COPD Flashcards
- All of the following play a role in the pathophysiology of COPD except:
A. Chronic inflammation from repeated exposure to noxious particles and gases
B. An imbalance between proteinases and antiproteinases
C. Inflammation similar to what is seen in asthma, which is mainly mediated through eosinophils and mast cells
D. Oxidative stress
E. Impairment of the normal protective and repair mechanisms in the lungs
C
- In COPD, where in the lungs is the primary site of obstruction?
A. Large bronchi
B. Large bronchioles
C. Mucus glands
D. Small bronchi and bronchioles
E. Trachea
D
- A 67-year-old man presents to his primary care physician complaining of productive cough and dyspnea on exertion for the past 6 months; COPD is suspected. Which of the following further supports the diagnosis of COPD?
A. A 45 pack–year history of smoking
B. FEV1/FVC of 60% (0.60)
C. Family history of AAT deficiency
D. Fifteen years of employment in a plastics plant with exposure to talc
E. All of the above
E
- Which of the following is an adverse effect of tiotropium?
A. Hypokalemia
B. Dry mouth
C. Insomnia
D. Irritability
E. Seizures
B
- A 66-year-old man was admitted to the hospital 4 days ago for an acute COPD exacerbation. During this hospitalization, he has been treated with albuterol 2.5 mg via nebulizer every 4 hours, ipratropium 0.5 mg via nebulizer every 8 hours, prednisone 30 mg orally once daily, and
cefuroxime axetil 500 mg orally twice daily, as well as fluticasone 110 mcg inhaled twice daily and theophylline 200 mg orally twice daily (fluticasone and theophylline were continued from outpatient treatment). Today he complains of restlessness and feeling like his heart is racing, which he attributes to being unable to smoke since being admitted to the hospital. Which of the following is/are alternative causes of these symptoms?
A. Theophylline toxicity secondary to reduced metabolism
B. Adverse effect of albuterol
C. Adverse effect of fluticasone
D. All of the above
E. A and B only
E
- A 65-year-old woman with emphysema is seen in clinic today for a checkup. Her current COPD pharmacotherapy includes tiotropium 18 mcg once daily, an albuterol MDI as needed and formoterol 12 mcg every 12 hours. She is adherent with medications and uses her inhalers
correctly. She reports increasing use of albuterol over the last 3 months and increased breathlessness; she denies any recent changes in sputum. Her postbronchodilator FEV1 today is 42%. Which of the following is the most appropriate change to her current treatment regimen?
A. Add roflumilast 500 mcg orally every 24 hours
B. Add methylprednisolone 60 mg intravenously every 6 hours
C. Discontinue formoterol and start fluticasone furoate/vilanterol 100 mcg/ 25 mcg, one inhalation daily
D. Add fluticasone/salmeterol 500 mcg/50 mcg, one inhalation every 12 hours
E. Discontinue tiotropium and formoterol and start umeclidinium/vilanterol 62.5 mcg/25 mcg, one inhalation daily
C
- A 75-year-old man with severe COPD currently treated with tiotropium,
formoterol/budesonide, and albuterol MDI as needed presents to the clinic complaining of a more frequent cough, increased sputum production, and a change in sputum color. The last time
he had symptoms like these was 6 months ago, and at that time he was hospitalized for 3 days. After being diagnosed with a COPD exacerbation and continuing his current maintenance therapies, which of the following is the most appropriate initial treatment recommendation?
A. Mometasone 220 mcg inhalation every 12 hours
B. Doxycycline 100 mg orally every 12 hours
C. Ipratropium two inhalations every 6 hours
D. Theophylline 300 mg orally every 12 hours
E. All of the above are appropriate initial treatment recommendations
B
- An 81-year-old woman presents to the emergency department complaining of symptoms consistent with a COPD exacerbation. She tells you that she takes only tiotropium daily at home and that she is supposed to be on one other inhaler but has not had it refilled in the last 6 months.
Which of the following would be the most appropriate medication to add to her regimen in the emergency department?
A. Ipratropium
B. Aminophylline
C. Roflumilast
D. Levalbuterol
E. None of the above would be an appropriate recommendation
D
- Which of the following interventions might be appropriate for a patient with moderate (GOLD 2) COPD currently using only an albuterol MDI?
A. Oxygen therapy for 16 hours per day
B. Two weeks of pulmonary rehabilitation
C. Surgery (eg, bullectomy)
D. Lung transplantation
E. All of the above would be considered appropriate interventions
A
- A 67-year-old man with chronic cough and sputum production, an FEV1/FVC of 68% (0.68), and an FEV1 65% of predicted can be classified according to the GOLD guidelines as:
A. Not having COPD
B. GOLD 1: mild
C. GOLD 2: moderate
D. GOLD 3: severe
E. GOLD 4: very severe
C
- All of the following are appropriate patient education points for COPD except:
A. Smoking cessation counseling
B. Role of regular exercise
C. End-of-life issues and resuscitation wishes
D. When to quit taking medications as symptoms improve
E. Signs and symptoms of an exacerbation
D
- Inhaled corticosteroids may improve all of the following parameters in a COPD patient with an FEV1 of 55% except:
A. Symptom frequency
B. Lung function
C. Quality of life
D. Exacerbation rates
E. Mortality rates
E
- A 58-year-old man with COPD was started on inhaled corticosteroids 2 months ago. Which one of the following parameters would be best for evaluating the effectiveness of the inhaled corticosteroid and determining if continued use is needed?
A. Arterial blood gases
B. Body mass index
C. Symptom improvement
D. Chest x-ray
E. FEV1
C
- A 59-year-old man presents with cough, sputum production, and dyspnea with exertion that began 6 months ago. He is a nonsmoker, but he has worked as a bartender four nights a week for the last 32 years. Lung examination reveals significant wheezing bilaterally. Which one of the
following confirms the suspected diagnosis of COPD?
A. PaCO2 55 mm Hg (7.3 kPa) on arterial blood gas
B. Exposure to secondhand smoke
C. Postbronchodilator FEV1/FVC ratio of 60% (0.60)
D. FEV1 75%
E. Absence of infiltrates on chest x-ray
C
- A 72-year-old man with COPD, hypertension, dyslipidemia, coronary artery disease, and osteoarthritis presents to clinic for routine follow-up. He is currently treated with formoterol,
albuterol as needed, lisinopril, metoprolol, atorvastatin, aspirin, and acetaminophen. He reports no changes in his respiratory symptoms. His COPD Assessment Test (CAT) score is 9. He did go to an urgent care facility twice in the past 5 months for worsening COPD. He was treated with antibiotics and prednisone on both occasions. His pulmonary function tests (PFTs) today reveal an FEV1 of 54%. Which of the following is the most appropriate medication change to make today?
A. No changes are needed because the patient’s symptoms are stable
B. Change formoterol to the combination inhaler budesonide–formoterol
C. Add ciclesonide
D. Discontinue metoprolol
E. Both B and D should be done today
B
- Which of the following is an adverse effect of roflumilast that is particularly concerning in late-stage COPD patients?
A. Hypokalemia
B. Xerostomia
C. Urinary retention
D. Weight loss
D
- Which of the following medications used for managing COPD works primarily by blocking muscarinic receptors in bronchial smooth muscle leading to bronchodilation?
A. Indacaterol
B. Fluticasone
C. Umeclidinium
D. Roflumilast
C
- An 81-year-old woman presents to the emergency department complaining of symptoms consistent with a COPD exacerbation. She has a medical history of COPD, hypertension, heart failure with reduced ejection fraction, and osteoporosis. Her home medications are all dosed appropriately and include albuterol as needed, tiotropium, lisinopril, carvedilol, and spironolactone. After being admitted to the hospital and assuming that all her home medications are continued, which of the following would be the most appropriate medication to add for
treatment of her acute COPD exacerbation?
A. Ipratropium
B. Aminophylline
C. Roflumilast
D. Prednisone
D
- LABAs and/or LAMAs may improve all the following parameters in a COPD patient with an FEV 1 of 55% predicted except:
A. Symptom frequency
B. Lung function
C. Exacerbation rates
D. Mortality rates
D
- Which of the following may help predict a more favorable response to inhaled corticosteroids in patients with COPD?
A. Neutrophils
B. Eosinophils
C. Macrophages
D. Lymphocytes
B
- Where in the lungs is the primary site of obstruction in COPD?
A. Large bronchi
B. Large bronchioles
C. Mucus glands
D. Small bronchi and bronchioles
D
- A 63-year-old woman presents with cough, minimal sputum production, and dyspnea with exertion that began over a year ago but has been gradually worsening. She has smoked 1 pack of
cigarettes a day for the past 47 years. Which of the following confirms the suspected diagnosis of COPD?
A. PaO 2 60 mm Hg (8.0 kPa) on arterial blood gas
B. Oxygen saturation of 95% (0.95)
C. Postbronchodilator FEV 1 /FVC ratio of 64% (0.64)
D. Postbronchodilator FEV 1 of 75%
C
- All of the following are appropriate patient education points for COPD except:
A. Smoking cessation counseling
B. Role of regular exercise
C. Signs and symptoms of an exacerbation
D. When to quit taking medications as symptoms improve
D
- A 59-year-old man with no significant medical history comes to your ambulatory care clinic for a follow-up visit where he completes pulmonary function tests showing a FEV 1 /FVC ratio of 59% (0.59) and a CAT score of 8. Additionally, he acknowledges that he was admitted to the hospital roughly 2 months ago for a COPD exacerbation. As the clinical pharmacist at the clinic, you are asked what the most appropriate pharmacotherapy would be, assuming that he is on no outpatient medications at this time.
A. Tiotropium daily plus as-needed albuterol
B. Monotherapy with as-needed albuterol
C. Fluticasone/salmeterol twice a day plus tiotropium daily
D. Indacaterol daily
A
- Which one of the following clinical presentations is suggestive of COPD?
A. Sudden onset of cough and large volumes of purulent sputum
B. Chronic cough, sputum production, shortness of breath with activity; symptoms have gradually worsened over the last year
C. Wheezing and chest tightness that occurs when exposed to strong fumes; symptom onset in childhood
D. Cough, sputum production, shortness of breath, and fever; symptoms started 1 week ago
B
- A 66-year-old man was admitted to the hospital 4 days ago for an acute COPD exacerbation. During this hospitalization, he has been treated with albuterol 2.5 mg via nebulizer every 4 hours, prednisone 40 mg orally once daily, and azithromycin 500 mg orally once daily, as well as tiotropium 18 mcg inhaled once daily and theophylline 200 mg orally twice daily. Today he
complains of white patches on his tongue and the inside of his mouth. Which of the following is the most likely cause of this adverse effect?
A. Prednisone
B. Albuterol
C. Tiotropium
D. Theophylline
A
- A 65-year-old woman with emphysema is seen in clinic today for a checkup. Her current COPD pharmacotherapy includes tiotropium 18 mcg once daily and albuterol MDI every 4 hours as needed. She is adherent with medications and uses her inhalers correctly. She reports
increasing albuterol use over the last 3 months due to increased breathlessness; she denies any recent changes in sputum purulence or volume. Her CAT score today is 23 (compared to 18 3 months ago) and she has not had any exacerbations in the last 3 years. Which of the following is
the most appropriate change to her current treatment regimen?
A. Add roflumilast 500 mcg orally every 24 hours
B. Add methylprednisolone 60 mg intravenously every 6 hours
C. Add olodaterol 2.5 mcg two inhalations daily
D. Discontinue tiotropium and start umeclidinium 62.5 mcg one inhalation daily
C
- A 55-year-old non-smoker presents to the clinic complaining of persistent dyspnea and a chronic cough over the last 6 months. After appropriate tests are run, he is diagnosed with group B COPD, likely from occupational exposures, and is started on appropriate pharmacotherapy. At this point, which of the following nonpharmacologic recommendations would be most appropriate for this patient?
A. Lung volume reduction
B. Smoking cessation
C. Pulmonary rehabilitation
D. Noninvasive ventilation
C
- A 67-year-old man with COPD, hypertension, dyslipidemia, coronary artery disease, and osteoarthritis presents to clinic for routine follow-up. He is currently treated with tiotropium,
albuterol as needed, lisinopril, metoprolol, atorvastatin, aspirin, and acetaminophen. He reports no changes in his respiratory symptoms over the last 3 months and his CAT score today is 9. He went to an urgent care facility twice in the past 10 months (last visit 4 months ago) for worsening
COPD symptoms and was started on tiotropium at his last visit. Additionally, he was treated with antibiotics and prednisone at both urgent care visits. Which of the following is the most
appropriate recommendation to make today?
A. Evaluation of immunization status; administer influenza and/or pneumococcal vaccine if indicated
B. Add budesonide/formoterol inhaler
C. Add roflumilast
D. Discontinue metoprolol
C
- A 63-year-old man with a medical history of COPD, diabetes mellitus, and GERD presents to the emergency department complaining of cough, sputum production, and change in sputum
color over the last week. He had a similar presentation about 9 months ago and at that time was diagnosed with pneumonia. He reports that his COPD symptoms have been extremely well controlled (CAT scores of 4–6) over the last three years while he has been on as-needed albuterol
and umeclidinium, vilanterol, and fluticasone (Trelegy), except for this current episode and during his previous pneumonia diagnosis. A chest x-ray is done and shows a lower lobe opacity
in the right lung consistent with pneumonia. His serum eosinophil level is 45 cells/L (0.045 × 10 9 /L). Which of the following would be the most appropriate recommendation for managing his
COPD?
A. Discontinue the fluticasone
B. Schedule ipratropium/albuterol four times a day in addition to his current regimen
C. Add theophylline to his existing regimen
D. Add morphine for his persistent dyspnea
A
