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Asthma By Alaina Darby
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Which of the following is not a trigger for asthma?
Environmental exposure Food and additives Diseases Warm air
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Which is true about the development of asthma?
Its progression is primarily determined by genetics Viral infection during infancy increases incidence of asthma Environmental factors are most influential after immune development It may further develop into allergies
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Which of the following is true of asthma attack?
Bronchospasm occurs late in the attack Inflammation is mediated by histamine release by mast cells Inflammation is a delayed response Bronchospasm is mediated by cytokine signaling
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Which of the following is true of the progression of asthma?
Bronchospasm directly causes mucus hypersecretion through smooth muscle constriction Tissue edema and shedding of the surface epithelium is due to chronic inflammation Chronic inflammation causes remodeling of pulmonary tissue Bronchospasm is caused by the activation of adrenergic nerves
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Which of the following is true of bronchoconstriction?
Non-asthmatics experience no bronchoconstriction at normal methacholine doses Hypersensitivity is an exaggerated response to normal stimulus dose Hyperreactivity is an exaggerated response to a high stimulus dose A positive reaction is considered to be a 20% rise in FEV1
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Which of following is a reason that asthma inhalers are so expensive in the US?
They no longer use CFC’s as a propellant They are no longer under patent They have a longer than usual patent They are fairly recent medications
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Which of the following is described by daily inhaler use, two nighttime attacks per week, and a PEF of 75%? Intermittent Severe Mild persistent Moderate persistent
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Which of the following does not promote bronchodilation?
Adenosine Theophylline Muscarinic antagonists cAMP
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Which of the following is true?
Muscarinic receptors are found in the large bronchioles, beta 2 receptors are found in the small bronchioles Muscarinic receptors are found in the large bronchioles, beta 2 receptors are found in the large bronchioles Muscarinic receptors are found in the small bronchioles, beta 2 receptors are found in the large bronchioles Muscarinic receptors are found in the small bronchioles, beta 2 receptors are found in the small bronchioles
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Which of the following is true about drug interactions with beta 2 agonists?
Saquinavir and diruetics can prolong the effects Beta blockers are physiological opposites MAOIs and TCAs exacerbate hypokalemia Beta blockers can prevent acute bronchospasm treatment
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Which of the following is a “reliever”?
Salmeterol Albuterol Formoterol Indacaterol
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Which of the following is a therapeutic action of albuterol?
Stabilize mast cells Contract smooth muscle Activate beta receptors Reverse hypokalemia
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Why are glucocorticoids often used in combination with beta agonists?
They cause additional bronchodilation They can also bind to and block the M3 receptors They cause upregulation of beta receptors They enhance delivery of the beta agonist to its site of action
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Beta agonists do not work well as bronchodilators in some patients, which of the following is not a reason for this? Prolonged use has led to uncoupling from the receptor Binding of beta-arrestin has led to internalization of the receptors Some patient exhibit SNPs causing diminished activity of the receptor Prolonged use has let to damage in the DNA encoding the receptor
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Which of the following is a reason continued use of LABAs?
They cause glucocorticoid receptor upregulation They enhance the effects of glucocorticoids Bronchoconstriction causes tissue remodeling Inflammation can often be prevented by LABA’s
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Which of the following is an inhaled steroid?
Methylprednisone Prednisone Beclomethasone dipropionate Prednisolone
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Which of the following is not a mechanism through which corticosteroids produce their effects?
Occupancy of importin alpha Increased mucus secretion Repression of transcription factors Increased anti-inflammatory lipocortins
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Which of the following is true of asthma?
Neutrophilic asthma is steroid sensitive Neutrophilic asthma leads to severe asthma Eosinophilic asthma is steroid resistant Eosinophilic asthma leads to severe asthma
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Which of the following is the primary reason for inhaling corticosteroids rather than taking them orally? Deliver it directly to the site of action Prevent oropharyngeal candidiasis Prevent systemic effects Avoid first pass metabolism
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Which of the following treatment regimens is the first choice of treatment for intermittent asthma?
SABA LABA ICS Cromolyn
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Which of the following is most important and most common in asthma?
Mast cells Eosinophils T lymphocytes Neutrophils
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Which of the following is an indicator of asthma death?
Mast cells Eosinophils T lymphocytes Neutrophils
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Which of the following is most responsible for the early response (within minutes)?
Mast cells Eosinophils T lymphocytes Neutrophils
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Which of the following is highly involved in the late response (hours) and hyperresponsiveness with repeated exposure? Mast cells Eosinophils T lymphocytes Neutrophils
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Amy is a 4 year old patient whose mother smokes
Amy is a 4 year old patient whose mother smokes. How should she be treated? Low dose ICS Cromolyn Low dose ICS + Theophylline Low dose ICS + LABA
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Which of the following should you recommend to a 22 y/o woman with asthma who has GERD and whose asthma is worse close to menstruation? PPI Pneumococcal vaccine Oral contraceptives H2 blocker
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Which of the following is not a risk factor for increased asthma severity?
Obesity Post-menstruation GERD Rhinitis
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Which of the following would be least likely to contribute to exercise induced asthma?
Warm, humid climate Respiratory infection Severe asthma Large exercise load
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TK is a 24 y/o female with asthma
TK is a 24 y/o female with asthma. Her maintenance treatment includes Advair and an albuterol inhaler for breakthrough symptoms. Which of the following would not be a counseling point to prevent her exercise induced asthma? Warmup before exercise Exercise indoors Albuterol 5-15 minutes before exercise Scarf over the mouth if exercising outside
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TD is a 3 y/o male who presents to your pharmacy with a wheeze, cough, and dyspnea, which his mother says get worse at night. She reports that his symptoms occur on a daily basis and wake him from sleep at least 1-2x a week. With What stage of asthma should he be diagnosed? Intermittent Mild Moderate Severe
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AJ is a 22 y/o male who presents to your pharmacy with a wheeze, cough, and dyspnea, which he says get worse at night and with exercise. He reports that it does cause interference with daily activities but not too much. His symptoms occur on a daily basis and wake him from sleep at least 1-2x a week. With What stage of asthma should he be diagnosed? Intermittent Mild Moderate Severe
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How should AJ be treated?
SABA PRN Theophylline Low dose ICS + LTRA Low dose ICS + LABA
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AJ’s personal best PEFR is 376. currently his PEFR is 223
AJ’s personal best PEFR is 376. currently his PEFR is 223. where is he currently? Green zone Yellow zone Red zone Friend zone
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BK is using his SABA once per week and is currently using a low dose ICS + LABA for therapy. Which of the following would be the preferred alteration of his therapy? Change to medium dose ICS Step down to low dose ICS Step up to medium dose ICS + LABA No change is needed
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Which of the following is not true of asthma management?
Type of medication is dictated by asthma severity for initiating therapy Amount of medication is dictated by asthma severity for initiating therapy Type of medication is dictated by asthma control for initiating therapy Scheduling of medication is dictated by asthma control for adjusting therapy
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Which of the following follow up periods would not be appropriate for the indication?
2 weeks after initiation 8 months for well controlled patient 3 months for step down therapy 1 month after initiation
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Which of the following would be preferred for a 7 y/o patient who needs step 3 therapy?
Low dose ICS + LABA Low dose ICS Medium dose ICS + LABA Medium dose ICS
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Which of the following is in QVAR?
Beclomethasone Budesonide Fluticasone Mometasone Ciclesonide
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Which of the following is in Alvesco?
Beclomethasone Budesonide Fluticasone Mometasone Ciclesonide
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Which of the following is in Pulmicort?
Beclomethasone Budesonide Fluticasone Mometasone Ciclesonide
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Which of the following is in Symbicort?
Beclomethasone Budesonide Fluticasone Mometasone Ciclesonide
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Which of the following is in Advair?
Beclomethasone Budesonide Fluticasone Mometasone Ciclesonide
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Which of the following is in Dulera?
Beclomethasone Budesonide Fluticasone Mometasone Ciclesonide
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How often should ICS’s be given?
Daily Twice a day Three times a day As needed
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Which of the following is suitable for all patients?
SABA for breakthrough symptoms Allergen avoidance for general control ICS for long term control
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Which of the following patients would it not be necessary to refer to a specialist?
Exacerbation requiring hospitalization Considering omalizumab Using medium dose ICS +LABA Using theophylline
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Which of the following is not a suitable long-term regimen?
Budesonide Formoterol Advair Flovent
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Which of the following is a key counseling point for all inhalers?
Breathe out first gently over several seconds Rinse and spit afterward Breath in fast and deep Inhale slowly over 4-5 seconds
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What is an important counseling point for the HandiHaler?
Inhale slowly for 4-5 seconds Make sure hands are dry when handling Shake before inhaling Hold breath for 2-4 seconds after inhaling
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Which of the following patients would be the best fit to receive Xolair?
Frequent ED visits and hospitalizations with low baseline immunoglobulin-E Add on for Patient with allergies Using medium dose ICS + LABA Patient using albuterol several times per day on Advair 500/50 and allergies Alternative to LABA due to concern for asthma related death
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