Asthma & COPD Questions

Question 1
A 45-year-old patient with a history of moderate to severe persistent asthma is being considered for omalizumab therapy. His asthma is exacerbated by environmental allergens, and traditional treatments have been insufficient to control his symptoms. What is the most appropriate indication for prescribing omalizumab in this patient?

A) Severe eosinophilic asthma unresponsive to corticosteroids
B) Asthma with elevated immunoglobulin E (IgE) levels triggered by environmental allergens
C) Chronic obstructive pulmonary disease (COPD) with a history of smoking
D) Exercise-induced asthma in athletes
E) Mild intermittent asthma with minimal symptoms

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Question 2
Which of the following conditions is characterized by reversible airflow obstruction and airway hyperresponsiveness?

A) Chronic Obstructive Pulmonary Disease (COPD)
B) Asthma
C) Emphysema
D) Bronchitis
E) Pulmonary Fibrosis

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Question 3
Which of the following is the primary cause of Chronic Obstructive Pulmonary Disease (COPD)?

A) Exposure to allergens
B) Respiratory infections
C) Smoking
D) Cold air
E) Exercise

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Question 4
What is a typical trigger for asthma but not commonly associated with COPD?

A) Exercise
B) Smoking
C) Air pollution
D) Chemical fumes
E) Dust

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Question 5
What diagnostic tool is used to differentiate between asthma and COPD?

A) Chest X-ray
B) Spirometry
C) Blood test
D) MRI
E) Electrocardiogram (ECG)

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Question 6
Which of the following genetic factors is associated with Chronic Obstructive Pulmonary Disease (COPD)?

A) Family history of asthma
B) Alpha-1 antitrypsin deficiency
C) Personal history of eczema
D) Atopic diseases
E) Aspirin-exacerbated respiratory disease (AERD)

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Question 7
Which of the following environmental exposures is most strongly linked to asthma?

A) Long-term exposure to air pollutants
B) Occupational exposure to chemicals and dust
C) Exposure to allergens such as dust mites and pollen
D) Tobacco smoke from direct smoking
E) Alpha-1 antitrypsin deficiency

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Question 8
Which condition is more commonly associated with boys during childhood and women in adulthood?

A) COPD
B) Asthma
C) Emphysema
D) Chronic bronchitis
E) Alpha-1 antitrypsin deficiency

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Question 9
Which of the following risk factors is associated with both asthma and COPD?

A) Aspirin sensitivity
B) Early childhood respiratory infections
C) Exposure to tobacco smoke
D) GERD
E) Allergic rhinitis

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Question 10
Which of the following is linked to exercise-induced bronchoconstriction (EIB) in asthma?

A) Cold or dry air
B) Physical overexertion
C) High humidity
D) Smoking
E) GERD

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Question 11
Which of the following management strategies is most important for COPD but not typically emphasized in asthma management?

A) Use of short-acting beta-agonists (SABAs)
B) Avoidance of triggers
C) Pulmonary rehabilitation
D) Inhaled corticosteroids (ICS)
E) Use of long-acting beta-agonists (LABAs)

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Question 12
A 30-year-old woman with a history of asthma presents to the emergency department with worsening shortness of breath and wheezing. She has been using her salbutamol inhaler more frequently than prescribed, and her symptoms have not improved. What is the most appropriate next step in her treatment?

A) Increase the dose of salbutamol to 12 puffs/day
B) Add an oral corticosteroid for immediate relief
C) Administer a second dose of salbutamol if no relief after 3 hours
D) Start a long-acting beta-2 agonist (LABA) for immediate relief
E) Add a beta blocker to reduce tachycardia

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Question 13
A 50-year-old man with COPD is prescribed indacaterol for once-daily use. Which of the following best describes the class and primary use of this medication?

A) Short-acting beta-2 agonist (SABA) for acute exacerbations of COPD
B) Long-acting beta-2 agonist (LABA) for long-term control of asthma
C) Ultra-long-acting beta-2 agonist (Ultra-LABA) for once-daily COPD management
D) Long-acting muscarinic antagonist (LAMA) for bronchodilation
E) Short-acting beta-1 agonist for quick relief of asthma symptoms

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Question 14
A 40-year-old man with asthma is being switched to a long-term maintenance therapy that includes both a LABA and an inhaled corticosteroid (ICS). Which of the following statements best explains the reason for combining these medications?

A) LABAs are used for quick relief of acute asthma symptoms
B) LABAs can be used as monotherapy for asthma management
C) LABAs reduce inflammation in the airways
D) LABAs should be combined with ICS for long-term control to prevent inflammation and reduce bronchospasms
E) ICS is only needed during asthma exacerbations

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Question 15
A 55-year-old woman with diabetes and cardiovascular disease is started on terbutaline for asthma. Which of the following is a potential side effect that the physician should monitor closely due to her comorbid conditions?

A) Hypotension
B) Hyperkalemia
C) Bradycardia
D) Hyperglycemia and tachycardia
E) Peripheral neuropathy

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Question 16
A 60-year-old patient with asthma is prescribed a beta-2 agonist. The physician advises him to avoid non-selective beta blockers such as propranolol. Why is this recommendation made?

A) Beta blockers can cause bronchospasms
B) Beta blockers enhance the bronchodilation effects of beta-2 agonists
C) Beta blockers reduce the risk of tachycardia
D) Beta blockers increase the absorption of beta-2 agonists
E) Beta blockers should be avoided to prevent hypoglycemia

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Question 17
A 42-year-old woman with moderate persistent asthma is prescribed beclomethasone as part of her maintenance therapy. She is concerned about potential side effects. Which of the following is the most appropriate strategy to reduce the risk of oral thrush?

A) Take the inhaler with food
B) Use a higher dose to minimize inhalations
C) Rinse the mouth thoroughly after each inhalation
D) Administer the inhaler at bedtime
E) Use a short-acting beta-agonist immediately after inhaling

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Question 18
A 10-year-old boy with asthma is prescribed fluticasone for long-term control. His parents are concerned about its potential impact on his growth. What is the best counseling point to provide?

A) Fluticasone will not affect his growth if used as prescribed
B) High doses of inhaled corticosteroids may slightly suppress growth, but the benefit outweighs the risk
C) Switching to oral corticosteroids would be safer for long-term use
D) His growth will stop completely while taking inhaled corticosteroids
E) Fluticasone should only be used during asthma exacerbations to avoid growth suppression

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Question 19
A 65-year-old man with COPD is transitioning from oral prednisone to inhaled budesonide for long-term management. What is the most important consideration during this transition?

A) Start the inhaled corticosteroid at a high dose and taper down quickly
B) Taper the oral corticosteroid gradually to avoid adrenal insufficiency
C) Switch to inhaled corticosteroids immediately and discontinue oral prednisone
D) Use both oral and inhaled corticosteroids at full doses
E) Discontinue oral corticosteroids first, then start inhaled corticosteroids

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Question 20
A 55-year-old man with asthma reports experiencing hoarseness after starting inhaled mometasone. Which of the following is the most likely cause of this side effect?

A) Systemic absorption of mometasone
B) Vocal cord irritation from local deposition of the steroid
C) Increased mucus production due to steroid use
D) Bronchospasm triggered by the inhaler
E) Adrenal insufficiency from steroid withdrawal

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Question 21
A 30-year-old woman with asthma asks why her inhaled corticosteroid (ICS) therapy is not effective during an asthma attack. What is the most appropriate response?

A) Inhaled corticosteroids take time to reduce inflammation and are not intended for immediate symptom relief
B) Inhaled corticosteroids need to be used at higher doses during an asthma attack
C) Inhaled corticosteroids should be used only during asthma exacerbations
D) Inhaled corticosteroids must be combined with oral corticosteroids for acute relief
E) Inhaled corticosteroids should be discontinued during an asthma attack

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Question 22
A 50-year-old woman with asthma is using a metered-dose inhaler (MDI) for her inhaled corticosteroid therapy. She frequently experiences oral thrush. What is the best modification to her inhalation technique to reduce this side effect?

A) Use a spacer device with the inhaler
B) Switch to a dry powder inhaler
C) Increase the frequency of inhalations
D) Take the inhaler with food
E) Use the inhaler only during exacerbations

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Question 23
A 12-year-old boy with mild persistent asthma is prescribed montelukast as an add-on therapy to his inhaled corticosteroids. What is the most appropriate counseling point for his parents regarding the use of this medication?

A) Montelukast should be taken twice daily for optimal control
B) Montelukast is effective for acute asthma attacks
C) Montelukast should be taken in the evening to optimize its effects
D) Montelukast requires dose adjustments based on exercise frequency
E) Montelukast has significant drug interactions that need to be monitored

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Question 24
A 30-year-old woman with exercise-induced bronchoconstriction (EIB) is prescribed montelukast. She asks how the medication will help her condition. What is the most accurate response?

A) Montelukast will prevent exercise-induced bronchoconstriction by blocking leukotrienes that cause airway constriction
B) Montelukast will immediately relieve symptoms during an exercise-induced bronchospasm
C) Montelukast should be taken during exercise for maximum effect
D) Montelukast reduces inflammation in the airways but does not affect bronchoconstriction
E) Montelukast should only be used for allergic rhinitis, not exercise-induced asthma

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Question 25
A 50-year-old man with a history of asthma and seasonal allergic rhinitis is prescribed montelukast. He reports experiencing mood changes and agitation after starting the medication. What should the physician do next?

A) Continue montelukast and monitor symptoms
B) Reduce the dose of montelukast
C) Discontinue montelukast and switch to another asthma controller
D) Prescribe a sedative to manage the mood changes
E) Increase the dose of montelukast to overcome side effects

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Question 26
A 7-year-old child with asthma is taking montelukast for long-term asthma control. His parents inquire about the potential side effects. Which of the following side effects should they be most concerned about?

A) Hyperactivity
B) Severe gastrointestinal bleeding
C) Neuropsychiatric symptoms such as agitation or hallucinations
D) Hypoglycemia
E) Weight gain

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Question 27
A 45-year-old woman with asthma controlled by inhaled corticosteroids and montelukast is looking to reduce her steroid dose due to side effects. How does montelukast help minimize the need for higher doses of corticosteroids?

A) Montelukast directly reduces mucus production, eliminating the need for corticosteroids
B) Montelukast reduces airway inflammation, allowing for a decrease in corticosteroid use
C) Montelukast replaces corticosteroids entirely for asthma control
D) Montelukast decreases the need for corticosteroids by stimulating bronchodilation
E) Montelukast prevents infection, reducing exacerbations that require steroids

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Question 28
A 28-year-old woman with aspirin-sensitive asthma is prescribed montelukast. Which of the following best describes the role of montelukast in this patient’s treatment?

A) Montelukast provides immediate relief of asthma symptoms after aspirin exposure
B) Montelukast prevents bronchoconstriction caused by aspirin sensitivity
C) Montelukast prevents allergic rhinitis symptoms, but not asthma symptoms
D) Montelukast reduces the production of aspirin in the body
E) Montelukast is used only during acute exacerbations of aspirin-sensitive asthma

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Question 29
Which of the following best describes the mechanism of action of montelukast?

A) Inhibition of histamine receptors
B) Blockade of leukotriene receptors
C) Stimulation of beta-2 adrenergic receptors
D) Suppression of cytokine production
E) Inhibition of acetylcholine release

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Question 30
Which of the following medications can decrease theophylline levels by inducing its metabolism?

A) Ciprofloxacin
B) Clarithromycin
C) Rifampin
D) Amiodarone
E) Fluoxetine

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Question 31
Which of the following drugs can increase theophylline levels by inhibiting its metabolism through the CYP1A2 enzyme?

A) Phenytoin
B) Rifampin
C) Cimetidine
D) Carbamazepine
E) Phenobarbital

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Question 32
Which of the following biologics works by binding to IgE and preventing its interaction with receptors on mast cells and basophils?

A) Mepolizumab
B) Benralizumab
C) Omalizumab
D) Reslizumab
E) Dupilumab

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Question 33
Which of the following biologics targets the IL-5 pathway, specifically leading to the depletion of eosinophils through antibody-dependent cell-mediated cytotoxicity (ADCC)?

A) Omalizumab
B) Benralizumab
C) Dupilumab
D) Reslizumab
E) Mepolizumab

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Question 34
Which biologic is associated with a rare but serious risk of anaphylaxis and also increases creatine phosphokinase levels?

A) Dupilumab
B) Omalizumab
C) Mepolizumab
D) Reslizumab
E) Benralizumab

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Question 35
Which biologic inhibits both IL-4 and IL-13 signaling to reduce inflammation and airway hyperreactivity?

A) Benralizumab
B) Dupilumab
C) Omalizumab
D) Mepolizumab
E) Reslizumab

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Question 36
Which biologic therapy is most likely to be associated with conjunctivitis as a side effect?

A) Omalizumab
B) Mepolizumab
C) Dupilumab
D) Benralizumab
E) Reslizumab

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Question 37
A 60-year-old man with severe COPD is prescribed roflumilast as an add-on therapy. He is already on bronchodilators and inhaled corticosteroids but continues to experience frequent exacerbations. What is the mechanism of action of roflumilast?

A) Inhibits leukotriene production, reducing airway inflammation
B) Increases cyclic AMP levels by inhibiting phosphodiesterase-4 (PDE4), reducing airway inflammation
C) Blocks IL-5 receptors to decrease eosinophil counts
D) Enhances beta-2 receptor activation to promote bronchodilation
E) Inhibits IgE binding to mast cells, preventing allergic responses

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Question 38
A 55-year-old woman with COPD has been on roflumilast for the past month. She reports a loss of appetite and significant weight loss. What is the most appropriate next step in managing her therapy?

A) Increase the dose of roflumilast
B) Add a mucolytic to her treatment regimen
C) Monitor her weight and consider discontinuing roflumilast if weight loss continues
D) Prescribe a proton pump inhibitor (PPI) for gastrointestinal discomfort
E) Replace roflumilast with a short-acting bronchodilator

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Question 39
A 48-year-old man with COPD is prescribed roflumilast. He is also taking erythromycin for a respiratory infection. What is the most important drug interaction to consider in this case?

A) Roflumilast may reduce the efficacy of erythromycin
B) Erythromycin may increase the risk of psychiatric side effects from roflumilast
C) Erythromycin, a CYP3A4 inhibitor, may increase the plasma concentration of roflumilast, leading to increased side effects
D) Roflumilast increases the risk of hepatotoxicity when combined with erythromycin
E) Roflumilast decreases the absorption of erythromycin

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Question 40
A 12-year-old girl with cystic fibrosis is prescribed dornase alfa to help manage her symptoms. What is the primary action of this medication in cystic fibrosis?

A) Enhances mucus production to lubricate the airways
B) Breaks down the DNA in mucus, reducing its viscosity
C) Inhibits leukotriene receptors to reduce airway inflammation
D) Stimulates beta-2 receptors to promote bronchodilation
E) Increases surfactant production in the lungs

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Question 41
A 65-year-old woman with chronic bronchitis experiences frequent exacerbations with excessive mucus production. She is prescribed acetylcysteine to help manage her symptoms. What is the most important counseling point regarding the use of this medication?

A) Acetylcysteine may cause excessive dryness of the airways
B) Acetylcysteine should be used only during acute exacerbations
C) Acetylcysteine may cause bronchospasm, so monitoring for breathing difficulties is important
D) Acetylcysteine is most effective when combined with oral corticosteroids
E) Acetylcysteine should be taken with food to minimize gastrointestinal side effects

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Question 42
A 45-year-old woman with asthma is prescribed a metered-dose inhaler (MDI) containing an inhaled corticosteroid. She asks the pharmacist how to properly use her inhaler to avoid common side effects like oral thrush. What is the most appropriate counseling point?

A) Use the inhaler while lying down to maximize absorption
B) Use the inhaler after meals to avoid side effects
C) Rinse your mouth thoroughly with water after each use
D) Inhale quickly and deeply when using the inhaler
E) Take the inhaler at bedtime to minimize side effects

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Question 43
A 65-year-old man with COPD is prescribed a long-acting beta-agonist (LABA) inhaler. The pharmacist is counseling him on how to properly use the inhaler. What should the pharmacist emphasize regarding the timing of this medication?

A) Use the LABA inhaler only during acute exacerbations
B) The LABA inhaler should be used every 4 hours, as needed
C) The LABA inhaler is for long-term control and should be taken consistently, not for immediate relief
D) The LABA inhaler should be taken immediately after a short-acting bronchodilator for maximum effect
E) The LABA inhaler should be discontinued if symptoms improve after one week

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Question 44
A 58-year-old woman with COPD has been prescribed both a short-acting beta-agonist (SABA) and a long-acting muscarinic antagonist (LAMA) inhaler. She asks the pharmacist when to use each inhaler. What is the most appropriate response?

A) Use the SABA inhaler daily for long-term control and the LAMA inhaler only during exacerbations
B) Use the SABA inhaler only for quick relief of symptoms and the LAMA inhaler daily for long-term control
C) Use both the SABA and LAMA inhalers daily for long-term control
D) Use the LAMA inhaler in the morning and the SABA inhaler before bed
E) Use the SABA inhaler before meals and the LAMA inhaler after meals

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Question 45
A 34-year-old man with asthma presents to the pharmacy to pick up his albuterol inhaler. The pharmacist notices that he is refilling it frequently. What should the pharmacist advise him regarding his asthma management?

A) Use albuterol more frequently to control symptoms
B) Reduce albuterol use and rely more on lifestyle changes
C) Consult with his physician about possibly adding a long-term controller medication, as frequent use of albuterol suggests poorly controlled asthma
D) Switch to a long-acting beta-agonist (LABA) inhaler for acute relief
E) Increase the number of puffs per dose to extend the duration of relief

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Question 46
A 70-year-old man with COPD asks the pharmacist if there are any lifestyle changes that could help improve his symptoms. What should the pharmacist recommend?

A) Increase caffeine intake to stimulate breathing
B) Perform regular cardiovascular exercise, such as walking or cycling, to improve lung function
C) Avoid physical activity to prevent exacerbations
D) Only use inhalers when symptoms are severe
E) Limit fluid intake to reduce mucus production

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Question 47
A 45-year-old woman with asthma is using an inhaled corticosteroid and reports frequent coughing and throat irritation. What should the pharmacist recommend to help minimize this side effect?

A) Take a higher dose of the inhaled corticosteroid
B) Use a spacer device with the inhaler
C) Discontinue the inhaled corticosteroid
D) Take the inhaler before meals to reduce irritation
E) Switch to oral corticosteroids for better control

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Question 48
A 50-year-old man with COPD visits the pharmacy for a refill of his tiotropium inhaler. He mentions that he frequently experiences dry mouth after using the inhaler. What should the pharmacist recommend?

A) Discontinue tiotropium and switch to a beta-agonist
B) Increase fluid intake and consider sucking on sugar-free candy to relieve dry mouth
C) Use the inhaler less frequently to reduce dry mouth
D) Use a humidifier when taking the medication
E) Switch to an oral anticholinergic medication

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Question 49
A 30-year-old woman with asthma uses a combination inhaler that contains both a long-acting beta-agonist (LABA) and an inhaled corticosteroid (ICS). She asks the pharmacist if she can stop using the inhaler once her symptoms improve. What is the best counseling advice?

A) Stop using the inhaler when symptoms improve
B) Reduce the dosage of the inhaler when symptoms improve
C) Continue using the inhaler as prescribed, even when symptoms improve
D) Switch to a short-acting inhaler for maintenance once symptoms improve
E) Only use the inhaler during asthma exacerbations

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Question 50
A 62-year-old woman with COPD is prescribed an albuterol inhaler for quick relief of symptoms. She is unsure when to use her inhaler. What is the most appropriate advice?

A) Use albuterol every morning and evening
B) Use albuterol as needed for shortness of breath or wheezing
C) Use albuterol before meals to improve lung function
D) Use albuterol after taking long-acting bronchodilators
E) Use albuterol once a week for maintenance therapy

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Question 51
A 58-year-old man with asthma mentions that he experiences frequent nighttime symptoms that wake him up. He currently uses a short-acting beta-agonist (SABA) as needed. What should the pharmacist recommend?

A) Increase the use of the SABA at night
B) Add a long-acting bronchodilator or an inhaled corticosteroid to improve nighttime control
C) Use a humidifier at night to prevent asthma symptoms
D) Take the SABA before bed to prevent symptoms
E) Switch to oral steroids for better control

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Question 52
A 70-year-old man with COPD asks the pharmacist about ways to reduce mucus production. What is the most appropriate recommendation?

A) Increase fluid intake to help thin the mucus
B) Use a short-acting beta-agonist (SABA) more frequently
C) Switch to an inhaled corticosteroid for better mucus control
D) Reduce physical activity to decrease mucus production
E) Avoid using any inhalers to minimize mucus production

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Question 53
A 48-year-old woman with asthma is concerned about the side effects of her inhaled corticosteroid (ICS). She asks the pharmacist how to reduce the risk of side effects like oral thrush. What is the best advice?

A) Decrease the frequency of ICS use
B) Take the ICS with meals to reduce side effects
C) Rinse the mouth thoroughly with water after each use of the ICS
D) Use the ICS only during asthma exacerbations
E) Switch to an oral corticosteroid to avoid local side effects

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Question 54
A 35-year-old man with asthma asks the pharmacist about preventing exercise-induced bronchoconstriction (EIB). He currently experiences symptoms during exercise. What should the pharmacist recommend?

A) Use a long-acting beta-agonist (LABA) before exercise
B) Use a short-acting beta-agonist (SABA) 15 minutes before exercise
C) Take a corticosteroid before exercise
D) Use an inhaled corticosteroid (ICS) after exercise
E) Avoid all exercise to prevent symptoms

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Question 55
A 45-year-old woman with a history of asthma presents to the pharmacy with a prescription for monotherapy with salmeterol (a long-acting beta-agonist). She has been experiencing daily asthma symptoms and is frequently using her rescue inhaler. What is the most appropriate course of action?

A) Dispense the prescription and counsel the patient on proper inhaler technique
B) Call the prescriber to recommend adding an inhaled corticosteroid (ICS) to the regimen
C) Recommend switching salmeterol to a short-acting beta-agonist (SABA)
D) Advise the patient to use salmeterol more frequently to control symptoms
E) Recommend discontinuing salmeterol due to potential side effects

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Question 56
A 60-year-old man with COPD is prescribed a combination of tiotropium (LAMA) and salbutamol (SABA) for symptom management. He reports worsening symptoms and difficulty performing daily activities. His current regimen includes using salbutamol three times a day. What would be the most appropriate therapeutic adjustment?

A) Switch salbutamol to a long-acting beta-agonist (LABA)
B) Add an inhaled corticosteroid (ICS) to his regimen
C) Increase the frequency of salbutamol to five times a day
D) Discontinue tiotropium and replace it with a short-acting muscarinic antagonist (SAMA)
E) Recommend using salbutamol as needed for exacerbations only

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Question 57
A 30-year-old woman with asthma is currently using a combination inhaler containing formoterol (LABA) and budesonide (ICS) twice daily. She presents with a prescription for montelukast (leukotriene receptor antagonist) as an add-on therapy. She has well-controlled asthma and has not had an exacerbation in the past year. What should the pharmacist do?

A) Dispense the prescription for montelukast and counsel the patient on its use
B) Suggest reducing the dose of formoterol/budesonide to prevent over-treatment
C) Contact the prescriber to discuss whether the montelukast is necessary given the patient’s well-controlled asthma
D) Recommend discontinuing budesonide and replacing it with montelukast
E) Instruct the patient to use montelukast only during exacerbations

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Question 58
A 75-year-old man with COPD is prescribed the combination of fluticasone/salmeterol (ICS/LABA) for maintenance therapy. He has a history of frequent exacerbations and has been hospitalized twice in the past year for COPD-related issues. The patient reports that his symptoms have improved but is concerned about potential side effects. What would be the most appropriate next step?

A) Discontinue fluticasone and continue salmeterol alone
B) Discontinue the inhaled corticosteroid (ICS) due to the risk of pneumonia in COPD
C) Continue fluticasone/salmeterol and monitor for side effects, such as pneumonia
D) Add oral corticosteroids for further exacerbation prevention
E) Switch to a SABA-only regimen for maintenance

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Question 59
A 50-year-old man with moderate COPD is prescribed a combination of tiotropium (LAMA) and vilanterol/fluticasone (LABA/ICS). He is also taking oral theophylline for symptom control. What should the pharmacist assess regarding this regimen?

A) Theophylline levels should be closely monitored due to potential toxicity
B) Discontinue vilanterol/fluticasone and continue theophylline as monotherapy
C) Recommend increasing the dose of theophylline for better control
D) Discontinue tiotropium due to duplication of therapy with theophylline
E) Advise the patient to take theophylline only during exacerbations

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Question 60
A 60-year-old woman with asthma reports using her albuterol inhaler multiple times a day for symptom relief, despite being on inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA). What is the most appropriate therapeutic change?

A) Increase the dose of the LABA
B) Consider adding oral corticosteroids for long-term control
C) Evaluate for proper inhaler technique and adherence to maintenance therapy
D) Switch from ICS/LABA to SABA monotherapy
E) Add leukotriene receptor antagonists for better control

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Question 61
A 45-year-old man with moderate COPD is prescribed a combination of tiotropium (LAMA) and vilanterol/fluticasone (LABA/ICS) for maintenance therapy. He has experienced a reduction in exacerbations and reports improved breathing since starting the regimen. What is the best course of action?

A) Discontinue vilanterol/fluticasone due to potential side effects
B) Continue the current therapy as it is effective in controlling symptoms
C) Switch to a short-acting bronchodilator for better control
D) Reduce the dose of fluticasone due to pneumonia risk
E) Replace tiotropium with a SAMA for quicker relief

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Question 62
A 60-year-old woman with asthma is prescribed a combination inhaler containing budesonide (ICS) and formoterol (LABA) twice daily. She reports no asthma attacks in the past year and is adherent to her medication. What is the most appropriate recommendation?

A) Continue the current regimen to maintain control of asthma
B) Discontinue budesonide and switch to formoterol monotherapy
C) Add montelukast for better control
D) Reduce the dose of formoterol to prevent side effects
E) Stop all medication since the patient is symptom-free

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Question 63
A 55-year-old man with a history of frequent COPD exacerbations has been on tiotropium (LAMA) and fluticasone/salmeterol (ICS/LABA). He reports fewer exacerbations and better symptom control since starting therapy. What is the best approach for managing his condition?

A) Discontinue fluticasone due to risk of pneumonia
B) Continue the current regimen as it has been effective in reducing exacerbations
C) Add oral theophylline for better symptom control
D) Reduce tiotropium dosing to prevent side effects
E) Stop all medications and monitor the patient’s condition

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Some case questions

Case
A 35-year-old woman with mild persistent asthma comes to the pharmacy to pick up her new prescription for a low-dose inhaled corticosteroid (ICS). She asks the pharmacist why she needs to take this medication daily even when she is feeling fine.

Question 1 (Pharmacist Counseling):
How should the pharmacist explain the importance of daily use of inhaled corticosteroids for asthma management?

A) Inhaled corticosteroids should only be used during asthma attacks to relieve symptoms quickly.
B) Inhaled corticosteroids prevent airway inflammation and should be taken daily to control asthma and prevent exacerbations, even when the patient feels fine.
C) Inhaled corticosteroids should be stopped as soon as symptoms improve to avoid side effects.
D) Inhaled corticosteroids are for short-term use and should not be continued beyond 2 weeks.
E) Inhaled corticosteroids are interchangeable with short-acting bronchodilators.

Follow-Up Question:
What should the pharmacist advise the patient to do after using her inhaled corticosteroid to prevent local side effects?

A) Drink a glass of milk
B) Take an antihistamine
C) Rinse her mouth with water and spit it out
D) Avoid eating or drinking for an hour
E) Brush her teeth immediately before using the inhaler

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Case
A 42-year-old man with moderate asthma is prescribed a combination inhaler containing a low-dose ICS and a long-acting beta-agonist (LABA). He asks the pharmacist if he still needs to use his rescue inhaler (SABA) now that he is on combination therapy.

Question 1 (Pharmacist Counseling):
How should the pharmacist counsel the patient regarding the use of his rescue inhaler (SABA) while on ICS + LABA therapy?

A) The patient should discontinue using his rescue inhaler since the ICS + LABA combination will prevent all asthma symptoms.
B) The patient should continue using his rescue inhaler as needed for acute symptoms, even though he is on ICS + LABA therapy.
C) The patient should use his rescue inhaler daily, even if he doesn’t experience symptoms.
D) The patient should switch to using the LABA for immediate symptom relief.
E) The patient should alternate between SABA and LABA every other day.

Follow-Up Question:
What is an important point to counsel the patient about regarding the use of LABA in asthma treatment?

A) LABA should be used as a replacement for SABA during asthma attacks.
B) LABA should always be used in combination with an ICS in asthma treatment, never as monotherapy.
C) LABA can be used as needed for quick relief of symptoms.
D) LABA should be taken only when experiencing severe symptoms.
E) LABA should be discontinued if the patient develops a cough.

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Case
A 65-year-old woman with moderate COPD is prescribed tiotropium (LAMA) for maintenance therapy. She asks the pharmacist if she should stop using her rescue inhaler (albuterol) now that she is on tiotropium.

Question 1 (Pharmacist Counseling):
How should the pharmacist counsel the patient regarding the use of her rescue inhaler while on tiotropium?

A) The patient should stop using her rescue inhaler since tiotropium will prevent all symptoms.
B) The patient should continue using her rescue inhaler as needed for acute symptoms, even though she is on tiotropium.
C) The patient should use her rescue inhaler daily as part of her regular regimen.
D) The patient should use tiotropium only during exacerbations.
E) The patient should alternate between tiotropium and albuterol every day.

Follow-Up Question:
If the patient continues to experience frequent exacerbations despite using tiotropium, what would be the next step in managing her COPD?

A) Add a LABA to her regimen for better symptom control.
B) Switch to using a SAMA instead of tiotropium.
C) Discontinue tiotropium and switch to oral corticosteroids.
D) Use her SABA on a scheduled basis instead of PRN.
E) Discontinue all inhalers and use mucolytics.

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Case
A 70-year-old man with severe COPD has been using a combination of LAMA + LABA + ICS for several months. He continues to experience frequent exacerbations that require hospitalization. His pulmonologist recommends starting roflumilast. The patient asks the pharmacist what this medication does and how it will help.

Question 1 (Pharmacist Counseling):
How should the pharmacist counsel the patient on the role of roflumilast in COPD management?

A) Roflumilast is a bronchodilator that will provide immediate relief of symptoms.
B) Roflumilast is an anti-inflammatory medication that helps reduce exacerbations in severe COPD, especially for patients with chronic bronchitis.
C) Roflumilast should replace his current inhalers to better control his symptoms.
D) Roflumilast is a short-term medication used only during acute exacerbations.
E) Roflumilast primarily treats oxygen deficiency and is used for patients requiring supplemental oxygen.

Follow-Up Question:
What side effects should the patient be aware of when starting roflumilast?

A) Tachycardia and insomnia
B) Nausea, diarrhea, and weight loss
C) Drowsiness and confusion
D) Fluid retention and edema
E) Hair loss and vision changes