ACCP Pharmacotherapy Exam with complete solutions latest version.pdf,
Exams of Pharmacology
A 32-year old woman with persistent asthma has shortness of breath (SOB)
and wheezing that occur twice weekly. Her medical history includes allergic
rhinitis, depression, and polycystic ovary syndrom. She uses her albuterol
hydrofluoroalkane (HFA) inhaler twice weekly, usually when outside at the
park. She wakes up at night coughing about once weekly. Her current drugs
include albuterol HFA 1 or 2 puffs every 4-6 hours as needed for SOB,
fluticasone/salmeterol Diskus 250/50 1 puff twice daily, loratadine 10 mg
once daily for "allergies", fluticasone nasal spray 50 mcg 2 sprays each nostril
once daily, and metformin 500 mg twice daily. Sertraline 50 mg once daily
was initiated 2 months before this presentation. She does not have a peak
flow meter, but she follows her asthma action plan. The patient cannot
remember the last time she had to visit the emergency department (ED) for
an exacerbation. What best addresses the - ANSWERAdd montekulast 10 mg
once daily at bedtime.
(This patient's asthma is not well controlled (symptoms occur more than 2
days/week, bedtime symptoms occur 1-3 times a week, and the patient
requires short-acting β-agonist (SABA) use 2 days/week). The patient may
benefit from the addition of montelukast (an alternative agent) because she
has allergic rhinitis (already uses intranasal steroid and daily antihistamine)
and reports that the symptoms usually occur when outdoors (pollen
exposure), which may mean that an allergic component is worsening her
,symptoms. Montelukast should not be withheld from a patient who might
benefit from it, even if the patient has concomitant depression.)
The following four patients have very poorly controlled asthma on high dose
inhaled corticosteroids (ICS) plus a LABA. Which patient would benefit most
from a trial of golimumab?
A. A fifty-year-old architect with severe plaque psoriasis.
B. An 18-year-old College freshman with irritable bowel disease.
C. A 62-year-old retired man with osteoarthritis of the knee.
D. A 24-year-old man with poorly controlled bipolar disorder. - ANSWERA
fifty-year-old architect with severe plaque psoriasis.
(Golimumab, A human monoclonal antibody Tumor Necrosis Factor Alpha
(TNF-α), Is most likely to benefit the patient with concomitant inflammatory
disorders (poorly controlled asthma) and severe plaque psoriasis.)
A 39-year-old man with asthma presents to the clinic for a follow-up
amy»intrnent. His medical history includes very poorly controlled asthma,
erectile dysfunction, degenerative disk disease, and hypertension. His current
drugs include mometasone/formoterol 200/5 mcg 2 puffs twice daily,
albuterol HFA I or 2 puffs every 4-6 hours as needed for SOB/wheezing,
sildenafil 50 mg as needed, naproxen 500 mg twice daily, and
hydrochlorothiazide 12.5 mg once daily. His vital signs include oxygen
saturation 97% on room air, blood pressure (BP) 130/74 mm Hg, heart rate
(HR) 90 beats/minute, and peak expiratory flow 300 L/minute (best of three
with adequate effort, personal best 550 L/minute). His social history is
positive for tobacco use (1/2 pack/day), and he states that he does not drink
alcohol or take illicit drugs. Induced sputum sample is positive for WBCs:
neutrophils predominant. Other test results are fraction of nitr -
ANSWERTiotropium DPI 18 mcg once daily.
,(This patient is most likely to benefit from a trial of tiotropium added to his
high-dose ICS plus LABA therapy)
A 25-year-old woman who previously received a diagnosis of mild persistent
asthma reports to her primary care physician's office for her 6-week follow-
up. She states that she still has symptoms several times per week that require
the use of her albuterol inhaler, as well as one or two nighttime awakenings
per month. Her current drug regimen includes fluticasone 110 mcg 1 puff by
mouth twice daily.
Which one of the following would be the
most appropriate change to her asthma medication regimen?
A. Increase fluticasone to 220 mcg 2 puffs by mouth twice daily.
B. Discontinue fluticasone and initiate mometasone 110 mcg 1 puff by mouth
twice daily.
C. Increase fluticasone to 220 mcg I puffby mouth twice daily plus
montelukast 10 mg by mouth daily.
D. Discontinue fluticasone and initiate fluticasone'salmeterol 100/50 1 puff by
mouth twice daily. - ANSWERANSWER D: Discontinue fluticasone and initiate
fluticasone/salmeterol 100/50 1 puff by mouth twice daily.
(This patient has mild asthma (step 2) that is not well controlled. Therefore,
she needs step-up therapy to step 3. The preferred treatment for step 3
therapy is a low-dose ICS plus a LABA or a medium-dose ICS alone (ANSWER
D is correct).
Fluticasone 220 mcg 2 puffs twice daily is a high-dose ICS, which is
appropriate for step 5 and 6 therapy (ANSWER A is incorrect).
Mometasone 110 mcg 1 puff twice daily is a low-dose ICS regimin,
appropriate for step 2 therapy; it does not represent a step-up in therapy
(ANSWER B is incorrect). An increase to fluticasone 220 mcg 1 puff twice daily
, plus montelukast is a medium-dose ICS plus a leukotriene and is consistent
with step 4 therapy (ANSWER C is incorrect).)
A 69-year-old woman (height 65 inches [165 cm], weight 65 kg) has patient
group C/stage 3 chronic obstructive pulmonary disease (COPD), angina,
hypertension, and depression. She also has a history of tobacco smoking for
35 years but is ready to quit smoking. Her home drugs include amlodipine 10
mg orally daily and a fluticasone 250 mcg/salmeterol 50 mcg inhaler twice
daily. The patient's vital signs include the following: BP 180/90 mm Hg, HR 92
beats/minute, and respiratory rate (RR) 18 breaths/minute. Her CrCl is 50
mL/minute/1.73m^2.
Which one of the following is the most appropriate choice for smoking
cessation for this patient?
A. Bupropion SR.
B. Nicotine patch.
C. Nicotine inhaler.
D. Varenicline. - ANSWERANSWER A: Bupropion SR.
(This patient, who wishes to quit smoking, has a history of depression. Of the
choices listed, bupropion is least likely to have a drug-disease interaction or
cause harmful adverse effects and may have the added benefit of improving
her depression (ANSWER A is correct).
Nicotine-based options are not preferred in this patient with a history of
hypertension (currently uncontrolled, based on vital signs) and angina; both
arc precautions to using nicotine patches or an inhaler (ANSWER B and
ANSWER C are incorrect).
Both cardiovascular disease and depression are precautions for using
varenicline (ANSWER D is incorrect).)
Exams of Pharmacology
A 32-year old woman with persistent asthma has shortness of breath (SOB)
and wheezing that occur twice weekly. Her medical history includes allergic
rhinitis, depression, and polycystic ovary syndrom. She uses her albuterol
hydrofluoroalkane (HFA) inhaler twice weekly, usually when outside at the
park. She wakes up at night coughing about once weekly. Her current drugs
include albuterol HFA 1 or 2 puffs every 4-6 hours as needed for SOB,
fluticasone/salmeterol Diskus 250/50 1 puff twice daily, loratadine 10 mg
once daily for "allergies", fluticasone nasal spray 50 mcg 2 sprays each nostril
once daily, and metformin 500 mg twice daily. Sertraline 50 mg once daily
was initiated 2 months before this presentation. She does not have a peak
flow meter, but she follows her asthma action plan. The patient cannot
remember the last time she had to visit the emergency department (ED) for
an exacerbation. What best addresses the - ANSWERAdd montekulast 10 mg
once daily at bedtime.
(This patient's asthma is not well controlled (symptoms occur more than 2
days/week, bedtime symptoms occur 1-3 times a week, and the patient
requires short-acting β-agonist (SABA) use 2 days/week). The patient may
benefit from the addition of montelukast (an alternative agent) because she
has allergic rhinitis (already uses intranasal steroid and daily antihistamine)
and reports that the symptoms usually occur when outdoors (pollen
exposure), which may mean that an allergic component is worsening her
,symptoms. Montelukast should not be withheld from a patient who might
benefit from it, even if the patient has concomitant depression.)
The following four patients have very poorly controlled asthma on high dose
inhaled corticosteroids (ICS) plus a LABA. Which patient would benefit most
from a trial of golimumab?
A. A fifty-year-old architect with severe plaque psoriasis.
B. An 18-year-old College freshman with irritable bowel disease.
C. A 62-year-old retired man with osteoarthritis of the knee.
D. A 24-year-old man with poorly controlled bipolar disorder. - ANSWERA
fifty-year-old architect with severe plaque psoriasis.
(Golimumab, A human monoclonal antibody Tumor Necrosis Factor Alpha
(TNF-α), Is most likely to benefit the patient with concomitant inflammatory
disorders (poorly controlled asthma) and severe plaque psoriasis.)
A 39-year-old man with asthma presents to the clinic for a follow-up
amy»intrnent. His medical history includes very poorly controlled asthma,
erectile dysfunction, degenerative disk disease, and hypertension. His current
drugs include mometasone/formoterol 200/5 mcg 2 puffs twice daily,
albuterol HFA I or 2 puffs every 4-6 hours as needed for SOB/wheezing,
sildenafil 50 mg as needed, naproxen 500 mg twice daily, and
hydrochlorothiazide 12.5 mg once daily. His vital signs include oxygen
saturation 97% on room air, blood pressure (BP) 130/74 mm Hg, heart rate
(HR) 90 beats/minute, and peak expiratory flow 300 L/minute (best of three
with adequate effort, personal best 550 L/minute). His social history is
positive for tobacco use (1/2 pack/day), and he states that he does not drink
alcohol or take illicit drugs. Induced sputum sample is positive for WBCs:
neutrophils predominant. Other test results are fraction of nitr -
ANSWERTiotropium DPI 18 mcg once daily.
,(This patient is most likely to benefit from a trial of tiotropium added to his
high-dose ICS plus LABA therapy)
A 25-year-old woman who previously received a diagnosis of mild persistent
asthma reports to her primary care physician's office for her 6-week follow-
up. She states that she still has symptoms several times per week that require
the use of her albuterol inhaler, as well as one or two nighttime awakenings
per month. Her current drug regimen includes fluticasone 110 mcg 1 puff by
mouth twice daily.
Which one of the following would be the
most appropriate change to her asthma medication regimen?
A. Increase fluticasone to 220 mcg 2 puffs by mouth twice daily.
B. Discontinue fluticasone and initiate mometasone 110 mcg 1 puff by mouth
twice daily.
C. Increase fluticasone to 220 mcg I puffby mouth twice daily plus
montelukast 10 mg by mouth daily.
D. Discontinue fluticasone and initiate fluticasone'salmeterol 100/50 1 puff by
mouth twice daily. - ANSWERANSWER D: Discontinue fluticasone and initiate
fluticasone/salmeterol 100/50 1 puff by mouth twice daily.
(This patient has mild asthma (step 2) that is not well controlled. Therefore,
she needs step-up therapy to step 3. The preferred treatment for step 3
therapy is a low-dose ICS plus a LABA or a medium-dose ICS alone (ANSWER
D is correct).
Fluticasone 220 mcg 2 puffs twice daily is a high-dose ICS, which is
appropriate for step 5 and 6 therapy (ANSWER A is incorrect).
Mometasone 110 mcg 1 puff twice daily is a low-dose ICS regimin,
appropriate for step 2 therapy; it does not represent a step-up in therapy
(ANSWER B is incorrect). An increase to fluticasone 220 mcg 1 puff twice daily
, plus montelukast is a medium-dose ICS plus a leukotriene and is consistent
with step 4 therapy (ANSWER C is incorrect).)
A 69-year-old woman (height 65 inches [165 cm], weight 65 kg) has patient
group C/stage 3 chronic obstructive pulmonary disease (COPD), angina,
hypertension, and depression. She also has a history of tobacco smoking for
35 years but is ready to quit smoking. Her home drugs include amlodipine 10
mg orally daily and a fluticasone 250 mcg/salmeterol 50 mcg inhaler twice
daily. The patient's vital signs include the following: BP 180/90 mm Hg, HR 92
beats/minute, and respiratory rate (RR) 18 breaths/minute. Her CrCl is 50
mL/minute/1.73m^2.
Which one of the following is the most appropriate choice for smoking
cessation for this patient?
A. Bupropion SR.
B. Nicotine patch.
C. Nicotine inhaler.
D. Varenicline. - ANSWERANSWER A: Bupropion SR.
(This patient, who wishes to quit smoking, has a history of depression. Of the
choices listed, bupropion is least likely to have a drug-disease interaction or
cause harmful adverse effects and may have the added benefit of improving
her depression (ANSWER A is correct).
Nicotine-based options are not preferred in this patient with a history of
hypertension (currently uncontrolled, based on vital signs) and angina; both
arc precautions to using nicotine patches or an inhaler (ANSWER B and
ANSWER C are incorrect).
Both cardiovascular disease and depression are precautions for using
varenicline (ANSWER D is incorrect).)
