AGNP BOARD EXAM QUESTIONS Respiratory Prescribing (Questions 100)
Question:
Treatment of Bordetella pertussis in a patient with a hypersensitivity to macrolides is:
doxycycline.
clindamycin (Cleocin).
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:
Treatment of Bordetella pertussis in a patient with a hypersensitivity to macrolides is:
doxycycline.
clindamycin (Cleocin).
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.
