline.

Pulmicort Respules are used primarily in this population group: A) Seniors B) Adults aged 30-50 years C) Children D) Patients who have failed theophylline E) Patients who have failed leukotriene modifying agents

C) Children Pulmicort Respules are nebulizer suspensions indicated for children.

CH is a 16 year-old teenager who has asthma. His only medication is Ventolin HFA which he uses 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) Continue to take the Ventolin PRN for acute symptoms. D) Start Pulmicort Flexhaler 2 inhalations BID for better symptom control. CH's asthma is not controlled as evidenced by his Ventolin usage. Ventolin should not be taken on a scheduled basis; he needs to be on maintenance therapy (a controller).

Which of the following statements concerning omalizumab is correct? A) Omalizumab is a phosphodiesterase-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; each dose must be administerd in a healthcare setting. D) Omalizumab can be administered subcutaneously 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; each dose must be administerd in a healthcare setting. Omalizumab is a monoclonal antibody that prevents binding of IgE to the high-affinity receptors on basophils and mast cells. Omalizumab is used as adjunctive therapy for patients 6 years and older who have allergies and severe, persistent asthma. Clinicians who administer omalizumab should be prepared and equipped to identify and treat anaphylaxis.

A patient has been prescribed AirDuo RespiClick for asthma. What does this product contain? A) Budesonide and tiotropium B) Mometasone and formoterol C) Fluticasone and formoterol D) Fluticasone and salmeterol E) Budesonide and salmeterol

D) Fluticasone and salmeterol The AirDuo RespiClick is a new formulation of fluticasone/salmeterol.

What are the ingredients in Symbicort? A) Salmeterol + fluticasone B) Formoterol + fluticasone C) Salmeterol + beclomethasone D) Formoterol + budesonide E) Mometasone + formoterol

D) Formoterol + budesonide FBS!!!

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 for up to 2 hours.

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

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. Xopenex is levalbuterol, the R-isomer of albuterol. It is available in a metered-dose inhaler (Xopenex HFA) and for use in a nebulizer. The frequency of systemic effects (tachycardia, headache, nervousness) is reported to be similar to albuterol.

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

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? A) Zileuton B) Theophylline C) Indacaterol D) Reslizumab E) Montelukast

E) Montelukast Three leukotriene modifiers are indicated for use in children with asthma. Montelukast is indicated for patients at least one year old, zafirlukast is indicated for patients 5 years and older and zileuton is indicated for patients 12 years and older.

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) Neuropsychiatric events The warning involves neuropsychiatric events; behavior and mood-related changes have been reported. This warning was added in 2009 and applies to all the leukotriene modifiers.