Chapter 35: Asthma

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

History of Present Illness: LY is a 45 year old female who presents to her PCP on August 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains prescriptions from her PCP, but is often resistant to suggestions and advice from healthcare providers. Allergies: no known drug allergies Past Medical History: hypertension, osteoarthritis, allergic rhinitis, asthma, and anxiety Current Medications (obtained from active prescription bottles on 8/1): Zestril 10 mg daily Hydrochlorothiazide 12.5 mg daily ProAir HFA 2 inhalations Q6H PRN (last two refill dates: 7/29, 6/3) Protonix 40 mg daily Prednisone taper 10 mg daily x 4 days, 5 mg daily x 4 days, 2.5 mg x 2 days then stop (on day 5 of treatment) Ibuprofen 400 mg daily Zyrtec D 1 tablet BID Pulmicort Flexhaler 1 inhalation BID Theophylline 300 mg PO daily Expired Prescriptions and No Refills: 3/15: Xanax 0.5 mg TID x 30 days. No refills 3/15: Zoloft 50 mg daily. Disp #30. No refills. 4/25: Valium 2 mg BID x 5 days. No refills. 6/1: Lyrica 50 mg TID. Disp #90. No refills Vitals: Height: 5'6" Weight: 125 pounds BP: 152/86 mmHg HR: 95 BPM RR: 13 BPM Temp: 98.5°F Pain: 2/10 Physical Exam: Neuro: alert and oriented HEENT: few white plaques on the tongue and inner cheeks CV: RRR Abdomen: normal bowel sounds Extremities: no edema noted, good reflexes Labs: Na (mEq/L) = 139 (135 - 145) K (mEq/L) = 3.1 (3.5 - 5) Cl (mEq/L) = 100 (95 - 103) HCO3 (mEq/L) = 25 (24 - 30) BUN (mg/dL) = 12 (7 - 20) SCr (mg/dL) = 0.8 (0.6 - 1.3) Glucose (mg/dL) = 147 (100 - 125) TSH (mIU/L) = 0.15 (0.3 - 3) Ca (mg/dL) = 8.8 (8.5 - 10.5) Albumin (g/dL) = 3.2 (3.5 - 5) Theophylline peak level (mcg/mL) = 7 Question 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: Discontinue Pulmicort Flexhaler and start Advair Diskus *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.

What is the generic name of Xopenex? A: Levalbuterol B: Tiotropium C: Omalizumab D: Arformoterol E: Mepolizumab

A: Levalbuterol

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

History of Present Illness: LY is a 45 year old female who presents to her PCP on August 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains prescriptions from her PCP, but is often resistant to suggestions and advice from healthcare providers. Allergies: no known drug allergies Past Medical History: hypertension, osteoarthritis, allergic rhinitis, asthma, and anxiety Current Medications (obtained from active prescription bottles on 8/1): Zestril 10 mg daily Hydrochlorothiazide 12.5 mg daily ProAir HFA 2 inhalations Q6H PRN (last two refill dates: 7/29, 6/3) Protonix 40 mg daily Prednisone taper 10 mg daily x 4 days, 5 mg daily x 4 days, 2.5 mg x 2 days then stop (on day 5 of treatment) Ibuprofen 400 mg daily Zyrtec D 1 tablet BID Pulmicort Flexhaler 1 inhalation BID Theophylline 300 mg PO daily Expired Prescriptions and No Refills: 3/15: Xanax 0.5 mg TID x 30 days. No refills 3/15: Zoloft 50 mg daily. Disp #30. No refills. 4/25: Valium 2 mg BID x 5 days. No refills. 6/1: Lyrica 50 mg TID. Disp #90. No refills Vitals: Height: 5'6" Weight: 125 pounds BP: 152/86 mmHg HR: 95 BPM RR: 13 BPM Temp: 98.5°F Pain: 2/10 Physical Exam: Neuro: alert and oriented HEENT: few white plaques on the tongue and inner cheeks CV: RRR Abdomen: normal bowel sounds Extremities: no edema noted, good reflexes Labs: Na (mEq/L) = 139 (135 - 145) K (mEq/L) = 3.1 (3.5 - 5) Cl (mEq/L) = 100 (95 - 103) HCO3 (mEq/L) = 25 (24 - 30) BUN (mg/dL) = 12 (7 - 20) SCr (mg/dL) = 0.8 (0.6 - 1.3) Glucose (mg/dL) = 147 (100 - 125) TSH (mIU/L) = 0.15 (0.3 - 3) Ca (mg/dL) = 8.8 (8.5 - 10.5) Albumin (g/dL) = 3.2 (3.5 - 5) Theophylline peak level (mcg/mL) = 7 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

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

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

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.

A: Pulmicort respules are given via nebulization. B: The generic name is budesonide. D: Pulmicort respules can be used as first-line therapy. *Pulmicort respules are stored at room temperature. Shake well before using.

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.

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.

History of Present Illness: LY is a 45 year old female who presents to her PCP on August 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains prescriptions from her PCP, but is often resistant to suggestions and advice from healthcare providers. Allergies: no known drug allergies Past Medical History: hypertension, osteoarthritis, allergic rhinitis, asthma, and anxiety Current Medications (obtained from active prescription bottles on 8/1): Zestril 10 mg daily Hydrochlorothiazide 12.5 mg daily ProAir HFA 2 inhalations Q6H PRN (last two refill dates: 7/29, 6/3) Protonix 40 mg daily Prednisone taper 10 mg daily x 4 days, 5 mg daily x 4 days, 2.5 mg x 2 days then stop (on day 5 of treatment) Ibuprofen 400 mg daily Zyrtec D 1 tablet BID Pulmicort Flexhaler 1 inhalation BID Theophylline 300 mg PO daily Expired Prescriptions and No Refills: 3/15: Xanax 0.5 mg TID x 30 days. No refills 3/15: Zoloft 50 mg daily. Disp #30. No refills. 4/25: Valium 2 mg BID x 5 days. No refills. 6/1: Lyrica 50 mg TID. Disp #90. No refills Vitals: Height: 5'6" Weight: 125 pounds BP: 152/86 mmHg HR: 95 BPM RR: 13 BPM Temp: 98.5°F Pain: 2/10 Physical Exam: Neuro: alert and oriented HEENT: few white plaques on the tongue and inner cheeks CV: RRR Abdomen: normal bowel sounds Extremities: no edema noted, good reflexes Labs: Na (mEq/L) = 139 (135 - 145) K (mEq/L) = 3.1 (3.5 - 5) Cl (mEq/L) = 100 (95 - 103) HCO3 (mEq/L) = 25 (24 - 30) BUN (mg/dL) = 12 (7 - 20) SCr (mg/dL) = 0.8 (0.6 - 1.3) Glucose (mg/dL) = 147 (100 - 125) TSH (mIU/L) = 0.15 (0.3 - 3) Ca (mg/dL) = 8.8 (8.5 - 10.5) Albumin (g/dL) = 3.2 (3.5 - 5) Theophylline peak level (mcg/mL) = 7 Based on her patient profile, all of the following are possible asthma triggers for LY except: A:Obesity B: Ibuprofen C: Stress D: Allergic rhinitis E: GERD

A:Obesity *Based on her body weight, LY is not obese. NSAIDs (aspirin, ibuprofen, naproxen, diclofenac) and non-selective beta-blockers are medications that may trigger asthma symptoms. The use of Protonix suggests LY suffers from reflux disease. Other triggers to watch for include cold air, exercise, dust mites, pet dander and airborne pollens (grass, tree, weeds, etc.).

What is the generic name of Arnuity Ellipta? A: Mometasone B: Fluticasone C: Indacaterol D: Aclidinium E: Tiotropium

B: Fluticasone

History of Present Illness: LY is a 45 year old female who presents to her PCP on August 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains prescriptions from her PCP, but is often resistant to suggestions and advice from healthcare providers. Allergies: no known drug allergies Past Medical History: hypertension, osteoarthritis, allergic rhinitis, asthma, and anxiety Current Medications (obtained from active prescription bottles on 8/1): Zestril 10 mg daily Hydrochlorothiazide 12.5 mg daily ProAir HFA 2 inhalations Q6H PRN (last two refill dates: 7/29, 6/3) Protonix 40 mg daily Prednisone taper 10 mg daily x 4 days, 5 mg daily x 4 days, 2.5 mg x 2 days then stop (on day 5 of treatment) Ibuprofen 400 mg daily Zyrtec D 1 tablet BID Pulmicort Flexhaler 1 inhalation BID Theophylline 300 mg PO daily Expired Prescriptions and No Refills: 3/15: Xanax 0.5 mg TID x 30 days. No refills 3/15: Zoloft 50 mg daily. Disp #30. No refills. 4/25: Valium 2 mg BID x 5 days. No refills. 6/1: Lyrica 50 mg TID. Disp #90. No refills Vitals: Height: 5'6" Weight: 125 pounds BP: 152/86 mmHg HR: 95 BPM RR: 13 BPM Temp: 98.5°F Pain: 2/10 Physical Exam: Neuro: alert and oriented HEENT: few white plaques on the tongue and inner cheeks CV: RRR Abdomen: normal bowel sounds Extremities: no edema noted, good reflexes Labs: Na (mEq/L) = 139 (135 - 145) K (mEq/L) = 3.1 (3.5 - 5) Cl (mEq/L) = 100 (95 - 103) HCO3 (mEq/L) = 25 (24 - 30) BUN (mg/dL) = 12 (7 - 20) SCr (mg/dL) = 0.8 (0.6 - 1.3) Glucose (mg/dL) = 147 (100 - 125) TSH (mIU/L) = 0.15 (0.3 - 3) Ca (mg/dL) = 8.8 (8.5 - 10.5) Albumin (g/dL) = 3.2 (3.5 - 5) Theophylline peak level (mcg/mL) = 7 Question 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

B: It should be dosed using her total body weight D: Her level is within the goal therapeutic range *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.

B: JW should gargle with warm warm and spit out the rinse after using his medications. D: JW should purchase a spacer device and use it with his Flovent HFA.

History of Present Illness: LY is a 45 year old female who presents to her PCP on August 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains prescriptions from her PCP, but is often resistant to suggestions and advice from healthcare providers. Allergies: no known drug allergies Past Medical History: hypertension, osteoarthritis, allergic rhinitis, asthma, and anxiety Current Medications (obtained from active prescription bottles on 8/1): Zestril 10 mg daily Hydrochlorothiazide 12.5 mg daily ProAir HFA 2 inhalations Q6H PRN (last two refill dates: 7/29, 6/3) Protonix 40 mg daily Prednisone taper 10 mg daily x 4 days, 5 mg daily x 4 days, 2.5 mg x 2 days then stop (on day 5 of treatment) Ibuprofen 400 mg daily Zyrtec D 1 tablet BID Pulmicort Flexhaler 1 inhalation BID Theophylline 300 mg PO daily Expired Prescriptions and No Refills: 3/15: Xanax 0.5 mg TID x 30 days. No refills 3/15: Zoloft 50 mg daily. Disp #30. No refills. 4/25: Valium 2 mg BID x 5 days. No refills. 6/1: Lyrica 50 mg TID. Disp #90. No refills Vitals: Height: 5'6" Weight: 125 pounds BP: 152/86 mmHg HR: 95 BPM RR: 13 BPM Temp: 98.5°F Pain: 2/10 Physical Exam: Neuro: alert and oriented HEENT: few white plaques on the tongue and inner cheeks CV: RRR Abdomen: normal bowel sounds Extremities: no edema noted, good reflexes Labs: Na (mEq/L) = 139 (135 - 145) K (mEq/L) = 3.1 (3.5 - 5) Cl (mEq/L) = 100 (95 - 103) HCO3 (mEq/L) = 25 (24 - 30) BUN (mg/dL) = 12 (7 - 20) SCr (mg/dL) = 0.8 (0.6 - 1.3) Glucose (mg/dL) = 147 (100 - 125) TSH (mIU/L) = 0.15 (0.3 - 3) Ca (mg/dL) = 8.8 (8.5 - 10.5) Albumin (g/dL) = 3.2 (3.5 - 5) Theophylline peak level (mcg/mL) = 7 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).

History of Present Illness: LY is a 45 year old female who presents to her PCP on August 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains prescriptions from her PCP, but is often resistant to suggestions and advice from healthcare providers. Allergies: no known drug allergies Past Medical History: hypertension, osteoarthritis, allergic rhinitis, asthma, and anxiety Current Medications (obtained from active prescription bottles on 8/1): Zestril 10 mg daily Hydrochlorothiazide 12.5 mg daily ProAir HFA 2 inhalations Q6H PRN (last two refill dates: 7/29, 6/3) Protonix 40 mg daily Prednisone taper 10 mg daily x 4 days, 5 mg daily x 4 days, 2.5 mg x 2 days then stop (on day 5 of treatment) Ibuprofen 400 mg daily Zyrtec D 1 tablet BID Pulmicort Flexhaler 1 inhalation BID Theophylline 300 mg PO daily Expired Prescriptions and No Refills: 3/15: Xanax 0.5 mg TID x 30 days. No refills 3/15: Zoloft 50 mg daily. Disp #30. No refills. 4/25: Valium 2 mg BID x 5 days. No refills. 6/1: Lyrica 50 mg TID. Disp #90. No refills Vitals: Height: 5'6" Weight: 125 pounds BP: 152/86 mmHg HR: 95 BPM RR: 13 BPM Temp: 98.5°F Pain: 2/10 Physical Exam: Neuro: alert and oriented HEENT: few white plaques on the tongue and inner cheeks CV: RRR Abdomen: normal bowel sounds Extremities: no edema noted, good reflexes Labs: Na (mEq/L) = 139 (135 - 145) K (mEq/L) = 3.1 (3.5 - 5) Cl (mEq/L) = 100 (95 - 103) HCO3 (mEq/L) = 25 (24 - 30) BUN (mg/dL) = 12 (7 - 20) SCr (mg/dL) = 0.8 (0.6 - 1.3) Glucose (mg/dL) = 147 (100 - 125) TSH (mIU/L) = 0.15 (0.3 - 3) Ca (mg/dL) = 8.8 (8.5 - 10.5) Albumin (g/dL) = 3.2 (3.5 - 5) Theophylline peak level (mcg/mL) = 7 Question 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 can decrease theophylline levels? (Select ALL that apply.) A: Allopurinol B: Citalopram C: Carbamazepine D: Primidone E: Quinidine

C: Carbamazepine D: Primidone

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).

BH 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: Flovent HFA *Flovent HFA is a therapeutic substitution for QVAR. They are both inhaled corticosteroid products.

Which of the following are correct statements regarding Asthmanefrin? A: This medication contains the R-isomer of epinephrine. B: This medication is only 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: This medication is not preferred in patients with asthma. *Asthmanefrin is a racemic mixture of epinephrine that is available OTC. Since it is not beta-2 selective, it is not preferred as a SABA in asthma.

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: 2 inhalations BID.

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

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

D: Formoterol + budesonide

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 systemic steroids must be tapered? 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 if stopped abruptly. D: They can cause hypothalamic pituitary adrenal axis suppression. E: They can cause bizarre, psychiatric behavior if stopped abruptly.

D: They can cause hypothalamic pituitary adrenal axis suppression. *Corticosteroids need to be tapered due to hypothalamic pituitary adrenal axis suppression.

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

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; no units or commas; include leading zero when answer is less than 1.)

The patient's dose is 1.5 mg (0.1 mg/kg x 15 kg). When using the 0.5% solution, 0.3 mL would be needed (500 mg/100 mL = 1.5 mg/x mL, where x = 0.3 mL). 0.3