Top 200/300 Asthma & COPD Quiz

Which of the following incorrectly matches a brand of tiotropium with its respective dosage form?

A. Spiriva Handihaler; Dry-powder inhaler

B. Spiriva HFA; Metered-dose inhaler

C. Spiriva Respimat; Soft-mist inhaler

B. Spiriva HFA; Metered-dose inhaler

Spiriva HFA Metered-Dose inhaler; tiotropium is not available as a metered-dose inhaler. Spiriva Respimat is a soft-mist inhaler. Spiriva Handihaler is a dry-powder inhaler.

Which of the following classes includes fluticasone?

A. Long-acting beta-2 agonist

B. Inhaled corticosteroid

C. Long-acting muscarinic antagonist

D. Short-acting beta-2 agonist

B. Inhaled corticosteroid

Which of the following descriptions is accurate for Serevent Diskus?

A. Soft mist inhaler

B. Metered dose inhaler

C. Dry powder inhaler

D. Twist inhaler

C. Dry powder inhaler

Serevent Diskus is the brand name for salmeterol and is a dry powder inhaler. Serevent Diskus is not an MDI or SMI. "Twist inhalers" do not exist. Asmanex Twisthaler exists, but it a dry powder inhaler also.

Budesonide is commercially available in the following preparations, EXCEPT:

A. topical foam.

B. nasal inhalation.

C. oral inhalation.

D. powder for reconstitution.

D. powder for reconstitution.

Budesonide is not commercially available as a powder for reconstitution. Budesonide is available as a dry powder for inhalation under the brand name Pulmicort Flexhaler. Budesonide topical foam is available for mild to moderate ulcerative colitis. Budesonide nasal inhalation can be used for the treatment of nonallergic rhinitis. The brand name is Rhinocort Allergy.

True or False: If ipratropium is the only active ingredient in an inhaled product, it is available over the counter

False

Ipratropium alone or in combination with another product (e.g., ipratropium + albuterol = Combivent Respimat) requires a valid prescription.

Roflumilast is available in which of the following dosage forms?

A. Oral capsule

B. Oral solution

C. Oral disintegrating tablet

D. Oral tablet

D. Oral tablet

Which of the following counseling points is important to include for Pulmicort Flexhaler?

A. Not necessary to rinse mouth after use

B. Long-term use can increase risk of immunosuppression

C. Blow nose first

D. Shake well prior to use

B. Long-term use can increase risk of immunosuppression

Long-term use of corticosteroids increases the risk of immunosuppression and makes someone more susceptible to infection. Patients should be instructed to rinse their mouth after each use to avoid an oral yeast infection. Pulmicort Flexhaler is a dry powder inhaler and should not be shook prior to use. Pulmicort Flexhaler is for oral inhalation, not nasal inhalation.

The pregnancy recommendation associated with ipratropium is best described as:

A. no risk.

B. unknown.

C. low risk.

D. high risk.

C. low risk.

Uncontrolled asthma during pregnancy can be harmful to the patient and/or developing fetus so asthma treatment is typically continued throughout pregnancy. Little human data exists but no data suggests ipratropium is hazardous to a developing fetus. Not enough data exists to conclude that there is absolutely no risk to a developing fetus exposed to ipratropium.

True or False: As an oral inhalation, albuterol HFA does not cause systemic adverse effects.

False

an oral inhalation is a systemic form of administration and thus has the capability to produce systemic reactions. The incidence of tremor is 5-38%, with increasing frequency as age increases

True or False: Atrovent HFA is the brand name of ipratropium

True

Which of the following classifications is most appropriate for albuterol?

A. Short-acting muscarinic-antagonist

B. Short-acting beta-antagonist

C. Short-acting beta-agonist

D. Short-acting muscarinic-agonist

C. Short-acting beta-agonist

Short-acting beta-agonist. Antagonism of beta receptors would cause constriction of bronchial smooth muscle, exacerbating asthma symptoms. Site of action is beta receptors, not muscarinic receptors. Site of action is beta receptors, not muscarinic receptors; albuterol is an agonist, not an antagonist

Which regimen is most appropriate for a patient using roflumilast for COPD exacerbation prophylaxis?

A. 250 mcg once daily x 8 weeks, then 500 mcg once daily.

B. 500 mcg once daily, no titration is needed.

C. 250 mcg once daily x 4 weeks, then 500 mcg once daily.

D. 250 mcg once daily, no titration is needed.

C. 250 mcg once daily x 4 weeks, then 500 mcg once daily.

250 mcg once daily x 4 weeks, then 500 mcg once daily. The initial dose of 250 mcg is used to improve tolerability. A dose of 250 mcg daily is not therapeutic in COPD exacerbation prevention, so a titration to 500 mcg is needed. A titration period of 8 weeks is inappropriate. Titration greater than 4 weeks prevents the patient from receiving COPD exacerbation prophylaxis, despite being eligible. 250 mcg is not a therapeutic dose and needs to be titrated to 500 mcg. Initiation at 500 mcg can be intolerable for patients and is not recommended.

True or False: tiotropium is C/I when breast-freeding

False

What is the mechanism of action of tiotropium?

A. Activation of muscarinic receptors in bronchial smooth muscle causing bronchodilation

B. Inhibition of muscarinic receptors in bronchial smooth muscle causing bronchoconstriction

C. Inhibition of muscarinic receptors in bronchial smooth muscle causing bronchodilation

D. Activation of muscarinic receptors in bronchial smooth muscle causing bronchoconstriction

C. Inhibition of muscarinic receptors in bronchial smooth muscle causing bronchodilation

Inhibition of muscarinic receptors in bronchial smooth muscle causing bronchodilation, allowing for improved inspiratory volume. Tiotropium inhibits muscarinic receptors, not activates. Bronchodilation is caused by inhibition of muscarinic receptors, not activation. Tiotropium inhibits muscarinic receptors, not activates. Bronchoconstriction would cause the airways to tighten, passing less air through and making it more difficult to breathe. Bronchoconstriction would cause the airways to tighten, passing less air through and making it more difficult to breathe. 

Which of the following products is a brand of a tiotropium-only product?

A. Atrovent HFA

B. Stiolto Respimat

C. Spiriva Respimat

D. Seebri Breezhaler

C. Spiriva Respimat

Spiriva Respimat; Spiriva Respimat is a soft mist inhaler that contains tiotropium only. Seebri Breezhaler is the brand name for a Glycopyrrolate oral inhalation. Atrovent HFA is a dry-powder inhaler containing ipratropium. Stiolto Respimat is a soft mist inhaler that contains both tiotropium and olodaterol. 

True or False: Salmeterol is long-acting muscarinic antagonist inhaled medication.

False

Salmeterol is a long-acting beta-2 agonist. Its brand name is Serevent Diskus.

True or False: Inhaled corticosteroids are recommended for the treatment of asthma during pregnancy.

True

Which of the following products is a metered dose inhaler?

Atrovent HFA

Pulmicort Flexhaler

Serevent Diskus

Asmanex Twisthaler

Atrovent HFA

Atrovent HFA is an MDI. Asmanex Twisthaler is a dry powder inhaler. Pulmicort Flexhaler is dry powder inhaler. Serevent Diskus is a dry powder inhaler.

Which of the following agents is a long-acting beta-2 agonist?

Atrovent HFA

QVAR Redihaler

Asmanex Twisthaler

Serevent Diskus

Serevent Diskus

Serevent Diskus is the brand name for salmeterol and is a long-acting beta-2 agonist. Asmanex Twisthaler is the brand name for mometasone and is an inhaled corticosteroid. Atrovent HFA is the brand name for ipratropium and is a short-acting muscarinic antagonist. QVAR Redihaler is the brand name for beclomethasone and is an inhaled corticosteroid.

What adverse effect is most common with tiotropium?

Diarrhea

Xerostomia

Hypersalivation

Bradycardia

Xerostomia

Xerostomia; As tiotropium is an oral inhalation, dry mouth is a common adverse effect due to the drug’s anticholingeric properties. As an oral inhalation, tiotropium does not have a significant effect on bowel movements. If bowel movements are affected, it would most likely induce constipation due to the anticholinergic properties. Tiotropium use is more associated with tachycardia than bradycardia. As an anticholinergic, hypersalivation is unlikely

Of the following adverse effects, which is most likely caused by fluticasone?

Tachycardia

Xerostomia

Thrush

Diarrhea

Thrush

Fluticasone, and other inhaled corticosteroids, are known for their adverse effect of thrush (oral yeast infection) if a patient does not rinse their mouth after use. Xerostomia is likely caused by tiotropium, a long-acting muscarinic antagonist (LAMA), due to its anticholinergic effects. Tachycardia is more likely to be associated with a short-acting beta-2 agonist like albuterol. Diarrhea is an associated adverse effect of PDE-4 inhibitors (e.g., roflumilast).

What is the mechanism of action of fluticasone?

vasodilation and anti-inflammatory activity

activation of beta receptors

vasoconstriction and anti-inflammatory activity

antagonism of beta receptors

vasoconstriction and anti-inflammatory activity

Vasoconstriction and anti-inflammatory properties. Fluticasone is a corticosteroid that activates vasoconstriction and treats inflammation. Fluticasone does not act on beta receptors. Vasodilation would cause increased difficulty to breathe air in, which would worsen allergic rhinitis as opposed to vasoconstriction that will open the nasal passages and sinuses. Fluticasone does not act on beta receptors

True or False: If needed, a spacer can be used with a Pulmicort Flexhaler.

False

Pulmicort Flexhaler (generic: budesonide) is a dry powder inhaled corticosteroid and should not be used with a spacer.

What is the mechanism of action of roflumilast?

A. Inhibition of PDE-4, which creates an accumulation of cyclic AMP in cells essential to COPD pathogenesis

B. Activation of PDE-4, which creates an accumulation of cyclic AMP in cells essential to COPD pathogenesis

C. Directly inhibits cyclic AMP to induce an accumulation in cells essential to COPD pathogenesis

D. Directly activates cyclic AMP to induce an accumulation in cells essential to COPD pathogenesis

A. Inhibition of PDE-4, which creates an accumulation of cyclic AMP in cells essential to COPD pathogenesis

Inhibition of PDE-4, which creates an accumulation of cyclic AMP in cells essential to COPD pathogenesis. PDE-4 is an enzyme that facilitates the metabolism of cyclic AMP. By inhibition of this enzyme, there is less metabolism of cAMP, leading to an accumulation of cAMP. cAMP is then able to reduce the release of inflammatory factors. Without the inflammatory factors, the airways are thus able to dilate for improved breathing.

PDE-4 is inhibited, not activated, through roflumilast. Activation of PDE-4 would cause lower concentrations of cAMP and resulting increased inflammatory properties. Roflumilast acts on PDE-4, not cAMP. Roflumilast acts on PDE-4, not cAMP

Which of the following options best describes the pregnancy recommendation for roflumilast?

Contraindicated in 1st trimester only

Contraindicated in all trimesters

Compatible

Moderate Risk throughout pregnancy

Moderate Risk throughout pregnancy

Moderate Risk; Per Briggs in Lexicomp, there is no human data to determine a pregnancy recommendation for humans using roflumilast. There have been animal data to suggest moderate risk, however - “developmental toxicity, at doses that were ≤10 or less than the human dose, occurred in only one of three species tested, but teratogenicity was not observed. However, the lack of human pregnancy experience prevents a better assessment of the embryo–fetal risk. “

Which of the following dosage forms does not exist for albuterol?

Nasal Spray

Metered-dose inhaler

Nebulizer Solution

Dry powder inhaler

Nasal Spray

Albuterol is not available as a nasal spray. Ventolin HFA and Proventil HFA are albuterol MDIs. ProAir Digihaler and ProAir RespiClick are albuterol DPIs. Albuterol nebulizing solution is available for inhalation

Pulmicort Flexhaler is an example of which drug class?

Long-acting muscarinic antagonist

Long-acting beta-2 agonist

Inhaled corticosteroid

Short-acting beta-2 agonist

Inhaled corticosteroid

Pulmicort Flexhaler is the brand name for budesonide and is an inhaled corticosteroid used in the treatment of asthma.

True or False: The brand name for mometasone is Atrovent HFA.

False

The brand name for mometasone is Asmanex HFA or Asmanex Twisthaler depending on the device. Atrovent HFA is the brand name for ipratropium.

Which of the following products is a short-acting muscarinic antagonist?

Ipratropium

Mometasone

Tiotropium

Salmeterol

Ipratropium

Salmeterol is a long-acting beta-2 agonist. Tiotropium is a long-acting muscarinic antagonist. Mometasone is an inhaled corticosteroid. 

What is the generic name for Daliresp?

Crisaborole

Roflumilast

Betamethasone

Apremilast

Roflumilast

Crisaborole is the generic name for Eucrisa. Apremilast is the generic name for Otezla. Betamethasone is the generic name for Diprolene. 

What is the appropriate dosing regimen for a Ventolin HFA inhaler being used for as-needed symptom relief?

2 inhalations every 4 hours as needed

1 inhalations every 6 hours as needed

2 inhalation every 8 hours as needed

2 inhalations every 2 hours as needed

2 inhalations every 4 hours as needed

Which of the following descriptions mostly accurately portrays the pregnancy and lactation status of budesonide?

A. Compatible in both pregnancy and breast-feeding

B. Compatible in breastfeeding but should be avoided during pregnancy

C. Contraindicated in both pregnancy and breast-feeding

D. Contraindicated in pregnancy, compatible with breast-feeding

A. Compatible in both pregnancy and breast-feeding

Uncontrolled asthma can be more detrimental to a pregnancy (increased risk of preeclampsia, preterm birth, gestational diabetes development, etc.) than continuing ICS use.

Briggs’ Drug in Pregnancy and Lactation suggests budesonide is present in breast milk but considered compatible in breast-feeding.

The brand name Atrovent HFA is an example of which drug class?

Short-acting muscarinic antagonist

Long-acting muscarinic antagonist

Inhaled corticosteroid

Short-acting beta-2 agonist

Short-acting muscarinic antagonist

Atrovent HFA is the brand name for ipratropium and is a short-acting muscarinic antagonist. An example of an inhaled corticosteroid is mometasone. An example of a long-acting muscarinic antagonist is tiotropium. An example of a short-acting beta-2 agonist is albuterol.

Which of the following agents is an inhaled corticosteroid?

Salmeterol

Albuterol

Fluticasone

Ipratropium

Fluticasone

When initiating Serevent Diskus inhaler, what adverse effect is important to educate a patient on?

Palpitations

Bitter taste

Oral yeast infection

Constipation

Palpitations

Salmeterol as a long-acting beta-2 agonist is known to cause palpitations as an adverse effect. Inhaled corticosteroids are responsible for oral yeast infections if the mouth is not rinsed after use. Ipratropium can cause a bitter taste in the mouth. Constipation is not an adverse effect associated with salmeterol.

What is the appropriate therapeutic class to classify fluticasone?

Mast Cell Stabilizer

Muscarinic Agonist

Beta Agonist

Corticosteroid

Steroid

To which therapeutic drug class does roflumilast belong?

Short-acting muscarinic antagonist

Glucocorticoid

Phosphodiesterase-4 enzyme inhibitor

Short-acting beta agonist

Phosphodiesterase-4 enzyme inhibitor

True or False: Mometasone is classified as a short-acting beta-2 agonist.

False

ICS (brand name asmanex hfa or twiisthaler)

What is the branded product for budesonide?

Asmanex HFA

ProAir HFA

Serevent Diskus

Pulmicort Flexhaler

Pulmicort Flexhaler

Pulmicort Flexhaler is the name brand for budesonide. Serevent Diskus is the name brand for salmeterol. Asmanex HFA is the brand name for mometasone. ProAir HFA is the brand name for albuterol.

True or False: Prior to the initial use of Atrovent HFA, it is important to "prime" the device.

True

What is the branded product for salmeterol?

Serevent Diskus

QVAR Redihaler

Striverdi Respimat

Pulmicort Flexhaler

Serevent Diskus

Pulmicort Flexhaler is the name brand for budesonide. QVAR Redihaler is the name brand for beclomethasone. Striverdi Respimat is the brand name olodaterol.

All of the following brand names are associated with albuterol, EXCEPT:

ProAir RespiClick.

Spiriva.

Proventil HFA.

Ventolin HFA.

Spiriva

Spiriva is the brand name of tiotropium. ProAir is the brand name for an albuterol dry-powder inhaler. Ventolin HFA is the brand name for an albuterol dry-powder inhaler. Proventil HFA is the brand name for an albuterol dry-powder inhaler. 

If a patient is switching to Asmanex HFA from Asmanex Twisthaler, which of the following counseling points should be included to highlight the differences?

Throat irritation may occur

A spacer cannot be used

Rinse mouth after each use

Shake well prior to use

Shake well prior to use

Although the Asmanex Twisthaler and Asmanex HFA are both mometasone products, one is a dry powder inhaler, and one is a metered dose inhaler. The Asmanex Twisthaler as a dry powder does not require shaking prior to use like the Asmanex HFA does. Both products require rinsing after use due to being inhaled corticosteroids. Both products may cause throat irritation after inhalation. A spacer can be used with a metered dose inhaler but not a dry powder inhaler. If a patient is struggling with coordination, a spacer may be helpful to add to their Asmanex HFA inhaler.

Which of the following counseling points is appropriate for a Spiriva Handihaler?

A. The provided capsule must be taken orally prior to use of the device

B. Upon inserting the cartridge into the device, you should still see about ⅛ of an inch of the cartridge outside of the device.

C. The medication cartridge must be changed prior to each use

D. The provided capsule is not for oral administration, but rather it should be placed directly into the respective site in the device

D. The provided capsule is not for oral administration, but rather it should be placed directly into the respective site in the device

The provided capsule is not for oral administration, but rather it should be placed directly into the respective site in the device; the Spiriva Handihaler comes with a blister pack of capsules that are to be placed inside the handihaler device. The device pierces the capsule for inhalation of the capsule’s contents. 

The Spiriva Handihaler does not use a medication cartridge. The capsule provided should not be taken orally as its contents are meant to be inhaled. This is a counseling point for the Spiriva Respimat inhaler, not the Spiriva Handihaler

Which of the following dosing schedules is appropriate for a Serevent Diskus inhaler when treating asthma in adults?

Two inhalations twice daily

As needed for acute bronchospasm

One inhalation twice daily

Two inhalations once daily

One inhalation twice daily

How does albuterol relieve asthma symptoms?

A. Relaxes bronchial smooth muscle by action on beta1-receptors

B. Constricts bronchial smooth muscle by action on beta1-receptors

C. Relaxes bronchial smooth muscle by action on beta2-receptors

D. Constricts bronchial smooth muscle by action on beta2-receptors

C. Relaxes bronchial smooth muscle by action on beta2-receptors

Albuterol acts on beta2-receptors, not beta1-receptors. Albuterol acts on beta2-receptors, not beta1-receptors, to relax bronchial smooth muscle, not constrict. Albuterol relaxes bronchial smooth muscle, not constricts

To which drug class does tiotropium belong?

Long-acting beta-agonist

Long-acting muscarinic-antagonist

Short-acting beta-agonist

Short-acting muscarinic-antagonist

Long-acting muscarinic-antagonist

Long-acting muscarinic-antagonist; Tiotropium is a LAMA as it ompetitively and reversibly inhibits the action of acetylcholine at type 3 muscarinic (M3) receptors in bronchial smooth muscle causing bronchodilation. Tiotropium does not act on beta-receptors. Tiotropium does not act on beta-receptors. Tiotropium has a half-life of 25 hours for a DPI and 25-44 hours for a SMI, making it a long-acting agent

True or False: When counseling on roflumilast, the patient should be informed that this medication will now serve as both their maintenance and exacerbation therapy.

False

Roflumilast is not to be used to treat acute exacerbations and a rescue inhaler should be used instead of these instances.

True or False: An important counseling point for budesonide includes "rinse mouth with water (without swallowing) after each use."

True

Budesonide is an inhaled corticosteroid and can cause oral thrush if the mouth is not rinsed after use.

True or False: A common adverse effect of Atrovent HFA is dry mouth.

True

Short-acting muscarinic antagonists (SAMAs) are known to cause dry mouth due to their anticholinergic activity.

Which of the following fluticasone products is available over-the-counter?

Arnuity Ellipta

Flovent HFA

Flonase

Flonase

Asmanex HFA products exist in all of the following formulations, EXCEPT:

Asmanex HFA 100 mcg/actuation.

Asmanex HFA 200 mcg/actuation.

Asmanex HFA 10 mcg/actuation.

Asmanex HFA 50 mcg/actuation.

Asmanex HFA 10 mcg/actuation.

True or False: Use of fluticasone is compatible in both pregnancy and breastfeeding.

True

Which of the following incorrectly matches the brand Fluticasone with its respective dosage form?

Flovent Diskus; Soft-mist inhaler

Flovent HFA; Metered-dose inhaler

Flonase; Nasal suspension

Arnuity Ellipta; Dry-powder inhaler

Flovent Diskus; Soft-mist inhaler

Flovent Diskus-Soft Mist Inhaler; Flovent diskus is a dry powder inhaler, not a soft mist inhaler. Flovent HFA is a metered-dose inhaler. Arnuity ellipta is a dry-powder inhaler. Flonase is a nasal suspension. 

True or False: Use of albuterol is compatible in pregnancy.

True

While excessive use should be avoided due to potential to cause maternal and fetal hyperglycemia and tachycardia through activation of beta-receptors, there has been no association found between anomalies in pregnancy and albuterol use.

True or False: Initial therapy dosing differs between Asmanex HFA and Asmanex Twisthaler.

True

Asmanex HFA initial therapy for corticosteroid naïve patients is 200 mcg twice daily.

Asmanex Twisthaler initial therapy for corticosteroid naïve patients is 440 mcg once daily or 220 mcg twice daily.

True or False: Inhaled corticosteroids as a drug class do not have any associated US Boxed Warnings to consider.

True

Unlike long-acting beta-2 agonists (e.g., salmeterol), inhaled corticosteroids do not carry a US Boxed Warning.

Which of the following counseling points is important to including when instructing a patient on use of their Serevent Diskus inhaler?

Breathe out fully before inhaling the dose

Dry powder inhalers do not expire

Prime the inhaler prior to use

Shake before use

Breathe out fully before inhaling the dose

A patient should breathe out fully before inhaling to ensure they are able to take a deep breath during drug inhalation. Dry powder inhalers do not require priming.Serevent Diskus devices should be discarded 6 weeks after removal from protective foil packaging or when the dose counter is “0.”Dry powder inhalers do not need shaking prior to use. It is important to hold the device in a level, flat position.

Which of the following regimens is recommended for Atrovent HFA acute exacerbation treatment of COPD?

One inhalation three times daily

Four inhalations every 20 minutes for 3 doses

Two inhalations four times daily

Two inhalations twice daily

Two inhalations four times daily

When counseling an adult patient on a Pulmicort Flexhaler for asthma maintenance treatment, how many times per day should they be using the inhaler?

Once daily

Twice daily

Four times daily

Three times daily

Twice daily

All of the following are brand names for fluticasone, EXCEPT:

Arnuity Ellipta.

Flovent HFA.

Pulmicort.

Flonase.

Pulmicort

Pulmicort is a budesonide oral inhalation. Flonase is the brand name for an OTC fluticasone nasal spray. Flovent HFA is the brand name for a fluticasone DPI. Arnuity Ellipta is the brand name for a breath activated fluticasone inhaler. 

Which of the following respiratory inhalers can be found and purchased in an over the counter item?

Mometasone

Beclomethasone

No inhaler listed is available over the counter

Salmeterol

No inhaler listed is available over the counter

A patient prescribed a Spiriva Handihaler should use which of the following regimens for COPD maintenance?

One inhalation for a single capsule

Two inhalations of a single capsule

Two inhalations each for two capsules

One inhalation each for two capsules

Two inhalations of a single capsule

A single capsule holds 18 mcg Tiotropium – the recommended dose for COPD maintenance with the Spiriva Handihaler. Two inhalations are used to ensure full contents of the capsule are inhaled. Two capsules would be a total of 36 mcg Tiotropium, an inappropriately high dose. Two capsules would be a total of 36 mcg Tiotropium, an inappropriately high dose. A single inhalation can compromise how much tiotropium is actually delivered to the lungs. 

Which of the following counseling points is appropriate for a new Ventolin HFA prescription?

A. When inhaling from the Ventolin HFA inhaler, inhale as much volume as possible and then release the dose

B. The device needs to be shaken prior to each use

C. A spacer cannot be used for ease of use in younger patients

D. The device needs to be primed for every use

B. The device needs to be shaken prior to each use

The device needs to be shaken prior to each use; shaking the device prior to each use ensures the medication has been properly dispersed through the device and is ready for administration. Ventolin HFA is a metered dose inhaler and can be used with a spacer for ease of use in pediatric patients. Ventolin HFA only needs to be primed for first use, if it has been dropped, or if it has been more than two weeks since the last use. Inhalation and dose administration should occur concurrently to ensure appropriate delivery of the medication into the lungs

Which agent is most likely to lead to development of an oral yeast infection?

Serevent Diskus

Atrovent HFA

Asmanex HFA

Asmanex HFA

Inhaled corticosteroids, like Asmanex HFA, are the most notorious for causing oral yeast infections. Serevent Diskus is more likely to cause palpitations. Atrovent HFA is more likely to cause dry mouth.

Which of the following pharmacologic categories has a US Boxed Warning for asthma-related death?

Short-acting beta-2 agonist

Inhaled corticosteroid

Long-acting muscarinic antagonist

Long-acting beta-2 agonist

Long-acting beta-2 agonist

Long-acting beta-2 agonists (LABA) agents (like salmeterol) should not be used as monotherapy (without inhaled corticosteroid therapy) as it increased the risk of asthma-related death. LABA therapy for asthma should be reserved for add-on therapy when a patient is using an inhaled corticosteroid but is still inadequately controlled. SABA, ICS, and LAMA agents do not have an associated US Boxed Warning for asthma-related death. 

Which of the following adverse effects is most associated with roflumilast use?

Increased Appetite

Drowsiness

Weight Loss

Constipation

Weight Loss

Weight loss; Per lexicomp, the incidence for weight loss between 5-10% of body weight is between 8-20% and the incidence for weight loss >10% is 7%. Roflumilast use is associated with diarrhea. Per lexicomp, 10% incidence rate. Roflumilast is associated with insomnia. Per lexicomp, 2% incidence rate. Roflumilast is associated with decreased appetite. Per lexicomp, 2% incidence rate.

Which of the following options is correct for Atrovent HFA and US Boxed Warnings?

This agent does not have a US Boxed Warning

Oral candidiasis

Asthma-related death

Increased risk of bronchitis

This agent does not have a US Boxed Warning

Atrovent HFA is the brand name for ipratropium and is a short-acting muscarinic antagonist. SAMA agents do not carry a US Boxed Warning. Atrovent HFA is the brand name for ipratropium and is a short-acting muscarinic antagonist. Bronchitis is a reported respiratory adverse effect of ipratropium but is not a US Boxed Warning. Oral candidiasis is an adverse reaction to inhaled corticosteroids, not short-acting muscarinic antagonists. The US Boxed Warning for asthma-related death is for long-acting beta-2 agonists like salmeterol.

True or False: Asmanex Twisthaler carries a US Boxed Warning, but Asmanex HFA does not.

False

Neither Asmanex (HFA or Twisthaler) preparation has an associated US Boxed Warning.