Review Problems Exam III

Which of the following tests assesses lung function before initiating therapy with Afrezza?

a) Forced expiratory volume in one second (FEV1)
b) Forced vital capacity (FVC)
c) Total lung capacity (TLC)
d) Peak expiratory flow rate (PEFR)
e) Residual volume (RV)

a) Forced expiratory volume in one second (FEV1)

Which of the following statements is true?

a) Pulmonary drug delivery is performed only to treat local conditions, e.g., asthma, and infection.
b) The treatment of asthma involves the deposition of the therapeutic agent at the alveoli.
c) Systemic absorption of certain therapeutic agents occurs following pulmonary drug delivery.
d) Pulmonary drug delivery is associated with a slow onset of drug action.

c) Systemic absorption of certain therapeutic agents occurs following pulmonary drug delivery.

Most metered-dose inhalers need to be shaken well immediately before use. Which metered-dose inhaler does not have to be shaken before use?

a) QVAR RediHaler
b) Symbicort
c) Xopenex HFA
d) Flovent HFA
e) Asmanex HFA

a) QVAR RediHaler

Explanation: QVAR RediHaler, Alvesco, Atrovent, and Respimat are MDI products that need not be shaken before use.

What is the purpose of ethanol as an excipient?

increases the vapor pressure of the propellant in MDIs [co-solvents decrease vapor pressure]

What is the purpose of cremophor EL as an excipient?

enhance the solubility of therapeutic agent in ophthalmic solution

What is the purpose of carbomer as an excipient?

increase the viscosity and stabilize an ophthalmic emulsion

What is the purpose of phenylmercuric acetate as an excipient?

to inhibit oxidative degradation of therapeutic agent [preservative, organomercurial compound]

Which of the following statements are true about the formulation of dry powder inhalers?

a) Propellants are not required.
b) The particle size of the therapeutic agent should be less than 5 microns.
c) Lactose is commonly used to improve the flow properties of the powdered drug.
d) Using interactive powder mixtures, both lactose and the active drug reach the site of action.

a and c

Explanation:

A: propellants such as HFA are required in MDIs

incorrect - D: lactose or mannitol are used as carrier molecules and they separate upon inhalation and are deposited in the mouth or throat

When a patient is instructed to hold a breath for 5 to 10 seconds after pulmonary inhalation, what mechanism of deposition is the drug likely to undergo?

a) Inertial impaction
b) Sedimentation
c) Brownian diffusion
d) All of the above

b) Sedimentation

and

c) Brownian diffusion

Concerning the formulation and use of metered-dose inhalers, which of the following statements is true?

a) Oxidation of drugs is minimized.
b) Metered-dose inhalers are usually formulated to ensure that the drug is soluble within the propellant system.
c) Metered-dose inhalers require the inclusion of a preservative.
d) Metered-dose inhalers can be easily formulated to contain water.

a) Oxidation of drugs is minimized

Explanation: A is correct packaging excludes atmospheric O2

B is wrong b/c it can also be suspended

C is wrong b/c there's no need for preservatives in airtight containers

D is wrong b/c water reduces the vapor pressure of propellant so if it's added as a co-solvent the amt should be limited. For example, a small nebulizer [respimat] can be made w/ water and is a metered dose but is NOT an MDI b/c no propellant

Pulmicort Respules are used primarily in this population group:

a) Adults aged 30-50 years
b) Children

b) Children

Explanation: nebulizer suspensions that are particularly useful for patients who struggle w/ inhalers [i.e., children]

A patient's asthma is well controlled with Flovent HFA 220 mcg 2 inhalations BID. He is picking up his refill and asks if anything can help with his sore throat. When inspected, the pharmacist recognizes the throat is sore due to thrush. What are some counseling points the pharmacist can provide that will help to reduce the risk of thrush in the future?

a) drink 8 oz of water after taking the medication.
b) gargle with warm water and spit out the rinse after using the medication.
c) use a spacer device with Flovent HFA.
d) clean the Flovent HFA inhaler after each use

b and c

Explanation: risk of thrush can be decreased by rinsing mouth after use and using a spacer

Which inhaler has a window that turns from green to red to indicate a dose was given?

a) Anoro Ellipta (umeclidinium/vilanterol)
b) Striverdi Respimat (olodaterol)
c) Spiriva HandiHaler (tiotropium bromide)
d) Tudorza Pressair (aclidinium)

d) Tudorza Pressair (aclidinium)

Which of the following statements is NOT true?

a) Ocular dosage forms are always sterile.
b) Ophthalmic dosage forms are employed to treat local conditions, e.g., infection, and inflammation.
c) Ocular dosage forms may be employed to treat intraocular disorders.
d) Ocular dosage forms are also used to deliver therapeutic agents systemically.

d) Ocular dosage forms are also used to deliver therapeutic agents systemically.

Regarding nasal dosage forms, which of the following statements is true?

a) Nasal dosage forms are always sterile.
b) Nasal dosage forms are only employed to treat local conditions, e.g., infection, and inflammation.
c) Liquid nasal dosage forms are principally aqueous formulations. (solution or suspension)
d) Nasal dosage forms may be used to deliver therapeutic agents systemically.

c and d

Explanation: solution or suspensions are aq formulations

Which counseling statements concerning eye drop administration are correct?

a) Wash your hands thoroughly before using eye drops.
b) While looking up, use one finger to pull down the lower eyelid gently.
c) Touch the tip of the dropper against the lower eyelid and squeeze the bottle to insert a drop.
d) After inserting a drop, close the eye and press a finger between the eye and the top of the nose for one minute.
e) If using another eye drop medication, wait at least one minute before using the second eye drop

a, b, and d

Explanation: c is wrong b/c touching the tip can lead to contamination and e is wrong b/c it should be 5+ minutes

Which of the following DPI devices contain the drug in a bulk powder?

a) Pulmicort® Flexhaler
b) Advair® Diskus
c) Spiriva® HandiHaler
d) Relenza® Diskhaler
e) All of the above

a) Pulmicort® Flexhaler

Which of the following statements NOT is true?

a) The choice of drug salt influences the subsequent absorption.
b) The pH of the formulation influences drug absorption.
c) Increasing the viscosity of eye drop formulation can result in a greater extent of drug absorption.
d) The rate of drug absorption from ophthalmic ointments is greater than from eye drop formulations.

d) The rate of drug absorption from ophthalmic ointments is greater than from eye drop formulations.

explanation: the rate is faster from eye drops, the extent can be higher from ointments b/c of prolonged contact time

Which of the following pairings is correct?

a) Pulmicort® and ultrasonic nebulizer
b) Cayston® and Altera nebulizer system
c) Ventavis® and Respimant
d) Combivent and I-neb AAD system
e) Arikayce® and Lamira Nebulizer System

b and e

Explanation: A is wrong b/c pulmicort is a susp that should be used with a jet nebulizer and ultrasonic nebulizers use high-freq vibration that can affect suspensions

C is wrong b/c ventavis uses an I-neb AAD

D is wrong b/c combivent is a respimat system that uses an aq soln

1) A reduced aerosol velocity was observed when a manufacturer changed the type of propellant in their new MDI product. This change would most likely cause...
a) a decrease in oropharyngeal deposition
b) an increase in the deposition in the respiratory region
c) an increase in drug loss due to impaction

a and b

Which of the following drug products are considered intraocular?

a) Restasis®
b) Iluvien®
c) Dextenza®
d) Ozurdex®

b and d

Explanation: A = opthalmic, B = intravitreal, C = opthalmic insert/intracanalicular, and D = intravitreal implant

Which of the following could potentially impact the therapeutic response to a dry powder inhaler?

A. The patient is unable to generate a sufficient pressure due to issues with inhaling

B. Different inhalation patterns and techniques can lead to variable dosing

C. Powder if left behind on the inhaler

a and b

Explanation: c would be incorrect b/c powder left behind after administration is normal!

Match the area of lung with the predominant type of deposition (brownian, sedimentation, impaction): Trachea

impaction

Match the area of lung with the predominant type of deposition (brownian, sedimentation, impaction): Bronchi

impaction

Match the area of lung with the predominant type of deposition (brownian, sedimentation, impaction): Terminal Bronchioles

sedimentation

Match the area of lung with the predominant type of deposition (brownian, sedimentation, impaction): Alveolar Ducts

brownian diffusion

Match the area of lung with the predominant type of deposition (brownian, sedimentation, impaction): Alveolar Sacs

brownian diffusion

What is drug deposition is impacted by...

A. aerosol
B. formulation
C. patient related
D. disease related
E. all of the above

E. all of the above

Explanation: humidity, particle size and shape, properties of the propellant, inhalation patterns, breath-holding time, and type/severity of lung disease will affect pulmonary drug deposition

Determine whether each particle in the image below if isotonic, hypertonic, or hypotonic

A = hypotonic

B = hypertonic

C and D = isotonic

explanation: it is better to use hypertonic particles when wanted to go deeper in the longs as the droplet will not grow and potentially deposit earlier

A patient receives a new prescription for Pulmicort in order to manage their asthma. They noticed that they started to develop raised, white lesions on their cheeks and tongue. They go to their provider and are diagnosed with thrush. What counseling point could their pharmacist have provided them to have prevented this from occurring?

After using the medication, the patient can gargle warm water in the back of their throat to help prevent thrush. The patient should spit out the water solution when done gargling.

Which of the following are advantages of using nebulized solutions?

A.It is formulated as a gentle mist, meaning there is no forced impaction
B.Reduces the deposition in the throat and mouth
C.The patient does not need to have hand-mouth coordination
D.Less adverse systemic effects
E. All of the above

E. All of the above

What is NOT a potential issue with metered dose inhalers (MDIs)?

A.The propellant can leak resulting in a concentrated product
B.Moisture can interfere with aerosolization
C.Oxidation of drugs is minimized
D.They can initiate a cough reflex

C.Oxidation of drugs is minimized

Explanation: C is true of MDIs, but it's a positive thing and would NOT be an issue! Oxidation of the drug particle could lead to drug instability or degradation

Based on your knowledge of deposition of particles, what would happen to the drug if the particle size and velocity was increased?

Inertial Impaction:

- smaller particle sizes or velocities will result in an increased uptake into the lungs.

- larger particles will have more momentum and will not allow for them to navigate the complex lung structures.

- a similar deposition pattern happens when you increase velocity as the particle will likely undergo impaction [esp upper regions of resp tract] and become swallowed in the GIT

- decreases deposition in lungs and increases systemic effects when particle size and velocity increases

What are some possible complications or potential issues with nasal drug delivery?

A. placement
B. clearance
C. irritation
D. absorption
E. all of the above

E. all of the above

explanation: A b/c wrong placement can lead to different responses. B b/c mucociliary clearance interferes w/ absorption. C b/c nasal mucosa is sensitive. D b/c allergies and congestion can interfere

Identify which of the following is not a proper counseling point for nasal drug delivery:

A.Gently blow the nose before administration to clear nasal passages
B.Keep the head upright and close on nostril
C.Insert the spray nozzle and angle the nozzle inward
D.Do not breath deeply
E.Keep the head level for 10 to 20 seconds after administration

C.Insert the spray nozzle and angle the nozzle inward

explanation: nozzle should be angled OUTward

What are some items that a patient should know before using a nasal gel such as Natesto?

A.The pump must be primed before using by inverting the pump and then depressing it 10 times
B.The tip of the pump should come in contact with the lateral wall of the nostril
C.Do not blow the nose or sniff for one hour after administration
D.Wash hands after use
E. All of the above

E. All of the above

Why should patients be advised to apply pressure after the administration of eye drops?

A.To prevent tear ducts from allowing excess water that would dilute the ocular solution
B.To delay drainage of the eye drop into the nasal cavity
C.To ensure that the excess solution does not spill over the side of the eye
D.We should not place pressure on the eye after administration as this could result in contamination of the eye drop

B.To delay drainage of the eye drop into the nasal cavity

Which of the following is NOT true about ocular dosage forms?

A.They are meant for local disease states and conditions
B.They are always sterile
C.They can have systemic effects due to limited absorption
D.They can be used for extra-ocular and intraocular disorders

C.They can have systemic effects due to limited absorption

Which of the following excipients can be used as a vehicle to dissolve the drug?

A. Cremophor EL
B. Benzalkonium chloride
C. Sodium thiosulfate and edetate disodium
D. Polysorbate 80
E. Carbomer 1342
F. Glycerin

A. Cremophor EL

Which of the following excipients can be used as humectant to reduce evaporation of water?

A. Cremophor EL
B. Benzalkonium chloride
C. Sodium thiosulfate and edetate disodium
D. Polysorbate 80
E. Carbomer 1342
F. Glycerin

F. Glycerin

Which of the following excipients can be used as a preservative?

A. Cremophor EL
B. Benzalkonium chloride
C. Sodium thiosulfate and edetate disodium
D. Polysorbate 80
E. Carbomer 1342
F. Glycerin

B. Benzalkonium chloride

Which of the following excipients can be used as a viscosity increasing agent?

A. Cremophor EL
B. Benzalkonium chloride
C. Sodium thiosulfate and edetate disodium
D. Polysorbate 80
E. Carbomer 1342
F. Glycerin

E. Carbomer 1342

Which of the following excipients can be used as a wetting agent?

A. Cremophor EL
B. Benzalkonium chloride
C. Sodium thiosulfate and edetate disodium
D. Polysorbate 80
E. Carbomer 1342
F. Glycerin

D. Polysorbate 80

What counseling points would you use when instructing a patient on how to administer their eye drops?

wash hands before,

remove contacts and wait 15+ min after administration,

dropper tip should not touch eye,

don't blink/rub eyes.

second drop can be applied 5 min after the previous