Drugs for COPD Flashcards
Which of the following drugs is classified as a Short-Acting Beta2-Adrenergic Agonist (SABA) and is commonly the first medication prescribed for patients with COPD?
A. Salmeterol
B. Terbutaline
C. Tiotropium
D. Roflumilast
B. Terbutaline
Explanation: Terbutaline is a SABA, commonly prescribed as the first medication to relieve dyspnea in COPD. Salmeterol is a LABA, tiotropium is a LAMA, and roflumilast is a PDE4 inhibitor.
Which of these medications is a Long-Acting Muscarinic Antagonist (LAMA) used for COPD management?
A. Salbutamol
B. Ipratropium
C. Tiotropium
D. Budesonide
C. Tiotropium
Explanation: Tiotropium is a long-acting muscarinic antagonist (LAMA) used for COPD. Salbutamol is a SABA, ipratropium is a SAMA, and budesonide is an ICS.
The combination of ipratropium and salbutamol provides which of the following benefits for COPD patients?
A. Greater improvement in FEV1 and bronchodilation with fewer side effects
B. Longer duration of action compared to tiotropium
C. Prevention of pneumonia and tuberculosis risk
D. Reduced cardiovascular risk compared to using salbutamol alone
A. Greater improvement in FEV1 and bronchodilation with fewer side effects
Explanation: Combining ipratropium (SAMA) and salbutamol (SABA) provides greater bronchodilation and lung function improvement with a similar or lower incidence of side effects than either drug alone.
Which drug has been found to reduce the risk of moderate and severe acute exacerbations in COPD and is safe for long-term use?
A. Salbutamol
B. Roflumilast
C. Tiotropium
D. Formoterol
D. Formoterol
Explanation: Formoterol, a LABA, provides sustained improvements in COPD and is safe for long-term use, reducing exacerbation risk. Roflumilast is used as an add-on therapy in severe cases, salbutamol is a SABA, and tiotropium is a LAMA.
ICS (Inhaled Corticosteroids) therapy in COPD should generally be used in which scenario?
A. Monotherapy in mild COPD
B. Combination therapy with LABA in moderate to severe COPD
C. Combination therapy with SABA in all stages of COPD
D. Monotherapy in severe COPD
B. Combination therapy with LABA in moderate to severe COPD
Explanation: ICS therapy in COPD is most effective as part of combination therapy with LABA for moderate to severe disease. ICS monotherapy is not recommended due to increased mortality risks.
Which of the following is a major adverse effect associated with regular use of inhaled corticosteroids in COPD patients?
A. Increased risk of hypokalemia
B. Increased risk of pneumonia
C. Increased risk of glaucoma
D. All of the above
D. All of the above
Explanation: Inhaled corticosteroids in COPD can increase the risk of pneumonia, may worsen glaucoma, and cause bone density loss.
Which medication is indicated as an add-on therapy for severe COPD with chronic bronchitis and frequent exacerbations, and acts by inhibiting the breakdown of cyclic AMP?
A. Tiotropium
B. Theophylline
C. Roflumilast
D. Salmeterol
C. Roflumilast
Explanation: Roflumilast is a PDE4 inhibitor used as an add-on therapy in severe COPD with chronic bronchitis and frequent exacerbations. It reduces inflammation by inhibiting cyclic AMP breakdown.
What is the primary goal of pharmacologic therapy for stable COPD patients?
A. To achieve complete reversibility of airway limitation
B. To prevent exacerbations and improve quality of life through optimal bronchodilation
C. To eliminate the need for exercise tolerance testing
D. To completely cure COPD
B. To prevent exacerbations and improve quality of life through optimal bronchodilation
Explanation: The main goal of COPD treatment is symptom management and prevention of exacerbations, not curing or completely reversing airway limitation.
Which adverse effect is commonly associated with the use of short-acting muscarinic antagonists (SAMAs) like ipratropium?
A. Tachycardia and tremor
B. Mydriasis and glaucoma
C. Hyperglycemia and hypertension
D. Weight gain and fatigue
B. Mydriasis and glaucoma
Explanation: SAMAs like ipratropium can cause dry mouth, metallic taste, and if released into the eye, can lead to mydriasis and worsen glaucoma. Tachycardia and tremor are more common with SABAs.
When considering combination therapy for COPD, which of the following best describes the concept of “step-up step-down” therapy?
A. Increasing drug dosage continuously as symptoms progress
B. Starting with triple therapy and reducing drugs as symptoms improve
C. Initiating treatment with ICS monotherapy and adding LABA and LAMA as needed
D. Starting with SABAs and only using LAMAs in severe cases
B. Starting with triple therapy and reducing drugs as symptoms improve
Explanation: “Step-up step-down” therapy involves adjusting medications as symptoms change, with triple therapy reserved for severe cases, and reducing the therapy if the patient’s symptoms stabilize.
Which of the following medications is most likely to cause oropharyngeal candidiasis as a side effect?
A. Salbutamol
B. Tiotropium
C. Budesonide
D. Roflumilast
C. Budesonide
Correct: Budesonide is an inhaled corticosteroid (ICS) known to cause oropharyngeal candidiasis due to its immunosuppressive action in the local oropharyngeal area. Rinsing the mouth after use can help mitigate this effect.
A. Salbutamol
Incorrect: Salbutamol, a short-acting beta2-adrenergic agonist (SABA), does not typically cause oropharyngeal candidiasis. Its main adverse effects are tremor, tachycardia, and hypokalemia.
B. Tiotropium
Incorrect: Tiotropium, a long-acting muscarinic antagonist (LAMA), can cause dry mouth but is not associated with an increased risk of oropharyngeal candidiasis.
D. Roflumilast
Incorrect: Roflumilast, a phosphodiesterase-4 (PDE4) inhibitor, has gastrointestinal side effects like nausea and weight loss, but it does not cause oropharyngeal candidiasis.
When considering long-term antibiotic use to prevent COPD exacerbations, which of the following conditions should be monitored for in patients?
A. Risk of QTc prolongation
B. Increased sputum production
C. Enhanced bronchodilation
D. Risk of hyperglycemia
A. Risk of QTc prolongation
Correct: Long-term antibiotic use, particularly with macrolides such as azithromycin, can increase the risk of QTc prolongation, making regular monitoring necessary.
B. Increased sputum production
Incorrect: Long-term antibiotics can reduce exacerbations and sputum production rather than increase it.
C. Enhanced bronchodilation
Incorrect: Antibiotics do not provide bronchodilation effects. They work to reduce exacerbations by preventing or treating bacterial infections.
D. Risk of hyperglycemia
Incorrect: Hyperglycemia is not typically associated with long-term antibiotic use. This side effect is more relevant to beta2-agonists, especially at higher doses.
For patients with COPD who require triple therapy (ICS/LAMA/LABA), what is the preferred method of administration?
A. Sequentially using separate inhalers
B. As-needed dosing
C. Single-inhaler triple therapy (SITT)
D. Administered via nebulizer at night only
C. Single-inhaler triple therapy (SITT)
Correct: Single-inhaler triple therapy (SITT) simplifies administration and improves adherence by combining ICS, LAMA, and LABA in a single device.
A. Sequentially using separate inhalers
Incorrect: Although patients can use separate inhalers, it is not the preferred approach as it reduces adherence due to the complexity of multiple devices.
B. As-needed dosing
Incorrect: COPD medications, especially in severe cases, are most effective when taken regularly rather than as-needed.
D. Administered via nebulizer at night only
Incorrect: Nebulizers are not commonly used for all COPD medications, especially triple therapy, and night-only dosing does not provide the optimal effect.
Which bacterial pathogens are commonly associated with acute COPD exacerbations in patients with less than four exacerbations per year?
A. Pseudomonas aeruginosa and Klebsiella species
B. Moraxella catarrhalis and Haemophilus influenzae
C. Staphylococcus aureus and Escherichia coli
D. Mycoplasma pneumoniae and Legionella pneumophila
B. Moraxella catarrhalis and Haemophilus influenzae
Correct: Moraxella catarrhalis and Haemophilus influenzae, along with Streptococcus pneumoniae, are the most common pathogens associated with exacerbations in COPD patients with fewer exacerbations per year.
A. Pseudomonas aeruginosa and Klebsiella species
Incorrect: These pathogens are generally seen in more complicated cases of COPD with frequent exacerbations or those with recent antibiotic use.
C. Staphylococcus aureus and Escherichia coli
Incorrect: These bacteria are not the primary pathogens in typical COPD exacerbations; they may be found in more complicated or nosocomial infections.
D. Mycoplasma pneumoniae and Legionella pneumophila
Incorrect: These pathogens are more commonly associated with atypical pneumonias rather than with acute exacerbations of COPD.
The “step-up step-down” therapy approach in COPD management involves:
A. Gradually increasing medication until symptoms resolve, then stopping abruptly
B. Combining oral and inhaled medications as disease severity increases
C. Increasing medications as symptoms worsen and reducing them as they stabilize
D. Switching medications after each exacerbation
C. Increasing medications as symptoms worsen and reducing them as they stabilize
Correct: “Step-up step-down” therapy in COPD means increasing treatment during symptom exacerbation and gradually decreasing as symptoms stabilize.
A. Gradually increasing medication until symptoms resolve, then stopping abruptly
Incorrect: This approach is too abrupt; step-down therapy involves a gradual reduction rather than an abrupt stop to avoid symptom rebound.
B. Combining oral and inhaled medications as disease severity increases
Incorrect: Step-up therapy primarily involves adding or increasing inhaled medications, with oral medications as a last resort or in severe cases.
D. Switching medications after each exacerbation
Incorrect: Treatment adjustments are based on ongoing symptom management and exacerbation frequency rather than switching medications after each exacerbation.
