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 Ciprofloxacin, clarithromycin and zafirlukast can all increase levels of theophylline.

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

A. Nucala Nucala is an interleukin-5 receptor antagonist.

Which of the following medications is available as a dry powder inhaler? A. Pulmicort Flexhaler B. QVAR C. Xopenex D. Symbicort E. Accuneb

A. Pulmicort Flexhaler Pulmicort Flexhaler is available as a dry powder inhaler.

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 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. This medication comes with a dose counter. D. This medication should not be used with a spacer device. E. Always use the Diskus in a level, flat position. Advair Diskus is dosed 1 inhalation BID. Since it is a dry powder inhaler, it cannot be used with a spacer device.

Alexa Grist 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. Hepatotoxicity Zileuton can cause liver toxicity; liver enzymes must be monitored each month for the first 3 months, then every 2-3 months for the rest of the year, and periodically thereafter.

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? A. Long-acting bronchodilators B. Inhaled corticosteroids C. Leukotriene modifiers D. Theophylline E. Immunomodulators

B. Inhaled corticosteroids Inhaled corticosteroids are the drugs of choice for maintenance of persistent asthma.

Albuterol comes in all of the following formulations EXCEPT: A. Syrup B. Injection C. Tablet D. Nebulizer solution E. Metered dose inhaler

B. Injection Albuterol does not come in an injection formulation.

Jason Wallach is well-controlled on his asthma medications which include Flovent HFA 220 mcg BID, Foradil 1 capsule 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 Mr. Wallach'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 Foradil. 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. Mr. Wallach should gargle with warm warm and spit out the rinse after using his medications. D. Mr. Wallach should purchase a spacer device and use with his Flovent HFA. Thrush is a side effect of his Flovent.

Which of the following are correct statements regarding Asthmanefrin? (Select ALL that apply.) A. This medication contains the R-isomer of epinephrine. B. This medication is available OTC. 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.

B. This medication is available OTC. 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.

Cassandra Day is a 17 year-old with asthma. She likes to play basketball. Before heading to the court, Ms. Day needs to use her albuterol inhaler to help prevent exercise-induced symptoms. Choose the correct statement regarding albuterol: A. Albuterol HFA inhalers are damaging to the ozone. B. Albuterol is a beta-2 antagonist and is 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. A brand name for albuterol is Ventolin. Albuterol inhalers are short-acting beta-2 adrenergic agonists taken as needed for rapid, short-term relief of asthma symptoms or to prevent an asthma attack. HFA inhalers have replaced CFC inhalers because HFA inhalers do not damage the ozone.

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 between 30 and 50 years old C. Children D. Patients who have failed theophylline E. Patients who have failed luekotriene modifying agents

C. Children Pulmicort respules are indicated for children.

Caleb Hayhoe 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. Continue to take the Ventolin PRN for acute symptoms. D. Start Pulmicort Flexhaler 2 inhalations BID for better symptom control. Caleb'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). LABAs should not be used as monotherapy

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. Flovent HFA Flovent HFA is a therapeutic substitution for QVAR.

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. Omalizumab can cause anaphylaxis. 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 12 years and older who have allergies and severe, persistent asthma. Clinicians who administer omalizumab should be prepared and equipped to identify and treat anaphylaxis.

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. Advair HFA is dosed at 2 inhalations twice daily.

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. Advair Diskus treats both airway constriction and inflammation. Advair Diskus contains salmeterol, a long-acting beta-2 agonist (which opens the airways) and fluticasone, an inhaled corticosteroid (which reduces inflammation). The mechanisms of action were reversed in the question. The correct dose for Advair Diskus is 1 inhalation twice daily.

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. QVAR The brand name of beclomethasone for asthma is QVAR.

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: A. The patient will require a higher dose of theophylline than most 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 vomiting, ventricular tachycardias, and seizures. E. Theophylline should be dosed on the patient's actual body weight.

D. Signs of theophylline toxicity include vomiting, ventricular tachycardias, and seizures. Heart failure can increase theophylline levels; therefore, the patient may require a lower dose of theophylline. Although high-protein diets can decrease levels, patients should not limit the amount of protein consumed.

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.

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: A. This is inappropriate; QVAR HFA is used only for patients needing high dose ICS therapy. B. This is inappropriate; QVAR HFA should not be used in children due to growth retardation. C. This is inappropriate; QVAR HFA is in the same drug class as albuterol. 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. This is appropriate; QVAR HFA is considered a first line agent per the asthma guidelines Inhaled corticosteroids, like QVAR HFA, are first line therapy for anyone with persistent asthma as demonstrated in this case.