ASTHMA

Based on her recent asthma exacerbation and use of her ProAir HFA, LY needs a step up in her asthma treatment. Which of the following would be appropriate? A Discontinue Pulmicort Flexhaler and start Advair Diskus B Continue her current medications and start Advair Diskus C Perform skin testing to determine if treatment with reslizumab is needed D Discontinue Pulmicort Flexhaler and start Serevent Diskus E Discontinue Pulmicort Flexhaler and start Flovent HFA

A Advair Diskus contains a long-acting beta-2 agonist (which opens the airways) and an inhaled corticosteroid (which reduces inflammation). It is a combination inhaler that treates the two primary lung processes occurring in asthma. Serevent Diskus contains salmeterol (a LABA) and Flovent HFA contains fluticasone; neither would provide an appropriate step up in treatment. Use of monoclonal antibodies such as reslizumab should be reserved for patients with severe forms of eosinophilic asthma who have failed first line inhaled treatments.

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 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.

Which of the following asthma medications works by blocking interleukin-5 receptors? A Nucala B Xolair C Accolate D Dulera E Theo-24

A. Nucala is an interleukin-5 receptor antagonist.

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 Hyokalemia C Hyperglycemia D Bradycardia E Headache

ABC The major side effects of inhaled beta-2 agonists include nervousness, tremor, shakiness, cough, tachycardia, hyperglycemia and hypokalemia.

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.

ADE 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.

When assessing theophylline treatment in LY, which of the following statements is true? (Select ALL that apply.) A It should be dosed using her ideal body weight B It should be dosed using her total body weight C Her level is below the goal therapeutic range D Her level is within the goal therapeutic range E Her level cannot be assessed as a trough should have been ordered

BD The therapeutic range for theophylline is 5-15 mcg/mL (peak levels at steady state are appropriate). In most patients it should be dosed using ideal body weight (IBW); in this case, LY is less than her IBW so total body weight should be used.

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 warm 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.

BD 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.

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

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.

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

CD Carbamazepine and primidone can increase the metabolism of theophylline, therefore, decreasing levels of theophylline.

LY is prescribed Advair Diskus for her asthma. Which of the following counseling points should be reviewed with LY? (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 the mouth with water and spit after each dose of medication. E Never breathe into the Diskus.

CDE Never take an extra dose, even if the patient did not taste or feel the medication. Keep the Diskus dry at all times.

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 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 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 The AirDuo RespiClick is a new formulation of fluticasone/salmeterol.