Week 3 Respiratory: Midterm 1 Practice questions

Fill in the blank: Omalizumab administration has resulted in ________ (bronchospasm, hypotension, syncope, urticaria, and/or angioedema) after injection and patient must be monitored for up to ______ minutes after administration

1. Anaphylaxis 2. 120 (Black box warning)

____(codeine, dextromethorphan, benzonatate) suppress a dry nonproductive cough, and _____(guaifenesin) are used to enhance sputum clearance by decreasing its viscosity and/or increasing production.

1. Antitussives 2. Expectorants

Fill in the blank(s): All patients with asthma should receive treatment with a _____ medication and a _____medication.

1. Controller 2. reliever

Fill in the blank: The symptoms of allergic rhinitis can also be managed with ___-generation antihistamines (H1 receptor antagonists), although these agents are more effective in ____ than treating symptoms.

1. Second-generation 2. Preventing

Fill in the blank: Systemic corticosteroids are useful in the treatment of _____ exacerbations of asthma or COPD ____ responding adequately to other treatments.

1. Severe 2. not

Which medication class can mask the signs of hypoglycemia? 1. β-Blockers 2. Corticosteroids 3. Mineralocorticoids 4. Antitussives

1. β-Blockers Low blood sugar levels trigger the release of epinephrine, which produces the autonomic symptoms of hypoglycemia including tremor, palpitations, anxiety, and diaphoresis. β-Blockers can block the effects of epinephrine on adrenergic receptors. Patients with diabetes who receive β-blockers should be counseled to monitor carefully for diaphoresis as this may be their only autonomic indicator of a hypoglycemic episode (mediated by activation of the cholinergic system). Patients with longstanding diabetes, those treated to aggressive glucose-lowering targets, and those with history of frequent hypoglycemic episodes are at higher risk for hypoglycemia unawareness.

Fill in the blank(s): Long-acting β2 agonists (LABAs; salmeterol, formoterol) provide bronchodilation for at least __ hours.

12

Fill in the blank Cromolyn nasal spray is an OTC mast cell stabilizer with antiinflammatory properties approved for use in adults and children over age ___ years old.

2

Fill in the blank: GINA guidelines recommend tiotropium as an add-on therapy in patients ___ years of age and older who are not well controlled on an ICS/LABA

6

Select all that apply. Dextromethorphan is contraindicated in which of the following A. Children under 2 B. With concurrent use or within 14 days of MAOI use C. Concurrently with Guaifenesin

A and B

Which of the following antihistamines are the most appropriate to use for a 70-year-old patiet? A. Certrizine B. Diphenhydramine C. Loratidine D. Brompheniramine E. Chlorpheniramine

A and C (second generation antihistamines). B, D, E are first-generation antihistamines and meet Beers Criteria for Potentially Inappropriate Medication Use in Older Adults (Practice Pearl)

Select all that apply: Which intranasal corticosteroids is preferred in treatment of vasomotor rhinitis? A. fluticasone propionate B. flunisolide C. Fluticasone furoate D. triamcinolone acetonide E. Beclomethasone dipropionate

A and E. Seasonal rhinitis are B, C, D

Select all that apply. Sudafed administration should be avoided in which of the following populations: A. patients taking MAOIs or within a 14 day window of stopping MAOIs. B. patients with severe coronary artery disease C. patients with uncontrolled hypertension D. patients who actively smoke.

A, B, C

Select all that apply. Which of the following are unpleasant/adverse effects of Cromolyn nasal spray? A. nasal itching B. unpleasant taste in the mouth C. nasal burning D. sneezing

A, B, C, D

Select all that apply. Which of the following should a provide consider using caution with when prescribing Ipratropium nasal spray to? A. closed-angle glaucoma B. bladder or urinary obstructions C. cardiac arrhythmias D. older adults E. patients who operate machinery or drive.

A, B, C, D, E

Select all that apply: Common environmental triggers for allergic rhinitis are A. pollen B. pets C. dust mites D. molds E. pests. F. food products

A, B, C, D, E (Allergy and Respiratory Therapy teaching point)

Select all that apply Contraindications to Decongestants (oral or nasal) include which of the following? A. Benign prostatic hyperplasia or urinary obstruction. B. Diabetes mellitus C Heart disease/HTN D. Increased intraocular pressure or angle-closure glaucoma E. Renal failure

A, B, C, D, E. ALSO Seizure disorders and Thyroid disease (practice pearl)

Select all that apply: Which of the following are important health maintenance strategies for COPD patients. A. Maintaining a healthy diet and taking antioxidants B vitamin C C. Staying active at an exercise level that does not induce significant dyspnea

A, B, and C (COPD teaching points)

Select all that apply: Which of the following are important steps to decrease incidence of oral candidiasis with inhaler use: A. Use all medications as instructed. Do not use more or less of the medication. B. Rinse your mouth with water or mouthwash after inhalation to prevent corticosteroid accumulation on the oropharyngeal mucosa. C. Keep all medication devices clean, following manufacturers' recommendations.

A, B, and C (COPD teaching points)

Which of the following is the maintenance inhaler of choice for elderly patients with COPD only who struggle with compliance? A. Anoro ellipta B. Breo ellipta C. ICS-formoterol

A.

The trilogy ellipta inhaler is a ICS/LABA/LAMA combo. Which of the following medications below is the generic name for the Trilogy Ellipta? A. fluticasone furoate/vilaterol/umeclidium B. vilaterol/umeclidium/ipratropium C. fluticasone furoate/mometasone/umeclidium

A. (only choice with ICS, LABA, and LAMA

What is the primary adverse effect reported with Cetirizine administration in children 5-11 years old? A. Headache B. Irritability C. Somnolence D. Dysuria

A. Headache

Select all that apply: Which of the following COPD medications are considered first-line treatment? A. aclidinium B. glycopyrrolate C. tiotropium D. umeclidinium

A. aclidinium B. glycopyrrolate C. tiotropium D. umeclidinium (All are LAMAs)

Select all that apply: Which of the following medications for allergic rhinitis are considered first-line treatment? A. beclomethasone B. budesonide C. Fluticasone D. ciclesonide E. Mometasone F. triamcinolone

A. beclomethasone B. budesonide C. Fluticasone D. ciclesonide E. Mometasone F. triamcinolone (all intranasal corticosteroids)

Which of the following medication classes are first-line treatment for inhaled corticosteroids? A. intranasal corticosteroids B inhaled corticosteroids C. nasal/topical decongestants

A. intranasal corticosteroids (INSs)

Fill in the blank: ____ may occur during or within 20 minutes of reslizumab infusions, and must be administered only in health care settings that can provide emergency care.

Anaphylaxis (Black box Warning)

Which does the Respiratory study guide state has a more bitter taste, Astelin or Astepro?

Astelin per study guide, other sources say both

Which of the following intranasal corticosteroids is preferred for prevention of nasal polyps once they have been removed in an allergic rhinitis patient ? A. flunisolide B beclomethasone dipropionate C. fluticasone furoate D. fluticasone propionate

B

Which of the following is the maintenance inhaler of choice for elderly patients with COPD and/or asthma who struggle with compliance? A. Anoro ellipta B. Breo ellipta C. ICS-formoterol

B.

A pharmaceutical company develops a new drug to treat the symptoms of chronic obstructive pulmonary disease. In preclinical studies, the drug caused bronchodilation but did not cause significant vasoconstriction, nor an increase in heart rate or contractility. Which of the following drugs does this new drug resemble? A. Epinephrine B. Arformoterol C. Norepinephrine D. Dobutamine

B. Aformoterol Since the new drug causes bronchodilation and does not cause vasoconstriction or increase in heart rate and contractility, the drug is likely to have β2 agonistic activity but not α1 or β1 agonistic activity, which is similar to arformoterol that is a selective β2 agonist. Epinephrine, norepinephrine, and dobutamine cause an increase in blood pressure.

What is the primary adverse effect reported with Cetirizine administration in children 6 months to 2 years old? A. Headache B. Irritability C. Somnolence D. Dysuria

B. Irritability

Select all that apply: In what trimester(s) does Omalizumab cross the placenta? A. First B. Second C. Third

B. Second and C. Third. Practice Pearl--Omalizumab crosses the placenta during the second and third trimesters. Clinical trials lack data to address risk, though fetal risk is potentially higher in the third trimester. Consider the mother's clinical status and level of asthma control.No information is available regarding Omalizumab in breast milk or risks to the fetus. Consider developmental and health benefits to the infant with breastfeeding as well as the mother's clinical status and level of asthma control.

An asthma patient was given a nonselective β agonist to relieve bronchoconstriction. Which adverse effect would you expect in this patient? A. Bradycardia B. Tachycardia C. Hypotension D. Worsening bronchoconstriction

B. Tachycardia A nonselective β agonist activates both β1 and β2 receptors. β1 Activation causes an increase in heart rate (tachycardia), contractility, and subsequent increase in blood pressure. It relieves bronchoconstriction because of the β2 receptor activation.

Which of the following is the correct class of medication for decongestants? A. intranasal corticosteroids B. alpha-adrenergic receptor agonists C. alpha-adrenergic receptor antagonists

B. alpha-adrenergic receptor agonists

For intranasal corticosteroids in pediatrics which of the following is the most correct answer when it comes to monitoring? A. lack of symptom control B. potential decrease in growth velocity C. sleep disturbances

B. decrease in growth velocity (Practice Pearls Life Span Considerations with INS in all ages do not exceed recommended dosing levels.)

Select all that apply Zileuton therapy is inappropriate in which of the following: A. 30-year-old women B. A 12-year-old boy C. A 7-year-old girl. D. A 70-year-old

C and D. Practice Pearl Zileuton: Not recommended for children younger than 12 years of age due to risk of hepatoxicity or older adults (females over age 65 are at increased risk of alanine transaminase (ALT) elevations)

Which of the following is the most reported adverse effect of Azelastine and Olopatadine administration? A. Rhinorrhea B. Dry Mouth C. Bitter taste D. Weight gain

C. Bitter taste (the other are true but less common)

Which medication used for treatment of asthma and allergic rhinitis has a black box warning about risk of serious neuropsychiatric events including agitation, aggression, depression, sleep disturbances, and suicidal thoughts and behaviors (including suicide): A. Albuterol B. Zileuton C. Montelukast D. Theophylline

C. Montelukast

What is the primary adverse effect reported with Cetirizine administration in >12 years old? A. Headache B. Irritability C. Somnolence D. Dysuria

C. Somnolence

Select all that apply: In what trimester does Benralizumab cross the placenta? A. First B. Second C. Third

C. Third. Practice Pearl--Clinical trials lack data to address risk, though fetal risk is potentially higher in the third trimester. Consider the mother's clinical status and level of asthma control. No information is available regarding benralizumab in breast milk or risks to the fetus. Consider developmental and health benefits to the infant with breastfeeding as well as the mother's clinical status and level of asthma control.

During a dental cleaning, a patient with asthma is noted to have white patches in his oral cavity, which can be easily scraped off. He states that the lesions appeared after he was started on a new inhaler for controlling his worsening asthma. Which of the following drugs most likely contributed to the symptoms this patient? A. Beclomethasone B. Cromolyn C. Levalbuterol D. Zileuton

Correct answer = A. Inhaled corticosteroids such as beclomethasone are associated with development of oropharyngeal candidiasis due to a local immunosuppressant effect. Levalbuterol, cromolyn, and zileuton are not associated with oropharyngeal candidiasis.

A 25-year-old woman complains of symptoms of allergic rhinitis, including excessive sneezing and itchy and runny nose. Which of the following medications would be most useful in this case? A. Cromolyn B. Fluticasone C. Ipratropium D. Montelukast

Correct answer = B. Intranasal corticosteroids such as fluticasone are the most effective therapy for symptoms of allergic rhinitis. Symptoms can also be prevented with H1 receptor antagonists. Cromolyn is a mast cell stabilizer. Intranasal cromolyn can be used to prevent attacks of allergic rhinitis, although it is not as effective as corticosteroids.- Ipratropium is useful to reduce rhinorrhea (runny nose), but it does not help with sneezing. Montelukast is a less effective agent in the treatment of allergic rhinitis.

Which category of allergic rhinitis medications is most likely to be associated with rhinitis medicamentosa (rebound nasal congestion) with prolonged use? A. Intranasal corticosteroid B. Intranasal decongestant C. Leukotriene antagonist D. Oral antihistamine

Correct answer = B. Intranasal decongestants should be used no longer than 3 days due to the risk of rebound nasal congestion (rhinitis medicamentosa). For this reason, the α-adrenergic agents should not be used in the long-term treatment of allergic rhinitis. The other agents may be used as chronic therapies.

Which of the following therapeutic options for COPD acts by inhibiting phosphodiesterase-4? A. Dupilumab B. Roflumilast C. Salmeterol D. Tiotropium

Correct answer = B. Roflumilast is a PDE-4 inhibitor. Dupilumab is a monoclonal antibody against interleukin-4 (IL-4) and interleukin-13 (IL-13). It is indicated for the treatment of asthma. Salmeterol is a long-acting β2-adrenergic agonist (LABA), and tiotropium is a long-acting muscarinic antagonist (LAMA).

A patient with asthma complains of increasing frequency of asthma attacks. He has been using an albuterol inhaler when he has symptoms. However, this is not helping him much lately, and he is suffering from daily asthma symptoms. Which of the following is the most appropriate for management of asthma in this patient? A. Add salmeterol B. Add oral prednisone C. Change albuterol to budesonide/formoterol D. Change albuterol to salmeterol

Correct answer = C. A patient who is inadequately controlled with inhaled albuterol needs an ICS-containing controller treatment to reduce symptoms and the risk of asthma exacerbation. Budesonide/formoterol is an ICS/LABA combination that can be used on as-needed basis or as a daily controller medication, depending on the frequency and severity of symptoms. Oral prednisone would be considered if the patient does not improve with addition of an ICS to the regimen and if he is having acute severe

A 32-year-old man with a history of opioid addiction presents with cough due to a viral upper respiratory system infection. Which of the following treatments is appropriate symptomatic treatment of cough in this patient? A. Guaifenesin/dextromethorphan B. Guaifenesin/codeine C. Benzonatate D. Montelukast

Correct answer = C. Benzonatate suppresses the cough reflex through peripheral action and has no abuse potential. Dextromethorphan, an opioid derivative, and codeine, an opioid, both have abuse potential. Montelukast is not indicated for cough suppression.

A 22-year-old woman with asthma goes hiking with her friends on a cold, windy day. While hiking, she suddenly experiences difficulty in breathing, dry cough, and chest tightness. Which of the following drugs can provide prompt relief of her symptoms? A. Inhaled fluticasone B. Inhaled beclomethasone C. Inhaled albuterol D. Inhaled salmeterol

Correct answer = C. Inhalation of a SABA with a rapid onset, such as albuterol, usually provides quick relief of symptoms. Inhaled budesonide/formoterol would also be an excellent option. Although it is a LABA, formoterol has a rapid onset of action. Inclusion of the inhaled corticosteroid budesonide will help reduce the risk of future exacerbations. Inhaled corticosteroids such as beclomethasone and fluticasone are effective long-term controller medications to treat chronic airway inflammation but do not provide any immediate effect for bronchospasm when used as single agents. Salmeterol is a long- acting β2 agonist, and the onset of action is delayed. It should not be used for quick relief of symptoms.

41.4 A 68-year-old man has COPD with moderate airway obstruction. Despite using salmeterol twice daily, he reports continued symptoms of shortness of breath with mild exertion. Which of the following agents is the most appropriate addition to his current therapy? A. Systemic corticosteroids B. Albuterol C. Tiotropium D. Roflumilast

Correct answer = C. The addition of an anticholinergic bronchodilator to the LABA salmeterol would be appropriate and provide additional therapeutic benefit. Systemic corticosteroids are used to treat exacerbations in patients with COPD but not recommended for chronic use. The addition of a SABA (albuterol) is less likely to provide additional benefit since the patient is already using medication with the same mechanism of action. Roflumilast is not indicated, since the patient is not reporting exacerbations and only has moderate airway obstruction.

A 56-year-old man is newly diagnosed with COPD. During the last year he has had two respiratory illnesses that required treatment with antibiotics and an inhaler. His COPD Assessment Test score is 9, and the provider categorizes the COPD as group C. Which of the following is the most appropriate treatment for this patient? A. Formoterol/glycopyrrolate B. Indacaterol C. Salmeterol/fluticasone D. Tiotropium

Correct answer = D. A LAMA (tiotropium) is the preferred treatment for COPD group C. Patients in group C have a lower COPD symptom burden but are at higher risk of future exacerbations. Monotherapy with a LABA (indacaterol) could be considered for patients in group A or B. A combination of LABA/LAMA (formoterol/glycopyrrolate) could be a next step if the patient does not respond to tiotropium. A LABA/ICS combination (salmeterol/fluticasone) is recommended for certain patients in group D (for example, those with higher eosinophil counts).

A patient complains of chest tightness and difficulty breathing after taking aspirin or other NSAIDs. Examination reveals nasal polyps and increased eosinophils on differential white blood cell count. Which of the following drugs would be most appropriate to control his symptoms? A. Albuterol B. Oxymetazoline C. Roflumilast D. Zileuton

Correct answer = D. The patient suffers from aspirin-exacerbated respiratory disease (AERD). Zileuton, an antileukotriene drug, is the most appropriate choice to control his symptoms, which are secondary to excess leukotriene production following administration of NSAIDs. Albuterol is a short-acting β2-adrenergic agonist (SABA) used to relieve symptoms of an acute asthma attack. Roflumilast is an agent for treatment of COPD, and oxymetazoline is a nasal decongestant used for short-term management of symptoms of allergic rhinitis.

Which inhaled corticosteroid should be discontinued if no improvement is seen in 3 weeks? A. flunisolide B mometasone furoate C. ciclenoside D. beclomethasone

D

Which of the following intranasal corticosteroids is preferred for chronic rhinosinusitis with nasal polyps? A. triamcinolone acetonide B mometasone furoate C. fluticasone furoate D. fluticasone propionate

D

Which of the following adrenergic agonists used in the treatment of asthma increases the risk of asthma-related deaths when used as a single agent? A. Albuterol B. Epinephrine C. Ephedrine D. Salmeterol

D. Salmeterol Long-acting β agonists (LABAs) such as salmeterol have been shown to increase the risk of asthma-related deaths when used alone and have a boxed warning related to this. The combination of a LABA with an inhaled corticosteroid is a preferred regimen for moderate to severe asthma.

True or false. First-generation antihistamines are preferred to second-generation antihistamines.

False

True or false: Nasal sprays should be sprayed directly on the septum.

False (Allergy and Respiratory Therapy teaching point)

True or false Studies have been done on Cromolyn nasal spray in pregnant and breast feeding women proving safety for fetus/baby. Animal trials reveal no evidence of fetal harm.

False Practice pearl--Clinical trials on pregnant women lack data to address fetal risk. Consider the mother's clinical status and level of asthma control. It is unknown whether cromolyn is excreted in breast milk. Weigh potential benefits to the mother against adverse effects on the infant.

True or false. Because intranasal antihistamine sprays are topical use in Pregnancy and Lactation is recommended.

False. Practice Pearl Weigh potential benefits to the mother against potential risk to the fetus. Breastfeeding is not recommended. Weigh potential benefits to the mother against adverse effects on the infant.

True or false: Women are regularly pregnant or breastfeed while taking intranasal corticosteroids.

False. Practice Pearl---Weigh potential benefits to the mother against potential risk to the fetus. Breastfeeding is not recommended. Weigh potential benefits to the mother against potential adverse effects on the infant.

True or false. Studies have been done on PO Montelukast in pregnant and breast feeding women proving safety for fetus/baby.

False. Practice Pearl--Animal trials reveal no demonstratable risk to the fetus. However, there are no adequate and well-controlled studies in pregnant women. Montelukast is excreted in breast milk at ranges below the therapeutic index. Weigh the benefits of breastfeeding to the mother and infant against adverse effects on the infant.

True or false Studies have been done on Ipratropium nasal spray in pregnant and breast feeding women proving safety for fetus/baby.

False. Practice Pearl--Animal trials reveal no evidence of fetal harm. Clinical trials on pregnant women lack data to address fetal risk. Consider mother's clinical status and level of asthma control. There are no data regarding presence in or effect on human milk or on potential effects on infants. Weigh potential benefits to the mother against adverse effects on the infant.

True or false Sudafed/Pseudoephedrine can be used throughout pregnancy in smaller doses.

False. Practice Pearl--Avoid use in the first trimester. Weigh potential benefits to the mother against potential risk to the fetus. Pseudoephedrine hydrochloride is excreted in breast milk. Adverse effects include irritability in nursing infants and a decrease in milk production. Consider the risk to the infant versus the benefits of breastfeeding.

True or false: Reslizumab is always appropriate in pregnancy and breast feeding.

False. Practice Pearl--Limited data exist regarding reslizumab and pregnancy risk. Consider the mother's clinical status and level of asthma control. Consider the long half-life of reslizumab prior to prescribing. No information is available regarding reslizumab in breast milk or risks to the fetus. Consider developmental and health benefits to infants with breastfeeding as well as the mother's clinical status and level of asthma control.

True or false: Cromolyn is regularly prescribed during pregnancy and lactation.

False. Practice pearl--Animal trials reveal no evidence of fetal harm. Clinical trials on pregnant women lack data to address fetal risk. Consider use during pregnancy only if clearly needed. It is unknown whether cromolyn is excreted in breast milk. Use caution and consider the potential benefit of treatment to the potential adverse effects on the infant.

True or False. Benzonatate does not contain opioids like some antitussives and is regularly used in pregnant and breast feeding women

False. Practice pearl--Weigh potential benefits to the mother against potential risk to the fetus. Breastfeeding is not recommended. It is not known whether benzonatate is excreted in breast milk. Consider alternative treatment.

True or false Because they are secondary antihistamines, Cetirizine and Fexofenadine use in pregnancy and lactation is recommended

False. Practice pearl. Clinical animal studies have shown no risk to the fetus. However, there are no adequate and well-controlled studies in pregnant women. Weigh potential benefits to the mother against potential risk to the fetus, and limit to short-term use. Breastfeeding is not recommended. Weigh potential benefits to the mother against potential risk to the infant.

True or false. Sudafed PE and Sudafed have the same generic name.

False. Sudafed PE is Phenylephrine and Sudafed is Pseudoephedrine

True or false: Zilueton therapy is appropriate in pregnancy and lactation

False: Practice Pearl--There are no adequate, well-controlled studies in pregnant women, and fetal risk is unknown. Evaluate risks to the mother and the fetus associated with poorly controlled asthma during pregnancy. Zileuton is excreted in breast milk; breastfeeding is contraindicated.

Fill in the blank: _______ combo is the preferred reliever medication for the treatment of asthma.

ICS/folmoterol

What is the main pediatric concern for Afrin listed in the Edmunds text?

In children age 5 and younger, accidental ingestion caused serious cardiopulmonary and neurological effects.

Fill in the blank: All patients with COPD should have a ____included in the treatment regimen for quick relief of symptoms.

SABA

True or False: Because of the rapid onset of formoterol, an ICS/formoterol combination can be used as both a daily controller medication and also for quick relief of asthma symptoms as needed.

True

True or False: If no improvements seen within 2 weeks of starting or changing ICS medications or dosing, the dose should be increased?

True

True or False: Mast cell stabilizers, leukotriene modifiers and monoclonal antibodies are add-on therapies in patients with asthma who are either inadequately controlled or unable to tolerate ICS.

True

True or False: Monotherapy with LABAs is contraindicated in asthma, and these agents should be used in combination with ICS.

True

True or false Fexofenadine oral disintegrating tablets contain phenylalanine and are contraindicated in patients with phenylketonuria.

True

True or false Sedative effects are common with cetirizine administration and may decrease mental alertness; therefore advise patients to avoid use if operating machinery or driving.

True

True or false alcohol, opioids, sedatives, antidepressants, quinidine, disopyramide, and monoamine oxidase inhibitors increase the CNS and/or anticholinergic effects of Benadryl.

True

True or false. Guaifenesin should not be used in children younger than age 2 due to serious and life-threatening effects

True

True or false. Pediatric patients may experience paradoxical CNS stimulation, excitation, and mental alertness with Diphenhydramine administration.

True

True or false: Inhaled β2-adrenergic agonists directly relax airway smooth muscle.

True

True or false: Patients should be instructed to rinse the mouth in a "swish-and-spit" method with water following use of ICS to reduce the risk of oral candidiasis and hoarseness.

True

True or false: Second-generation antihistamines do not cause sedation because they do not cross the blood-brain barrier.

True

True or false Interventions to help manage allergic rhinitis include acaricides, protective barriers, humidity control, hand sanitizers, cleaning and the use of vacuum filters, and laminar airflow systems.

True (Allergy and Respiratory Therapy teaching point)

True or false. Evaluation of the physical environment (inside and outside) is helpful in identifying allergen triggers.

True (Allergy and Respiratory Therapy teaching point)

True or false: PCPs should counsel asthmatic patients on nonpharmacologic strategies to improve health outcomes, such as smoking cessation, avoidance of environmental and occupational triggers, avoidance of indoor and outdoor allergens, physical activity, weight reduction and a healthy diet, breathing and relaxation techniques, and psychological responses to stress (emotional or physical).

True (Asthma teaching points)

True or false: Patients should recognize early signs and symptoms of worsening asthma such as wheezing, shortness of breath, coughing, or yellow, green, gray, bloody, or thicker-than-usual sputum and activate their asthma action plan and seek help.

True (Asthma teaching points)

True or false. Smoking cessation therapy is an important to slow the progression of COPD.

True (COPD teaching points)

True or false INSs are considered safer than antihistamines and more effective than leukotriene receptor antagonists (LTRAs)

True (Practice Pearls Life Span Considerations with INS in all ages do not exceed recommended dosing levels.)

True or false. Breast feeding is contraindicated with leukotriene modifiers.

True (only Montelukast if benefit is high enough to mother)

True or false. It is not known whether guaifenesin is excreted in breast milk or whether it is safe to use during pregnancy. Weigh potential benefits to the mother against potential risk to the infant.

True (practice pearl)

True or false The FDA has required changes in the labels on all cough and cold medicines containing opioids.

True The labels must: 1) Limit the use of these products to adults 18 years of age and older, and state that the risks of these medicines outweigh their benefits in children younger than 18; 2) Include a boxed warning regarding the risks of misuse, abuse, addiction, overdose, death, and slowed or difficult breathing (Black box warning)

True or false: Chronic rhinosinusitis (CRS) is classified by the absence or presence of nasal polyps.

True chronic rhinosinusitis without nasal polyps (CRSsNPs) and chronic rhinosinusitis with nasal polyps (CRSwNPs).

True or false. Intranasal decongestants provide symptomatic relief of nasal congestion and do not improve nasal itching, sneezing, or rhinorrhea.

True.

True or false. Dextromethorphan is safe to use in the first trimester of pregnancy and while breastfeeding.

True. Practice Pearl-- Available without a prescription, dextromethorphan is considered to be safe to use in the first trimester and has not been related to increased risk to the fetus. Dextromethorphan is compatible with breastfeeding when recommended dosing is followed. Avoid products containing alcohol.

True or false Diphenhydramine crosses the placenta.

True. Practice Pearl--Weigh potential benefits to the mother against potential risk to the fetus. Limit to short-term use. Breastfeeding is not recommended. Weigh potential benefits to the mother against potential adverse effects on the infant

Fill in the blank(s): Controller medications contain _____ to reduce airway inflammation and the risk of asthma exacerbations.

inhaled corticosteroids (ICSs)

Fill in the blank: COPD is characterized by progressive ______ airflow obstruction.

irreversible

Fill in the blank(s): Short-acting β2 agonists (SABAs; albuterol or levalbuterol) are used for ___ relief of symptoms in asthma.

quick

Fill in the blank: Patients should not use asthma medications more often than ordered. If they feel that their symptoms are not under control or that they are using the ______ ________more than ordered, they should contact their health care provider.

rescue inhaler