ACCP Pharmacotherapy (To study for the BCPS Exam) QUESTIONS WITH COMPLETE SOLUTIONS LATEST UPDATED 2023

ACCP Pharmacotherapy (To study for the BCPS Exam) QUESTIONS WITH COMPLETE SOLUTIONS LATEST UPDATED 2023 A 32-year old woman with persistent asthma has shortness of breath (SOB) and wheezing that occur twice weekly. Her medical history includes allergic rhinitis, depression, and polycystic ovary syndrom. She uses her albuterol hydrofluoroalkane (HFA) inhaler twice weekly, usually when outside at the park. She wakes up at night coughing about once weekly. Her current drugs include albuterol HFA 1 or 2 puffs every 4-6 hours as needed for SOB, fluticasone/salmeterol Diskus 250/50 1 puff twice daily, loratadine 10 mg once daily for "allergies", fluticasone nasal spray 50 mcg 2 sprays each nostril once daily, and metformin 500 mg twice daily. Sertraline 50 mg once daily was initiated 2 months before this presentation. She does not have a peak flow meter, but she follows her asthma action plan. The patient cannot remember the last time she had to visit the emergency department (ED) for an exacerbation. What best addresses the patient's current symptoms? - CORRECT ANSWER Add montekulast 10 mg once daily at bedtime. (This patient's asthma is not well controlled (symptoms occur more than 2 days/week, bedtime symptoms occur 1-3 times a week, and the patient requires short-acting β-agonist (SABA) use 2 days/week). The patient may benefit from the addition of montelukast (an alternative agent) because she has allergic rhinitis (already uses intranasal steroid and daily antihistamine) and reports that the symptoms usually occur when outdoors (pollen exposure), which may mean that an allergic component is worsening her symptoms. Montelukast should not be withheld from a patient who might benefit from it, even if the patient has concomitant depression.) The following four patients have very poorly controlled asthma on high dose inhaled corticosteroids (ICS) plus a LABA. Which patient would benefit most from a trial of golimumab? A. A fifty-year-old architect with severe plaque psoriasis. B. An 18-year-old College freshman with irritable bowel disease. C. A 62-year-old retired man with osteoarthritis of the knee. D. A 24-year-old man with poorly controlled bipolar disorder. - CORRECT ANSWER A fifty-year-old architect with severe plaque psoriasis. (Golimumab, A human monoclonal antibody Tumor Necrosis Factor Alpha (TNF-α), Is most likely to benefit the patient with concomitant inflammatory disorders (poorly controlled asthma) and severe plaque psoriasis.)