Asthma

A patient states that he uses his albuterol inhaler 4 days per week (about 6 puffs on each of those days). While completing a medication reconciliation at the clinic, the pharmacist notices that his albuterol inhaler is the Ventolin HFA brand that contains 60 inhalations per canister. Based on his current usage, how many weeks will his inhaler last? (Round answer to the nearest tenth)

2.5 Ventolin HFA comes in two sizes, 200 inhalations and 60 inhalations per canister. The patient is using 24 inhalations per week (6 inhalations on 4 days of the week). 60 inhalations/24 inhalations per week = 2.5 weeks

How often on average is LY using her ProAir HFA inhaler based on the refill history? > 3-4 inhalations per day > 2 inhalations per day > 4-6 inhalations per day < 2 inhalations per week > 6-8 inhalations per day

3-4 inhalations per day

TJ uses Spiriva Respimat 2.5mcg/inhalation. He inhales 5 mcg once daily. If each cartridge contains 60 metered actuations, how long will each cartridge last? > 30 days > 60 days > 90 days > 45 days > 14 days

30 days

ST, a 35 year old 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 1000 mg in 1L of NS at 30 mL/hr How many milligrams of theophylline will ST receive per day?

576 ST will receive 576 of theophylline (1 mg/mL x 30 mL/hr x 24 hrs = 720 mg of aminophylline; the conversion for aminophylline to theophylline is 80%; 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 4 mg chewable tablet taken once daily in the evening > A 10 mg chewable tablet taken once daily in the evening > A 10 mg chewable tablet taken BID > A 5 mg chewable tablet taken BID > A 5 mg chewable tablet taken once daily in the evening

> A 4 mg chewable tablet taken once daily in the evening

Choose the correct statement regarding the use of a prednisone taper in LY > Inhaled prednisone is the preferred formulation for an exacerbation > A taper is appropriate; prednisone should be used for the shortest duration possible > Since LY had an exacerbation, oral steroids should be continued indefinitely > Prednisone may cause LY to have a reduced appetite and anorexia > Oral steroids should only be used in severe, persistent asthma (step 6), not for exacerbations

> A taper is appropriate; prednisone should be used for the shortest duration possible

Which of the following medications can increase theophylline levels and possibly result in theophylline toxicity? > Clarithromycin > Famotidine > Zafirlukast > Bupropion > Ciprofloxacin

> Clarithromycin > Zafirlukast > Ciprofloxacin

CH is a 16 year old teenager who has asthma. His only medications are Ventolin HFA and Flovent HFA, which he uses both only as needed 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? > Start salmeterol inhalation BID for better symptom control, discontinue Flovent prn > Take ventolin 2 inhalations Q4-6H starting today, continue Flovent prn > Start Singulair 20 mg PO QHS > Continue to take the Ventolin PRN for acute symptoms > Start Pulmicort Flexhaler 2 inhalations BID for better symptom control, discontinue Flovent prn

> Continue to take the Ventolin PRN for acute symptoms > Start Pulmicort Flexhaler 2 inhalations BID for better symptom control, discontinue Flovent prn

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? > Discontinue Pulmicort Flexhaler and start Advair Diskus > Continue her current medications and start Advair Diskus > Discontinue Pulmicort Flexhaler and start salmeterol > Discontinue Pulmicort Flexhaler and start Flovent HFA > Perform skin testing to determine if treatment with reslizumab is needed

> Discontinue Pulmicort Flexhaler and start Advair Diskus

A patient has been prescribed Advair Diskus for asthma. What does this product contain? > Mometasone and formoterol > Fluticasone and salmeterol > Budesonide and tiotropium > Budesonide and salmeterol > Fluticasone and formoterol

> Fluticasone and salmeterol

When assessing theophylline treatment in LY, which of the following statements is true? > Her level is within the goal therapeutic range > Her level is below the goal therapeutic range > Her loading dose should have been calculated using total body weight > Her level cannot be assessed as a trough should have been ordered > Her loading dose should have been calculated using her ideal body weight

> Her level is within the goal therapeutic range > Her loading dose should have been calculated using total body weight

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: > Mix with 4 oz of applesauce and administer within 24 hours > The granule packet can be opened up to 8 hours prior to use > Mix with a tablespoon of breast milk or formula; the mixture can be stored for up to 2 hours > Mix with one tablespoon of warm water > Mix with a spoonful of cool, mashed carrots and administer within minutes

> Mix with a spoonful of cool, mashed carrots and administer within minutes

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.) > For best results, perform the assessments in a supine position > Record the highest number of each day in a log book > If the value recorded is < 150 mL seek medical help immediately, regardless of symptoms > Use the peak flow meter in the morning, before taking any asthma medications > Blow out slow and steady to get as much air exhaled as possible

> Record the highest number of each day in a log book > If the value recorded is < 150 mL, seek medical help immediately, regardless of symptoms > Use the peak flow meter in the morning, before taking any asthma medications

Place the instructions below for proper use of an albuterol MDI inhaler in the correct order:

> Shake for 5 seconds > Breathe out fully to expel as much air from the lungs as possible > Place the mouthpiece into the mouth and close lips around it > Press the top of the canister while breathing in deeply and slowly > Hold breath as long as possible, up to 10 seconds

CD is a 25 year old female with asthma whose home medications include Arnuity Ellipa 2 inhalations daily, Proventil HFA 1-2 inhalations Q4-6H PRN, loratadine 10 mg daily and a multivitamin. She states that her symptoms are generally well-controlled but notices that she consistently has difficulty breathing during her aerobics class. What would be the most appropriate treatment change for CD's current complaint? > Discontinue the Arnuity Ellipta, start salmeterol > Switch the Arnuity Ellipta to Flovent Diskus > Add prednisone 10 mg, take two hours prior to exercise > Take 2 inhalations of Proventil 5-15 minutes before exercise > Take 2 inhalations of Arnuity Ellipta 30 minutes before exercise

> Take 2 inhalations of Proventil 5-15 minutes before exercise

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

> The dose should be administered with a quick and forceful inhalation > This medication should not be used with a spacer device > This medication contains a rescue drug, albuterol

A patient is prescribed Advair Diskus for her asthma. Which of the following counseling points should be reviewed? > Wash the Diskus with a wet cloth weekly > If she does not feel or taste the medication, take another dose > This is not a rescue medication for acute asthma attacks > Rinse the mouth with water and split after each dose of medication > Never breathe into the Diskus

> This is not a rescue medication for acute asthma attacks > Rinse the mouth with water and split after each dose of medication > Never breathe into the Diskus

Which of the following are possible side effects of LY's rescue inhaler? > Tremor > Hypokalemia > Leukocytosis > Hyperglycemia > Bradycardia

> Tremor > Hypokalemia > Hyperglycemia

In addition to an annual influenza vaccine, which of the following vaccination recommendations is appropriate for LY? > Prevnar 20 now, and Pneumovax 23 in 12 months > Prevnar 13 now, and Vaxneuvance in 12 months > Vaxneuvance now, and Pneumovax 23 in 12 months > Prevnar 13 now, and Pneumovax 23 after age 65 > Pneumovax 23 after age 65

> Vaxneuvance now, and Pneumovax 23 in 12 months

Which of the following medications is available as a dry powder inhaler? Symbicort Breo Ellipta Bevespi Aerosphere ProAir HFA Alvesco

Breo Ellipta

Which of the following medications can decrease theophylline levels? Carbamazepine Citalopram Allopurinol Quinidine Primidone

Carbamazepine Primidone

Pulmicort Respules are used primarily in this population group: Children Adults aged 30-50 years Patients who have failed theophylline Patients over the age of 55 years Patients who have failed leukotriene modifying agents

Children

What are the medications in Symbicort? Salmeterol + fluticasone Salmeterol + beclomethasone Mometasone + formoterol Formoterol + fluticasone Formoterol + budesonide

Formoterol + budesonide

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? Buccal Oral Inhaled Patch Intravenous

Inhaled

JW is well-controlled on his asthma medications which include Flovent HFA 220 mcg 2 inhalations BID, Salmeterol 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 salmeterol 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.

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

Which of the following medication classes has a boxed warning regarding an increased risk of asthma-related deaths when used as monotherapy? > Inhaled corticoteroids > Theophylline > Short-acting beta-2 agonists > Long-acting beta-2 agonists > Leukotriene modifiers

Long-acting beta-2 agonists

Which of the following asthma medications works by blocking interleukin-5 receptors? Dulera Mepolizumab Xolair Zafirlukast Theophylline

Mepolizumab

SC is a 4 year old patient with mdoerate 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? Reslizumab Indacaterol Theophylline Zileuton Montelukast

Montelukast

A patient is starting on SIngulair. Which of the following is a warning associated with the use of Singulair? > Floppy iris syndrome > Bone marrow suppression > Peripheral neuropathy > Neuropsychiatric events > Hepatotoxicity

Neuropsychiatric events

Which of the following statements concerning omalizumab is correct? > Omalizumab is dosed based on IgG levels and body weight > Omalizumab can be administered intramuscularly at home if an adult or parent has received training > Omalizumab can cause anaphylaxis; the first dose must be administered in a healthcare setting > Omalizumab is indicated for initial therapy in patients who have allergies and mild, persistent asthma > Omalizumab is a phosphodiesterase-5 inhibitor that causes bronchodilation

Omalizumab can cause anaphylaxis; the first dose must be administered in a healthcare setting

Which medication is most likely contributing to the HEENT finding on the physical exam? > Theophylline > ProAir > Zyrtec-D > Pulmicort > Ibuprofen

Pulmicort

Most metered-dose inhalers need to be shaken well immediately before use. Which metered-dose inhaler does not have to be shaken before use? > Asmanex HFA > QVAR RediHaler > Symbicort > Xopenex HFA > Flovent HFA

QVAR Redihaler

Which of the following are possible asthma triggers for LY? > Stress > Allergic Rhinitis > Ibuprofen > Obesity > GERD

Stress Allergic rhinitis Ibuprofen GERD

Which of the following is an appropriate treatment option for a patient with a new diagnosis of intermittent asthma? Symbicort PRN Salmeterol PRN Medrol Spiriva Respimat Advair Diskus PRN

Symbicort PRN

Which medication on LY's profile works by blocking phosphodiesterase and increasing cAMP? > ProAir HFA > Theophylline > Prednisone > Pulmicort Flexhaler > Zyrtec D

Theophylline

A 70 year old patient has been prescribed Xopenex. Choose the correct statement concerning Xopenex: > Xopenex causes more tachycardia than albuterol > Xopenex requires more frequent dosing than albuterol > Xopenex is the R-isomer of albuterol > Xopenex is the brand name for indacaterol > Xopenex is only available as a nebulizer solution

Xopenex is the R-isomer of albuterol