NUR 600: ADVANCED CLINICAL PHARMACOLOGY: RESPIRATORY: EXAM 4
STUDY GUIDE QUESTIONS WITH COMPLETE SOLUTIONS
1) Chronic Obstructive Pulmonary Disease (COPD) -- Answer ✔✔ Characterized
by chronic progressive airflow limitation. • Typically thought of as chronic
bronchitis and/or emphysema; however, the current Global Obstructive Lung
Disease guidelines do not include either term in the definition of COPD.
Causes: tobacco smoking is the most common risk factor. Air pollutant exposure,
a history of severe respiratory infections as a child, and hereditary alpha-1
antitrypsin deficiency are other risk factors.
2) COPD Diagnostic Criteria -- Answer ✔✔ Chronic cough with our without
chronic sputum production. • Persistent progressive dyspnea that worsens with
exercise. • May or may not complain of chest tightness. •
May or may not have audible wheezing, cyanosis, barrel-shaped chest, low
diaphragms, and signs of cor pulmonale. • Spirometry is required for diagnosis of
COPD
3) Initiating Drug Therapy for COPD -- Answer ✔✔ The current GOLD guidelines
recommend drug therapy based on the COPD group.
Nondrug therapy includes tobacco cessation, avoidance of environmental and
occupational irritants, and energy conservation.
, COPD is an irreversible but treatable medical condition; the goals of therapy are
to reduce symptoms and reduce risk.
Risk may be reduced by delaying disease progression and preventing and treating
exacerbations.
- Short beta antagonist (SABA) for acute bronchospasm - Albuterol,
Levalbuterol, Epinephrine
- If SABA doesn't work. Adding low dose inhaled corticosteroid
(budesonide)
- If that doesn't work, increased dose of ICS or add long acting beta agonist
(salmeterol)
If none of previous meds work, use increased dose of ICS with LABA
If doesn't work, the HIGH dose ICS paired with LABA
If doesn't work, High does ICS +LABA+oral corticosteroid (prednisone)
4) Short-Acting Beta2-Agonists -- Answer ✔✔ Albuterol (Proventil HFA, Ventolin
HFA, ProAir HFA) MDI 90 mcg/inhalation; 1- 2 inhalations q4-q6 hours as needed
•
Albuterol (ProAir) DPI 117 mcg/inhalation 1-2 inhalations q4-6 hours as needed •
Albuterol (AccuNeb) 0.083% (2.5 mg/3 mL), 0.5% (2.5 mg/0.5 mL) solution for
nebulization; 2.5 mg 3 to 4 times a day as needed
5) Short-Acting Anticholinergics -- Answer ✔✔ Ipratropium bromide (Atrovent)
MDI 17 mcg/inhalation; 34 mcg four times daily •
Ipratropium bromide (Atrovent) solution for nebulization 0.02%; 500 mcg (2.5
mL) three to four times per day
6) Short-Acting Anticholinergic and Short-Acting Beta2- Adrenergic Agonist --
Answer ✔✔ Ipratropium bromide plus albuterol (DuoNeb) solution for
nebulization 500 mcg ipratropium bromide plus 2.5 mg albuterol per 3 mL; 3 mL
every 4-6h •
, Ipratropium bromide plus albuterol (Combivent Respimat) SMI 20 mcg
ipratropium bromide plus 100 mcg albuterol per inhalation; 1 inhalation four
times daily
7) LongActing Beta 2 - Agonists -- Answer ✔✔ Arformoterol (Brovana): 15 mcg/2
mL solution for nebulization; 15 mcg twice daily
Formoterol (Perforomist): 20 mcg/2 mL solution for nebulization; 20 mcg q12h
Formoterol (Perforomist): 20 mcg/2 mL solution for nebulization; 20 mcg q12h
Indacaterol
(Arcapta Breezhaler) DPI 75 mcg/inhalation; 75 mcg once daily Indacaterol
(Arcapta Breezhaler) DPI 75 mcg/inhalation; 75 mcg once daily
Olodaterol (Striverdi Respimat) AMI 2.5 mcg/actuation; 5 mcg once daily
Olodaterol (Striverdi Respimat) AMI 2.5 mcg/actuation; 5 mcg once daily
Salmeterol (Serevent Diskus) DPI 50mcg/inhalation; 50 mcg q12h Salmeterol
(Serevent Diskus) DPI
8) Long-Acting Anticholinergics -- Answer ✔✔ Tiotropium bromide (Spiriva
Handihaler) DPI 18 mcg; 18 mcg once daily •
Tiotropium bromide (Spiriva Respimat) SMI 2.5 mcg/inhalation; 5 mcg once daily •
Aclidinium bromide (Tudorza Pressair) DPI 400 mcg/actuation; 400 mcg twice
daily •
Umeclidinium bromide (Incruse Ellipta) DPI 62.5 mcg/inhalation; 62.5 mcg once
daily
9) Combination Long Acting Anticholinergic and Long-Acting Beta2-Agonists --
Answer ✔✔ Tiotropium 2.5 mcg and olodaterol 2.5 mcg per inhalation SMI
(Stiolto Respimat); 2 inhalations once daily
10) Combination Long Acting Beta2-Agonists and Corticosteroids -- Answer ✔✔
Formoterol 4.5 mcg and budesonide 160 mcg per inhalation MDI (Symbicort); 2
inhalations twice daily • Salmeterol 50 mcg and fluticasone 250 mcg per inhalation
DPI (Advair Diskus); 1 inhalation q12h • Vilanterol 25 mcg and fluticasone 100
mcg per inhalation DPI (Breo Ellipta); 1 inhalation daily
STUDY GUIDE QUESTIONS WITH COMPLETE SOLUTIONS
1) Chronic Obstructive Pulmonary Disease (COPD) -- Answer ✔✔ Characterized
by chronic progressive airflow limitation. • Typically thought of as chronic
bronchitis and/or emphysema; however, the current Global Obstructive Lung
Disease guidelines do not include either term in the definition of COPD.
Causes: tobacco smoking is the most common risk factor. Air pollutant exposure,
a history of severe respiratory infections as a child, and hereditary alpha-1
antitrypsin deficiency are other risk factors.
2) COPD Diagnostic Criteria -- Answer ✔✔ Chronic cough with our without
chronic sputum production. • Persistent progressive dyspnea that worsens with
exercise. • May or may not complain of chest tightness. •
May or may not have audible wheezing, cyanosis, barrel-shaped chest, low
diaphragms, and signs of cor pulmonale. • Spirometry is required for diagnosis of
COPD
3) Initiating Drug Therapy for COPD -- Answer ✔✔ The current GOLD guidelines
recommend drug therapy based on the COPD group.
Nondrug therapy includes tobacco cessation, avoidance of environmental and
occupational irritants, and energy conservation.
, COPD is an irreversible but treatable medical condition; the goals of therapy are
to reduce symptoms and reduce risk.
Risk may be reduced by delaying disease progression and preventing and treating
exacerbations.
- Short beta antagonist (SABA) for acute bronchospasm - Albuterol,
Levalbuterol, Epinephrine
- If SABA doesn't work. Adding low dose inhaled corticosteroid
(budesonide)
- If that doesn't work, increased dose of ICS or add long acting beta agonist
(salmeterol)
If none of previous meds work, use increased dose of ICS with LABA
If doesn't work, the HIGH dose ICS paired with LABA
If doesn't work, High does ICS +LABA+oral corticosteroid (prednisone)
4) Short-Acting Beta2-Agonists -- Answer ✔✔ Albuterol (Proventil HFA, Ventolin
HFA, ProAir HFA) MDI 90 mcg/inhalation; 1- 2 inhalations q4-q6 hours as needed
•
Albuterol (ProAir) DPI 117 mcg/inhalation 1-2 inhalations q4-6 hours as needed •
Albuterol (AccuNeb) 0.083% (2.5 mg/3 mL), 0.5% (2.5 mg/0.5 mL) solution for
nebulization; 2.5 mg 3 to 4 times a day as needed
5) Short-Acting Anticholinergics -- Answer ✔✔ Ipratropium bromide (Atrovent)
MDI 17 mcg/inhalation; 34 mcg four times daily •
Ipratropium bromide (Atrovent) solution for nebulization 0.02%; 500 mcg (2.5
mL) three to four times per day
6) Short-Acting Anticholinergic and Short-Acting Beta2- Adrenergic Agonist --
Answer ✔✔ Ipratropium bromide plus albuterol (DuoNeb) solution for
nebulization 500 mcg ipratropium bromide plus 2.5 mg albuterol per 3 mL; 3 mL
every 4-6h •
, Ipratropium bromide plus albuterol (Combivent Respimat) SMI 20 mcg
ipratropium bromide plus 100 mcg albuterol per inhalation; 1 inhalation four
times daily
7) LongActing Beta 2 - Agonists -- Answer ✔✔ Arformoterol (Brovana): 15 mcg/2
mL solution for nebulization; 15 mcg twice daily
Formoterol (Perforomist): 20 mcg/2 mL solution for nebulization; 20 mcg q12h
Formoterol (Perforomist): 20 mcg/2 mL solution for nebulization; 20 mcg q12h
Indacaterol
(Arcapta Breezhaler) DPI 75 mcg/inhalation; 75 mcg once daily Indacaterol
(Arcapta Breezhaler) DPI 75 mcg/inhalation; 75 mcg once daily
Olodaterol (Striverdi Respimat) AMI 2.5 mcg/actuation; 5 mcg once daily
Olodaterol (Striverdi Respimat) AMI 2.5 mcg/actuation; 5 mcg once daily
Salmeterol (Serevent Diskus) DPI 50mcg/inhalation; 50 mcg q12h Salmeterol
(Serevent Diskus) DPI
8) Long-Acting Anticholinergics -- Answer ✔✔ Tiotropium bromide (Spiriva
Handihaler) DPI 18 mcg; 18 mcg once daily •
Tiotropium bromide (Spiriva Respimat) SMI 2.5 mcg/inhalation; 5 mcg once daily •
Aclidinium bromide (Tudorza Pressair) DPI 400 mcg/actuation; 400 mcg twice
daily •
Umeclidinium bromide (Incruse Ellipta) DPI 62.5 mcg/inhalation; 62.5 mcg once
daily
9) Combination Long Acting Anticholinergic and Long-Acting Beta2-Agonists --
Answer ✔✔ Tiotropium 2.5 mcg and olodaterol 2.5 mcg per inhalation SMI
(Stiolto Respimat); 2 inhalations once daily
10) Combination Long Acting Beta2-Agonists and Corticosteroids -- Answer ✔✔
Formoterol 4.5 mcg and budesonide 160 mcg per inhalation MDI (Symbicort); 2
inhalations twice daily • Salmeterol 50 mcg and fluticasone 250 mcg per inhalation
DPI (Advair Diskus); 1 inhalation q12h • Vilanterol 25 mcg and fluticasone 100
mcg per inhalation DPI (Breo Ellipta); 1 inhalation daily
