CH14 RESPIRATORY Pharma 5th edition Woo, Robinson question and answers.docx

  Digoxin levels need to be monitored closely when the following medication is started: Loratadine Diphenhydramine Ipratropium Albuterol - Correct Answers: Albuterol Patients with pheochromocytoma should avoid which of the following classes of drugs because of the possibility of developing hypertensive crisis? Expectorants Beta-2-agonists Antitussives Antihistamines - Correct Answers: Beta-2-agonists Harold, a 42-year-old African American, has moderate persistent asthma. Which of the following asthma medications should be used cautiously, if at all? Betamethasone, an inhaled corticosteroid Salmeterol, an inhaled long-acting beta-agonist Albuterol, a short-acting beta-agonist Montelukast, a leukotriene modifier - Correct Answers: Salmeterol, an inhaled long-acting beta-agonist Long-acting beta-agonists (LTBAs) received a Black Box Warning from the U.S. Food and Drug Administration due to the: Risk of life-threatening dermatological reactions Increased incidence of cardiac events when LTBAs are used Increased risk of asthma-related deaths when LTBAs are used Risk for life-threatening alterations in electrolytes - Correct Answers: Increased risk of asthma-related deaths when LTBAs are used The bronchodilator of choice for patients taking propranolol is: Albuterol Pirbuterol Formoterol Ipratropium - Correct Answers: Ipratropium James is a 52-year-old overweight smoker taking theophylline for his persistent asthma. He tells his provider he is going to start the Atkin's diet for weight loss. The appropriate response would be: Congratulate him on making a positive change in his life. Recommend he try stopping smoking instead of the Atkin's diet. Schedule him for regular testing of serum theophylline levels during his diet due to increased excretion of theophylline. Decrease his theophylline dose because a high-protein diet may lead to elevated theophylline levels. - Correct Answers: Recommend he try stopping smoking instead of the Atkin's diet. Li takes theophylline for his persistent asthma and calls the office with a complaint of nausea, vomiting, and headache. The best advice for him would be to: Reassure him this is probably a viral infection and should be better soon Have him seen the same day for an assessment and theophylline level Schedule him for an appointment in 2 to 3 days, which he can cancel if he is better Order a theophylline level at the laboratory for him - Correct Answers: Schedule him for an appointment in 2 to 3 days, which he can cancel if he is better Tiotropium bromide (Spiriva) is an inhaled anticholinergic: Used for the treatment of chronic obstructive pulmonary disease (COPD) Used in the treatment of asthma Combined with albuterol for treatment of asthma exacerbations Combined with fluticasone for the treatment of persistent asthma - Correct Answers: Used for the treatment of chronic obstructive pulmonary disease (COPD) Christy has exercise-induced and mild persistent asthma and is prescribed two puffs of albuterol 15 minutes before exercise and as needed for wheezing. One puff per day of beclomethasone (QVAR) is also prescribed. Teaching regarding her inhalers includes: Use one to two puffs of albuterol per day to prevent an attack with no more than eight puffs per day Beclomethasone needs to be used every day to treat her asthma Report any systemic side effects she is experiencing, such as weight gain Use the albuterol metered-dose inhaler (MDI) immediately after her corticosteroid MDI to facilitate bronchodilation - Correct Answers: Beclomethasone needs to be used every day to treat her asthma When prescribing montelukast (Singulair) for asthma, patients or parents of patients should be instructed: Montelukast twice a day is started when there is an asthma exacerbation. Patients may experience weight gain on montelukast. Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking montelukast. Lethargy and hypersomnia may occur when taking montelukast. - Correct Answers: Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking montelukast. Montelukast (Singulair) may be prescribed for: A 6-year-old child with exercise-induced asthma A 2-year-old child with moderate persistent asthma An 18-month-old child with seasonal allergic rhinitis None of the above; montelukast is not approved for use in children - Correct Answers: A 2-year-old child with moderate persistent asthma The known drug interactions with the inhaled corticosteroid beclomethasone (QVAR) include: Albuterol MMR vaccine Insulin None of the above - Correct Answers: None of the above The first-line treatment for cough related to an upper respiratory tract infection (URI) in a 5-year-old child is: Fluids and symptomatic care Dextromethorphan and guaifenesin syrup (Robitussin DM for Kids) Guaifenesin and codeine syrup (Tussin AC) Chlorpheniramine and dextromethorphan syrup (Nyquil for Kids) - Correct Answers: Fluids and symptomatic care When educating patients who are starting on inhaled corticosteroids, the provider should tell them that: They need to get any live vaccines before starting the medication. Inhaled corticosteroids need to be used daily during asthma exacerbations to be effective. Patients should rinse their mouths out after using the inhaled corticosteroid to prevent thrush. They can triple the dose number of inhalations of medication during colds to prevent needing systemic steroids. - Correct Answers: Patients should rinse their mouths out after using the inhaled corticosteroid to prevent thrush. Martin is a 60-year-old patient with hypertension. The first-line decongestant to prescribe would be: Oral pseudoephedrine Oral phenylephrine Nasal oxymetazoline Nasal azelastine - Correct Answers: Nasal oxymetazoline Patients with allergic rhinitis may benefit from a prescription of: Fluticasone (Flonase) Cetirizine (Zyrtec) OTC cromolyn nasal spray (Nasalcrom) Any of the above - Correct Answers: Any of the above Howard is a 72-year-old male who occasionally takes diphenhydramine for his seasonal allergies. Monitoring for this patient taking diphenhydramine would include assessing for: Urinary retention Cardiac output Peripheral edema Skin rash - Correct Answers: Urinary retention Cough and cold medications that contain a sympathomimetic decongestant such as phenylephrine should be used cautiously in what population: Older adults Hypertensive patients Infants All of the above - Correct Answers: All of the above Decongestants such as pseudoephedrine (Sudafed): Are Schedule III drugs in all states Should not be prescribed or recommended for children under 4 years of age Are effective in treating the congestion children experience with the common cold May cause drowsiness in patients of all ages - Correct Answers: Should not be prescribed or recommended for children under 4 years of age First-generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies because they are: More effective than first-generation antihistamines Less sedating than the first-generation antihistamines Prescription products, therefore are covered by insurance Able to be taken with central nervous system (CNS) sedatives, such as alcohol - Correct Answers: Less sedating than the first-generation antihistamines When recommending dimenhydrinate (Dramamine) to treat motion sickness, patients should be instructed to: Take the dimenhydrinate after they get nauseated Drink lots of water while taking the dimenhydrinate Take the dimenhydrinate 15 minutes before it is needed Double the dose if one tablet is not effective - Correct Answers: Take the dimenhydrinate 15 minutes before it is needed