AGNP BOARD EXAM QUESTIONS Respiratory Prescribing (100 Questions) well explained solution to pursue A+

Document Content and Description Below

AGNP BOARD EXAM QUESTIONS Respiratory Prescribing (Questions 100) Question: Treatment of Bordetella pertussis in a patient with a hypersensitivity to macrolides is: doxycycline. clindamycin (Cleo... cin). metronidazole (Flagyl). sulfamethoxazole/trimethoprim (Bactrim). Correct Explanation: Sulfamethoxazole/trimethoprim (Bactrim) is an alternative choice for patients in whom a macrolide is contraindicated. Question: The mainstay of treatment in the management of mild and moderate croup is symptomatic relief that includes: antibiotics. beta-2 agonists. corticosteroids. Correct decongestants. Explanation: The mainstay of treatment in the management of mild and moderate croup is symptomatic relief, which includes corticosteroids (inhaled or oral). Antibiotics, beta-2 agonists and decongestants have not been studied, and their use is discouraged. Question: In adults with community-acquired pneumonia in which B-lactamase producing Haemophilus influenzae is identified as the causative organism, the outpatient treatment of choice is: amoxicillin (Amoxil). azithromycin (Zithromax). Cefixime (Suprax). Correct oseltamivir (Tamiflu). Explanation: The treatment of choice in adults with B-lactamase producing Haemophilus influenzae community acquired pneumonia is cefixime (Suprax). Amoxicillin is recommended in the presence of non-B-lactamase producing Haemophilus influenzae. Alternate antibiotics include fluoroquinolones (ie. moxifloxacin [Avelox]), doxycycline, azithromycin and clarithromycin. Question: A patient with sinusitis is treated with amoxicillin. Caution is advised with concomitant use of: lisinopril (Zestril). fexofenadine (Allegra). warfarin (Coumadin). Correct furosemide (Lasix). Explanation: Amoxicillin should be used with caution with warfarin (Coumadin). The combination will increase the INR and thus increase the risk of bleeding, possibly due to altered vitamin K production by gut flora. Amoxicillin can be co- administered with lisinopril (Zestril), fexofenadine (Allegra), and furosemide (Lasix). Question: A patient with bacterial sinusitis taking an oral penicillin should be instructed: to monitor capillary blood glucose readings if they have diabetes. that additional protection against pregnancy is necessary if they are taking an oral contraceptive. Correct to use an anti-diarrheal if they experience diarrhea. to avoid penicillin if they are pregnant or trying to become pregnant. Explanation: Penicillin is a beta-lactam antibiotic. The drug interactions of most concern with the beta-lactam antibiotics are those with oral contraceptive products, methotrexate and valproic acid. In the case oral contraceptives, even though a small percentage of women may potentially experience decreased effectiveness of these birth control products while taking beta-lactam antibiotic, alternative birth control methods should be considered while taking these antibiotics. Anti-diarrheal medicine should not be taken because it may worsen or prolong diarrhea. Most penicillins are safe to use during pregnancy. Penicillins may cause false readings with some urine glucose tests. Question: An example of a beta2-adrenergic receptor agonist used in the treatment of asthma is: dobutamine. denopamine. xamoterol. albuterol. Correct Explanation: ß2 (beta2) adrenergic receptor agonists, also known as adrenergic ß2 receptor agonists, act on the ß2 adrenergic receptor. Like other ß adrenergic agonists, they cause smooth muscle relaxation. ß2 adrenergic agonists' effects on smooth muscle cause dilation of bronchial passages. They are primarily used to treat asthma and other pulmonary disorders, such as COPD. Examples of a beta2-adrenergic receptor agonists are albuterol, xamoterol, and terbutaline. The others are examples of beta1-adrenergic receptor agonists. Question: Benzonatate (Tessalon Perles), a non-narcotic antitussive,: does not cause sedation. is centrally acting on cough receptors. is safe in children 6 years and older. should be swallowed whole. Correct Explanation: Benzonatate (Tessalon Perles) capsules act peripherally by anesthetizing the stretch receptors located in the respiratory passages, lungs, and pleura by dampening their activity and thereby reducing the cough reflex. It is approved for the relief of cough in adults and children older than 10 years. Benzonatate capsules should be swallowed whole. Severe hypersensitivity reactions (including bronchospasm, laryngospasm and cardiovascular collapse) have been reported from sucking or chewing the capsule instead of swallowing it. This is thought to be related to a local anesthetic property of the drug. The most common side effects of benzonatate are sedation, headache and dizziness. Question: Which of the following medications, when combined with pulmonary rehabilitation, enhances exercise performance? Ipratropium bromide (Atrovent). Levalbuterol (Xopenex) inhaled. Salmeterol (Serevent Diskus). Tiotropium (Spiriva HandiHaler). Correct Explanation: Tiotropium (Spiriva HandiHaler), a long-acting antimuscarinic antagonist, enhances the effectiveness of pulmonary rehabilitation in increasing exercise performance. Question: Which of the following would NOT be a potential adverse reaction of an intramuscular corticosteroid? anuria. Correct angioedema. cardiac arrhythmias. mood swings. Explanation: Anuria has not been reported as a potential side effect of intramuscular corticosteroids. Reactions that may occur include anaphylaxis, angioedema, convulsions, depression, emotional instability, euphoria, headache, insomnia, mood swings, neuritis, neuropathy, paresthesia, personality changes, bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure, and tachycardia. Question: Doxycycline (Vibramycin), for the treatment of pneumonia, is classified as a: fluoroquinolone. penicillin. macrolide. tetracycline. Correct Explanation: Doxycycline (Vibramycin), demeclocycline (Declomycin) and minocycline (Minocin) are tetracycline derivatives. Doxycycline (Vibramycin) is the preferred treatment of pneumonia caused by Mycoplasma pneumoniae. Question: The main side effect related to the use of long-acting antimuscarinic antagonists is: dry mouth. Correct headache. tachycardia. watering eyes. Explanation: The main side effect is dryness of mouth. Inhaled anticholinergic drugs are poorly absorbed, which limits the troublesome systemic effects observed with atropine. Extensive use of this class of agents in a wide range of doses and clinical settings has shown them to be very safe. Question: Theophylline (Theo-24) relaxes bronchial smooth muscle and: depresses the central nervous system. decreases renal blood flow. slows the heart rate. produces anti-inflammatory effects. Correct Explanation: The main actions of theophylline (Theo-24) are to relax bronchial smooth muscle and exert both positive inotropic and chronotropic actions (increased heart muscle contractility and efficiency and increased heart rate). Theophylline also increases blood pressure and renal blood flow, and produces anti-inflammatory effects. It also stimulates the central nervous system, mainly in the medullary respiratory center. Question: Fluticasone/salmeterol is a combination inhaler that is branded as: Advair Diskus. Correct Pulmicort. Spiriva. Symbicort. Explanation: Fluticasone/salmeterol is a combination inhaler that is branded as Advair Diskus. It is a combination of an inhaled corticosteroid and a long-acting bronchodilator. Symbicort is a combination of budesonide and formoterol. Spiriva is a short-acting antimuscarinic antagonist agent. Budesonide (Pulmicort) is an inhaled corticosteroid. Question: The initial bronchodilator in the treatment of chronic bronchitis is: albuterol (ProAir HFA). Correct fluticasone propionate (Flovent HFA) salmeterol (Serevent). tiotropium (Spiriva HandiHaler). Explanation: The principal initial bronchodilator in the treatment of chronic bronchitis is a short-acting bronchodilator or short-acting antimuscarinic antagonist. Short-acting beta agonists such as albuterol (ProAir HFA) are the initial choices for as needed use. Short-acting antimuscarinic antagonist agents (i.e. ipratropium bromide [Atrovent]) may also be utilized on an as needed basis. Question: The treatment of choice in the outpatient setting for an adult with community-acquired pneumonia caused by Mycoplasma pneumoniae or Chlamydophila pneumoniae is a: aminoglycoside. cephalosporin (3rd generation). macrolide. Correct penicillin. Explanation: The treatment of choice in the outpatient setting for an adult with community-acquired pneumonia caused by Mycoplasma pneumoniae or Chlamydophila pneumoniae is a macrolide or a tetracycline. If those are contraindicated, an alternative would be a fluoroquinolone. Question: A patient with diabetes who is started on corticosteroids for the treatment of chronic bronchitis exacerbation should be instructed to monitor for: diaphoresis. increased urination. Correct weight loss. decreased thirst. Explanation: A patient with diabetes who is started on corticosteroids for the treatment of chronic bronchitis exacerbation should be instructed to monitor for symptoms of hyperglycemia (increased urination, increased thirst, and hunger). These drugs can increase blood glucose levels and insulin resistance. They stimulate glucose secretion by the liver and reduce glucose transport into adipose and muscle cells, resulting in reduced glucose clearance. Question: The beta2 adrenergic receptor agonist most commonly used to prevent bronchospasm associated with exercise-induced asthma is: fluticasone (Flovent). salmeterol (Serevent). albuterol. Correct budesonide (Pulmicort). Explanation: Short-acting beta-2 agonists (SABAs) are the most commonly used preexercise medications for exercise-induced asthma. SABAs include albuterol, levalbuterol (Xopenex FHA) and pirbuterol (Maxair). Fluticasone (Flovent) is an inhaled steroid. Salmeterol (Serevent) is a long-acting beta-2 agonist (LABA). Budesonide (Pulmicort) is an inhaled steroid. Question: Levofloxacin, for the treatment of community acquired pneumonia, is classified as a: fluoroquinolone. Correct penicillin. macrolide. tetracycline. Explanation: Levofloxacin is classified as a fluoroquinolone. Levofloxacin tablets are indicated for the treatment of community-acquired pneumonia due to Streptococcus pneumoniae (excluding multi-drug-resistant isolates [MDRSP]), Haemophilus influenzae, Haemophilus parainfluenzae, Mycoplasma pneumoniae, or Chlamydophila pneumoniae. Question: When considering the use of theophylline to treat chronic bronchitis, its use is limited due to: low-risk profile. minimal effects on lung function. wide therapeutic window. frequent drug-drug interactions. Correct Explanation: Theophylline is not commonly used because of limited potency, narrow therapeutic window, high-risk profile, and frequent drug-drug interactions. Theophylline is insufficient to relieve airflow obstruction and has only modest effects on lung function in moderate to severe chronic bronchitis. Question: Patients with severe emphysema who are receiving chronic inhaled steroids are at increased risk of developing: arthritis. bronchospasms. hypokalemia. pneumonia. Correct Explanation: The long-term use of inhaled steroids in patients with severe emphysema is associated with higher prevalence of oral candidiasis, hoarse voice, skin bruising and pneumonia. Question: For the treatment of a patient experiencing bronchospasms in response to an allergen, the LEAST favorable route for the administration of epinephrine, a catecholamine, is: intramuscular. sublingual. subcutaneous. oral. Correct Explanation: Catecholamines are destroyed by digestive enzymes. Included among catecholamines are epinephrine (adrenaline), norepinephrine (noradrenaline), and dopamine. Epinephrine is best absorbed via sublingual, intramuscular (IM), and subcutaneous (SC) routes. Question: Tiotropium (Spiriva HandiHaler), used in the treatment of chronic bronchitis,: does not cause paradoxical bronchospasm. is contraindicated in patients with hypersensitivity to ipratropium (Atrovent HFA). Correct should not be combined with an inhaled steroid due to adverse reactions. requires dosage adjustment in geriatrics and hepatically impaired patients. Explanation: Tiotropium (Spiriva HandiHaler) is contraindicated in patients with a hypersensitivity to tiotropium, ipratropium, or any components of this product. No dosage adjustment is required for geriatric, hepatically impaired, or renally impaired patients. Some inhaled medicines, including Spiriva HandiHaler, may cause paradoxical bronchospasm. No adverse reactions have been noted with the combined use of Spiriva HandiHaler and short-acting and long-acting sympathomimetic (beta-agonists) bronchodilators, methylxanthines, and oral and inhaled steroids. Question: Which of the following is NOT a potential side effect of albuterol (ProAir HFA)? Gastroesophageal reflux disease Correct Paradoxical bronchospasm Prolongation of the QTc interval Tremor Explanation: Paradoxical bronchospasm, prolongation of the QTc interval and tremor are potential side effects of albuterol (ProAir HFA). Other side effects include nervousness, headache, tachycardia, palpitations, dizziness, weakness, muscle cramps, hypokalemia and hyperglycemia. Question: When prescribing a macrolide such as erythromycin for a patient with strep pharyngitis, the patient should be informed that they may experience: nausea and vomiting. Correct urticaria and exanthem. itching and jaundice. abdominal cramps and diarrhea. Explanation: Minor side effects of macrolides include nausea, vomiting, diarrhea, and tinnitus. Serious side effects, including allergic reaction and cholestatic hepatitis (inflammation and congestion of bile ducts in the liver), are generally associated only with the use of erythromycin. Question: According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, oral prednisone for an acute exacerbation of emphysema should be administered for: 3 days. 5 days. Correct 10 days. 14 days. Explanation: During acute exacerbations, systemic steroids are superior to inhaled corticosteroids. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, the administration of oral prednisone for an exacerbation of emphysema should be administered for 5 days. This appears to be as effective as a 10-14 day course. Question: With the use of tiotropium (Spiriva HandiHaler), the patient should be instructed that: contents are under pressure and may explode. the inhaler has a dose counter to alert when empty. a capsule that contains a dry powder is activated inside the inhaler. Correct it delivers a fine mist that should be breathed in slowly. Explanation: Tiotropium (Spiriva HandiHaler) comes in a dry powder contained in a capsule that is put into a special inhaler. Spiriva capsules should only be administered via the HandiHaler device and should not be used for administering other medications. Remind patients that the contents of Spiriva capsules are for oral inhalation only and must not be swallowed. Spiriva Respimat delivers a slow moving mist that makes it easier for the patient to inhale the medication, compared to the Spiriva HandiHaler. Question: Caution is advised when theophylline (Theo-24) is prescribed for patients with a history of: atrial fibrillation. Correct diabetes. narrow-angle glaucoma. mild renal impairment. Explanation: Theophylline should be used with extreme caution in patients with active peptic ulcer disease, seizure disorder or cardiac arrhythmias (not including bradyarrhythmias) due to the increased risk of exacerbation of these conditions. Question: Dextromethorphan, a cough suppressant, is safe to administer to patients who have: difficulty clearing secretions. Parkinson's disease. hypertension. Correct depression and are taking venlafaxine (Effexor). Explanation: The use of dextromethorphan, a cough suppressant, is contraindicated in patients with difficulty clearing secretions or with Parkinson's disease. Dextromethorphan decreases the sensitivity of cough receptors and interrupts cough impulse transmission by depressing the medullary cough center through sigma receptor stimulation. Also, due to serotonergic effects, caution should be used when administering to patients who are taking certain selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) (i.e. venlafaxine [Effexor]). Question: Glucocorticoids are indicated for the treatment of: acute bronchitis. asthma exacerbations. Correct lupus. dry cough. Explanation: Glucocorticoids are indicated for the treatment of exacerbations of asthma and COPD because of their anti-inflammatory activity. Mineralocorticoids are indicated for the treatment of adrenal hyperplasia, Addison's disease and may be useful in some cases of hypotension. Question: For asthma symptoms requiring use of a short-acting bronchodilator more than 2 times a week, the preferred addition to the treatment regimen is: short-acting anticholinergics. low-dose inhaled corticosteroid. Correct adding a long-acting bronchodilator. xanthines. Explanation: For asthma symptoms requiring use of a short-acting bronchodilator more than 2 times a week, the preferred addition to the treatment regimen is a low-dose inhaled corticosteroid. Second-line options instead of a low-dose inhaled corticosteroid are cromolyn, a leukotriene-receptor antagonist or theophylline. Question: Amoxicillin/clavulanate (Augmentin), a beta-lactam antibiotic,: has a 6-hour half-life. is highly protein bound. is primarily excreted unchanged in the urine. Correct is readily diffused into brain and spinal tissue. Explanation: Approximately 50% to 70% of the amoxicillin and approximately 25% to 40% of the clavulanic acid are excreted unchanged in urine. Neither component in amoxicillin/clavulanate (Augmentin) is highly protein-bound. Amoxicillin diffuses readily into most body tissues and fluids, with the exception of the brain and spinal fluid. The half-life of amoxicillin after the oral administration of Augmentin is 1.3 hours and that of clavulanic acid is 1 hour. Question: An example of an inhaled glucocorticoid used in the treatment of asthma is: albuterol (ProAir HFA) budesonide (Pulmicort) Correct ipratropium (Atrovent HFA) montelukast (Singulair) Explanation: Budesonide (Pulmicort) is an inhaled corticosteroid used in the treatment of asthma. The mechanism of action of inhaled glucocorticoids is to decrease the activity of inflammatory cells and mediators. Question: Which statement is NOT true about beta2-agonists? There are short-acting and long-acting formulations. Long-acting beta2-agonists have no effect on decline of lung function and mortality. Stimulation of beta2 receptors may cause resting tachycardia and somatic tremor. Long-acting beta2-agonists have no effect on reduction of exacerbations. Correct Explanation: The principal action of beta2-agonists is to relax airway smooth muscle by stimulating beta2-adrenergic receptors, which increase cyclic AMP and produce functional antagonism to bronchoconstriction. There are short-acting (SABA) and long-acting (LABA) beta2-agonists. Twice-daily LABAs significantly improve FEV1 and lung volumes, dyspnea, health status, exacerbation rate and number of hospitalizations, but they have no effect on mortality or rate of decline of lung function. Stimulation of beta2-adrenergic receptors can produce resting sinus tachycardia, cardiac rhythm disturbances, and exaggerate somatic tremor, regardless of route of administration. Question: The mechanism of action of inhaled glucocorticoids in the treatment of chronic obstructive pulmonary disease is to: block the action of acetylcholine. decrease the activity of inflammatory mediators. Correct relax the smooth muscles of the bronchi. stimulate beta 2 receptors. Explanation: The mechanism of action of inhaled glucocorticoids in the treatment of chronic obstructive pulmonary disease is to decrease the activity of inflammatory cells and mediators. Budesonide (Pulmicort) is an inhaled corticosteroid used in the treatment of chronic obstructive pulmonary disease. Question: Robitussin DM is a combination of dextromethorphan and: benzonatate. benzocaine. guaifenesin. Correct phenylephrine. Explanation: Robitussin DM is a combination of dextromethorphan and guaifenesin for the treatment of cough. It can be purchased over the counter. It is not recommended for children younger than 6 years. Question: Leukotriene antagonists such as montelukast (Singulair) should not be prescribed if the patient has preexisting: asthma. colitis. depression. Correct peripheral vascular disease. Explanation: Neuropsychiatric changes have been reported in association with leukotriene antagonists such as montelukast (Singulair). These changes may include dream abnormalities, insomnia, anxiety, depression, suicidal thinking, and in rare cases, suicide. Therefore, caution is advised when prescribing montelukast to patients with active or preexisting anxiety or depression, or symptoms that suggest psychiatric disorders. Question: Doxycycline (Vibramycin) is the preferred treatment of pneumonia caused by: Haemophilus influenzae. Mycoplasma pneumoniae. Correct Staphylococcus aureus. Streptococcus pneumoniae. Explanation: Doxycycline (Vibramycin) is the preferred treatment of pneumonia caused by Mycoplasma pneumoniae. It is classified as a tetracycline. Question: Which of the following medications is classified as a short-acting antimuscarinic antagonist (SAMA)? Albuterol (ProAir HFA). Budesonide (Pulmicort). Ipratropium (Atrovent HFA). Correct Montelukast (Singulair). Explanation: Ipratropium (Atrovent HFA) is a short-acting antimuscarinic antagonist. It works by blocking the action of acetylcholine and thus causes mild bronchodilation and prevents bronchoconstriction. Albuterol (ProAir HFA) is a short-acting beta agonist (SABA); budesonide (Pulmicort) is an inhaled corticosteroid; and montelukast (Singulair) is a leukotriene receptor agonist. Question: For asthma symptoms occurring daily with nighttime symptoms greater than one time per week, the preferred daily treatment is a: long-acting bronchodilator. long-acting bronchodilator and an inhaled corticosteroid. Correct long-acting bronchodilator and a leukotriene receptor antagonist. high-dose inhaled corticosteroid and theophylline. Explanation: For asthma symptoms occurring daily with nighttime symptoms greater than one time per week, the preferred treatment is a long-acting bronchodilator and an inhaled corticosteroid. Question: When used in the treatment of chronic obstructive pulmonary disease (COPD), macrolides: inhibit beta-lactamase. prevent bacterial DNA from replicating. inhibit bacterial cell wall synthesis. inhibit bacterial protein synthesis. Correct Explanation: Macrolides such as erythromycin (Erytab) and azithromycin (Zithromax) inhibit bacterial protein synthesis and growth by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Macrolides exert several immune- modulatory and anti-inflammatory effects. Penicillins inhibit bacterial cell wall synthesis while fluoroquinolones prevent bacterial DNA from replicating. Question: Which medication is classified as a xanthine? Budesonide (Pulmicort) Ipratropium (Atrovent HFA) Montelukast (Singulair) Theophylline (Theo-24) Correct Explanation: Theophylline (Theo-24) is classified as a xanthine. It is used in the treatment of asthma. It causes bronchodilation by relaxing smooth muscles of the bronchi and pulmonary blood vessels. Question: Bactrim DS can be used to treat a patient with pneumonia. The "DS" in trimethoprim- sulfamethoxazole (Bactrim DS) stands for: diethylstilbestrol. double strength. Correct double stranded. the chemical element darmstadtium. Explanation: The "DS" in trimethoprim-sulfamethoxazole (Bactrim DS) stands for double strength. In Bactrim DS, each tablet contains 800 mg sulfamethoxazole and 160 mg trimethoprim. In Bactrim, each tablet contains 400 mg of sulfamethoxazole and 80 mg of trimethoprim. Diethylstilbestrol (DES) is a synthetic form of estrogen. Question: Theophylline (Theo-24) may have an effect on the serum concentrations of: BUN and creatinine. hematocrit and platelets. potassium and magnesium. total cholesterol and uric acid levels. Correct Explanation: As a result of its pharmacological effects, theophylline at serum concentrations within the 10 to 20 mcg/mL range modestly increases plasma glucose, uric acid, free fatty acids, total cholesterol, HDL, HDL/LDL ratio, and urinary free cortisol excretion. Question: The recommended treatment for community-acquired pneumonia secondary to an atypical pathogen in a previously healthy patient who has a macrolide allergy is: azithromycin (Zithromax). doxycycline (Vibramycin). Correct metronidazole (Flagyl). sulfamethoxazole/trimethoprim (Bactrim). Explanation: Doxycycline (Vibramycin) is a reasonable alternative for second-line therapy in patients with an allergy or contraindication to use of a macrolide. Macrolides (clarithromycin or azithromycin) are used in patients with community-acquired pneumonia secondary to atypical pathogens who are previously healthy who have no risk of drug-resistant infections. Risk factors for drug resistance include use of antibiotics within the past 3 months or known regional resistance. Question: Routine management of bronchiolitis in moderately ill children includes: antibiotics. bronchodilators. nebulized hypertonic saline. Correct oral steroids. Explanation: Supportive care and anticipatory guidance are the mainstays of management of nonsevere bronchiolitis. Nebulized hypertonic saline 5% is recommended because it is safe, inexpensive and effective for moderately ill ambulatory patients. A trial dose of a bronchodilator is no longer recommended and should not routinely be used. Steroids may be considered if lower airway inflammation is present. Antibiotics should only be administered when highly suspicious of bacterial infections. Question: The brand name for albuterol (inhaled) is: Advair. Flovent. Serevent. Ventolin. Correct Explanation: The brand name for albuterol (inhaled) is Ventolin and ProAir Ventolin HFA. The generic name of Advair is fluticasone propionate/salmeterol; Flovent is fluticasone propionate; and Serevent is salmeterol. Question: The mechanism of action of short-acting antimuscarinic antagonists (SAMA) such as ipratropium is to: block the action of acetylcholine. Correct decrease the activity of inflammatory mediators. relax the smooth muscles of the bronchi. stimulate beta 2 receptors. Explanation: The mechanism of action of short-acting antimuscarinic antagonists (SAMA) such as ipratropium is to block the muscarinic effects of acetylcholine. SAMAs cause mild bronchodilation and prevent bronchoconstriction in the treatment of obstructive pulmonary diseases. Question: Azithromycin (Zithromax) and other macrolides are safe to administer with: carbamazepine (Tegretol). carvedilol (Coreg). Correct ondansetron (Zofran). verapamil (Calan). Explanation: Azithromycin (Zithromax) and other macrolides are safe to administer with beta- blockers (i.e. carvedilol [Coreg]), which are CYP2D6 inducers. Calcium channel blockers (verapamil [Calan]), carbamazepine (Tegretol), omeprazole (Prilosec), ranitidine (Zantac), ritonavir (Norvir), digoxin (Lanoxin), 5HT3 receptor antagonists (ondansetron), and statins are CYP3A4 inhibitors. Question: The initial recommended treatment for uncomplicated acute bronchitis in adults is: antibiotics. antihistamines. antitussives. Correct decongestants. Explanation: Most cases of acute bronchitis are viral and resolve without treatment within a couple of weeks. Management of cough is recommended with antitussives. Because of the risk of antibiotic resistance and Clostridium difficile infection, antibiotics should not be routinely used in the treatment of acute bronchitis. Decongestants and antihistamines are ineffective unless there is confirmed sinusitis or underlying allergy. The FDA has recommended that cough and cold preparations not be used in children younger than 6 years. Question: Doxycycline (Doryx), for the treatment of pneumonia,: does not cause photosensitivity. guarantees protection against malaria when taken appropriately. is less likely to predispose the patient to vaginal candidiasis. may cause esophageal irritation and ulceration. Correct Explanation: Doxycycline (Doryx) may cause esophageal irritation and ulceration. The patient should be instructed to drink fluids liberally. The patient should avoid excessive sunlight or artificial ultraviolet light while receiving doxycycline and to discontinue therapy if phototoxicity occurs. The use of doxycycline might increase the incidence of vaginal candidiasis. Question: An example of a long-acting bronchodilator is: albuterol (ProAir HFA). budesonide (Pulmicort). ipratropium (Atrovent HFA). salmeterol (Serevent Diskus). Correct Explanation: An example of a long-acting bronchodilator is salmeterol (Serevent Diskus). Albuterol (ProAir HFA) is a short-acting beta agonist (SABA); budesonide (Pulmicort) is an inhaled corticosteroid; and ipratropium (Atrovent HFA) is a short-acting antimuscarinic antagonist. Question: The most common symptom of theophylline toxicity is: headache. hypoglycemia. lethargy. vomiting. Correct Explanation: The most common symptom of theophylline toxicity (acute or chronic) is severe and protracted vomiting. Seizures, hypotension, and significant dysrhythmias usually are observed when serum levels approach 80 mcg/mL. Seizures are more common with acute overdose than with chronic overdose. In chronic exposures, seizures may develop at lower serum concentrations. Cardiac dysrhythmias are more common following a chronic overdose rather than acute overdose and with lower serum concentrations. Question: The generic name for Tessalon Perles, used to treat cough, is: benzonatate. Correct benzocaine. guaifenesin. phenylephrine. Explanation: The brand name of Tessalon Perles is benzonatate. Benzonatate is an non-narcotic antitussive used in the treatment of cough. Benzocaine is an anesthetic; guaifenesin is a expectorant; and phenylephrine is a decongestant. Question: Albuterol (ProAir HFA), used in the treatment of asthma, causes bronchodilation by: blocking the action of acetylcholine. decreasing the activity of inflammatory mediators. relaxing the smooth muscles of the bronchi. stimulating beta 2 receptors. Correct Explanation: Albuterol (ProAir HFA) is a short-acting bronchodilator used in the treatment of asthma. Albuterol causes bronchodilation by stimulating beta 2 receptors in the lungs. Question: Patients who are already on tiotropium (Spiriva) for chronic obstructive pulmonary disease should not take a(n): short-acting anticholinergic agent. Correct short-acting bronchodilator. long-acting bronchodilator. inhaled corticosteroid. Explanation: Patients should not take short-acting anticholinergic agents if the chronic obstructive pulmonary disease is already being treated with tiotropium (Spiriva), which is a long- acting anticholinergic. Question: The antibiotic of choice in the management of Bordetella pertussis in all age groups is: azithromycin (Zithromax). Correct doxycycline. clindamycin (Cleocin). metronidazole (Flagyl). Explanation: The antibiotic of choice in the management of Bordetella pertussis in all age groups is a macrolide. Azithromycin and clarithromycin are preferred in infants younger 1 month who are not allergic. The choice of macrolide should take into account effectiveness, safety, tolerability and ease of adherence. Question: Which of the following scenarios would NOT warrant monitoring of a serum theophylline level? Exacerbation of chronic bronchitis New diagnosis of diabetes Prior to initiating therapy Prior to a routine pulmonary function test Correct Explanation: As long as routine monitoring of serum theophylline levels has been performed and the patient is not symptomatic, there is no indication to perform a theophylline level prior to a routine pulmonary function test. Serum theophylline concentration measurements should be measured when: initiating therapy; making a dose increase in a symptomatic patient; or signs or symptoms of theophylline toxicity are present. Theophylline levels should also be measured in the presence of an acute illness (e.g., fever >102 degrees), worsening of a chronic illness; or a change in treatment regimen that may alter theophylline clearance (i.e. hepatitis); or a change in medications that may interact with theophylline (i.e., fluoroquinolones, allopurinol, beta-blockers, phenobarbital and phenytoin and verapamil, etc.). Question: The peak blood levels for trimethoprim and sulfamethoxazole contained in Bactrim DS are approximately: 3 hours. Correct 6 hours. 8 hours. 10 hours. Explanation: Peak blood levels for sulfamethoxazole and trimethoprim occur 1 to 4 hours after oral administration. The mean serum half-lives of sulfamethoxazole and trimethoprim are 10 and 8 to 10 hours, respectively. During administration of 800 mg sulfamethoxazole and 160 mg trimethoprim bid, the mean steady-state plasma concentration of trimethoprim was 1.72 µg/mL. These steady-state levels were achieved after 3 days of drug administration. Question: Benzonatate (Tessalon Perles), used to treat cough, is classified as a(n): expectorant. mucolytic. narcotic antitussive. non-narcotic antitussive. Correct Explanation: Benzonatate (Tessalon Perles) is classified as a non-narcotic antitussive. Benzoate anesthetizes respiratory passages, lungs, and pleural stretch receptors; thereby, reducing the cough reflex. Question: Montelukast (Singulair), a leukotriene inhibitor, is: indicated for the treatment of chronic asthma in adults and children 12 months and older. Correct not indicated for exercise-induced bronchoconstriction for children ages 6-11. indicated in the relief of seasonal allergic rhinitis symptoms in children and adults 12 months and older. indicated for the prophylactic and chronic treatment of chronic bronchitis and emphysema. Explanation: Montelukast (Singulair) is indicated for the prophylaxis and treatment of chronic asthma in adults and children 12 months and older. Other indications for Singulair are: prevention of exercise-induced bronchoconstriction (EIB) in patients 6 years and older; seasonal allergic rhinitis in patients 2 years and older; and perennial allergic rhinitis in patients 6 months and older. The safety and effectiveness in pediatric patients younger than 12 months with asthma, 6 months with perennial allergic rhinitis, and 6 years with exercise-induced bronchoconstriction have not been established. Question: Which of the following is a short-acting bronchodilator? Albuterol (ProAir HFA). Correct Formoterol (Foradil aerolizer). Ipratropium bromide (Atrovent HFA). salmeterol (Serevent Diskus). Explanation: Albuterol (ProAir HFA) is a short-acting bronchodilator. Formoterol and salmeterol are long-acting bronchodilators. Ipratropium bromide (Atrovent HFA) is classified as a short- acting antimuscarinic antagonist. Question: Albuterol (ProAir HFA) is NOT recommended for use in the treatment of: a 3-year-old with bronchospasms. Correct a 6-year-old with exercise induced asthma. a 45-year-old smoker with COPD exacerbation. a 65-year-old with a history of percutaneous coronary intervention. Explanation: The use of short-acting bronchodilators is NOT recommended in children younger than 4 years. Albuterol (ProAir HFA) inhalation aerosol is indicated for the prevention and relief of bronchospasm in patients 4 years and older with reversible obstructive airway disease, and for the prevention of exercise-induced bronchospasm in patients 4 years and older. Albuterol, like all other beta-adrenergic agonists, can produce a clinically significant cardiovascular effect and should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension. Question: Toxic effects of theophylline (Theo-24) may be increased by: phenobarbital. phenytoin. rifampin. cimetidine. Correct Explanation: Theophylline (Theo-24) use is complicated by its interaction with various drugs and its narrow therapeutic range. Toxicity is increased by erythromycin (Ery-Tab), cimetidine (Tagamet), and fluoroquinolones, such as ciprofloxacin (Cipro). Phenobarbital, phenytoin (Dilantin), and rifampin (Rifadin) can potentially decrease the effectiveness of theophylline. Question: When used in the treatment of lower respiratory tract infections, macrolides: mainly inhibit growth of gram-positive cocci and atypical pathogens. Correct mainly inhibit growth of gram-negative cocci. are considered bacteriostatic at high concentrations. do not usually become group A streptococcus resistant. Explanation: Macrolide antibiotics are primarily used to treat lower respiratory tract infections caused by atypical pathogens (e.g., Mycoplasma pneumoniae, Bordetella pertussis). They have limited activity against gram-positive pathogens like Streptococcus pneumoniae. Macrolide-resistant strains of Streptococcus are common. Macrolides are bacteriostatic, but at high doses may be bactericidal. They are considered bacteriostatic but may be bactericidal at higher concentrations. Macrolide-resistant strains of group A streptococcus (GAS) are common. Question: With acute exacerbation of bronchitis, inhaled steroid use should be: stopped. increased in frequency. decreased in frequency. transitioned to a higher dose. Correct Explanation: With acute exacerbation of bronchitis, inhaled steroid use should be transitioned to a higher dose. Higher doses of inhaled corticosteroids are used during transition from systemic to inhaled corticosteroid therapy or in mild exacerbation. With mild exacerbation the maintenance dose should be increased. Question: Which of the following is a combination long-acting beta2-agonist and an inhaled steroid? Ipratropium bromide/albuterol Olodaterol/tiotropium Salbutamol/ipratropium Salmeterol/fluticasone Correct Explanation: Salmeterol/fluticasone is a combination inhaled long-acting beta2-agonist and an inhaled steroid manufactured under the brand name of Advair. Question: Potential drug-drug interactions may occur when albuterol is combined with: ACE inhibitors. leukotriene antagonists. potassium-wasting medications. Correct serotonin (5HT1) receptor agonist. Explanation: The combination of short-acting bronchodilators and potassium-wasting medications may increase the occurrence of hypokalemia. Consider monitoring potassium levels. Question: Which medication is NOT appropriate treatment for exercise-induced asthma? Short-acting bronchodilator monotherapy Inhaled corticosteroids Leukotriene receptor antagonists Long-acting bronchodilator monotherapy Correct Explanation: Exercise-induced asthma may be treated with inhaled corticosteroids, short-acting bronchodilators and leukotriene receptor antagonists. Long-acting beta blockers may be used in combination with inhaled corticosteroids for patients with abnormal spirometry and/or more persistent symptoms. Question: An indication for the use of beta2 adrenergic receptor agonists is: tachycardia. asthma. Correct hypokalemia. hypertension. Explanation: ß2 (beta2) adrenergic receptor agonists, also known as adrenergic ß2 receptor agonists, act on the ß2 adrenergic receptor. Like other ß adrenergic agonists, they cause smooth muscle relaxation. ß2 adrenergic agonists' effects on smooth muscle cause dilation of bronchial passages. They are primarily used to treat asthma and other pulmonary disorders, such as COPD. Examples of a beta2-adrenergic receptor agonists are albuterol , xamoterol, and terbutaline. Question: A patient who is receiving warfarin (Coumadin) requires the initiation of doxycycline (Doryx) for the treatment of pneumonia. The nurse practitioner knows that: this may cause a severe drug-drug interaction. the warfarin (Coumadin) dose may need to be decreased. Correct the warfarin (Coumadin) dose may need to be increased. this is one of the few drugs that warfarin (Coumadin) does not interact with. Explanation: Because tetracyclines depress plasma prothrombin activity, patients who are on anticoagulant therapy may require downward adjustment of their anticoagulant dosage. The combination of warfarin (Coumadin) and doxycycline (Doryx) may cause an increase in the INR and subsequent risk of bleeding. Hepatic metabolism is inhibited and alteration of vitamin K-producing gut flora may occur. Question: In children between the ages of 5-11, the long-term use of which asthma medication may cause a transient slowing of growth? Albuterol sulfate (Proventil) inhaled Budesonide (Pulmicort Flexhaler) inhaled Correct Levalbuterol (Xopenex) inhaled Montelukast (Singulair) oral Explanation: The use of inhaled corticosteroids in the management of persistent asthma in children between the ages of 5-11 is beneficial and recommended. However, medium doses of inhaled corticosteroids may cause local adverse effects (i.e. candidiasis) or a transient slowing of growth. Monitoring of growth should be performed in all children. Question: The primary antibiotic option for suspected pneumocystis pneumonia (PCP) in a patient with HIV infection is: moxifloxacin (Avelox). amphotericin B liposomal (AmBisome). levofloxacin (Levaquin). sulfamethoxazole/trimethoprim (Bactrim). Correct Explanation: The primary antibiotic option for suspected pneumocystis pneumonia (PCP) in an adult or adolescent patient with HIV infection is sulfamethoxazole/trimethoprim (Bactrim). Secondary options include dapsone, pyrimethamine (Daraprim), leucovorin and atovaquone (Mepron). Question: Which asthma medication does NOT directly exhibit an anti-inflammatory action? Cromolyn sodium (Intal) Fluticasone propionate (Flovent HFA) Ipratropium bromide (Atrovent HFA) Correct Theophylline (Theo-24) Explanation: Ipratropium bromide (Atrovent HFA) is an anticholinergic (parasympatholytic) agent that appears to inhibit vagally-mediated reflexes by antagonizing the action of acetylcholine, the transmitter agent released at the neuromuscular junctions in the lung to produce bronchodilation. Atrovent HFA does not exhibit anti-inflammatory properties. Glucocorticoids (i.e. fluticasone propionate [Flovent HFA]), cromolyn sodium (Intal) and xanthines (i.e. theophylline [Theo-24]) all exhibit anti-inflammatory properties. Question: In the treatment of chronic obstructive pulmonary disease (COPD), common side effects of corticosteroids may include: hypotension and hyperkalemia. muscle weakness and hyponatremia. hypernatremia and hypokalemia. Correct weight loss and hirsutism. Explanation: Common side effects of corticosteroids may include hypernatremia, hypokalemia, hypertension, muscle weakness, weight gain, and hirsutism, especially around the face. Long-term use may cause a moon face, a "buffalo hump" or rounding of the back. Question: Which of the following is an adrenergic drug that acts on the sympathetic nervous system? Epinephrine Correct Atropine Scopolamine Pilocarpine Explanation: Epinephrine is an adrenergic drug. Adrenergic drugs are also called adrenergic amines or sympathomimetic drugs. They work by stimulating the sympathetic nervous system (SNS). Adrenergic drugs cause increased blood pressure, vasoconstriction, bronchial dilatation, and increased heart rate. Atropine, scopolamine, and pilocarpine are all parasympathomimetic drugs that stimulate the parasympathetic nervous system. They are also known as cholinergics because of the action on the neurotransmitter acetylcholine. Question: Prolonged use of corticosteroids in children generally does NOT lead to: obesity. syndrome of inappropriate antidiuretic hormone (SIADH). Correct osteoporosis. growth retardation. Explanation: The prolonged use of corticosteroids can cause obesity or growth retardation in children. It also can lead to psychiatric disturbances such as depression, euphoria, insomnia, or mood swings. Osteoporosis may develop with long-term corticosteroid use, due to calcium loss. Question: Levofloxacin (Levaquin) is associated with potentially serious side effects, including: esophageal ulcer. pericarditis. pseudotumor cerebri. spontaneous tendon rupture. Correct Explanation: Levofloxacin (Levaquin) is associated with potentially serious side effects including tendinitis and tendon rupture, peripheral neuropathy, central nervous system effects including convulsions, toxic psychoses, and increased intracranial pressure. Question: The likelihood of a drug-related rash is increased when Augmentin is administered to a patient with a: diagnosis of mononucleosis. Correct hypersensitivity to clarithromycin. milk allergy. decreased glomerular filtration rate. Explanation: A high percentage of patients with mononucleosis who receive amoxicillin develop an erythematous skin rash. Thus, Augmentin should not be administered to patients with mononucleosis. Clarithromycin is a macrolide. Augmentin should be contraindicated in patients with a history of serious hypersensitivity reactions (e.g., anaphylaxis or Stevens-Johnson syndrome) to amoxicillin, clavulanate or to other beta-lactam antibacterial drugs (e.g., penicillins and cephalosporins). Question: Patient instructions for the use of inhaled steroids would NOT include to: hold breath for 5-10 seconds after deeply inhaling the medication. store the inhaler at room temperature. float the canister in water to determine whether it is empty. Correct rinse mouth with water, gargle and spit after inhalation. Explanation: Most inhalers have a dose counter. Putting the canister in water to see if it floats is not a reliable test. Some inhalers will float when they are full. Instruct the patient to hold the breath for 5-10 seconds after they have deeply inhaled the medication. This lets the medicine reach deep into the lungs. Patients should be instructed to rinse their mouth with water, gargle, and spit after using the medication. This helps reduce side effects related to the medication, such as oral candidiasis. Question: Long-acting bronchodilators, such as salmeterol (Serevent Diskus), are indicated in the treatment of: intermittent asthma in patients 12 years and older. exercise-induced asthma when the short-acting bronchodilator is ineffective. mild persistent asthma in ages 5-11 years. moderate persistent asthma in 5-11-year-olds, when combined with low-dose inhaled steroid. Correct Explanation: Long-acting bronchodilators (LABAs), such as salmeterol (Serevent Diskus), are indicated in the treatment of moderate persistent asthma in 5-11- year-olds, when combined with a low-dose inhaled steroid. They are indicated as concomitant therapy with a long-term asthma control medication, such as an inhaled corticosteroid, in patients aged 4 years and older with reversible obstructive airway disease. This is due to increased asthma-related deaths related to salmeterol use. Question: Inhaled antimuscarinic agents, such as ipratropium bromide (Atrovent HFA),: only come in a short-acting form. reduce exacerbation rates better than beta2-agonists. Correct increase cyclic AMP to create antagonism to bronchoconstriction. are rarely utilized due to significant side effect profile. Explanation: Inhaled antimuscarinic agents block the bronchoconstrictor effects of acetylcholine on M3 muscarinic receptors expressed in airway smooth muscle. There are short-acting antimuscarinics (SAMAs) and long-acting antimuscarinic antagonists (LAMAs). A greater effect on exacerbation rates for LAMA treatment (tiotropium) versus LABA treatment has been shown. Inhaled anticholinergic drugs are poorly absorbed, which limits the troublesome systemic effects observed with atropine. LABAs have proven to be very safe. Question: The patient's use of inhaler technique should be evaluated: at the initiation of therapy. at each visit. Correct every 6 months. yearly. Explanation: The patient's use of inhaler technique should be evaluated at each visit. The patient should bring the inhaler and demonstrate use to the provider regularly. It is important to determine proper use and delivery, especially before determining that the therapy is insufficient. Question: The mechanism of action of dextromethorphan is to: decrease parasympathetic tone of arterioles. decrease the sensitivity of cough receptors in the medulla. Correct relax smooth muscles in the bronchial tubes. increase surface velocity of airflow during cough. Explanation: The mechanism of action of dextromethorphan is to decrease the sensitivity of cough receptors in the medulla. It can help reduce the sensitivity and activity of the cough center and prevent it from triggering a cough. Question: Xanthines such as theophylline, used in the treatment of COPD, cause bronchodilation by: blocking the action of acetylcholine. decreasing the activity of inflammatory mediators. relaxing the smooth muscles of the bronchi. Correct stimulating beta 2 receptors. Explanation: Xanthines such as theophylline, used in the treatment of COPD cause bronchodilation by relaxing the smooth muscles of the bronchi and pulmonary blood vessels. Question: Unless contraindicated, all patients with a diagnosis of emphysema should receive: inhaled corticosteroids. influenza vaccination. Correct supplemental oxygen. theophylline (Theo-24). Explanation: Vaccination against influenza (all COPD patients) and pneumococcus (all COPD patients older than 65 or with other cardiopulmonary disease) is recommended because it reduces the incidence of lower respiratory tract infections. Inhaled corticosteroids are not indicated in all patients with emphysema. The risks versus the benefits should be weighed. Theophylline is indicated for persistent symptoms if inhaled therapy is insufficient to relieve airflow obstruction. The 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines generally advise against the routine practice of prescribing supplemental oxygen to stable COPD patients without severe resting hypoxemia. Question: Levofloxacin (Levaquin) should be avoided in patients with a history of: diabetes. hypotension. myasthenia gravis. Correct transient ischemic attacks. Explanation: Fluoroquinolones including levofloxacin (Levaquin) have neuromuscular blocking activity and may exacerbate muscle weakness in patients with myasthenia gravis. In patients with a known history of myasthenia gravis, serious adverse reactions include death and requirement for ventilatory support. Levofloxacin should therefore be avoided in these patients. Question: Which of the following medications is slowly and incompletely metabolized by the liver and excreted largely unchanged in the urine within 24 hours of oral administration? Fexofenadine (Allegra) Acetylcysteine (Mucomyst) Guaifenesin (Mucinex) Pseudoephedrine hydrochloride (Sudafed) Correct Explanation: Pseudoephedrine hydrochloride (Sudafed) and other systemic decongestants are slowly and incompletely metabolized by the liver and excreted largely unchanged in the urine within 24 hours of oral administration. Fexofenadine (Allegra) is largely excreted in the feces. Acetylcysteine (Mucomyst) is extensively metabolized in the liver and partially excreted in the urine. Guaifenesin is readily absorbed from the gastrointestinal tract and is rapidly metabolized and excreted in the urine. Question: For complaints of dysphonia related to the use of mometasone (Asmanex Twisthaler), the patient should be advised to: stop the inhaler immediately. decrease the dosage. apply an oropharyngeal analgesic prior to use. utilize a spacer for administration. Correct Explanation: For complaints of dysphonia related to the use of mometasone (Asmanex Twisthaler), the nurse practitioner should advise the patient to use a spacer when taking the medication. Using a spacer causes less deposition of the droplets in the mouth, which can cause dysphonia. If the asthma is well controlled, stopping the medication is not appropriate. The use of an oropharyngeal analgesic (i.e., Chloraseptic spray) would not help with inhibit dysphonia. Question: For previously healthy children with mild to moderate symptoms of suspected bacterial community-acquired pneumonia secondary to Streptococcus pneumoniae, the first-line therapy is: amoxicillin (Amoxil). Correct ceftriaxone (Rocephin). erythromycin base (Ery-Tab). trimethoprim-sulfamethoxazole (Bactrim DS). Explanation: Amoxicillin (Amoxil) should be the first-line choice in previously healthy children with suspected bacterial community-acquired pneumonia (CAP) secondary to Streptococcus pneumoniae. Amoxicillin provides appropriate coverage for Streptococcus pneumoniae, the most prominent invasive pathogen. Alternatives, in the case of non-IgE penicillin allergy, are second- and third-generation cephalosporins. Macrolide antibiotics should be considered when an atypical pathogen is suspected. Question: Montelukast (Singulair) is more than 99% bound to plasma proteins, extensively metabolized and eliminated via: bile. Correct expired breaths. sweat. urine. Explanation: Montelukast (Singulair) is more than 99% bound to plasma proteins, extensively metabolized and eliminated via bile. Question: For the treatment of chronic bronchitis, macrolides are contraindicated in patients who: are allergic to penicillin. have mild renal insufficiency. have hepatic dysfunction. Correct are pregnant. Explanation: Macrolides should be avoided in patients who have hepatic dysfunction because the risk of hepatotoxicity is increased. Macrolides are safe to use during pregnancy and in those with penicillin allergies; however, they should be used with caution in patients with renal insufficiency. Question: Which of the following is an muscarinic antagonist for use in exacerbations of chronic bronchitis? albuterol (ProAir HFA). fluticasone propionate (Flovent HFA) salmeterol (Serevent). tiotropium (Spiriva HandiHaler). Correct Explanation: Tiotropium (Spiriva HandiHaler) is a muscarinic antagonist used in the maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. It is also indicated to reduce exacerbations in COPD patients. Question: Montelukast (Singulair) blocks or inhibits the action of: adenosine receptors. leukotrienes. Correct stretch receptors. substance P. Explanation: Montelukast (Singulair) blocks or inhibits the action of leukotrienes. In asthma, leukotriene-mediated effects include airway edema, smooth muscle contraction, and altered cellular activity associated with the inflammatory process. In allergic rhinitis, cysteinyl leukotriene receptors are released from the nasal mucosa after allergen exposure during both early- and late-phase reactions and are associated with symptoms of allergic rhinitis. Question: When treating a patient with amoxicillin, he should be instructed to take the medication: with food. with milk. with a large glass of water. Correct with a high-fat meal. Explanation: Amoxicillin is readily absorbed by the gastric mucosa and may be taken without regard to food or milk. It should be taken at about the same time each day for the prescribed period of time. Question: A patient with pertussis is allergic to macrolide antibiotics and is being treated with trimethoprim sulfamethoxazole. She does NOT need to be monitored for: crystalluria. leukopenia. hyperglycemia. elevated liver enzymes. Correct Explanation: Additional monitoring of blood glucose may be warranted for diabetic patients receiving sulfamethoxazole and trimethoprim (Bactrim), especially if they are on oral hypoglycemics including glipizide and glyburide. CBC should be considered due to potential for aplastic anemia, thrombocytopenia, leukopenia, neutropenia, hemolytic anemia, and megaloblastic anemia. Urinalysis with microscopic examination and renal function tests should be performed during therapy in patients with impaired renal function. Question: Which medication has the greatest effect on the reduction of emphysema exacerbations? An inhaled corticosteroid A short-acting bronchodilator A long-acting bronchodilator A long-acting muscarinic antagonist. Correct Explanation: Long-acting muscarinic antagonists (LAMAs) are more effective in reducing exacerbations and hospitalizations compared to long-acting bronchodilators. Inhaled corticosteroids, when combined with long-acting beta agonists, are beneficial for reduction of exacerbations. A short-acting bronchodilator is indicated in symptom management of an exacerbation. Question: In Augmentin, amoxicillin and clavulanate are combined. The action of clavulanate is to: inhibit cell wall synthesis. bind to beta lactamase, hindering enzymatic activity. Correct inhibit nucleic acid and protein synthesis. increase permeability of the cell wall. Explanation: In Augmentin, clavulanate binds to beta lactamase, hindering enzymatic activity. This protects other beta-lactam antibiotics from beta lactamase catalysis, thereby enhancing their antibacterial effects. This agent is used in conjunction with beta lactamase susceptible antibiotics, such as penicillins and cephalosporins, to treat infections caused by beta lactamase-producing organisms. Question: In the treatment of pneumonia, a macrolide such as clarithromycin should NOT be coadministered with: acetaminophen. atorvastatin. Correct furosemide. propanolol. Explanation: The combination of certain macrolides, such as clarithromycin, and certain HMG-CoA reductase inhibitors, such as atorvastatin, is not advisable because it can lead to debilitating myopathy and rhabdomyolysis due to inhibition of the 3A4 enzymes. Question: In an acute upper respiratory infection, beta-lactam antibiotics: have a bacteriostatic effect on bacteria. inhibit cell wall synthesis of gram-positive bacteria. Correct are mostly narrow-spectrum. inhibit growth of MRSA. Explanation: Beta lactam antibiotics inhibit cell wall synthesis of bacteria by interfering with synthesis of peptidoglycan, a critical component of bacterial cell walls. Examples of beta lactam antibiotics include penams, cephalosporins, cephems, monobactams, and carbapenems. They are used in the treatment of pneumonia, acute bronchitis, and sinusitis and are effective against many gram-positive bacteria. Question: Which of the following medications does NOT produce bronchodilation? Short-acting anticholinergic Beta-adrenergic agonists Glucocorticosteroids Correct Xanthines Explanation: Glucocorticosteroids are used in the suppression of the inflammatory response in asthma and do NOT cause bronchodilation. [Show More]

Last updated: 2 years ago

Preview 1 out of 30 pages