Pulmonary Diseases Flashcards
Which of the following statements concerning omalizumab is correct?
a. Phosphodiesterase-5 inhibitor that causes bronchodilation
b. Indicated for initial therapy in pts who have allergies and mild, persistent asthma
c. Can cause anaphylaxis; the 1st dose must be administered in a healthcare setting
d. Can be administered IM at home if an adult or parent has received training
e. Is dosed based on IgG levels and body weight
c
-Omalizumab is a monoclonal antibody that prevents IgE binding to the high-affinity receptors on basophils and mast cells.
-Is used as adjunctive therapy for pts 6 years and older with allergies and severe, persistent asthma.
-Clinicians who administer omalizumab should be prepared and equipped to identify and treat anaphylaxis.
-Self-administration is now permitted in certain situations, but the first 3 doses must be given in a healthcare setting.
Place the instructions below for proper use of an albuterol MDI inhaler in the correct order.
a. Breathe out fully to expel as much air from the lungs as possible.
b. Shake for 5 seconds
c. Hold breath as long as possible, up to 10 seconds.
d. Press the top of the canister while breathing in deeply and slowly.
e. Place the mouthpiece into the mouth and close lips around it.
b, a, e, d, c
Which of the following meds can decrease theophylline levels?
a. Allopurinol
b. Citalopram
c. Carbamazepine
d. Primidone
e. Quinidine
c, d
-Other things that can decrease theophylline: Fosphenytoin, phenobarbital, phenytoin, rifampin, ritonavir, smoking, St. John’s wort, levothyroxine, high-protein diet, and charbroiled meats
MS is a 4 y/o girl with asthma. She will receive montelukast. Select the correct dose for a 4 y/o child.
a. 4 mg chewable tab once daily in the evening
b. 5 mg chewable tab once daily in the evening
c. 5 mg chewable tab BID
d. 10 mg chewable tab once daily in the evening
e. 10 mg chewable tab BID
a
-Adults: 10 mg daily in the evening
-6-14 y/o: 5 mg daily in the evening
-1-5 y/o: 4 mg daily in the evening
A pt is prescribed Advair Diskus for her asthma. Which of the following counseling points should be reviewed?
a. Wash the Diskus with a wet cloth weekly.
b. If she doesn’t feel or taste the med, take another dose.
c. This isn’t a rescue med for acute asthma attacks.
d. Rinse the mouth with water and spit after each dose of med.
e. Never breathe into the Diskus.
c, d, e
-Never take an extra dose
-Keep the Diskus dry at all times
Which of the following med classes has a BBW regarding an increased risk of asthma-related deaths when used as monotherapy?
a. Long-acting beta-2 agonists
b. Leukotriene modifiers
c. Theophylline
d. Short-acting beta-2 agonists
e. Inhaled corticosteroids
a
CH is a 16 y/o teenage who has asthma. His only meds are Ventolin HFA and Flovent HFA, which he uses both only PRN 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’s now Thursday. What would be an appropriate recommendation to make at this time?
a. Take Ventolin 2 inhalations Q4-6H starting today, continue Flovent PRN.
b. Start salmeterol 1 inhalation BID for better symptom control, d/c Flovent PRN.
c. Continue to take Ventolin PRN for acute symptoms.
d. Start Pulmicort Flexhaler 2 inhalations BID for better symptom control, d/c Flovent PRN.
e. Start Singulair 20 mg PO QHS.
c, d
A pt is started on the ProAir RespiClick. Which of the following statements are correct regarding ProAir RespiClick?
a. This med contains a rescue drug, albuterol.
b. The device should be shaken before the dose is administered.
c. This med contains a propellant (e.g., HFA).
d. This med shouldn’t be used with a spacer device.
e. The dose should be administered with a quick and forceful inhalation.
a, d, e
RespiClick inhalers are DPIs. They have similar shape shape to an MDI, but they shouldn’t be shaken, and the dose should be administered with a quick, forceful inhalation.
HPI: LY is a 45 y/o female who presents to her PCP on Aug 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains Rx’s from her PCP, but is often resistant to suggestions from her PCP, but is often resistant to suggestions and advice from healthcare providers.
Current Meds (obtained from active Rx bottles on 8/1):
-Zestril 10 mg QD
-HCTZ 12.5 mg daily
-ProAir HFA 2 inhalations Q6H PRN (last 2 refill dates: 7/29, 6/3)
-Protonix 40 mg QD
-Prednisone taper 10 mg QD x 4 days, 5 mg QD x 4 days, 2.5 mg x 2 days then stop (on day 5 of tx)
-Ibuprofen 400 mg QD
-Zyrtec D 1 tab BID
-Pulmicort Flexhaler 1 inhalation BID
-Theophylline 300 mg PO QD
PE: Few white plaques on the tongue
Which med is most likely contributing to the HEENT finding on the physical exam?
a. Pulmicort
b. Zyrtec D
c. ProAir
d. Theophylline
e. Ibuprofen
a
Inhaled corticosteroids, such as Pulmicort Flexhaler, can cause PO thrush.
HPI: LY is a 45 y/o female who presents to her PCP on Aug 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains Rx’s from her PCP, but is often resistant to suggestions from her PCP, but is often resistant to suggestions and advice from healthcare providers.
Current Meds (obtained from active Rx bottles on 8/1):
-Zestril 10 mg QD
-HCTZ 12.5 mg daily
-ProAir HFA 2 inhalations Q6H PRN (last 2 refill dates: 7/29, 6/3)
-Protonix 40 mg QD
-Prednisone taper 10 mg QD x 4 days, 5 mg QD x 4 days, 2.5 mg x 2 days then stop (on day 5 of tx)
-Ibuprofen 400 mg QD
-Zyrtec D 1 tab BID
-Pulmicort Flexhaler 1 inhalation BID
-Theophylline 300 mg PO QD
PE: Few white plaques on the tongue
How often, on average, is LY using her ProAir HFA inhaler based on the refill hx?
a. < 2 inhalations per week
b. 2 inhalations per day
c. 3-4 inhalations per day
d. 4-6 inhalations per day
e. 6-8 inhalations per day
c
Most albuterol inhalers, including ProAir HFA, contain 200 inhalations per canister. Based on the refill hx, LY used 1 inhaler in 56 days (between June 3rd and July 29th). 200 inhalations/56 days = 3.6 inhalations per day.
HPI: LY is a 45 y/o female who presents to her PCP on Aug 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains Rx’s from her PCP, but is often resistant to suggestions from her PCP, but is often resistant to suggestions and advice from healthcare providers.
Current Meds (obtained from active Rx bottles on 8/1):
-Zestril 10 mg QD
-HCTZ 12.5 mg daily
-ProAir HFA 2 inhalations Q6H PRN (last 2 refill dates: 7/29, 6/3)
-Protonix 40 mg QD
-Prednisone taper 10 mg QD x 4 days, 5 mg QD x 4 days, 2.5 mg x 2 days then stop (on day 5 of tx)
-Ibuprofen 400 mg QD
-Zyrtec D 1 tab BID
-Pulmicort Flexhaler 1 inhalation BID
-Theophylline 300 mg PO QD
PE: Few white plaques on the tongue
How often, on average, is LY using her ProAir HFA inhaler based on the refill hx?
a. < 2 inhalations per week
b. 2 inhalations per day
c. 3-4 inhalations per day
d. 4-6 inhalations per day
e. 6-8 inhalations per day
c
Most albuterol inhalers, including ProAir HFA, contain 200 inhalations per canister. Based on the refill hx, LY used 1 inhaler in 56 days (between June 3rd and July 29th). 200 inhalations/56 days = 3.6 inhalations per day.
Which of the following are possible side effects of the rescue inhaler, albuterol?
a. Tremor
b. Hypokalemia
c. Hyperglycemia
d. Bradycardia
e. Leukocytosis
a, b, c
Major side effects include: Nervousness, tremor, shakiness, cough, tachycardia, hyperglycemia, and hypokalemia
HPI: LY is a 45 y/o female who presents to her PCP on Aug 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains Rx’s from her PCP, but is often resistant to suggestions from her PCP, but is often resistant to suggestions and advice from healthcare providers.
PMH: HTN, osteoarthritis, allergic rhinitis, asthma, and anxiety
Current Meds (obtained from active Rx bottles on 8/1):
-Zestril 10 mg QD
-HCTZ 12.5 mg daily
-ProAir HFA 2 inhalations Q6H PRN (last 2 refill dates: 7/29, 6/3)
-Protonix 40 mg QD
-Prednisone taper 10 mg QD x 4 days, 5 mg QD x 4 days, 2.5 mg x 2 days then stop (on day 5 of tx)
-Ibuprofen 400 mg QD
-Zyrtec D 1 tab BID
-Pulmicort Flexhaler 1 inhalation BID
-Theophylline 300 mg PO QD
Vitals: 5’6”, 125 lbs, BP 152/86, HR 95
PE: Few white plaques on the tongue
Which of the following are possible asthma triggers for LY?
a. Obesity
b. Ibuprofen
c. Stress
d. Allergic rhinitis
e. GERD
b, c, d, e
HPI: LY is a 45 y/o female who presents to her PCP on Aug 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains Rx’s from her PCP, but is often resistant to suggestions from her PCP, but is often resistant to suggestions and advice from healthcare providers.
PMH: HTN, osteoarthritis, allergic rhinitis, asthma, and anxiety
Current Meds (obtained from active Rx bottles on 8/1):
-Zestril 10 mg QD
-HCTZ 12.5 mg daily
-ProAir HFA 2 inhalations Q6H PRN (last 2 refill dates: 7/29, 6/3)
-Protonix 40 mg QD
-Prednisone taper 10 mg QD x 4 days, 5 mg QD x 4 days, 2.5 mg x 2 days then stop (on day 5 of tx)
-Ibuprofen 400 mg QD
-Zyrtec D 1 tab BID
-Pulmicort Flexhaler 1 inhalation BID
-Theophylline 300 mg PO QD
Vitals: 5’6”, 125 lbs, BP 152/86, HR 95
PE: Few white plaques on the tongue
Choose the correct statement regarding the use of a prednisone taper in LY.
a. PO steroids should only be used in severe, persistent asthma (step 6), not for exacerbations.
b. Since LY had an exacerbation, PO steroids should be continued indefinitely.
c. A taper is appropriate; prednisone should be used for the shortest duration possible.
d. Inhaled prednisone is the preferred form for an exacerbation.
e. Prednisone may cause LY to have a reduced appetite and anorexia.
c
HPI: LY is a 45 y/o female who presents to her PCP on Aug 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains Rx’s from her PCP, but is often resistant to suggestions from her PCP, but is often resistant to suggestions and advice from healthcare providers.
PMH: HTN, osteoarthritis, allergic rhinitis, asthma, and anxiety
Current Meds (obtained from active Rx bottles on 8/1):
-Zestril 10 mg QD
-HCTZ 12.5 mg daily
-ProAir HFA 2 inhalations Q6H PRN (last 2 refill dates: 7/29, 6/3)
-Protonix 40 mg QD
-Prednisone taper 10 mg QD x 4 days, 5 mg QD x 4 days, 2.5 mg x 2 days then stop (on day 5 of tx)
-Ibuprofen 400 mg QD
-Zyrtec D 1 tab BID
-Pulmicort Flexhaler 1 inhalation BID
-Theophylline 300 mg PO QD
Vitals: 5’6”, 125 lbs, BP 152/86, HR 95
PE: Few white plaques on the tongue
Choose the correct statement regarding the use of a prednisone taper in LY.
a. PO steroids should only be used in severe, persistent asthma (step 6), not for exacerbations.
b. Since LY had an exacerbation, PO steroids should be continued indefinitely.
c. A taper is appropriate; prednisone should be used for the shortest duration possible.
d. Inhaled prednisone is the preferred form for an exacerbation.
e. Prednisone may cause LY to have a reduced appetite and anorexia.
c
HPI: LY is a 45 y/o female who presents to her PCP on Aug 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains Rx’s from her PCP, but is often resistant to suggestions from her PCP, but is often resistant to suggestions and advice from healthcare providers.
PMH: HTN, osteoarthritis, allergic rhinitis, asthma, and anxiety
Current Meds (obtained from active Rx bottles on 8/1):
-Zestril 10 mg QD
-HCTZ 12.5 mg daily
-ProAir HFA 2 inhalations Q6H PRN (last 2 refill dates: 7/29, 6/3)
-Protonix 40 mg QD
-Prednisone taper 10 mg QD x 4 days, 5 mg QD x 4 days, 2.5 mg x 2 days then stop (on day 5 of tx)
-Ibuprofen 400 mg QD
-Zyrtec D 1 tab BID
-Pulmicort Flexhaler 1 inhalation BID
-Theophylline 300 mg PO QD
Which med on LY’s profile works by blocking phosphodiesterase and increasing cAMP?
a. ProAir HFA
b. Theophylline
c. Prednisone
d.Pulmicort Flexhaler
e. Zyrtec D
b
Theophylline is a non-selective phosphodiesterase inhibitor.
HPI: LY is a 45 y/o female who presents to her PCP on Aug 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains Rx’s from her PCP, but is often resistant to suggestions from her PCP, but is often resistant to suggestions and advice from healthcare providers.
PMH: HTN, osteoarthritis, allergic rhinitis, asthma, and anxiety
Current Meds (obtained from active Rx bottles on 8/1):
-Zestril 10 mg QD
-HCTZ 12.5 mg daily
-ProAir HFA 2 inhalations Q6H PRN (last 2 refill dates: 7/29, 6/3)
-Protonix 40 mg QD
-Prednisone taper 10 mg QD x 4 days, 5 mg QD x 4 days, 2.5 mg x 2 days then stop (on day 5 of tx)
-Ibuprofen 400 mg QD
-Zyrtec D 1 tab BID
-Pulmicort Flexhaler 1 inhalation BID
-Theophylline 300 mg PO QD
Vitals: 5’6”, 125 lbs, BP 152/86, HR 95
Theophylline peak level (mcg/mL) = 7
When assessing theophylline tx in LY, which of following statements is true?
a. Her LD should have been calculated using her ideal body weight.
b. Her LD should have been calculated using total body weight.
c. Her level is below the goal therapeutic range.
d. Her level is within the goal therapeutic range.
e. Her level can’t be assessed as a trough should have been ordered.
b, d
-Therapeutic range for theophylline is 5-15 mcg/mL (peak levels at steady state are appropriate).
-In most pts, it should be dosed using IBW. In this case, LY’s weight is less than her IBW, so total body weight should be used.
HPI: LY is a 45 y/o female who presents to her PCP on Aug 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains Rx’s from her PCP, but is often resistant to suggestions from her PCP, but is often resistant to suggestions and advice from healthcare providers.
PMH: HTN, osteoarthritis, allergic rhinitis, asthma, and anxiety
Current Meds (obtained from active Rx bottles on 8/1):
-Zestril 10 mg QD
-HCTZ 12.5 mg daily
-ProAir HFA 2 inhalations Q6H PRN (last 2 refill dates: 7/29, 6/3)
-Protonix 40 mg QD
-Prednisone taper 10 mg QD x 4 days, 5 mg QD x 4 days, 2.5 mg x 2 days then stop (on day 5 of tx)
-Ibuprofen 400 mg QD
-Zyrtec D 1 tab BID
-Pulmicort Flexhaler 1 inhalation BID
-Theophylline 300 mg PO QD
Vitals: 5’6”, 125 lbs, BP 152/86, HR 95
Theophylline peak level (mcg/mL) = 7
Based on her recent asthma exacerbation and use of her ProAir HFA, LY needs a step up in her asthma tx. Which of the following would be appropriate?
a. D/c Pulmicort Flexhaler and start Advair Diskus
b. Continue her current meds and start Advair Diskus
c. Perform skin testing to determine if tx with reslizumab is needed
d. D/c Pulmicort Flexhaler and start salmeterol
e. D/c Pulmicort Flexhaler and start Flovent HFA
a
-Advair Diskus contains a LABA (which opens the airways) and an ICS (which reduces inflammation).
-Salmeterol is a LABA, and Flovent HFA contains fluticasone; neither would provide an appropriate step-up in tx.
-Use of monoclonal antibodies, such as reslizumab, should be reserved for pts with severe forms of eosinophilic asthma who have failed 1st line inhaled treatments.
HPI: LY is a 45 y/o female who presents to her PCP on Aug 1st for a follow-up of multiple health problems, including a recent asthma exacerbation. She complains of stress and constantly worrying for the past year. She expresses fear about managing her finances and her health, though there have been no major changes in her life recently to contribute to this. She obtains Rx’s from her PCP, but is often resistant to suggestions from her PCP, but is often resistant to suggestions and advice from healthcare providers.
PMH: HTN, osteoarthritis, allergic rhinitis, asthma, and anxiety
Current Meds (obtained from active Rx bottles on 8/1):
-Zestril 10 mg QD
-HCTZ 12.5 mg daily
-ProAir HFA 2 inhalations Q6H PRN (last 2 refill dates: 7/29, 6/3)
-Protonix 40 mg QD
-Prednisone taper 10 mg QD x 4 days, 5 mg QD x 4 days, 2.5 mg x 2 days then stop (on day 5 of tx)
-Ibuprofen 400 mg QD
-Zyrtec D 1 tab BID
-Pulmicort Flexhaler 1 inhalation BID
-Theophylline 300 mg PO QD
Vitals: 5’6”, 125 lbs, BP 152/86, HR 95
Theophylline peak level (mcg/mL) = 7
In addition to an annual influenza vaccine, which of the following vaccination recommendations is appropriate for LY?
a. Pneumovax 23 after age 65
b. Prevnar 13 now and Pneumovax 23 after age 65
c. Vaxneuvance now and Pneumovax 23 in 12 months
d. Prevnar 13 now and Vaxneuvance in 12 months
e. Prevnar 20 now and Pneumovax 23 in 12 months
c
Vaxneuvance, followed by Pneumovax 23 in 12 months (or a single dose of Prevnar 20) is recommended for all pts 19-64 y/o with asthma.
SC is a 4 y/o pt with moderate persistent asthma. He has been poorly controlled on an albuterol inhaler and a low-dose inhaled corticosteroid. The Dr wants to add a leukotriene modifier to SC’s regimen. Which agent can be recommended?
a. Zileuton
b. Theophylline
c. Indacaterol
d. Reslizumab
e. Montelukast
e
3 leukotriene modifiers are indicated for use in kids with asthma:
-Montelukast is indicated for pts at least 1 year of age
-Zafirlukast is indicated for pts >/= 5 years
-Zileuton is indicated for pts >/= 12 years
ST, a 35 y/o male, is in the hospital for an acute exacerbation of his asthma.
Meds:
Albuterol neb PRN
Ipratropium neb PRN
Protonix 40 mg IV daily
Aminophylline IV 1000 mg in 1L of NS at 30 mL/hr
How many mg of theophylline will ST receive per day?
576
1 mg/mL x 30 mL/hr x 24 hours = 720 aminophylline
The conversion for aminophylline to theophylline is 80%:
- 720 mg x 0.8 = 576 mg theophylline
A pt states that he uses his albuterol inhaler 4 days per week (~ 6 puffs on each of those days). While completing a med rec 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 wks will his inhaler last?
2.5 weeks
Which of the following meds can increase theophylline levels and possibly result in theophylline toxicity?
a. Ciprofloxacin
b. Bupropion
c. Zafirlukast
d. Famotidine
e. Clarithromycin
a, c, e
Drugs that can increase theophylline levels d/t CYP1A2:
-Ciprofloxacin
-Cimetidine
-Fluvoxamine
-Propranolol
-Zafirlukast
-Zileuton
Drugs that can increase theophylline levels d/t CYP3A4:
-Clarithromycin
-Erythromycin
CD is a 25 y/o female with asthma whose home meds include Arnuity Ellipta 2 inhalations daily, Proventil HFA 1-2 inhalations Q4-6H PRN, loratadine 10 mg daily, and a MVI. 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 tx change for CD’s current complaint?
a. Take 2 inhalations of Proventil 5-15 min before exercise
b. Add prednisone 10 mg; take 2 hours prior to exercise
c. Take 2 inhalations of Arnuity Ellipta 30 min before exercise
d. Swith the Arnuity Ellipta to Flovent Diskus
e. D/c the Arnuity Ellipta and start salmeterol
a
Which of the following meds is available as a DPI?
a. ProAir HFA
b. Alvesco
c. Breo Ellipta
d. Symbicort
e. Bevespi Aerosphere
c
Pulmicort Respules are used primarily in this population group:
a. Pts > 55 y/o
b. Adults 30-50 y/o
c. Children
d. Pts who have failed theophylline
e. Pts who have failed leukotriene modifying agents
c
Pulmicort Respules are nebulizer suspensions indicated for children.
JW is well-controlled on his asthma meds which include Flovent HFA 220 mcg 2 inhalations BID, salmeterol 1 inhalation BID, and Proventil HFA 1-2 inhalations Q4-6H PRN symptoms. He’s picking up his refills and asks if anything can help with his sore throat. When inspected, the pharmacist recognizes the sore throat is d/t thrush. What are some counseling points the pharmacist can provide that will help reduce JW’s risk of thrush in the future?
a. JW should drink 8 oz of water after taking his meds.
b. JW should gargle with warm water and spit out the rinse after using his meds.
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 shouldn’t kiss others as this infection is contagious.
b, d
Thrush is a side effect of his Flovent that can be decreased by using a spacer.
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:
a. Mix with 4 oz of applesauce and administer within 24 hours
b. The granule packet can be opened up to 8 hours prior to use
c. Mix with 1 tbs of warm water
d. Mix with a spoonful of cool, mashed carrots, and administer within minutes
e. Mix with a tbs of breast milk or formula; the mixture can be stored for up to 2 hours
d
-Instruct caregivers using the granules not to open the granule packet until they’re ready to use it since granules mixed with food or liquids can’t be stored.
-Can be mixed with 1 tsp (5 mL) of baby formula or breast milk, or a spoonful of applesauce, mashed carrots, rice, or ice cream.
-Whatever it’s mixed with must be cold or at room temp.
-Instruct the caregivers not to mix the granules with extra amounts of milk or food; they need to make sure the entire dose has been consumed.
-Administer the mixture immediately (within 15 min).
