Week 10: Pharmacology of Asthma and COPD

Question 1

Which of the following best describes the mechanism of action of glucocorticoids in asthma management?

A) Activates beta-2 adrenergic receptors, leading to bronchodilation
B) Blocks muscarinic receptors in the bronchi to reduce bronchoconstriction
C) Inhibits phosphodiesterase-4, reducing cytokine release
D) Decreases synthesis of inflammatory mediators and reduces inflammatory cell activity

Answer 1

Correct Answer: D
Rationale:

A: This describes the action of beta-2 agonists, not glucocorticoids.
B: This describes the action of anticholinergics, not glucocorticoids.
C: This describes the mechanism of phosphodiesterase-4 inhibitors.
D: Glucocorticoids decrease the synthesis of leukotrienes, histamine, and prostaglandins, as well as inflammatory cell activity, reducing inflammation in asthma.

Question 2

A patient with COPD is prescribed a long-acting muscarinic antagonist (LAMA). What is the primary purpose of this medication?

A) To provide immediate relief during an exacerbation
B) To decrease inflammation and airway obstruction
C) To reduce bronchoconstriction for maintenance therapy
D) To prevent exercise-induced bronchospasm

Answer 2

Correct Answer: C
Rationale:

A: LAMAs are not used for acute exacerbations; SABAs are more appropriate.
B: LAMAs do not primarily decrease inflammation; they act on muscarinic receptors to reduce bronchoconstriction.
C: LAMAs, such as tiotropium, are used for long-term maintenance therapy to reduce bronchoconstriction in COPD.
D: Beta-2 agonists are used to prevent exercise-induced bronchospasm.

Question 3

What is the primary adverse effect of inhaled glucocorticoids that requires patient education?

A) Weight gain
B) Dry mouth
C) Oral thrush
D) Increased blood pressure

Answer 3

Correct Answer: C
Rationale:

A: Weight gain is more commonly associated with systemic glucocorticoids.
B: Dry mouth is more commonly associated with anticholinergics.
C: Oral thrush (candidiasis) is a common adverse effect due to local deposition of glucocorticoids in the oropharynx. Patients should be instructed to rinse their mouth after inhaler use.
D: Glucocorticoids are not associated with increased blood pressure when inhaled.

Question 4

A patient is using a metered-dose inhaler (MDI) for asthma management. Which instruction is most important to ensure effective drug delivery?

A) Exhale fully before activating the inhaler
B) Shake the inhaler after each puff
C) Hold your breath for 2 seconds after inhalation
D) Use the inhaler without a spacer

Answer 4

Correct Answer: A
Rationale:

A: Exhaling fully ensures that the lungs are ready to receive the medication when the inhaler is activated.
B: The inhaler should be shaken before the first puff, but not necessarily after each puff.
C: Holding the breath for at least 10 seconds after inhalation is recommended for maximum drug absorption.
D: Using a spacer is recommended to improve drug delivery and reduce deposition in the oropharynx.

Question 5

Which of the following combinations of drugs is most effective for long-term control of asthma in patients with frequent exacerbations?

A) Short-acting beta-2 agonist (SABA) and leukotriene receptor antagonist
B) Inhaled glucocorticoid and long-acting beta-2 agonist (LABA)
C) Anticholinergic and phosphodiesterase-4 inhibitor
D) Oral glucocorticoid and short-acting beta-2 agonist (SABA)

Answer 5

Correct Answer: B
Rationale:

A: While leukotriene receptor antagonists can aid in maintenance, SABAs are for acute exacerbations, not long-term control.
B: This combination provides anti-inflammatory benefits and long-term bronchodilation, addressing both aspects of asthma pathophysiology.
C: This combination is more appropriate for COPD management, not asthma.
D: Oral glucocorticoids are reserved for short-term use due to potential systemic side effects.

Question 6

A patient with exercise-induced bronchospasm (EIB) is prescribed a short-acting beta-2 agonist (SABA). When should the patient use the medication?

A) Immediately after exercise begins
B) 15 minutes before exercise
C) At bedtime the night before exercise
D) 30 minutes after completing exercise

Answer 6

Correct Answer: B
Rationale:

A: SABAs are not effective if used after exercise has started.
B: SABAs should be taken 15 minutes before exercise to prevent bronchospasm.
C: Using a SABA the night before does not provide effective prophylaxis for EIB.
D: Post-exercise administration does not prevent EIB, which occurs during or shortly after exercise.

Question 7

Which of the following is the primary purpose of combining a glucocorticoid with a long-acting beta-2 agonist (LABA) in asthma management?

A) To prevent systemic absorption of the glucocorticoid
B) To reduce the frequency of asthma-related deaths
C) To enhance bronchodilation during acute exacerbations
D) To minimize the adverse effects of LABAs when used alone

Answer 7

Correct Answer: D
Rationale:

A: The combination does not prevent systemic absorption of glucocorticoids.
B: LABAs used alone can increase asthma-related deaths, but the primary goal of combination therapy is safety and efficacy.
C: Combination therapy is not intended for acute exacerbations; SABAs are used instead.
D: The combination reduces the risk of asthma-related deaths and adverse effects associated with LABAs by ensuring concurrent anti-inflammatory action.

Question 8

What is the mechanism of action of leukotriene receptor antagonists in asthma treatment?

A) Inhibits phosphodiesterase-4, reducing inflammation
B) Blocks leukotriene receptors, reducing airway edema and mucus production
C) Stimulates beta-2 receptors, promoting bronchodilation
D) Reduces synthesis of prostaglandins, decreasing inflammation

Answer 8

Correct Answer: B
Rationale:

A: This describes phosphodiesterase-4 inhibitors, not leukotriene receptor antagonists.
B: Leukotriene receptor antagonists block receptors in airway cells, reducing edema, bronchoconstriction, and mucus production.
C: This describes beta-2 agonists, not leukotriene receptor antagonists.
D: Leukotriene receptor antagonists do not directly affect prostaglandin synthesis.

Question 9

A patient using a phosphodiesterase-4 (PDE-4) inhibitor for COPD reports gastrointestinal symptoms. What should the nurse prioritize in patient education?

A) Taking the medication with food to reduce symptoms
B) Stopping the medication immediately
C) Increasing the dose to improve efficacy
D) Switching to an inhaled corticosteroid

Answer 9

Correct Answer: A
Rationale:

A: Taking PDE-4 inhibitors with food can help mitigate gastrointestinal side effects.
B: Discontinuation may not be necessary unless symptoms are severe; consult the provider.
C: Increasing the dose could exacerbate adverse effects.
D: Switching medications may be considered later if side effects persist but is not the first action.

Question 10

Which of the following adverse effects is most commonly associated with inhaled beta-2 agonists?

A) Hypoglycemia
B) Tachycardia
C) Weight loss
D) Oral thrush

Answer 10

Correct Answer: B
Rationale:

A: Hypoglycemia is not a common side effect of beta-2 agonists.
B: Tachycardia is a well-known adverse effect of beta-2 agonists, especially at higher doses.
C: Weight loss is not associated with beta-2 agonists.
D: Oral thrush is an adverse effect of inhaled glucocorticoids, not beta-2 agonists.

Question 11

What is the recommended treatment for a patient experiencing an acute asthma exacerbation?

A) Inhaled long-acting beta-2 agonist (LABA)
B) Oral leukotriene receptor antagonist
C) Nebulized short-acting beta-2 agonist (SABA) and ipratropium with systemic glucocorticoids
D) Phosphodiesterase-4 inhibitor

Answer 11

Correct Answer: C
Rationale:

A: LABAs are not effective during acute exacerbations.
B: Leukotriene receptor antagonists are for maintenance, not acute management.
C: This combination quickly reduces airway inflammation and obstruction during acute exacerbations.
D: Phosphodiesterase-4 inhibitors are not indicated for acute exacerbations.

Question 12

Which patient is the best candidate for a dry powder inhaler (DPI) as their primary inhalation device?

A) A patient with severe arthritis in their hands
B) A patient with difficulty coordinating hand-breath movements
C) A pediatric patient with frequent asthma exacerbations
D) An adult with COPD who can generate sufficient inspiratory flow

Answer 12

Correct Answer: D
Rationale:

A: Severe arthritis may make it difficult to load or activate a DPI.
B: DPIs do not require hand-breath coordination, but patients need adequate inspiratory flow to activate the device.
C: Young children may not have sufficient inspiratory force to use a DPI effectively.
D: Adults with COPD who can generate sufficient inspiratory flow are ideal candidates for DPIs.

Question 13

A patient prescribed a leukotriene receptor antagonist reports mood changes and suicidal thoughts. What is the nurse’s priority action?

A) Advise the patient to discontinue the medication immediately
B) Instruct the patient to contact their healthcare provider promptly
C) Encourage the patient to continue the medication and monitor symptoms
D) Recommend switching to a short-acting beta-2 agonist

Answer 13

Correct Answer: B
Rationale:

A: Discontinuation should not occur without consulting the provider.
B: Neuropsychiatric symptoms are an adverse effect of leukotriene receptor antagonists, and immediate provider consultation is necessary.
C: Continuing the medication without addressing the symptoms could be dangerous.
D: Switching to a SABA does not address the underlying issue.

Question 14

Which of the following describes a key difference between metered-dose inhalers (MDIs) and nebulizers?

A) MDIs are more effective for drug delivery to the lungs
B) Nebulizers require more hand-breath coordination
C) MDIs are portable and quicker to use than nebulizers
D) Nebulizers produce smaller particles than MDIs

Answer 14

Correct Answer: C
Rationale:

A: Both devices are effective but depend on correct technique.
B: MDIs require more hand-breath coordination, not nebulizers.
C: MDIs are compact and quicker to administer, while nebulizers take more time.
D: Nebulizers produce fine mist particles, but not necessarily smaller than MDIs.

Question 15

What is the primary reason inhaled drugs are preferred over oral drugs for asthma and COPD?

A) They are less expensive than oral drugs
B) They cause fewer systemic side effects
C) They are easier for patients to administer
D) They provide better long-term control

Answer 15

Correct Answer: B
Rationale:

A: Cost is not the primary consideration; effectiveness and safety are prioritized.
B: Inhaled drugs target the lungs directly, minimizing systemic absorption and side effects.
C: Inhalers require proper technique and are not always easier for all patients.
D: Both oral and inhaled drugs can provide long-term control, but inhaled drugs are safer.

Question 16

Which adverse effect should the nurse monitor for in a patient taking oral glucocorticoids long-term for severe asthma?

A) Tachycardia
B) Adrenal insufficiency
C) Dysphonia
D) Dry mouth

Answer 16

Correct Answer: B
Rationale:

A: Tachycardia is associated with beta-2 agonists, not glucocorticoids.
B: Long-term systemic glucocorticoid use can suppress adrenal function, leading to adrenal insufficiency.
C: Dysphonia is a side effect of inhaled glucocorticoids.
D: Dry mouth is an adverse effect of anticholinergics, not glucocorticoids.

Question 17

What is the mechanism of action of phosphodiesterase-4 (PDE-4) inhibitors in COPD?

A) Blocks muscarinic receptors to prevent bronchoconstriction
B) Inhibits PDE-4, reducing inflammation and increasing mucociliary clearance
C) Stimulates beta-2 receptors, promoting bronchodilation
D) Inhibits leukotriene receptors, decreasing mucus production

Answer 17

Correct Answer: B
Rationale:

A: This describes the action of anticholinergics, not PDE-4 inhibitors.
B: PDE-4 inhibitors reduce inflammation by preventing the breakdown of cAMP and increasing mucociliary clearance.
C: This describes beta-2 agonists, not PDE-4 inhibitors.
D: PDE-4 inhibitors do not target leukotriene receptors.

Question 18

Which statement about anticholinergic drugs is accurate?

A) They are first-line treatments for asthma exacerbations
B) They block beta-2 receptors to promote bronchodilation
C) They are primarily used for maintenance therapy in COPD
D) They reduce inflammation in the airway

Answer 18

Correct Answer: C
Rationale:

A: Anticholinergics are not first-line treatments for asthma exacerbations; SABAs are used instead.
B: Anticholinergics block muscarinic, not beta-2, receptors.
C: Anticholinergics, such as tiotropium, are primarily used for maintenance therapy in COPD.
D: Anticholinergics do not directly reduce inflammation; they prevent bronchoconstriction.

Question 19

A patient is prescribed a metered-dose inhaler (MDI) with a spacer for asthma. Which statements about using the device should the nurse include in patient teaching?
(Select all that apply.)

A) “Shake the inhaler well before each use.”
B) “Exhale fully before placing the spacer in your mouth.”
C) “Inhale quickly and deeply to activate the medication release.”
D) “Hold your breath for at least 10 seconds after inhaling the medication.”
E) “Rinse the spacer weekly with warm water and let it air dry.”

Answer 19

Correct Answers: A, B, D, E
Rationale:

A: Shaking the inhaler ensures proper mixing of the medication.
B: Exhaling fully clears the lungs and prepares for maximum medication delivery.
C: Slow and steady inhalation is required; quick inhalation is incorrect.
D: Holding the breath allows the medication to settle in the lungs.
E: Proper cleaning of the spacer prevents buildup of medication and bacteria.

Question 20

A patient with COPD is prescribed tiotropium (LAMA). What should the nurse include in the patient teaching?

A) “Use this medication for quick relief during exacerbations.”
B) “You may experience dry mouth, which should lessen over time.”
C) “This medication is taken daily to prevent symptoms.”
D) “It is important to rinse your mouth after using this medication.”

Answer 20

Correct Answer: B, C
Rationale:

A: Tiotropium is not for quick relief; SABAs are used for acute exacerbations.
B: Dry mouth is a common side effect of tiotropium, and it often diminishes with use.
C: Tiotropium is taken daily for maintenance therapy in COPD.
D: Mouth rinsing is not required for tiotropium as it is for inhaled glucocorticoids.

Question 21

Which medications are commonly used for long-term control of asthma?
(Select all that apply.)

A) Inhaled glucocorticoids
B) Short-acting beta-2 agonists (SABAs)
C) Long-acting beta-2 agonists (LABAs)
D) Leukotriene receptor antagonists
E) Phosphodiesterase-4 inhibitors

Answer 21

Correct Answers: A, C, D
Rationale:

A: Inhaled glucocorticoids are the first-line treatment for long-term asthma control.
B: SABAs are used for quick relief, not long-term control.
C: LABAs are used in combination with glucocorticoids for long-term control.
D: Leukotriene receptor antagonists help in maintenance therapy.
E: PDE-4 inhibitors are primarily for COPD, not asthma.

Question 22

The nurse is teaching a patient with asthma about the potential side effects of inhaled glucocorticoids. Which side effects should the patient be aware of?
(Select all that apply.)

A) Oral thrush
B) Dysphonia
C) Tachycardia
D) Bone loss with long-term use
E) Peripheral edema

Answer 22

Correct Answers: A, B, D
Rationale:

A: Oral thrush is a common side effect; rinsing the mouth after use can prevent it.
B: Dysphonia (hoarseness) can result from medication deposition in the throat.
C: Tachycardia is associated with beta-2 agonists, not glucocorticoids.
D: Long-term use of glucocorticoids can lead to bone loss.
E: Peripheral edema is not a typical side effect of inhaled glucocorticoids.

Question 23

Which of the following is a priority intervention for a patient experiencing an acute COPD exacerbation?

A) Administering a long-acting beta-2 agonist (LABA)
B) Providing nebulized short-acting beta-2 agonist (SABA) and ipratropium
C) Prescribing leukotriene receptor antagonists
D) Instructing the patient to increase their daily tiotropium dose

Answer 23

Correct Answer: B
Rationale:

A: LABAs are not effective for acute management.
B: Nebulized SABA and ipratropium provide immediate relief by opening airways and reducing obstruction.
C: Leukotriene receptor antagonists are for maintenance, not acute exacerbations.
D: Increasing tiotropium dosage does not address immediate symptoms.

Question 24

Which inhalation device requires the least hand-breath coordination?

A) Metered-dose inhaler (MDI)
B) Dry powder inhaler (DPI)
C) Respimat
D) Nebulizer

Answer 24

Correct Answer: D
Rationale:

A: MDIs require good hand-breath coordination.
B: DPIs are breath-activated but require sufficient inspiratory force.
C: Respimats still require some hand-breath coordination.
D: Nebulizers deliver medication with every breath and do not require coordination.

Question 25

What are the benefits of using inhaled drugs for asthma and COPD compared to systemic drugs?
(Select all that apply.)

A) Faster onset of action
B) Decreased systemic side effects
C) Easier administration for patients
D) Direct delivery to the site of action
E) Longer duration of action

Answer 25

Correct Answers: A, B, D
Rationale:

A: Inhaled drugs act quickly during exacerbations.
B: Inhaled drugs reduce systemic side effects by targeting the lungs directly.
C: Administration can be challenging for patients without proper technique.
D: Direct delivery ensures effective treatment of airway issues.
E: Duration depends on the specific drug, not the route.

Question 26

A patient is using a long-acting beta-2 agonist (LABA) for asthma. Which additional medication is required to ensure safety?

A) A short-acting beta-2 agonist (SABA) for rescue use
B) An oral phosphodiesterase-4 inhibitor
C) A leukotriene receptor antagonist
D) An inhaled glucocorticoid

Answer 26

Correct Answer: D
Rationale:

A: While a SABA is needed for exacerbations, it does not address the safety of LABA use.
B: PDE-4 inhibitors are for COPD, not asthma.
C: Leukotriene receptor antagonists are maintenance drugs but not mandatory with LABA use.
D: Inhaled glucocorticoids reduce inflammation and mitigate the risks of LABAs when used together.

Question 27

The nurse is educating a patient about adverse effects of beta-2 agonists. What potential side effects should the patient monitor for?
(Select all that apply.)

A) Tremors
B) Hypotension
C) Tachycardia
D) Hyperglycemia
E) Dysphonia

Answer 27

Correct Answers: A, C, D
Rationale:

A: Tremors are a common side effect due to beta-2 receptor activation in skeletal muscles.
B: Beta-2 agonists may cause hypertension, not hypotension.
C: Tachycardia is a known side effect of beta-2 agonists.
D: Hyperglycemia can occur due to beta-2 receptor activation in the liver.
E: Dysphonia is a side effect of inhaled glucocorticoids, not beta-2 agonists.

Question 28

What are the two main categories of drugs used in the treatment of asthma and COPD?

Answer 28

Answer:

Anti-inflammatory drugs
Bronchodilators

Question 29

List three methods of inhaled drug delivery for asthma and COPD.

Answer 29

Answer:

Metered-dose inhaler (MDI)
Dry powder inhaler (DPI)
Nebulize

Question 30

What is the mechanism of action of glucocorticoids in asthma?

Answer 30

Answer:

Decreases synthesis of inflammatory mediators
Reduces activity of inflammatory cells
Reduces edema and mucus production

Question 31

What is the most common adverse effect of inhaled glucocorticoids?

Answer 31

Oral thrush

Question 32

Which drug class is commonly used for long-term asthma management to prevent bronchoconstriction and improve lung function?

Answer 32

Answer:

Beta-2 agonists

Question 33

What is the primary purpose of using a spacer with a metered-dose inhaler (MDI)?

Answer 33

Answer:

Reduces drug deposition in the oropharynx

Question 34

Name one adverse effect associated with the use of oral glucocorticoids for asthma or COPD.

Answer 34

Answer:

Bone loss

Question 35

What drug class is commonly used to treat exercise-induced bronchospasm (EIB)?

Answer 35

Answer:

Short-acting beta-2 agonists (SABAs)

Question 36

What type of inhaler is preferred for patients with limited hand-breath coordination?

Answer 36

Answer:

Nebulizer

Question 37

What is the primary goal of using long-acting muscarinic antagonists (LAMAs) in COPD?

Answer 37

Answer:

Maintenance therapy

Question 38

Which of the following are common adverse effects of long-term use of glucocorticoids?
(Select all that apply.)

A) Oral thrush
B) Hypertension
C) Bone loss
D) Increased appetite
E) Slowed growth in children

Answer 38

Correct Answers: A, C, E
Rationale:

A: Oral thrush is common with inhaled glucocorticoids.
C: Bone loss can occur with long-term use of glucocorticoids.
E: Glucocorticoid use can cause slowed growth in children.
B: Hypertension is more commonly associated with systemic glucocorticoids.
D: Increased appetite is typically associated with oral glucocorticoids, not inhaled.

Question 39

Which of the following statements are true about beta-2 agonists in asthma treatment?
(Select all that apply.)

A) They are used for quick relief during asthma exacerbations.
B) They can cause tachycardia and tremors as side effects.
C) They are always used alone in asthma management.
D) They help with both bronchodilation and inflammation reduction.
E) Inhaled beta-2 agonists can mask the worsening of inflammation in asthma.

Answer 39

Correct Answers: A, B, E
Rationale:

A: Beta-2 agonists, particularly short-acting ones (SABAs), are used for quick relief during exacerbations.
B: Tachycardia and tremors are common side effects of beta-2 agonists.
E: Inhaled beta-2 agonists may mask inflammation, delaying the recognition of worsening asthma.
C: Beta-2 agonists are often used with other medications, especially glucocorticoids, for asthma management.
D: Beta-2 agonists are bronchodilators, not anti-inflammatory agents.

Question 40

Which of the following are appropriate uses for leukotriene receptor antagonists (LTRAs) in asthma treatment?
(Select all that apply.)

A) Long-term control of asthma
B) Prevention of exercise-induced bronchospasm
C) Relief of acute asthma exacerbation
D) Treatment of allergic rhinitis
E) Acute symptom relief during an asthma attack

Answer 40

Correct Answers: A, B, D
Rationale:

A: LTRAs are used for long-term asthma control.
B: LTRAs can help prevent exercise-induced bronchospasm.
D: LTRAs are also effective for the treatment of allergic rhinitis.
C: LTRAs are not used for acute exacerbation relief.
E: LTRAs do not provide immediate relief during an asthma attack.

Question 41

Which of the following drugs are commonly used in the management of COPD?
(Select all that apply.)

A) Phosphodiesterase-4 inhibitors (PDE-4 inhibitors)
B) Leukotriene receptor antagonists (LTRAs)
C) Inhaled glucocorticoids
D) Long-acting muscarinic antagonists (LAMAs)
E) Short-acting beta-2 agonists (SABAs)

Answer 41

Correct Answers: A, C, D, E
Rationale:

A: PDE-4 inhibitors are used in COPD to reduce exacerbations.
C: Inhaled glucocorticoids are used for long-term control in COPD.
D: LAMAs are used for maintenance therapy in COPD.
E: SABAs are used for relief during acute exacerbations in COPD.
B: LTRAs are primarily used in asthma, not COPD.

Question 42

Which of the following are benefits of using a nebulizer for drug delivery in asthma or COPD?
(Select all that apply.)

A) Does not require hand-breath coordination
B) Provides quick relief during exacerbations
C) Can deliver medication continuously over time
D) Has a shorter administration time compared to other devices
E) Is portable and convenient for use at home

Answer 42

Correct Answers: A, C
Rationale:

A: Nebulizers do not require hand-breath coordination.
C: Nebulizers deliver medication continuously with each breath, which can be beneficial for consistent drug delivery.
B: Nebulizers do not provide quick relief; they are used for more continuous delivery.
D: Nebulizers generally take longer for drug delivery than inhalers.
E: Nebulizers are typically less portable than inhalers.

Question 43

Which of the following are common side effects of anticholinergics used in COPD?
(Select all that apply.)

A) Dry mouth
B) Pharyngeal irritation
C) Tachycardia
D) Increased mucus production
E) Urinary retention

Answer 43

Correct Answers: A, B, E
Rationale:

A: Dry mouth is a common side effect of anticholinergics.
B: Pharyngeal irritation is also common with inhaled anticholinergics.
E: Urinary retention can occur as a side effect of anticholinergics due to muscarinic receptor blockade.
C: Tachycardia is not typically associated with anticholinergics; it’s more common with beta-2 agonists.
D: Anticholinergics help reduce mucus production, not increase it.