45. Asthma Flashcards
A 70 year old patient has been prescribed Xopenex. Choose the correct statement concerning Xopenex:
A. Xopenex causes less tachycardia than albuterol.
B. Xopenex causes fewer headaches than albuterol.
C. Xopenex causes less nervousness than albuterol.
D. Xopenex is the R-isomer of albuterol.
E. Xopenex is the L-isomer of albuterol.
D. Xopenex is the R-isomer of the beta-2 adrenergic agonist albuterol. Like albuterol, it is available in a metered-dose inhaler (Xopenex HFA) and for use in a nebulizer. The frequency of systemic effects (tachycardia, headache, nervousness) is reported to be similar to albuterol.
A patient with asthma has been prescribed the Advair Diskus. Which of the following statements is correct?
A. Advair contains fluticasone, a long-acting beta-2 agonist.
B. Advair contains salmeterol, an inhaled corticosteroid.
C. Advair Diskus is dosed 1 inhalation once daily.
D. Advair treats both airway constriction and inflammation.
E. Advair Diskus must be used within 2 months of opening the foil pouch.
D. Advair 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 forAdvair Diskus is 1 inhalation twice daily.
Madison is a four year-old girl with asthma. She will receive montelukast. Select the correct dose for a four year-old child.
A. A 4 mg chewable tablet taken once daily in the evening
B. A 5 mg chewable tablet taken once daily in the evening
C. A 5 mg chewable tablet taken BID
D. A 10 mg chewable tablet taken once daily in the evening
E. A 10 mg chewable tablet taken BID
A. The montelukast dosage for pediatric patients 2-5 years of age is one 4-mg chewable tablet or one packet of 4-mg oral granules taken in the evening.
1-5 yo: 4mg QPM
6-14: 5mg QPM
15+: 10mg QPM
What is the sweetener used in the montelukast chewable tablets?
A. Sorbitol
B. Honey
C. Splenda
D. Phenylalanine
E. Sucrose
D. Phenylalanine is commonly used to sweeten chewable drugs; it cannot be used in patients with phenylketonuria (PKU).
Lilly is a 15 year-old girl with asthma. She uses a steroid inhaler daily and has an albuterol inhaler that she uses before she runs track. Track meets can be long and sometimes last several hours. Lilly’s albuterol inhaler ran out at the last meet and she became short of breath. Choose an appropriate recommendation that would provide longer-acting relief for Lilly to use prior to a track meet:
A. She can use Aerospan HFA instead of the short-acting beta agonist.
B. She can use Foradil instead of the short-acting beta agonist.
C. She can use Proventil instead of the short-acting beta agonist.
D. She can use theophylline instead of the short-acting beta agonist.
E. She can use Accolate instead of the short-acting beta agonist.
B. An albuterol inhalation lasts about 2-3 hours. If the patient requires a longer duration of action, long-acting beta-2 agonists can be used. She would still need to be dispensed an albuterol inhaler for “rescue” therapy.
Foradil (formoterol)
Accolate (zafirlukast)
A patient has been prescribed beclomethasone for asthma. What is the brand name of beclomethasone when used for asthma?
A. Beconase
B. Vancenase
C. Asmanex
D. QVAR
E. Nasonex
D. The brand name of beclomethasone for asthma is QVAR.
A patient with mild, intermittent asthma has been prescribed an albuterol MDI. Counsel the patient on the correct use of the device. Place the instructions for proper MDI technique below in the correct order (click and drag each statement into the proper order below).
A. Remove the dust cap from the inhaler.
B. Inspect the mouthpiece for any debris.
C. Place the mouthpiece on your lips and close your lips around it.
D. Press the top of the canister while you are breathing in deeply and slowly.
E. Hold your breath as long as you can, up to 10 seconds.
A, B, C, D, E.
A patient is starting on Singulair. What is a warning associated with the use of Singulair?
A. Hepatotoxicity
B. Peripheral neuropathy
C. Floppy iris syndrome
D. Bone marrow suppression
E. Behavior and mood changes
E. A serious warning involves behavior and mood-related changes have been reported: agitation including aggressive behavior or hostility, bad or vivid dreams, depression, disorientation (confusion), feeling anxious and hallucinations. This warning was added in 2009 and applies to all the leukotriene modifiers.
Which of the following steroids has the greatest antiinflammatory potency?
A. Fludrocortisone
B. Prednisone
C. Betamethasone
D. Triamcinolone
E. Cortisone
C. Bethamethasone and dexamethasone have the greatest antiinflammatory potency.
Raffi is a pharmacist in a busy store. Cheryl is a mother who came in with her eight year old daughter. The child had a new prescription for an albuterol inhaler. Raffi quickly instructed the mother how to use the MDI. When the mother got home, she had no idea how to instruct her daughter properly. The child, like many patients, had poor technique and did not obtain proper relief from the medicine. What is the most important thing that Raffi should have done to ensure that the parent and child understood how to use the inhaler?
A. Have the mother repeat back the instructions to him in a slow and deliberate manner.
B. The pharmacist should have repeated the instructions twice and asked the mother if she understood everything that was explained.
C. The pharmacist should have given the mother written instructions.
D. The pharmacist should have demonstrated how to use the inhaler and then watched the patient demonstrate proper technique.
E. The pharmacist should have had the technician, who may have had more time, demonstrate proper technique to the mother.
D. Delivery device instructions should be provided by demonstration. The only way to know for sure if the patient absorbed the information is to have them demonstrate proper use.
What is the therapeutic range for theophylline?
A. 1-5 mcg/mL
B. 2-10 mcg/mL
C. 5-15 mcg/mL
D. 10-20 mcg/mL
E. 50-100 mcg/mL
C. The therapeutic range for theophylline is 5-15 mcg/mL.
A patient with severe, persistent asthma has had an acute exacerbation. The physician has prescribed a short course of oral prednisone. Choose the correct statement:
A. Patients with severe asthma should always use inhaled, not oral steroids.
B. Oral steroids can cause many problems, including lowered blood glucose.
C. Prednisone is a prodrug of prednisolone.
D. A brand name is Medrol.
E. Oral steroids reduce appetite and cause anorexia.
C. Oral steroids, used chronically, have many adverse effects. The risk depends on the dose and duration (higher dose and longer duration will cause more problems). Oral steroids can increase blood pressure and increase appetite causing weight gain.
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?
A. Oral
B. Buccal
C. Intravenous
D. Patch
E. Inhaled
E. The inhaled route is preferred in asthma since the disease is in the airways of the lungs.
Which of the following medications can increase theophylline levels and possibly result in theophylline toxicity? (Select ALLthat apply.)
A. Ciprofloxacin
B. Bupropion
C. Zafirlukast
D. Ranitidine
E. Clarithromycin
A, C, E.
Counseling points on the use of the Foradil should include the following:
A. The capsules should be swallowed whole; do not crush or chew the caspule.
B. Leave the capsule sealed in the blister foil until just before use.
C. This medication can be used to treat an acute attack.
D. The capsules must be stored in the refrigerator by the patient.
E. This medication is dosed once daily.
B. Foradil is used in the aerolizer and not swallowed whole. It is used for maintenance therapy; not an acute asthma attack.
Foradil (formoterol)
A patient has been prescribed fluticasone for asthma. What is the brand name of fluticasone when used for asthma?
A. Aerospan
B. Flonase
C. Flomax
D. Flovent
E. Pulmicort
D. Be very careful with the steroids used for asthma and those used for allergic rhinitis as they are same generic drug name but different brand names and delivery devices.
Which of the following medications is a dry powder inhaler?
A. Pulmicort Flexhaler
B. QVAR
C. Xopenex
D. Symbicort
E. Accuneb
A. Pulmicort Flexhaler is a dry powder inhaler.
Pulmicort (budesonide)
Dawn has been using prednisone 10 mg PO daily for the past month post discharge from her recent asthma exacerbation. Her doctor wants to taper her off the medication. What is the reason corticosteroids 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 to occur if stopped abruptly.
D. They can cause hypothalamic pituitary adrenal axis suppression.
E. They can cause bizarre, psychiatric behavior if stopped abruptly.
D. Corticosteroids need to be tapered due to hypothalamic pituitary adrenal axis suppression.
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. Advair HFA is 2 inhalations twice daily.
Heather 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. Heather’s personal best number is 300. Now Heather is in the pharmacy and she has selected a peak flow meter to purchase but admits to forgetting the steps in using it. Which of the following statements are correct in counseling Heather on the appropriate use of a peak flow meter? (Select ALL that apply.)
A. Do the peak flow meter assessment in the morning, before you take your medications.
B. Perform one assessment (3 readings) per day and record the highest number of the assessment in a log book.
C. It is best to perform the assessment in a supine position with the legs not elevated higher than the lungs.
D. Coughing during the assessment invalidates the reading.
E. If the value recorded is less than 150, she should go to the hospital immediately, regardless of symptoms.
A, B, D, E.
Values below 50% of personal best, patients should go to hospital.
