p.69
Management of COPD Exacerbations
What is thromboprophylaxis?
Preventive treatment to reduce the risk of blood clots in hospitalized patients.
p.24
Pharmacologic Therapy for COPD
What should be monitored when using bupropion SR and varenicline?
Psychiatric disturbances.
p.43
Pharmacologic Therapy for COPD
What are the most common adverse effects of inhaled corticosteroids?
Oropharyngeal candidiasis and hoarse voice.
p.9
Pathophysiology of COPD
What occurs in advanced COPD that affects gas exchange?
Impaired gas exchange occurs, leading to hypoxemia and eventually hypercapnia.
p.38
Pharmacologic Therapy for COPD
Which type of medication may be more effective than LABAs for reducing exacerbations in moderate to very severe COPD?
LAMAs (Long-Acting Muscarinic Antagonists).
p.66
Pharmacologic Therapy for COPD
What benefits do antibiotics provide when indicated for exacerbations?
They reduce recovery time, risk of early relapse, risk of treatment failure, hospitalization duration, and mortality.
p.21
Pharmacologic Therapy for COPD
What factors influence the choice of NRT formulation?
Patient preference and various other factors.
p.63
Management of COPD Exacerbations
What type of therapy is recommended for managing COPD exacerbations?
Nonpharmacologic management.
p.52
Pharmacologic Therapy for COPD
What is the purpose of α1 - Antitrypsin Augmentation Therapy?
To maintain adequate plasma levels of the enzyme through weekly transfusions of pooled human AAT.
p.23
Pharmacologic Therapy for COPD
What type of receptor does Varenicline act on?
α4 β2 nicotinic acetylcholine receptor.
p.9
Pathophysiology of COPD
What is pulmonary hyperinflation and when does it occur in COPD?
Pulmonary hyperinflation occurs during exercise at first and then at rest with advancing disease.
p.35
Pharmacologic Therapy for COPD
What are examples of twice daily long-acting β2-agonists?
Salmeterol, formoterol, and arformoterol.
p.3
Chronic Obstructive Pulmonary Disease (COPD) Overview
What defines emphysema in the context of COPD?
Destruction of alveoli without fibrosis.
Is arterial blood gases (ABGs) necessary for diagnosing COPD?
No, ABGs are not necessary for diagnosis.
p.69
Management of COPD Exacerbations
Why should fluid balance be monitored closely in patients?
To prevent complications related to fluid overload or dehydration.
p.50
Vaccination Recommendations for COPD Patients
Which pneumococcal vaccine should be administered to adults with COPD?
Pneumococcal polysaccharide vaccine (PPSV23).
p.35
Pharmacologic Therapy for COPD
What are examples of once daily long-acting β2-agonists?
Indacaterol, olodaterol, and vilanterol.
p.60
Management of COPD Exacerbations
What characterizes a mild exacerbation?
Only short-acting bronchodilators are needed.
p.20
Pharmacologic Therapy for COPD
What are the first-line medications for tobacco use disorder?
Nicotine replacement therapy (NRT), Bupropion sustained-release (SR), and Varenicline.
p.35
Pharmacologic Therapy for COPD
What are some common adverse effects of β2-agonists?
Palpitations, tachycardia, hypokalemia, tremor, and sleep disturbance.
p.23
Pharmacologic Therapy for COPD
What effects does Varenicline have on withdrawal and craving?
It decreases withdrawal and craving.
p.40
Pharmacologic Therapy for COPD
Why is Theophylline's use limited?
Due to a narrow therapeutic index, multiple drug interactions, and adverse effects.
p.64
Pharmacologic Therapy for COPD
How can increased doses or frequency of bronchodilators help during an exacerbation?
They may provide additional benefit.
p.27
Treatment Goals for COPD
What is the goal of Long-Term Oxygen Therapy?
To achieve oxygen saturation of at least 90% and/or Pao2 of at least 60 mm Hg.
p.26
Nonpharmacologic Therapy for COPD
How many hours per day is long-term oxygen therapy administered?
Greater than 15 hours/day.
p.31
Pharmacologic Therapy for COPD
What important clinical outcomes are improved by long-acting bronchodilators?
Frequency of exacerbations, degree of dyspnea, and health-related quality of life.
p.61
Management of COPD Exacerbations
How does expiratory function change during COPD exacerbations?
Reduced expiratory function.
p.7
Pathophysiology of COPD
How does the inflammation in COPD differ from that in asthma?
The inflammation in COPD is mediated through neutrophils, macrophages, and CD8+ T lymphocytes, while asthma is mediated through eosinophils and mast cells.
What does GOLD 4 classification indicate?
Very Severe COPD with FEV1 less than 30% predicted.
p.58
Management of COPD Exacerbations
What characterizes a COPD exacerbation?
An acute event with worsening respiratory symptoms beyond normal variations, leading to a change in medication.
p.34
Pharmacologic Therapy for COPD
What are SABAs and why are they considered inconvenient for maintenance therapy?
SABAs (Short-Acting Beta-Agonists) are inconvenient for maintenance therapy due to the need for frequent dosing.
p.42
Pharmacologic Therapy for COPD
In which patients are inhaled corticosteroids (ICS) recommended?
In patients with moderate to very severe COPD with increased exacerbation risk who are not adequately controlled by first-line long-acting bronchodilators.
p.40
Pharmacologic Therapy for COPD
What is the primary action of Theophylline?
It is a nonselective phosphodiesterase inhibitor that increases intracellular cAMP within airway smooth muscle, resulting in bronchodilation.
p.54
Pharmacologic Therapy for COPD
When can β-blockers be continued in COPD patients?
When used to treat cardiovascular comorbidities.
p.47
Combination Therapy in COPD Management
What is a potential downside of triple therapy compared to LABA/LAMA combinations?
Increased incidence of pneumonia.
p.20
Pharmacologic Therapy for COPD
What is Varenicline?
A medication that helps people stop smoking by reducing cravings and withdrawal symptoms.
p.7
Pathophysiology of COPD
What role does AAT (antiproteinase) play in the lungs?
It inhibits trypsin, elastase, and several other proteolytic enzymes.
p.61
Management of COPD Exacerbations
What is a common change in mucus production during COPD exacerbations?
Increased mucus production.
p.17
Nonpharmacologic Therapy for COPD
What approach is recommended for patients willing to quit smoking?
A combined approach of behavioral and cognitive strategies along with pharmacotherapy.
p.41
Pharmacologic Therapy for COPD
What are the most common adverse effects of theophylline?
Heartburn, restlessness, insomnia, irritability, tachycardia, and tremor.
p.41
Pharmacologic Therapy for COPD
What are dose-related adverse effects of theophylline?
Nausea, vomiting, seizures, and arrhythmias.
p.4
Etiology and Risk Factors of COPD
What is the most common cause of COPD?
Cigarette smoke, including secondhand smoking.
p.63
Management of COPD Exacerbations
What is the target oxygen saturation for COPD exacerbation management?
88% to 92% (0.88 – 0.92).
p.4
Etiology and Risk Factors of COPD
Besides cigarette smoke, what other substances can contribute to COPD?
Marijuana and other forms of tobacco.
p.66
Pharmacologic Therapy for COPD
Are antibiotics recommended for all exacerbations in pharmacologic management?
No, they are not recommended for all exacerbations.
p.9
Pathophysiology of COPD
What happens when the narrowing of the airways worsens in COPD?
The rate of lung emptying slows, and the interval between inspirations does not allow expiration to the relaxation volume of the lungs.
p.24
Pharmacologic Therapy for COPD
What psychiatric disturbances are associated with bupropion SR and varenicline?
Depression, anxiety, and psychosis.
p.46
Combination Therapy in COPD Management
When is combination therapy indicated?
When monotherapy is not effective alone.
p.51
Vaccination Recommendations for COPD Patients
What vaccine can be used in select patients 65 years and older?
Pneumococcal conjugate vaccine (PCV13).
p.4
Etiology and Risk Factors of COPD
What rare hereditary condition can cause COPD?
A deficiency of α1-antitrypsin (AAT).
p.67
Management of COPD Exacerbations
When are antibiotics recommended for patients?
For patients with increased sputum purulence and either increased sputum volume or increased dyspnea, or all three symptoms, or those requiring mechanical ventilation.
p.69
Nonpharmacologic Therapy for COPD
Why is smoking cessation important in therapy?
It significantly improves health outcomes and reduces disease progression.
p.3
Chronic Obstructive Pulmonary Disease (COPD) Overview
What is a key characteristic of chronic bronchitis?
A chronic productive cough for at least 3 months in each of two consecutive years, with other causes excluded.
p.54
Pharmacologic Therapy for COPD
What effect do β-blockers have on COPD patients?
They may reduce mortality and exacerbation rates.
p.46
Combination Therapy in COPD Management
What is the preferred combination for COPD treatment?
Long acting anticholinergic with LABA.
p.51
Vaccination Recommendations for COPD Patients
Under what condition can PCV13 be administered to patients 65 and older?
If deemed appropriate by shared clinical decision-making.
p.4
Etiology and Risk Factors of COPD
What factors can reduce maximal attained lung function and increase the risk of COPD?
Maternal smoking, preterm birth, early childhood lung infections, air pollution, childhood asthma, and active smoking during adolescence.
p.62
Management of COPD Exacerbations
What are signs of a severe COPD exacerbation?
Use of accessory muscles to breathe, tachypnea, hypoxemia, and hypercarbia.
p.2
Chronic Obstructive Pulmonary Disease (COPD) Overview
What is Chronic Obstructive Pulmonary Disease (COPD)?
A progressive disease characterized by airflow limitation that is not fully reversible.
p.6
Pathophysiology of COPD
What causes chronic inflammation in the pathophysiology of COPD?
Repeated exposure to noxious particles and gases.
p.54
Pharmacologic Therapy for COPD
Why were β-blockers historically avoided in COPD patients?
Due to concerns of worsening respiratory status.
p.34
Pharmacologic Therapy for COPD
What should patients treated with LABAs have for as-needed use?
Patients treated with LABAs should have a SABA, such as albuterol, for as-needed use.
p.48
Combination Therapy in COPD Management
In which subgroup of COPD patients can ICS withdrawal be considered?
Nonfrequent exacerbating stable COPD patients with blood eosinophil counts less than 300 cells/μL.
p.27
Treatment Goals for COPD
What is the indication for Long-Term Oxygen Therapy in COPD patients?
Stable patients with severe resting hypoxemia (Pao2 at or below 55 mm Hg or Sao2 at or below 88%).
When should ABGs be assessed in COPD patients?
If oxygen saturation is less than 92%.
p.6
Pathophysiology of COPD
What is the role of proteinases and antiproteinases in COPD?
An imbalance between proteinases and antiproteinases contributes to the pathogenesis of COPD.
p.42
Pharmacologic Therapy for COPD
Why are ICS not recommended as monotherapy?
Because they are less effective than combined therapy with a long-acting beta-agonist (LABA).
p.14
Treatment Goals for COPD
What is a goal regarding lung function in COPD treatment?
Minimizing the rate of decline in lung function.
p.53
Pharmacologic Therapy for COPD
What is the benefit of daily oral azithromycin in COPD management?
It reduces the incidence of acute exacerbations.
p.55
Pharmacologic Therapy for COPD
What is the purpose of maintenance medications in COPD?
To manage symptoms and prevent exacerbations.
p.62
Management of COPD Exacerbations
What might patients exhibit during a severe COPD exacerbation?
Cyanosis and peripheral edema.
p.34
Pharmacologic Therapy for COPD
What is a key recommendation for patients using SABAs?
Patients should be advised to avoid excessive use of SABAs.
p.48
Combination Therapy in COPD Management
What is the blood eosinophil count threshold for considering ICS withdrawal in COPD patients?
Less than 300 cells/μL (0.3 × 10^9/L).
p.69
Vaccination Recommendations for COPD Patients
What role does vaccination play in therapy?
It helps prevent respiratory infections that can exacerbate COPD.
p.53
Pharmacologic Therapy for COPD
Are leukotriene modifiers recommended routinely for COPD?
No, they are not recommended routinely.
p.36
Pharmacologic Therapy for COPD
What are long-acting muscarinic antagonists (LAMAs)?
Tiotropium, umeclidinium, aclidinium, glycopyrrolate, and revefenacin.
p.25
Pharmacologic Therapy for COPD
What are some pharmacological options for increasing abstinence rates in smoking cessation?
Various Nicotine Replacement Therapies (NRTs), bupropion SR, and varenicline.
p.32
Pharmacologic Therapy for COPD
What is the preferred treatment approach for stable COPD?
Monotherapy with long-acting bronchodilators.
What FEV1/FVC ratio confirms airflow limitation in COPD?
A postbronchodilator FEV1/FVC ratio less than 70% (0.70).
p.22
Pharmacologic Therapy for COPD
In which patients is bupropion contraindicated?
Patients with seizure disorders, eating disorders, and those withdrawing from alcohol or sedative-hypnotics.
p.39
Pharmacologic Therapy for COPD
What serious condition can be precipitated by anticholinergics?
Narrow-angle glaucoma symptoms.
What does GOLD 3 classification indicate?
Severe COPD with FEV1 between 30% and 49% predicted.
p.46
Combination Therapy in COPD Management
What should be considered if a patient remains symptomatic?
Combination therapy of inhaled corticosteroid, LABA, and long acting anticholinergic.
p.67
Pharmacologic Therapy for COPD
What factors should be considered when selecting an antimicrobial regimen?
Severity of exacerbation and local resistance patterns.
p.64
Pharmacologic Therapy for COPD
What is the first-line pharmacologic agent for managing COPD exacerbations?
A short-acting β2-agonist with or without ipratropium via MDI or nebulizer.
p.45
Pharmacologic Therapy for COPD
What neurological adverse effects can be associated with PDE-4 inhibitors?
Insomnia, anxiety, depression, and suicidal ideation.
p.52
Pharmacologic Therapy for COPD
Is augmentation therapy recommended for individuals with AAT deficiency who do not have lung disease?
No, it is not recommended for those individuals.
What organization provides guidelines for COPD?
The Global Initiative for Chronic Obstructive Lung Disease (GOLD).
What is recommended for all COPD patients regarding AAT levels?
An AAT level assessment is recommended, especially in areas with high prevalence of AAT deficiency.
p.31
Pharmacologic Therapy for COPD
What is a key difference between long-acting and short-acting bronchodilators?
Long-acting bronchodilators are more expensive but superior in clinical outcomes.
p.53
Pharmacologic Therapy for COPD
What is a potential risk associated with daily oral azithromycin?
Prolongation of the QT interval.
p.8
Pathophysiology of COPD
What results from mucus, inflammatory debris, and disrupted tissue repair?
Narrowing of small airways.
p.33
Pharmacologic Therapy for COPD
What are long-acting β2-agonists (LABAs) used for in COPD management?
To provide continuous bronchodilation.
p.44
Pharmacologic Therapy for COPD
How do the side effects of PDE - 4 inhibitors compare to ICS and LABA?
They have more frequent side effects than ICS and LABA.
p.47
Combination Therapy in COPD Management
What is commonly used for patients who remain symptomatic on dual therapy?
Triple therapy with ICS, LABA, and LAMA.
p.14
Treatment Goals for COPD
What is a desired outcome of COPD treatment related to smoking?
Smoking cessation if applicable.
p.26
Nonpharmacologic Therapy for COPD
What is pulmonary rehabilitation effective for?
Patients with an FEV1 less than 50% predicted.
What is the purpose of the modified Medical Research Council Questionnaire (mMRC)?
To assess symptoms in patients with COPD.
p.5
Etiology and Risk Factors of COPD
What are some occupational risk factors for COPD?
Exposure to dusts, chemicals, vapors, irritants, and fumes.
p.50
Vaccination Recommendations for COPD Patients
What is the recommendation for patients older than 65 years regarding pneumococcal vaccination?
They should be revaccinated if it has been more than 5 years since initial vaccination and they were younger than 65 years at that time.
p.8
Pathophysiology of COPD
What is the effect of oxidative stress on antiproteinase activity?
It reduces antiproteinase activity, resulting in an imbalance.
p.53
Pharmacologic Therapy for COPD
Is N-acetylcysteine recommended routinely for COPD?
No, it is not recommended routinely.
p.40
Pharmacologic Therapy for COPD
What important drug interaction affects Theophylline metabolism?
Tobacco smoke induces Theophylline metabolism and increases its clearance.
p.7
Pathophysiology of COPD
What happens when there is a deficiency of AAT?
It results in unopposed proteinase activity, promoting destruction of alveolar walls and lung parenchyma, leading to emphysema.
p.25
Pharmacologic Therapy for COPD
What is a common practice when using NRTs?
Combining NRTs, such as using a nicotine patch with 'as needed' gum.
p.60
Management of COPD Exacerbations
What additional treatments are required for a moderate exacerbation?
Antibiotics and/or corticosteroids.
p.6
Pathophysiology of COPD
What are the consequences of chronic inflammation in COPD?
Pathologic changes in the central and peripheral airways, lung parenchyma, and pulmonary vasculature that lead to obstruction.
p.52
Pharmacologic Therapy for COPD
Can augmentation therapy be considered for patients with an FEV1 greater than 65%?
Yes, it can be considered even in those patients.
p.32
Pharmacologic Therapy for COPD
How can bronchodilators be administered for stable COPD?
They can be used as needed for symptoms or on a scheduled basis.
p.39
Pharmacologic Therapy for COPD
What are the most common side effects of anticholinergics?
Dry mouth, headache, and nasopharyngitis.
p.5
Etiology and Risk Factors of COPD
How does biomass smoke inhalation affect COPD risk?
It is considered a risk factor for developing COPD.
p.36
Pharmacologic Therapy for COPD
Which LAMAs require twice-daily dosing?
Aclidinium and glycopyrrolate.
p.25
Pharmacologic Therapy for COPD
What did a meta-analysis conclude about NRT, bupropion SR, and varenicline?
All improve smoking cessation rates.
What does GOLD 2 classification indicate?
Moderate COPD with FEV1 between 50% and 79% predicted.
p.44
Pharmacologic Therapy for COPD
For which patients is Roflumilast indicated?
Patients with severe COPD associated with chronic bronchitis and a history of exacerbations.
p.50
Vaccination Recommendations for COPD Patients
What type of vaccination should all adults with COPD receive annually?
Annual influenza vaccination.
p.20
Pharmacologic Therapy for COPD
What is Nicotine Replacement Therapy (NRT)?
A treatment that provides a low dose of nicotine to help reduce withdrawal symptoms.
p.42
Pharmacologic Therapy for COPD
What is the benefit of ICS in COPD patients?
ICS are most beneficial in preventing exacerbations in patients with elevated serum eosinophils (> 220 – 300 cells/μL).
p.8
Pathophysiology of COPD
What causes oxidative stress in the pathophysiology of COPD?
Smoke exposure and an increase in activated neutrophils and macrophages.
p.22
Pharmacologic Therapy for COPD
What neurotransmitters does bupropion block the reuptake of?
Dopamine (DA) and norepinephrine (NE).
p.26
Nonpharmacologic Therapy for COPD
What is the purpose of long-term oxygen therapy?
To reduce mortality and improve quality of life in patients with chronic respiratory failure.
Which assessment tool is abbreviated as mMRC?
Modified Medical Research Council Questionnaire.
p.25
Pharmacologic Therapy for COPD
How do NRTs, bupropion SR, and varenicline compare to placebo?
They increase abstinence rates at 6 months compared to placebo.
p.8
Pathophysiology of COPD
What are the consequences of mucus hypersecretion and ciliary dysfunction?
Chronic cough and sputum production.
p.5
Etiology and Risk Factors of COPD
How does asthma contribute to the risk of developing COPD?
It is a pre-existing condition that can increase the risk.
p.9
Pathophysiology of COPD
What develops late in the course of COPD and what can it result in?
Pulmonary hypertension develops late in COPD and can result in cor pulmonale, or right-sided heart failure.
p.54
Pharmacologic Therapy for COPD
Are β-blockers safe for COPD patients?
Yes, particularly β1-selective agents appear to be safe.
p.38
Pharmacologic Therapy for COPD
What should patients using a LAMA as maintenance therapy also be prescribed?
A SABA (Short-Acting Beta Agonist) as their rescue therapy.
p.20
Pharmacologic Therapy for COPD
What is Bupropion sustained-release (SR) used for?
It is used as a medication to help individuals quit smoking.
What might a complete blood count (CBC) reveal in COPD patients?
An elevated hematocrit that may exceed 55% (polycythemia).
p.6
Pathophysiology of COPD
What factors contribute to the pathogenesis of COPD?
Increased production or activity of destructive proteinases and inactivation or reduced production of protective antiproteinases.
What is the basis for diagnosing COPD?
Based on symptoms, risk factors, and spirometry.
p.8
Pathophysiology of COPD
What do inflammatory cells and mediators stimulate in COPD?
Mucus gland hyperplasia and mucus hypersecretion.
p.64
Pharmacologic Therapy for COPD
What should be discontinued if ipratropium is used?
Long-acting anticholinergics.
How is the severity of COPD classified?
Based on FEV1 postbronchodilator.
p.44
Pharmacologic Therapy for COPD
What is the primary action of Phosphodiesterase - 4 (PDE - 4) inhibitors?
They reduce inflammation by inhibiting the breakdown of cAMP.
p.33
Pharmacologic Therapy for COPD
List some long-acting β2-agonists (LABAs) used in COPD.
Salmeterol, formoterol, arformoterol, indacaterol, olodaterol, and vilanterol.
p.25
Pharmacologic Therapy for COPD
How do varenicline and combination NRT compare in effectiveness?
They were found to be equally effective.
p.2
Etiology and Risk Factors of COPD
How was COPD previously classified?
Into two types: chronic bronchitis and emphysema.
p.59
Etiology and Risk Factors of COPD
What are common precipitating factors for COPD exacerbations?
Air pollution, viral respiratory infections (usually rhinovirus), and bacterial respiratory tract infections (usually Haemophilus influenzae).
p.65
Pharmacologic Therapy for COPD
When should IV corticosteroids be used?
Only if the oral route is not tolerated.
p.38
Pharmacologic Therapy for COPD
Why is ipratropium not recommended as an alternative to albuterol?
Due to the risk of excessive anticholinergic effects when combined with LAMAs.
p.15
Etiology and Risk Factors of COPD
Who are considered high-risk patients in COPD?
Patients with a history of two or more exacerbations per year or those requiring hospitalization for exacerbations.
p.37
Pharmacologic Therapy for COPD
Why is Ipratropium not typically recommended?
Because it has a longer onset of action than SABAs and decreased efficacy compared to tiotropium.
p.22
Pharmacologic Therapy for COPD
How does bupropion help with nicotine dependence?
It reduces nicotine reinforcement, withdrawal, and craving.
What does GOLD 1 classification indicate?
Mild COPD with FEV1 at 80% predicted or greater.
p.44
Pharmacologic Therapy for COPD
Should Roflumilast be combined with theophylline?
No, it should not be combined with theophylline.
p.45
Pharmacologic Therapy for COPD
What are common gastrointestinal adverse effects of PDE-4 inhibitors?
Diarrhea, weight loss, nausea, and abdominal pain.
p.60
Management of COPD Exacerbations
What defines a severe exacerbation?
Hospitalization or emergency room visit is required, often with acute respiratory failure present.
p.36
Pharmacologic Therapy for COPD
What are some examples of anticholinergics (antimuscarinics)?
Ipratropium, tiotropium, aclidinium, and umeclidinium.
What does the COPD Assessment Test (CAT) evaluate?
The impact of COPD on a patient's health status.
p.37
Pharmacologic Therapy for COPD
How does the onset of action of Ipratropium compare to short-acting β2-agonists (SABAs)?
Ipratropium has a longer onset of action than SABAs.
p.59
Management of COPD Exacerbations
How do exacerbations associated with viral infections compare in severity?
They are often more severe.
p.14
Treatment Goals for COPD
What quality of life aspect is targeted in COPD treatment?
Maintaining or improving quality of life.
p.5
Etiology and Risk Factors of COPD
How does environmental air pollution relate to COPD?
It is a risk factor for developing the disease.
p.44
Pharmacologic Therapy for COPD
Is Roflumilast a first-line agent for COPD?
No, it is not a first-line agent.
p.3
Chronic Obstructive Pulmonary Disease (COPD) Overview
What are the two main phenotypes of COPD?
Chronic bronchitis and emphysema.
p.23
Pharmacologic Therapy for COPD
What does Varenicline prevent if a patient relapses?
It prevents the reinforcing effects of nicotine.
p.23
Pharmacologic Therapy for COPD
What are some warnings associated with Varenicline?
Seizures and cardiovascular adverse events (e.g., angina).
p.31
Pharmacologic Therapy for COPD
How do bronchodilators affect pulmonary rehabilitation efficacy?
They improve pulmonary rehabilitation efficacy and health status.
What type of symptoms do the mMRC and CAT tools assess?
Symptoms related to Chronic Obstructive Pulmonary Disease (COPD).
p.15
Treatment Goals for COPD
What is the goal of using inhaled long-acting bronchodilators in COPD treatment?
To reduce the frequency of exacerbations.
p.5
Etiology and Risk Factors of COPD
What type of respiratory infections in childhood can increase COPD risk?
Severe childhood respiratory infections.
p.53
Pharmacologic Therapy for COPD
What are some adverse effects of daily oral azithromycin?
Cardiovascular adverse effects, hearing loss, and bacterial resistance.
p.53
Pharmacologic Therapy for COPD
In which patients is daily oral azithromycin ideally used?
In former smokers with continued exacerbations while on appropriate inhaled therapy.
p.44
Pharmacologic Therapy for COPD
What is the effect of Roflumilast on symptoms and quality of life?
It has little effect on symptoms and quality of life.
p.2
Pathophysiology of COPD
What do current guidelines focus on regarding COPD?
Chronic airflow limitation, as many patients share characteristics of both chronic bronchitis and emphysema.
p.60
Management of COPD Exacerbations
What factors are exacerbation classifications based on?
The patient’s clinical status.
p.14
Treatment Goals for COPD
How does COPD treatment aim to affect exercise?
Improving exercise tolerance.
p.33
Pharmacologic Therapy for COPD
What is the purpose of short-acting β2-agonists in COPD treatment?
To provide rescue therapy for acute symptoms.
p.39
Pharmacologic Therapy for COPD
What is the cardiovascular safety profile of tiotropium and ipratropium?
No increased cardiovascular risk.
p.52
Pharmacologic Therapy for COPD
In which patients is augmentation therapy most beneficial?
Patients with an FEV1 of 35% to 49% predicted.
p.32
Pharmacologic Therapy for COPD
What are the main types of pharmacologic therapy for stable COPD?
Bronchodilators, including β2-agonists, anticholinergics, and methylxanthines.
p.62
Management of COPD Exacerbations
What are life-threatening signs of a COPD exacerbation?
Mental status changes, worsening respiratory status despite ventilator support, and hemodynamic instability.
p.27
Treatment Goals for COPD
What additional conditions may indicate the need for Long-Term Oxygen Therapy?
Evidence of pulmonary hypertension, peripheral edema suggesting congestive heart failure, or polycythemia.
p.31
Pharmacologic Therapy for COPD
What are the effects of bronchodilators in stable COPD?
They can increase FEV1, reduce symptoms, reduce exacerbation and hospitalization rates, and improve exercise tolerance.
p.40
Pharmacologic Therapy for COPD
When is Theophylline indicated for use?
If patients cannot use the inhalation route or remain symptomatic despite appropriate use of inhaled bronchodilators.
p.33
Pharmacologic Therapy for COPD
What type of therapy do most COPD patients need on a daily basis?
Continuous bronchodilator therapy with long-acting agents.
p.36
Pharmacologic Therapy for COPD
Which LAMAs allow for once-daily dosing?
Tiotropium, revefenacin, and umeclidinium.
p.15
Pharmacologic Therapy for COPD
What type of medication do high-risk COPD patients require?
Inhaled long-acting bronchodilators on a scheduled basis.
p.33
Pharmacologic Therapy for COPD
Name a few short-acting β2-agonists used in COPD.
Albuterol (salbutamol), levalbuterol (R-salbutamol), and terbutaline.
p.14
Treatment Goals for COPD
What is a preventive goal in the treatment of COPD?
Preventing and treating exacerbations.
p.5
Etiology and Risk Factors of COPD
What condition characterized by increased sensitivity of the airways is a risk factor for COPD?
Bronchial hyperresponsiveness.
p.50
Vaccination Recommendations for COPD Patients
When should patients older than 65 years be revaccinated with PPSV23?
A) Every year
B) If it has been more than 5 years since initial vaccination
C) Only if they have symptoms of COPD
D) Every 10 years
E) They do not need revaccination
B) If it has been more than 5 years since initial vaccination
Explanation: Patients older than 65 years should be revaccinated with the pneumococcal polysaccharide vaccine if it has been more than 5 years since their initial vaccination and they were younger than 65 at that time.
p.69
Management of COPD Exacerbations
Why is fluid balance important in patient care?
A) To ensure proper nutrition
B) To monitor blood pressure
C) To prevent dehydration
D) To monitor closely for complications
E) To enhance physical activity
D) To monitor closely for complications
Explanation: Monitoring fluid balance closely is essential in patient care to prevent complications related to fluid overload or dehydration, which can significantly impact recovery and overall health.
p.45
Pharmacologic Therapy for COPD
Which of the following is NOT an adverse effect of PDE - 4 inhibitors?
A) Weight loss
B) Nausea
C) Increased appetite
D) Insomnia
E) Headache
C) Increased appetite
Explanation: Increased appetite is not mentioned as an adverse effect of PDE - 4 inhibitors; instead, decreased appetite is noted, along with other adverse effects.
p.45
Pharmacologic Therapy for COPD
What neuropsychiatric effect has been reported with PDE - 4 inhibitors?
A) Euphoria
B) Anxiety
C) Increased energy
D) Memory loss
E) Hallucinations
B) Anxiety
Explanation: Anxiety is one of the neuropsychiatric effects reported with the use of PDE - 4 inhibitors, indicating the potential psychological impact of these medications.
p.35
Pharmacologic Therapy for COPD
Which of the following is a once daily long-acting β2-agonist?
A) Salmeterol
B) Formoterol
C) Indacaterol
D) Arformoterol
E) Vilanterol
C) Indacaterol
Explanation: Indacaterol is listed as a once daily long-acting β2-agonist, making it suitable for patients requiring consistent bronchodilation with a single daily dose.
p.23
Pharmacologic Therapy for COPD
What type of receptor does Varenicline act on?
A) α1 β2 adrenergic receptor
B) α4 β2 nicotinic acetylcholine receptor
C) GABA receptor
D) Serotonin receptor
E) Dopamine receptor
B) α4 β2 nicotinic acetylcholine receptor
Explanation: Varenicline is specifically identified as a partial agonist of the α4 β2 nicotinic acetylcholine receptor, which is crucial for its mechanism of action in smoking cessation.
p.17
Nonpharmacologic Therapy for COPD
What combined approach is recommended for patients willing to quit smoking?
A) Only behavioral strategies
B) Only pharmacotherapy strategies
C) A combined approach of behavioral and cognitive strategies with pharmacotherapy
D) No specific approach is recommended
E) Only support groups
C) A combined approach of behavioral and cognitive strategies with pharmacotherapy
Explanation: For patients willing to quit smoking, a combined approach that includes both behavioral and cognitive strategies along with pharmacotherapy is recommended to enhance the chances of successful cessation.
p.38
Pharmacologic Therapy for COPD
Which class of medications may be more effective than LABAs for reducing exacerbations in patients with moderate to very severe COPD?
A) SABA
B) LAMA
C) Corticosteroids
D) Methylxanthines
E) Leukotriene modifiers
B) LAMA
Explanation: Long-acting muscarinic antagonists (LAMAs) are indicated to be more effective than long-acting beta-agonists (LABAs) in reducing exacerbations in patients with moderate to very severe COPD.
p.47
Combination Therapy in COPD Management
What is a potential risk associated with triple therapy compared to LABA/LAMA combinations?
A) Increased risk of heart disease
B) Increased incidence of pneumonia
C) Decreased lung function
D) Increased risk of diabetes
E) Decreased medication adherence
B) Increased incidence of pneumonia
Explanation: Triple therapy appears to increase the incidence of pneumonia when compared to LABA/LAMA combinations, highlighting a significant risk that healthcare providers must consider.
p.65
Pharmacologic Therapy for COPD
When should IV corticosteroids be used in pharmacologic management?
A) As the first line of treatment
B) Only if the oral route is not tolerated
C) For long-term management
D) In all cases of COPD
E) When patients are stable
B) Only if the oral route is not tolerated
Explanation: IV corticosteroids should be used only if the oral route is not tolerated, indicating a specific condition under which this treatment is appropriate.
p.2
Pathophysiology of COPD
What do current guidelines for COPD focus on?
A) Specific types of lung cancer
B) Chronic airflow limitation
C) Treatment options only
D) Age-related lung diseases
E) Environmental factors
B) Chronic airflow limitation
Explanation: Current guidelines emphasize chronic airflow limitation rather than strictly categorizing COPD into chronic bronchitis and emphysema, reflecting a more integrated understanding of the disease.
p.59
Management of COPD Exacerbations
How do exacerbations associated with viral infections typically compare in severity?
A) They are less severe
B) They are equally severe
C) They are often more severe
D) They are not related to severity
E) They are more manageable
C) They are often more severe
Explanation: Exacerbations associated with viral infections, particularly rhinovirus, are often noted to be more severe, indicating the need for careful management during such episodes.
p.9
Pathophysiology of COPD
What occurs in advanced COPD that affects gas exchange?
A) Improved gas exchange
B) Impaired gas exchange
C) No change in gas exchange
D) Increased oxygen levels
E) Decreased carbon dioxide levels
B) Impaired gas exchange
Explanation: In advanced stages of COPD, impaired gas exchange occurs, leading to conditions such as hypoxemia (low oxygen levels) and hypercapnia (high carbon dioxide levels).
p.48
Combination Therapy in COPD Management
What is the eosinophil count threshold for considering ICS withdrawal in stable COPD patients?
A) 500 cells/μL
B) 300 cells/μL
C) 100 cells/μL
D) 400 cells/μL
E) 200 cells/μL
B) 300 cells/μL
Explanation: The guideline specifies that ICS withdrawal can be considered in stable COPD patients with blood eosinophil counts less than 300 cells/μL, which helps identify those who may not benefit from continued ICS therapy.
p.63
Management of COPD Exacerbations
What is the recommended oxygen saturation level for COPD exacerbation management?
A) 80% to 85%
B) 85% to 90%
C) 88% to 92%
D) 90% to 95%
E) 95% to 100%
C) 88% to 92%
Explanation: For managing COPD exacerbations, oxygen should be titrated to maintain a saturation level between 88% and 92%, ensuring adequate oxygenation without risking hypercapnia.
p.46
Combination Therapy in COPD Management
When is combination therapy indicated in COPD treatment?
A) When monotherapy is effective
B) When monotherapy is not effective alone
C) When the patient is asymptomatic
D) When the patient prefers oral medication
E) When the patient has no history of COPD
B) When monotherapy is not effective alone
Explanation: Combination therapy is indicated when monotherapy fails to provide adequate symptom relief, highlighting the need for a more comprehensive treatment approach.
p.37
Pharmacologic Therapy for COPD
What is the onset of action for Ipratropium?
A) 5 minutes
B) 10 minutes
C) 15 minutes
D) 30 minutes
E) 1 hour
C) 15 minutes
Explanation: Ipratropium has an onset of action of 15 minutes, which is longer than that of short-acting β2-agonists (SABAs), making it less favorable in some acute situations.
p.14
Treatment Goals for COPD
What is a key goal related to smoking in COPD treatment?
A) Encouraging smoking
B) Smoking cessation if applicable
C) Ignoring smoking habits
D) Increasing smoking frequency
E) Promoting tobacco use
B) Smoking cessation if applicable
Explanation: Smoking cessation is a crucial goal in the treatment of COPD, as it can significantly improve health outcomes and slow disease progression.
p.24
Pharmacologic Therapy for COPD
What is the primary concern regarding the use of bupropion SR and varenicline?
A) Weight gain
B) Cardiovascular issues
C) Psychiatric disturbances
D) Respiratory problems
E) Allergic reactions
C) Psychiatric disturbances
Explanation: The primary concern highlighted in the text is the association of bupropion SR and varenicline with psychiatric disturbances, which necessitates careful consideration when prescribing these medications for smoking cessation.
What must be excluded to diagnose chronic bronchitis?
A) Other respiratory diseases
B) Allergies
C) Smoking history
D) Age-related decline
E) Environmental factors
A) Other respiratory diseases
Explanation: To diagnose chronic bronchitis, it is essential to exclude other causes of a chronic productive cough, ensuring that the symptoms are specifically due to COPD.
p.4
Etiology and Risk Factors of COPD
Which factor is NOT associated with an increased risk of developing COPD?
A) Maternal smoking
B) Preterm birth
C) Active smoking during adolescence
D) Regular exercise
E) Childhood asthma
D) Regular exercise
Explanation: Regular exercise is not associated with an increased risk of developing COPD; rather, factors like maternal smoking, preterm birth, and active smoking during adolescence are linked to higher risks.
p.25
Pharmacologic Therapy for COPD
Which pharmacological option is noted for increasing abstinence rates at 6 months compared to placebo?
A) Only nicotine gum
B) Bupropion SR
C) Varenicline
D) Both B and C
E) None of the above
D) Both B and C
Explanation: Both bupropion SR and varenicline are highlighted as pharmacological options that increase abstinence rates at 6 months compared to placebo, indicating their effectiveness in smoking cessation.
p.50
Vaccination Recommendations for COPD Patients
What type of vaccine should be administered to all adults with COPD?
A) MMR vaccine
B) Pneumococcal polysaccharide vaccine
C) HPV vaccine
D) Zoster vaccine
E) DTaP vaccine
B) Pneumococcal polysaccharide vaccine
Explanation: The pneumococcal polysaccharide vaccine (PPSV23) is recommended for all adults with COPD to protect against pneumonia and other serious infections.
p.66
Pharmacologic Therapy for COPD
What is the role of antibiotics in the pharmacologic management of COPD exacerbations?
A) Recommended for all patients
B) Not recommended for all exacerbations
C) Only for mild cases
D) Used for prevention only
E) Always given intravenously
B) Not recommended for all exacerbations
Explanation: Antibiotics are not universally recommended for all COPD exacerbations; their use is indicated based on specific circumstances, particularly when there is a risk of complications.
p.46
Combination Therapy in COPD Management
What is the preferred combination therapy for COPD?
A) Inhaled corticosteroid and oral corticosteroid
B) Long acting anticholinergic with LABA
C) Short acting beta agonist and oral medication
D) Monotherapy with a short acting anticholinergic
E) Only inhaled corticosteroids
B) Long acting anticholinergic with LABA
Explanation: The preferred combination therapy for COPD is a long acting anticholinergic combined with a long-acting beta agonist (LABA), which is effective in managing symptoms.
p.46
Combination Therapy in COPD Management
What should be done if a patient remains symptomatic despite initial treatment?
A) Increase the dose of monotherapy
B) Switch to a different monotherapy
C) Initiate combination therapy with inhaled corticosteroid, LABA, and long acting anticholinergic
D) Discontinue all medications
E) Refer the patient for surgery
C) Initiate combination therapy with inhaled corticosteroid, LABA, and long acting anticholinergic
Explanation: If a patient remains symptomatic, the recommended approach is to initiate combination therapy that includes an inhaled corticosteroid, LABA, and a long acting anticholinergic to better manage symptoms.
p.43
Pharmacologic Therapy for COPD
What should be avoided regarding the long-term use of corticosteroids?
A) Inhaled corticosteroids
B) Oral corticosteroids
C) Topical corticosteroids
D) Short-term corticosteroids
E) All types of corticosteroids
B) Oral corticosteroids
Explanation: The text emphasizes that long-term use of oral corticosteroids should be avoided due to potential adverse effects, indicating a need for careful management of corticosteroid therapy.
p.31
Pharmacologic Therapy for COPD
What is one of the benefits of using bronchodilators in stable COPD patients?
A) They decrease FEV1
B) They increase FEV1
C) They worsen symptoms
D) They increase hospitalization rates
E) They reduce exercise tolerance
B) They increase FEV1
Explanation: Bronchodilators are known to increase FEV1 (Forced Expiratory Volume in 1 second), which is a key measure of lung function in patients with COPD.
p.14
Treatment Goals for COPD
What is a desired outcome regarding exacerbations in COPD treatment?
A) Preventing and treating exacerbations
B) Ignoring exacerbations
C) Encouraging more frequent exacerbations
D) Minimizing treatment for exacerbations
E) Accepting exacerbations as inevitable
A) Preventing and treating exacerbations
Explanation: Preventing and treating exacerbations is a vital goal in COPD management, as exacerbations can lead to significant health declines and hospitalizations.
p.32
Pharmacologic Therapy for COPD
What is the primary class of medications used in the pharmacologic therapy of stable COPD?
A) Antibiotics
B) Antidepressants
C) Bronchodilators
D) Antihistamines
E) Steroids
C) Bronchodilators
Explanation: Bronchodilators are the primary class of medications used in the pharmacologic therapy of stable COPD, helping to relieve symptoms by relaxing the muscles around the airways.
p.69
Management of COPD Exacerbations
What is thromboprophylaxis used for in hospitalized patients?
A) To prevent infections
B) To prevent blood clots
C) To manage pain
D) To enhance recovery
E) To monitor fluid intake
B) To prevent blood clots
Explanation: Thromboprophylaxis is a preventive measure used in hospitalized patients to reduce the risk of blood clots, which can be a serious complication during hospitalization.
p.65
Pharmacologic Therapy for COPD
What is the recommended dosage of oral prednisone or prednisolone in the corticosteroid course?
A) 20 mg
B) 30 mg
C) 40 mg
D) 50 mg
E) 60 mg
C) 40 mg
Explanation: The recommended dosage for the corticosteroid course is 40 mg of oral prednisone or prednisolone, which is crucial for effective treatment.
p.24
Pharmacologic Therapy for COPD
What psychiatric disturbances have been associated with bupropion SR and varenicline during smoking cessation?
A) Only depression
B) Depression, anxiety, and psychosis
C) Only anxiety
D) Only psychosis
E) None of the above
B) Depression, anxiety, and psychosis
Explanation: Both bupropion SR and varenicline have been linked to a range of psychiatric disturbances, including depression, anxiety, and psychosis, highlighting the importance of monitoring mental health during smoking cessation treatment.
p.24
Pharmacologic Therapy for COPD
Which medications are mentioned as having psychiatric side effects when used for smoking cessation?
A) Nicotine patches and gum
B) Bupropion SR and varenicline
C) Antidepressants
D) Antipsychotics
E) SSRIs
B) Bupropion SR and varenicline
Explanation: The text specifically mentions bupropion SR and varenicline as medications associated with psychiatric disturbances during smoking cessation, indicating their potential risks.
When should ABGs be assessed in COPD patients?
A) When oxygen saturation is less than 92%
B) When symptoms worsen
C) Only during hospital admission
D) When the patient is a smoker
E) When the patient is over 50 years old
A) When oxygen saturation is less than 92%
Explanation: The text specifies that ABGs should be assessed if the oxygen saturation is less than 92%, indicating a need for further evaluation in such cases.
p.37
Pharmacologic Therapy for COPD
How does the efficacy of Ipratropium compare to Tiotropium?
A) Ipratropium is more effective
B) They are equally effective
C) Ipratropium has decreased efficacy compared to Tiotropium
D) Tiotropium is less effective
E) They have no comparison
C) Ipratropium has decreased efficacy compared to Tiotropium
Explanation: Ipratropium is noted to have decreased efficacy compared to tiotropium, which is a long-acting anticholinergic agent, making tiotropium a preferred option in many cases.
p.8
Pathophysiology of COPD
What is a consequence of oxidative stress in the lungs due to smoke exposure?
A) Increased lung capacity
B) Reduced antiproteinase activity
C) Enhanced ciliary function
D) Decreased mucus production
E) Improved tissue repair
B) Reduced antiproteinase activity
Explanation: Oxidative stress from smoke exposure leads to an increase in activated neutrophils and macrophages, which reduces antiproteinase activity, resulting in an imbalance that contributes to lung pathology.
p.69
Nonpharmacologic Therapy for COPD
What is a crucial component of managing health in patients with respiratory conditions?
A) Increased physical activity
B) Importance of smoking cessation
C) Regular blood tests
D) High protein diet
E) Frequent hospital visits
B) Importance of smoking cessation
Explanation: Smoking cessation is vital for improving health outcomes in patients with respiratory conditions, as it reduces further damage to the lungs and enhances overall treatment effectiveness.
p.2
Chronic Obstructive Pulmonary Disease (COPD) Overview
What is the primary characteristic of Chronic Obstructive Pulmonary Disease (COPD)?
A) Complete reversibility of airflow limitation
B) Progressive disease with irreversible airflow limitation
C) Sudden onset of symptoms
D) Only affects the elderly
E) Primarily caused by allergies
B) Progressive disease with irreversible airflow limitation
Explanation: COPD is defined as a progressive disease characterized by airflow limitation that is not fully reversible, distinguishing it from other respiratory conditions.
p.53
Pharmacologic Therapy for COPD
Which of the following pharmacologic therapies is NOT recommended routinely for COPD?
A) Daily oral azithromycin
B) Leukotriene modifiers
C) N-acetylcysteine
D) Inhaled corticosteroids
E) Long-acting beta-agonists
B) Leukotriene modifiers
Explanation: Leukotriene modifiers are specifically mentioned as not being recommended routinely for the treatment of COPD, indicating their limited role in standard therapy.
p.43
Pharmacologic Therapy for COPD
Which of the following is a potential side effect of inhaled corticosteroids?
A) Weight loss
B) Hoarse voice
C) Insomnia
D) Increased heart rate
E) Dry skin
B) Hoarse voice
Explanation: A hoarse voice is identified as another common adverse effect of inhaled corticosteroids, indicating the need for patients to be aware of this potential side effect.
p.48
Combination Therapy in COPD Management
In which subgroup of COPD patients can a step-down in therapy (ICS withdrawal) be considered?
A) Frequent exacerbators with high eosinophil counts
B) Nonfrequent exacerbating stable COPD patients with eosinophil counts less than 300 cells/μL
C) Patients with asthma
D) Patients with a history of lung cancer
E) Patients with severe COPD symptoms
B) Nonfrequent exacerbating stable COPD patients with eosinophil counts less than 300 cells/μL
Explanation: A step-down in therapy, specifically the withdrawal of inhaled corticosteroids (ICS), is recommended for stable COPD patients who do not frequently exacerbate and have low eosinophil counts, indicating a lower likelihood of benefit from ICS.
p.21
Pharmacologic Therapy for COPD
What is a key factor in choosing a Nicotine Replacement Therapy (NRT) formulation?
A) Cost of the medication
B) Patient preference
C) Availability of the medication
D) Physician's recommendation
E) Duration of treatment
B) Patient preference
Explanation: The choice of NRT formulation is influenced by various factors, with patient preference being a significant consideration, ensuring that the selected method aligns with the patient's needs and comfort.
p.38
Pharmacologic Therapy for COPD
Why is ipratropium not recommended as an alternative to albuterol?
A) It is less effective
B) It causes excessive sedation
C) It has a risk of excessive anticholinergic effects when combined with LAMAs
D) It is too expensive
E) It is only available in tablet form
C) It has a risk of excessive anticholinergic effects when combined with LAMAs
Explanation: Ipratropium is not recommended as an alternative to albuterol due to the potential for excessive anticholinergic effects when used in conjunction with LAMAs, which can lead to adverse effects.
p.45
Pharmacologic Therapy for COPD
What is a common gastrointestinal adverse effect of Phosphodiesterase - 4 (PDE - 4) inhibitors?
A) Constipation
B) Diarrhea
C) Vomiting
D) Heartburn
E) Indigestion
B) Diarrhea
Explanation: Diarrhea is listed as one of the common adverse effects associated with the use of PDE - 4 inhibitors, highlighting the gastrointestinal impact of these medications.
p.43
Pharmacologic Therapy for COPD
What is a common adverse effect of inhaled corticosteroids?
A) Nausea
B) Oropharyngeal candidiasis
C) Headaches
D) Skin rash
E) Increased appetite
B) Oropharyngeal candidiasis
Explanation: Oropharyngeal candidiasis is noted as one of the most common adverse effects associated with the use of inhaled corticosteroids, highlighting the importance of monitoring for this condition in patients using these medications.
p.53
Pharmacologic Therapy for COPD
What is a potential benefit of daily oral azithromycin in COPD patients?
A) It increases lung capacity
B) It reduces the incidence of acute exacerbations
C) It eliminates the need for inhaled therapy
D) It cures COPD
E) It prevents all cardiovascular issues
B) It reduces the incidence of acute exacerbations
Explanation: Daily oral azithromycin is noted for its ability to reduce the incidence of acute exacerbations in COPD patients, making it a valuable option in certain cases.
p.3
Chronic Obstructive Pulmonary Disease (COPD) Overview
Which of the following is NOT a phenotype of COPD?
A) Chronic bronchitis
B) Emphysema
C) Asthma
D) Chronic obstructive pulmonary disease
E) None of the above
C) Asthma
Explanation: Asthma is not classified as a phenotype of COPD; the primary phenotypes of COPD are chronic bronchitis and emphysema.
p.51
Vaccination Recommendations for COPD Patients
What is the recommended age group for the pneumococcal conjugate vaccine (PCV13)?
A) 18 years and younger
B) 30 years and older
C) 65 years and older
D) 50 years and older
E) All ages
C) 65 years and older
Explanation: The pneumococcal conjugate vaccine (PCV13) is specifically recommended for select patients who are 65 years old and older, provided it is deemed appropriate through shared clinical decision-making.
p.23
Pharmacologic Therapy for COPD
What effects does Varenicline have on nicotine withdrawal?
A) Increases withdrawal symptoms
B) Decreases withdrawal and craving
C) Has no effect on withdrawal
D) Only increases craving
E) Causes immediate relapse
B) Decreases withdrawal and craving
Explanation: Varenicline is effective in decreasing withdrawal symptoms and cravings associated with nicotine addiction, making it a valuable aid in smoking cessation.
p.58
Management of COPD Exacerbations
What characterizes a COPD exacerbation?
A) A stable condition with no symptoms
B) A worsening of respiratory symptoms beyond normal variations
C) An improvement in respiratory function
D) A routine check-up
E) A decrease in medication needs
B) A worsening of respiratory symptoms beyond normal variations
Explanation: A COPD exacerbation is defined as an acute event where the patient's respiratory symptoms worsen significantly, surpassing their usual day-to-day variations, necessitating a change in medication.
p.63
Management of COPD Exacerbations
What is a potential intervention for severe COPD exacerbations?
A) Increased hydration
B) Mechanical ventilation
C) Home exercise programs
D) Dietary changes
E) Herbal supplements
B) Mechanical ventilation
Explanation: Mechanical ventilation may be necessary for severe COPD exacerbations when patients are unable to maintain adequate ventilation on their own.
p.14
Treatment Goals for COPD
What is one of the desired outcomes of treatment for COPD?
A) Increasing smoking habits
B) Reducing symptoms
C) Enhancing lung damage
D) Promoting sedentary lifestyle
E) Ignoring exacerbations
B) Reducing symptoms
Explanation: One of the key desired outcomes of treatment for COPD is to reduce symptoms, which is essential for improving the patient's overall health and quality of life.
p.9
Pathophysiology of COPD
What happens to lung emptying when the airways narrow?
A) It speeds up
B) It remains unchanged
C) It slows down
D) It stops completely
E) It becomes irregular
C) It slows down
Explanation: As the airways narrow, the rate of lung emptying slows, which affects the ability to fully exhale and leads to complications such as pulmonary hyperinflation.
p.9
Pathophysiology of COPD
What is pulmonary hyperinflation?
A) A condition where the lungs are under-inflated
B) A condition where the lungs are over-inflated
C) A type of lung cancer
D) A symptom of asthma
E) A normal respiratory function
B) A condition where the lungs are over-inflated
Explanation: Pulmonary hyperinflation occurs when the lungs become over-inflated, initially during exercise and later at rest, due to the inability to fully exhale.
p.17
Nonpharmacologic Therapy for COPD
What should be done for all smokers in the context of nonpharmacologic therapy?
A) They should be ignored
B) They should be assessed
C) They should be encouraged to smoke more
D) They should be referred to specialists only
E) They should be given medication immediately
B) They should be assessed
Explanation: It is important that all smokers are assessed as part of the nonpharmacologic therapy approach, ensuring that their needs and readiness to quit are understood.
p.35
Pharmacologic Therapy for COPD
Which of the following β2-agonists is administered twice daily?
A) Olodaterol
B) Vilanterol
C) Formoterol
D) Indacaterol
E) Arformoterol
C) Formoterol
Explanation: Formoterol is identified as a twice daily long-acting β2-agonist, which is important for managing symptoms in patients with respiratory conditions.
p.39
Pharmacologic Therapy for COPD
What is the most common side effect of anticholinergics?
A) Nausea
B) Dry mouth
C) Dizziness
D) Fatigue
E) Rash
B) Dry mouth
Explanation: The most common side effect of anticholinergics is dry mouth, along with headache and nasopharyngitis, highlighting the typical adverse effects associated with this class of medication.
p.63
Nonpharmacologic Therapy for COPD
Which of the following is a nonpharmacologic management strategy for COPD exacerbations?
A) Increased physical activity
B) Oxygen therapy
C) Antibiotic treatment
D) Corticosteroids
E) Bronchodilator therapy
B) Oxygen therapy
Explanation: Oxygen therapy is a key nonpharmacologic management strategy for COPD exacerbations, aimed at maintaining appropriate oxygen saturation levels.
p.65
Pharmacologic Therapy for COPD
What is the recommended duration for a corticosteroid course in pharmacologic management?
A) 3 days
B) 5 days
C) 7 days
D) 10 days
E) 14 days
B) 5 days
Explanation: A 5-day course using 40 mg of oral prednisone or prednisolone is recommended for pharmacologic management, indicating a specific treatment duration for effective management.
p.14
Treatment Goals for COPD
Which of the following is a goal related to lung function in COPD treatment?
A) Minimizing the rate of decline in lung function
B) Maximizing lung damage
C) Ignoring lung function
D) Increasing lung infections
E) Enhancing lung inflammation
A) Minimizing the rate of decline in lung function
Explanation: A critical goal in the treatment of COPD is to minimize the rate of decline in lung function, which helps maintain respiratory health over time.
p.17
Nonpharmacologic Therapy for COPD
Which of the following frameworks can be used to guide brief interventions for smoking cessation?
A) The 5 Ps
B) The 5 As and the 5 Rs
C) The 4 Ds
D) The 3 Cs
E) The 6 Ws
B) The 5 As and the 5 Rs
Explanation: The 5 As and the 5 Rs are specifically mentioned as frameworks that can guide brief interventions aimed at helping individuals quit smoking.
p.66
Pharmacologic Therapy for COPD
What benefits do antibiotics provide when indicated for COPD exacerbations?
A) Increase hospitalization duration
B) Increase mortality rates
C) Reduce recovery time and risk of treatment failure
D) Have no effect on relapse rates
E) Are only effective in outpatient settings
C) Reduce recovery time and risk of treatment failure
Explanation: When indicated, antibiotics can significantly reduce recovery time, the risk of early relapse, treatment failure, hospitalization duration, and mortality, especially in ICU patients.
p.5
Etiology and Risk Factors of COPD
Which of the following is considered an occupational risk factor for respiratory issues?
A) Regular exercise
B) Occupational exposure to dusts and chemicals
C) Healthy diet
D) Adequate hydration
E) Frequent handwashing
B) Occupational exposure to dusts and chemicals
Explanation: Occupational exposure to dusts and chemicals, including vapors, irritants, and fumes, is identified as a significant risk factor for respiratory conditions, highlighting the importance of workplace safety.
p.60
Management of COPD Exacerbations
What is required for a moderate exacerbation of COPD?
A) Only short-acting bronchodilators
B) Hospitalization
C) Additional antibiotics and/or corticosteroids
D) No treatment needed
E) Long-term oxygen therapy
C) Additional antibiotics and/or corticosteroids
Explanation: A moderate exacerbation of COPD typically requires additional treatment, including antibiotics and/or corticosteroids, to manage the worsening symptoms effectively.
p.51
Vaccination Recommendations for COPD Patients
What is required before administering PCV13 to patients 65 years and older?
A) Mandatory vaccination
B) Shared clinical decision-making
C) No prior vaccinations
D) Age verification only
E) Physician's discretion only
B) Shared clinical decision-making
Explanation: The administration of PCV13 to patients 65 years and older must be deemed appropriate through shared clinical decision-making, ensuring that the decision is made collaboratively between the patient and healthcare provider.
p.47
Combination Therapy in COPD Management
What is the purpose of triple therapy with ICS, LABA, and LAMA in COPD patients?
A) To cure COPD
B) To reduce symptoms in patients who remain symptomatic on dual therapy
C) To prevent all respiratory infections
D) To eliminate the need for any medication
E) To increase the incidence of pneumonia
B) To reduce symptoms in patients who remain symptomatic on dual therapy
Explanation: Triple therapy with ICS, LABA, and LAMA is commonly used to manage symptoms in COPD patients who do not achieve adequate relief with dual therapy, highlighting its role in symptom management.
p.69
Vaccination Recommendations for COPD Patients
What role does vaccination play in patient management?
A) It is not important
B) It helps in pain management
C) It prevents respiratory infections
D) It increases hospital stays
E) It reduces medication needs
C) It prevents respiratory infections
Explanation: Vaccination is crucial in managing patients with respiratory conditions as it helps prevent respiratory infections, which can exacerbate their condition and lead to serious complications.
p.17
Nonpharmacologic Therapy for COPD
What is considered a major challenge in nonpharmacologic therapy for COPD?
A) Diet management
B) Smoking cessation
C) Exercise programs
D) Regular check-ups
E) Medication adherence
B) Smoking cessation
Explanation: Smoking cessation is highlighted as a major challenge in nonpharmacologic therapy for COPD, emphasizing the difficulty many patients face in quitting smoking.
p.3
Pathophysiology of COPD
What distinguishes emphysema from chronic bronchitis in COPD?
A) Presence of a chronic cough
B) Destruction of alveoli without fibrosis
C) Increased mucus production
D) Fibrosis of lung tissue
E) Occurrence of wheezing
B) Destruction of alveoli without fibrosis
Explanation: Emphysema is characterized by the destruction of alveoli without fibrosis, which differentiates it from chronic bronchitis, where inflammation and mucus production are more prominent.
What organization is associated with guidelines for COPD?
A) World Health Organization (WHO)
B) American Lung Association
C) Global Initiative for Chronic Obstructive Lung Disease (GOLD)
D) National Institutes of Health (NIH)
E) Centers for Disease Control and Prevention (CDC)
C) Global Initiative for Chronic Obstructive Lung Disease (GOLD)
Explanation: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) is the organization that provides guidelines and recommendations for the management and treatment of COPD.
p.34
Pharmacologic Therapy for COPD
What is a disadvantage of using Short-Acting β2-Agonists (SABAs) for maintenance therapy?
A) They are too expensive
B) They require frequent dosing
C) They have too many side effects
D) They are ineffective
E) They are difficult to administer
B) They require frequent dosing
Explanation: SABAs are considered inconvenient for maintenance therapy primarily due to the need for frequent dosing, which can be burdensome for patients.
p.9
Pathophysiology of COPD
What condition can develop late in the course of COPD?
A) Asthma
B) Pulmonary hypertension
C) Pneumonia
D) Lung cancer
E) Tuberculosis
B) Pulmonary hypertension
Explanation: Pulmonary hypertension can develop late in the course of COPD, which may lead to cor pulmonale, or right-sided heart failure.
p.35
Pharmacologic Therapy for COPD
What is a common adverse effect of β2-agonists?
A) Hypotension
B) Bradycardia
C) Palpitations
D) Weight gain
E) Nausea
C) Palpitations
Explanation: Palpitations are one of the common adverse effects associated with the use of β2-agonists, along with other effects such as tachycardia and tremors.
p.38
Pharmacologic Therapy for COPD
What should patients using a LAMA as maintenance therapy also be prescribed?
A) Another LAMA
B) A corticosteroid
C) A SABA as rescue therapy
D) A LABA
E) An antibiotic
C) A SABA as rescue therapy
Explanation: Patients on LAMA maintenance therapy should also have a short-acting beta-agonist (SABA) prescribed for use as rescue therapy to manage acute symptoms.
p.59
Etiology and Risk Factors of COPD
Which of the following is a common precipitating factor for COPD exacerbations?
A) High altitude
B) Air pollution
C) Cold weather
D) Excessive exercise
E) Low humidity
B) Air pollution
Explanation: Air pollution is identified as one of the common precipitating factors for COPD exacerbations, highlighting its impact on respiratory health.
p.3
Etiology and Risk Factors of COPD
What is a defining characteristic of chronic bronchitis in COPD?
A) A chronic productive cough for at least 3 months in one year
B) A chronic productive cough for at least 3 months in each of two consecutive years
C) Shortness of breath without a cough
D) Destruction of alveoli with fibrosis
E) Occasional wheezing without a cough
B) A chronic productive cough for at least 3 months in each of two consecutive years
Explanation: Chronic bronchitis is characterized by a chronic productive cough lasting at least 3 months in each of two consecutive years, provided that other causes have been excluded.
Is arterial blood gases (ABGs) necessary for diagnosing COPD?
A) Yes, always
B) No, it is not necessary
C) Only in severe cases
D) Only for patients over 65
E) Yes, but only for smokers
B) No, it is not necessary
Explanation: The text states that arterial blood gases (ABGs) are not necessary for the diagnosis of COPD, indicating that other diagnostic methods may be sufficient.
p.45
Pharmacologic Therapy for COPD
Which of the following is a potential serious neuropsychiatric effect of PDE - 4 inhibitors?
A) Drowsiness
B) Suicidal ideation
C) Increased libido
D) Aggression
E) Confusion
B) Suicidal ideation
Explanation: Suicidal ideation is noted as a serious neuropsychiatric effect associated with PDE - 4 inhibitors, emphasizing the importance of monitoring mental health in patients taking these medications.
p.14
Treatment Goals for COPD
Which of the following is a goal related to the quality of life in COPD treatment?
A) Maintaining or improving quality of life
B) Decreasing quality of life
C) Ignoring patient comfort
D) Promoting chronic discomfort
E) Enhancing disease symptoms
A) Maintaining or improving quality of life
Explanation: A fundamental goal of COPD treatment is to maintain or improve the quality of life for patients, ensuring they can engage in daily activities and enjoy life despite their condition.
p.53
Pharmacologic Therapy for COPD
In which group of patients is daily oral azithromycin ideally used?
A) Current smokers with mild symptoms
B) Former smokers with continued exacerbations
C) Patients with no history of smoking
D) Patients with asthma only
E) Patients with no exacerbations
B) Former smokers with continued exacerbations
Explanation: Daily oral azithromycin is ideally used in former smokers who continue to experience exacerbations while on appropriate inhaled therapy, indicating its targeted application in specific patient populations.
p.36
Pharmacologic Therapy for COPD
Which of the following is NOT an anticholinergic medication?
A) Ipratropium
B) Tiotropium
C) Aclidinium
D) Umeclidinium
E) Albuterol
E) Albuterol
Explanation: Albuterol is a bronchodilator that belongs to the class of beta-agonists, not anticholinergics. The other options listed are all anticholinergic medications used in respiratory therapy.
p.58
Management of COPD Exacerbations
How are the majority of COPD exacerbations managed?
A) In a hospital setting
B) As an outpatient basis
C) With surgical intervention
D) Through home remedies
E) By increasing physical activity
B) As an outpatient basis
Explanation: The majority of COPD exacerbations can be effectively managed on an outpatient basis, indicating that many patients do not require hospitalization for treatment.
p.37
Pharmacologic Therapy for COPD
How often should Ipratropium be administered?
A) Every 2 to 4 hours
B) Every 4 to 6 hours
C) Every 6 to 8 hours
D) Once a day
E) Every hour
C) Every 6 to 8 hours
Explanation: Ipratropium should be administered every 6 to 8 hours, which is important for maintaining its therapeutic effects in managing respiratory conditions.
p.59
Etiology and Risk Factors of COPD
Which bacterial infection is commonly linked to COPD exacerbations?
A) Streptococcus pneumoniae
B) Escherichia coli
C) Haemophilus influenzae
D) Staphylococcus aureus
E) Klebsiella pneumoniae
C) Haemophilus influenzae
Explanation: Haemophilus influenzae is noted as the bacterial respiratory tract infection that is usually associated with COPD exacerbations, emphasizing its role in worsening the condition.
p.4
Etiology and Risk Factors of COPD
What is the most common cause of Chronic Obstructive Pulmonary Disease (COPD)?
A) Air pollution
B) Cigarette smoke
C) Marijuana use
D) Preterm birth
E) Childhood asthma
B) Cigarette smoke
Explanation: Cigarette smoke, including secondhand smoke, is identified as the most common cause of COPD, highlighting its significant role in the disease's etiology.
p.53
Pharmacologic Therapy for COPD
What is a significant risk associated with the use of daily oral azithromycin?
A) Increased appetite
B) Prolongation of the QT interval
C) Weight loss
D) Improved lung function
E) Decreased heart rate
B) Prolongation of the QT interval
Explanation: One of the significant risks associated with daily oral azithromycin is the potential for prolongation of the QT interval, which can lead to serious cardiovascular complications.
p.45
Pharmacologic Therapy for COPD
Which of the following adverse effects is related to appetite when using PDE - 4 inhibitors?
A) Increased appetite
B) Weight gain
C) Decreased appetite
D) Cravings
E) Nausea
C) Decreased appetite
Explanation: Decreased appetite is mentioned as an adverse effect of PDE - 4 inhibitors, indicating that these medications can negatively impact a patient's desire to eat.
What is the purpose of the modified Medical Research Council Questionnaire (mMRC)?
A) To assess lung capacity
B) To evaluate the severity of COPD symptoms
C) To measure blood pressure
D) To determine exercise tolerance
E) To diagnose asthma
B) To evaluate the severity of COPD symptoms
Explanation: The mMRC is specifically designed to assess the severity of symptoms in patients with Chronic Obstructive Pulmonary Disease (COPD), helping healthcare providers understand the impact of the disease on daily life.
p.60
Management of COPD Exacerbations
What defines a severe exacerbation of COPD?
A) Only short-acting bronchodilators needed
B) Additional antibiotics required
C) Hospitalization or emergency room visit required
D) No treatment needed
E) Mild symptoms present
C) Hospitalization or emergency room visit required
Explanation: A severe exacerbation of COPD is defined by the necessity for hospitalization or an emergency room visit, often accompanied by acute respiratory failure, indicating a critical clinical status.
p.54
Pharmacologic Therapy for COPD
What is the effect of β-blockers on COPD patients according to recent findings?
A) They worsen respiratory status
B) They have no effect on mortality
C) They may reduce mortality and exacerbation rates
D) They are harmful in all cases
E) They are only effective in non-smokers
C) They may reduce mortality and exacerbation rates
Explanation: Recent findings suggest that β-blockers may help reduce mortality and exacerbation rates in COPD patients, indicating a shift in their therapeutic use.
p.58
Management of COPD Exacerbations
What typically leads to a change in medication during a COPD exacerbation?
A) A stable condition
B) A decrease in symptoms
C) A worsening of respiratory symptoms
D) Routine medication review
E) Patient preference
C) A worsening of respiratory symptoms
Explanation: A COPD exacerbation often results in a change in medication due to the acute worsening of the patient's respiratory symptoms, which goes beyond their normal variations.
p.2
Etiology and Risk Factors of COPD
How was COPD previously classified?
A) Only as asthma
B) Into chronic bronchitis and emphysema
C) By age groups
D) Based on smoking history
E) Into acute and chronic types
B) Into chronic bronchitis and emphysema
Explanation: Historically, COPD was divided into two types: chronic bronchitis and emphysema, but current guidelines recognize that many patients exhibit characteristics of both conditions.
p.66
Pharmacologic Therapy for COPD
How long should antibiotics be administered for COPD exacerbations when indicated?
A) 3 to 5 days
B) 5 to 7 days
C) 7 to 10 days
D) 10 to 14 days
E) 1 to 2 days
B) 5 to 7 days
Explanation: When antibiotics are indicated for COPD exacerbations, they should be given for a duration of 5 to 7 days to effectively reduce recovery time and other associated risks.
p.37
Pharmacologic Therapy for COPD
Why is Ipratropium not typically recommended?
A) It is too expensive
B) It has a longer onset of action than SABAs
C) It is ineffective
D) It is only for children
E) It causes severe side effects
B) It has a longer onset of action than SABAs
Explanation: Ipratropium is not typically recommended because it has a longer onset of action compared to short-acting β2-agonists (SABAs) and decreased efficacy compared to tiotropium.
p.42
Pharmacologic Therapy for COPD
What is the significance of elevated serum eosinophils in COPD patients?
A) They indicate a need for surgery
B) They suggest a higher risk of lung cancer
C) They help determine the effectiveness of ICS in preventing exacerbations
D) They are unrelated to COPD management
E) They indicate a need for immediate hospitalization
C) They help determine the effectiveness of ICS in preventing exacerbations
Explanation: Elevated serum eosinophils (> 220 – 300 cells/μL) are associated with a greater benefit from ICS in preventing exacerbations in COPD patients, making eosinophil levels a useful marker in treatment decisions.
What might a complete blood count (CBC) reveal in COPD patients?
A) Low white blood cell count
B) Elevated hematocrit that may exceed 55%
C) Normal platelet levels
D) Decreased hemoglobin
E) Elevated lymphocyte count
B) Elevated hematocrit that may exceed 55%
Explanation: The text mentions that a CBC may reveal an elevated hematocrit, which can indicate polycythemia, a condition that may occur in COPD patients.
p.34
Pharmacologic Therapy for COPD
What should patients treated with Long-Acting β2-Agonists (LABAs) also have on hand?
A) A second LABA
B) A SABA such as albuterol
C) An inhaled corticosteroid
D) A systemic corticosteroid
E) A leukotriene receptor antagonist
B) A SABA such as albuterol
Explanation: Patients on LABAs should also have a SABA, like albuterol, available for as-needed use, serving as a 'rescue' medication for acute symptoms.
p.9
Pathophysiology of COPD
What is cor pulmonale?
A) A type of lung infection
B) A condition affecting the left side of the heart
C) Right-sided heart failure due to lung disease
D) A form of asthma
E) A normal heart function
C) Right-sided heart failure due to lung disease
Explanation: Cor pulmonale refers to right-sided heart failure that occurs as a result of pulmonary hypertension, which can develop in advanced COPD.
p.41
Pharmacologic Therapy for COPD
What are the most common adverse effects of theophylline?
A) Dizziness and headache
B) Heartburn, restlessness, insomnia, irritability, tachycardia, and tremor
C) Skin rash and fever
D) Weight gain and fatigue
E) Blurred vision and dry mouth
B) Heartburn, restlessness, insomnia, irritability, tachycardia, and tremor
Explanation: Theophylline is associated with several common adverse effects, including heartburn, restlessness, insomnia, irritability, tachycardia, and tremor, which are important for clinicians to monitor.
p.50
Vaccination Recommendations for COPD Patients
Which vaccination is recommended annually for patients with COPD?
A) Tetanus vaccine
B) Hepatitis B vaccine
C) Annual influenza vaccination
D) Measles vaccine
E) Varicella vaccine
C) Annual influenza vaccination
Explanation: The annual influenza vaccination is specifically recommended for patients with COPD to help prevent respiratory infections that can exacerbate their condition.
p.47
Combination Therapy in COPD Management
What recent evidence suggests about triple therapy in COPD?
A) It has no effect on mortality
B) It may reduce mortality
C) It increases the severity of symptoms
D) It is less effective than dual therapy
E) It is only effective in mild cases
B) It may reduce mortality
Explanation: New evidence indicates that triple therapy may reduce mortality in COPD patients, suggesting its potential benefits beyond symptom management.
p.59
Etiology and Risk Factors of COPD
What type of viral infection is most commonly associated with COPD exacerbations?
A) Influenza
B) Rhinovirus
C) Coronavirus
D) Adenovirus
E) Herpes simplex virus
B) Rhinovirus
Explanation: The rhinovirus is specifically mentioned as the viral respiratory infection that usually precipitates COPD exacerbations, indicating its significance in exacerbation severity.
p.14
Treatment Goals for COPD
What is a desired outcome regarding exercise in COPD treatment?
A) Improving exercise tolerance
B) Reducing physical activity
C) Avoiding exercise altogether
D) Increasing fatigue
E) Promoting inactivity
A) Improving exercise tolerance
Explanation: Improving exercise tolerance is a desired outcome in COPD treatment, as it helps patients maintain physical activity and overall health.
p.42
Pharmacologic Therapy for COPD
In which patients are inhaled corticosteroids (ICS) recommended?
A) Patients with mild COPD
B) Patients with moderate to very severe COPD with increased exacerbation risk
C) Patients with asthma only
D) Patients with no history of exacerbations
E) Patients with only mild symptoms
B) Patients with moderate to very severe COPD with increased exacerbation risk
Explanation: ICS are specifically recommended for patients with moderate to very severe COPD who have an increased risk of exacerbations and are not adequately controlled by first-line long-acting bronchodilators.
p.60
Management of COPD Exacerbations
What characterizes a mild exacerbation of COPD?
A) Hospitalization required
B) Only short-acting bronchodilators needed
C) Long-term corticosteroids needed
D) Additional antibiotics required
E) Acute respiratory failure present
B) Only short-acting bronchodilators needed
Explanation: A mild exacerbation of COPD is characterized by the need for only short-acting bronchodilators, indicating a less severe clinical status compared to moderate or severe exacerbations.
p.66
Pharmacologic Therapy for COPD
In which patient population are antibiotics particularly beneficial for COPD exacerbations?
A) Outpatient settings
B) Patients with mild symptoms
C) ICU patients
D) Patients with no prior history of exacerbations
E) Patients with stable COPD
C) ICU patients
Explanation: Antibiotics are particularly beneficial for ICU patients experiencing COPD exacerbations, as they help reduce mortality and improve recovery outcomes in this high-risk group.
p.5
Etiology and Risk Factors of COPD
What is a risk factor related to indoor air quality?
A) Regular physical activity
B) Biomass smoke inhalation
C) High protein diet
D) Adequate sleep
E) Low humidity levels
B) Biomass smoke inhalation
Explanation: Biomass smoke inhalation is a recognized risk factor for respiratory diseases, particularly in environments where biomass fuels are used for cooking and heating, contributing to indoor air pollution.
What FEV1/FVC ratio indicates airflow limitation in COPD?
A) Greater than 80%
B) Less than 70%
C) Exactly 70%
D) Between 50% and 70%
E) Less than 50%
B) Less than 70%
Explanation: A postbronchodilator FEV1/FVC ratio of less than 70% confirms airflow limitation that is not fully reversible, which is a key diagnostic criterion for COPD.
p.4
Etiology and Risk Factors of COPD
Which of the following is a rare hereditary cause of COPD?
A) Maternal smoking
B) α1-antitrypsin deficiency
C) Air pollution
D) Early childhood lung infections
E) Active smoking during adolescence
B) α1-antitrypsin deficiency
Explanation: A rare hereditary deficiency of α1-antitrypsin (AAT) is noted as a cause of COPD, distinguishing it from more common environmental factors.
p.27
Treatment Goals for COPD
What is the primary indication for long-term oxygen therapy in COPD patients?
A) Patients with mild asthma
B) Stable patients with severe resting hypoxemia
C) Patients with a history of smoking
D) Patients with frequent respiratory infections
E) Patients with normal oxygen levels
B) Stable patients with severe resting hypoxemia
Explanation: Long-term oxygen therapy is indicated for stable COPD patients who exhibit severe resting hypoxemia, specifically when Pao2 is at or below 55 mm Hg or Sao2 is at or below 88%.
What is the primary method used for diagnosing COPD?
A) Blood tests
B) Imaging studies
C) Spirometry
D) Physical examination
E) Allergy testing
C) Spirometry
Explanation: The diagnosis of COPD is primarily based on spirometry, which measures lung function and helps confirm airflow limitation.
p.8
Pathophysiology of COPD
What effect do inflammatory cells and mediators have on mucus glands?
A) They decrease mucus production
B) They stimulate mucus gland hyperplasia
C) They enhance ciliary function
D) They promote airway dilation
E) They reduce inflammation
B) They stimulate mucus gland hyperplasia
Explanation: Inflammatory cells and mediators stimulate mucus gland hyperplasia and mucus hypersecretion, which are key factors in the pathophysiology of chronic obstructive pulmonary disease (COPD).
p.28
Pharmacologic Therapy for COPD
What is the primary focus of the pharmacotherapy treatment algorithm for COPD?
A) Dietary recommendations
B) Exercise regimens
C) Medication management
D) Surgical interventions
E) Psychological counseling
C) Medication management
Explanation: The pharmacotherapy treatment algorithm for COPD primarily focuses on medication management to alleviate symptoms and improve the quality of life for patients with Chronic Obstructive Pulmonary Disease.
p.5
Etiology and Risk Factors of COPD
What condition is associated with increased bronchial sensitivity?
A) Asthma
B) Hypertension
C) Diabetes
D) Osteoporosis
E) Heart disease
A) Asthma
Explanation: Asthma is characterized by bronchial hyperresponsiveness, which means that the airways are overly sensitive to various stimuli, leading to difficulty in breathing and other respiratory symptoms.
p.41
Pharmacologic Therapy for COPD
Which of the following is a dose-related adverse effect of theophylline?
A) Heartburn
B) Restlessness
C) Nausea and vomiting
D) Insomnia
E) Irritability
C) Nausea and vomiting
Explanation: Nausea and vomiting are specifically noted as dose-related adverse effects of theophylline, indicating that these symptoms may increase with higher doses.
p.55
Pharmacologic Therapy for COPD
What is a common side effect of corticosteroids used in COPD treatment?
A) Weight loss
B) Increased appetite
C) Hair loss
D) Insomnia
E) Nausea
B) Increased appetite
Explanation: Corticosteroids, often used in the management of COPD, can lead to side effects such as increased appetite, which may contribute to weight gain in some patients.
p.44
Pharmacologic Therapy for COPD
Which PDE-4 inhibitor is mentioned in the text?
A) Theophylline
B) Salmeterol
C) Roflumilast
D) Budesonide
E) Montelukast
C) Roflumilast
Explanation: Roflumilast is specifically mentioned as a PDE-4 inhibitor used for treating severe COPD associated with chronic bronchitis.
p.40
Pharmacologic Therapy for COPD
In which situation is Theophylline indicated for use?
A) As a first-line treatment for all patients
B) When patients can use inhalation therapy
C) If patients cannot use the inhalation route or remain symptomatic despite inhaled bronchodilators
D) For patients with mild symptoms only
E) As a replacement for corticosteroids
C) If patients cannot use the inhalation route or remain symptomatic despite inhaled bronchodilators
Explanation: Theophylline is indicated for patients who cannot use inhalation therapy or who continue to experience symptoms despite appropriate use of inhaled bronchodilators.
p.32
Pharmacologic Therapy for COPD
How can bronchodilators be used in the management of stable COPD?
A) Only on a scheduled basis
B) Only as needed for symptoms
C) Both as needed for symptoms and on a scheduled basis
D) Only during exacerbations
E) Only for patients with severe COPD
C) Both as needed for symptoms and on a scheduled basis
Explanation: Bronchodilators can be used both as needed for symptom relief and on a scheduled basis to manage stable COPD effectively.
p.15
Pharmacologic Therapy for COPD
What treatment is recommended for patients requiring scheduled management of COPD?
A) Short-acting bronchodilators
B) Inhaled long-acting bronchodilators
C) Oral corticosteroids
D) Antibiotics
E) Home oxygen therapy
B) Inhaled long-acting bronchodilators
Explanation: Patients with COPD who are at high risk for exacerbations are recommended to use inhaled long-acting bronchodilators on a scheduled basis to reduce the frequency of exacerbations.
p.67
Management of COPD Exacerbations
What combination of symptoms indicates the need for antibiotics?
A) Increased sputum volume only
B) Increased dyspnea only
C) Increased sputum purulence with either increased sputum volume or increased dyspnea
D) Cough and fever
E) Chest pain and fatigue
C) Increased sputum purulence with either increased sputum volume or increased dyspnea
Explanation: The presence of increased sputum purulence along with either increased sputum volume or increased dyspnea indicates a need for antibiotic treatment in respiratory exacerbations.
p.42
Pharmacologic Therapy for COPD
Why are inhaled corticosteroids (ICS) not recommended as monotherapy in COPD?
A) They are too expensive
B) They are less effective than combined therapy with a long-acting beta-agonist (LABA)
C) They cause too many side effects
D) They are only effective in asthma
E) They are not available in inhaled form
B) They are less effective than combined therapy with a long-acting beta-agonist (LABA)
Explanation: ICS are not recommended as monotherapy because they have been shown to be less effective than when used in combination with a LABA, which enhances treatment efficacy in managing COPD.
p.31
Pharmacologic Therapy for COPD
Which of the following is NOT a benefit of bronchodilator therapy in stable COPD?
A) Reducing symptoms
B) Reducing exacerbation rates
C) Improving exercise tolerance
D) Increasing the risk of hospitalization
E) Improving health status
D) Increasing the risk of hospitalization
Explanation: Bronchodilators are intended to reduce exacerbation and hospitalization rates, not increase them, making option D incorrect.
p.4
Etiology and Risk Factors of COPD
Which of the following factors can potentially reduce maximal attained lung function?
A) Healthy diet
B) Air pollution
C) Regular physical activity
D) Adequate sleep
E) Non-smoking lifestyle
B) Air pollution
Explanation: Air pollution is identified as a factor that can potentially reduce maximal attained lung function, thereby increasing the risk of developing COPD.
p.31
Pharmacologic Therapy for COPD
How do long-acting bronchodilators compare to short-acting bronchodilators?
A) They are less effective
B) They are more expensive but superior in clinical outcomes
C) They are cheaper and equally effective
D) They have no impact on dyspnea
E) They are only used in emergencies
B) They are more expensive but superior in clinical outcomes
Explanation: Long-acting bronchodilators, while more expensive, are superior in important clinical outcomes such as frequency of exacerbations, degree of dyspnea, and health-related quality of life.
p.20
Pharmacologic Therapy for COPD
Which of the following medications is a sustained-release option for tobacco use disorder?
A) Varenicline
B) Bupropion sustained-release (SR)
C) Nicotine gum
D) Nicotine patches
E) Clonidine
B) Bupropion sustained-release (SR)
Explanation: Bupropion sustained-release (SR) is a first-line pharmacological treatment for tobacco use disorder, providing an alternative to nicotine replacement therapies.
p.33
Pharmacologic Therapy for COPD
Which of the following is a short-acting β2-agonist used for acute symptoms?
A) Salmeterol
B) Formoterol
C) Albuterol
D) Indacaterol
E) Olodaterol
C) Albuterol
Explanation: Albuterol (salbutamol) is a short-acting β2-agonist used for 'rescue' therapy to relieve acute symptoms in COPD patients.
p.20
Pharmacologic Therapy for COPD
What is the mechanism of action of Varenicline in treating tobacco use disorder?
A) It acts as a stimulant
B) It blocks nicotine receptors
C) It increases serotonin levels
D) It decreases dopamine levels
E) It acts as a sedative
B) It blocks nicotine receptors
Explanation: Varenicline works by partially stimulating nicotine receptors in the brain while also blocking nicotine from attaching to these receptors, which helps reduce cravings and withdrawal symptoms.
p.31
Pharmacologic Therapy for COPD
What is a primary goal of pharmacologic therapy in stable COPD?
A) To cure the disease
B) To reduce symptoms and improve quality of life
C) To eliminate the need for rehabilitation
D) To increase the severity of the disease
E) To prevent all hospital visits
B) To reduce symptoms and improve quality of life
Explanation: The primary goal of pharmacologic therapy in stable COPD is to reduce symptoms, improve exercise tolerance, and enhance the overall quality of life for patients.
p.39
Pharmacologic Therapy for COPD
Which of the following is a side effect of anticholinergics that affects the urinary system?
A) Increased urination
B) Urinary retention
C) Frequent urination
D) Incontinence
E) Urgency
B) Urinary retention
Explanation: Urinary retention is a known side effect of anticholinergics, which can lead to discomfort and complications in patients using these medications.
p.7
Etiology and Risk Factors of COPD
What percentage of smokers is likely to develop COPD?
A) 5% to 10%
B) 15% to 30%
C) 30% to 50%
D) 50% to 70%
E) 70% to 90%
B) 15% to 30%
Explanation: It is noted that 15% to 30% of smokers develop COPD, indicating a significant risk associated with smoking.
p.7
Pathophysiology of COPD
Which type of immune cells primarily mediate inflammation in COPD?
A) Eosinophils
B) Mast cells
C) Neutrophils, macrophages, and CD8+ T lymphocytes
D) B lymphocytes
E) Basophils
C) Neutrophils, macrophages, and CD8+ T lymphocytes
Explanation: The inflammation in COPD is primarily mediated by neutrophils, macrophages, and CD8+ T lymphocytes, which differs from the eosinophil and mast cell-mediated inflammation seen in asthma.
p.22
Pharmacologic Therapy for COPD
What is the primary action of bupropion as an antidepressant?
A) It increases serotonin levels
B) It blocks reuptake of dopamine and norepinephrine
C) It enhances GABA activity
D) It inhibits MAO enzymes
E) It decreases acetylcholine levels
B) It blocks reuptake of dopamine and norepinephrine
Explanation: Bupropion primarily acts as an antidepressant by blocking the reuptake of dopamine (DA) and norepinephrine (NE), which contributes to its therapeutic effects.
p.53
Pharmacologic Therapy for COPD
What are some potential adverse effects of daily oral azithromycin?
A) Weight gain and insomnia
B) Cardiovascular adverse effects and hearing loss
C) Increased energy and appetite
D) Skin rash and fever
E) Nausea and vomiting only
B) Cardiovascular adverse effects and hearing loss
Explanation: Daily oral azithromycin can lead to cardiovascular adverse effects, hearing loss, and bacterial resistance, highlighting the need for careful monitoring in patients receiving this therapy.
p.36
Pharmacologic Therapy for COPD
Which of the following medications is classified as a long-acting muscarinic antagonist (LAMA)?
A) Ipratropium
B) Albuterol
C) Glycopyrrolate
D) Salmeterol
E) Theophylline
C) Glycopyrrolate
Explanation: Glycopyrrolate is classified as a long-acting muscarinic antagonist (LAMA), along with tiotropium, umeclidinium, and aclidinium. These medications are used for long-term management of COPD.
p.27
Etiology and Risk Factors of COPD
Which of the following conditions may indicate the need for long-term oxygen therapy in COPD patients?
A) Normal lung function
B) Evidence of pulmonary hypertension
C) Mild shortness of breath
D) Occasional cough
E) Seasonal allergies
B) Evidence of pulmonary hypertension
Explanation: Evidence of pulmonary hypertension, along with peripheral edema suggesting congestive heart failure or polycythemia, can indicate the need for long-term oxygen therapy in stable COPD patients.
How is the severity of COPD classified?
A) Based on symptoms only
B) Based on FEV1 postbronchodilator
C) Based on patient age
D) Based on smoking history
E) Based on family history
B) Based on FEV1 postbronchodilator
Explanation: The classification of COPD severity is determined by the FEV1 postbronchodilator, which helps in assessing the extent of airflow limitation.
What is the Pao2 threshold that indicates the need for long-term oxygen therapy?
A) At or below 70 mm Hg
B) At or below 60 mm Hg
C) At or below 55 mm Hg
D) At or below 50 mm Hg
E) At or below 65 mm Hg
C) At or below 55 mm Hg
Explanation: Long-term oxygen therapy is indicated for stable COPD patients when Pao2 is at or below 55 mm Hg, highlighting the severity of their hypoxemia.
What is the FEV1 percentage range for GOLD 2, Moderate COPD?
A) 80% or greater
B) 50% – 79%
C) 30% – 49%
D) Less than 30%
E) 40% – 60%
B) 50% – 79%
Explanation: GOLD 2, or Moderate COPD, is classified as having an FEV1 percentage between 50% and 79% predicted, indicating a moderate level of airflow limitation.
p.7
Pathophysiology of COPD
What is the consequence of AAT deficiency in the lungs?
A) Increased lung capacity
B) Enhanced gas exchange
C) Destruction of alveolar walls
D) Reduced inflammation
E) Improved lung function
C) Destruction of alveolar walls
Explanation: A deficiency of AAT results in unopposed proteinase activity, which promotes the destruction of alveolar walls and lung parenchyma, leading to conditions such as emphysema.
p.28
Pharmacologic Therapy for COPD
What is the significance of treatment algorithms in managing COPD?
A) They provide a one-size-fits-all approach
B) They help tailor treatment to individual patient needs
C) They eliminate the need for patient monitoring
D) They focus solely on surgical options
E) They are only applicable in emergency situations
B) They help tailor treatment to individual patient needs
Explanation: Treatment algorithms for COPD are significant because they help healthcare providers tailor pharmacotherapy to the specific needs of individual patients, ensuring more effective management of the disease.
p.44
Pharmacologic Therapy for COPD
What is a notable characteristic of Roflumilast regarding its administration?
A) Administered intravenously
B) Administered orally
C) Administered via inhalation
D) Administered topically
E) Administered subcutaneously
B) Administered orally
Explanation: Roflumilast is administered orally, which is an important consideration for patient compliance and treatment regimens.
p.15
Management of COPD Exacerbations
What indicates a need for hospitalization in COPD patients?
A) Mild shortness of breath
B) One or more exacerbation(s) requiring hospitalization
C) Occasional cough
D) Stable condition
E) No history of exacerbations
B) One or more exacerbation(s) requiring hospitalization
Explanation: Patients with COPD who experience one or more exacerbation(s) that require hospitalization are considered to have a more severe form of the disease and need closer management.
What is recommended for all COPD patients regarding AAT levels?
A) AAT levels should be ignored
B) AAT levels should be assessed only in smokers
C) AAT levels should be assessed in all patients
D) AAT levels are only necessary for patients under 40
E) AAT levels should be checked only in emergency situations
C) AAT levels should be assessed in all patients
Explanation: The text recommends assessing AAT levels in all COPD patients, particularly in areas with a high prevalence of AAT deficiency, highlighting its importance in diagnosis.
p.20
Pharmacologic Therapy for COPD
What is considered a first-line medication for tobacco use disorder?
A) Aspirin
B) Nicotine replacement therapy (NRT)
C) Ibuprofen
D) Antidepressants
E) Antihistamines
B) Nicotine replacement therapy (NRT)
Explanation: Nicotine replacement therapy (NRT) is recognized as a first-line medication for treating tobacco use disorder, helping to reduce withdrawal symptoms and cravings.
p.25
Pharmacologic Therapy for COPD
What is a common practice when using nicotine replacement therapies (NRTs)?
A) Using only one type of NRT
B) Combining NRTs, such as a nicotine patch and gum
C) Avoiding NRTs altogether
D) Using NRTs only in the morning
E) Using NRTs only for a week
B) Combining NRTs, such as a nicotine patch and gum
Explanation: It is common to combine different forms of NRTs, such as using a nicotine patch along with 'as needed' gum, to enhance the effectiveness of smoking cessation efforts.
p.54
Pharmacologic Therapy for COPD
Why were β-blockers historically avoided in COPD patients?
A) They are too expensive
B) Concerns of worsening respiratory status
C) They have no known benefits
D) They cause severe side effects
E) They are ineffective
B) Concerns of worsening respiratory status
Explanation: Historically, β-blockers were avoided in COPD patients due to concerns that they could worsen respiratory status, reflecting a cautious approach to their use.
p.31
Pharmacologic Therapy for COPD
What aspect of health does pulmonary rehabilitation improve in COPD patients?
A) It decreases exercise tolerance
B) It has no effect on health status
C) It improves exercise tolerance and health status
D) It only improves symptoms
E) It increases hospitalization rates
C) It improves exercise tolerance and health status
Explanation: Pulmonary rehabilitation is effective in improving both exercise tolerance and overall health status in patients with COPD.
p.36
Pharmacologic Therapy for COPD
How often do aclidinium and glycopyrrolate need to be dosed?
A) Once daily
B) Twice daily
C) Three times daily
D) Once weekly
E) As needed
B) Twice daily
Explanation: Aclidinium and glycopyrrolate require twice-daily dosing, which is important for maintaining effective therapeutic levels in patients with COPD.
p.64
Pharmacologic Therapy for COPD
What is the first-line agent for pharmacologic management in COPD exacerbations?
A) Long-acting anticholinergics
B) Short-acting β2-agonists
C) Corticosteroids
D) Antibiotics
E) Mucolytics
B) Short-acting β2-agonists
Explanation: The first-line agents for pharmacologic management during COPD exacerbations are short-acting β2-agonists, which can be used with or without ipratropium via MDI or nebulizer.
p.26
Nonpharmacologic Therapy for COPD
What is a key benefit of long-term oxygen therapy?
A) It eliminates the need for surgery
B) It reduces mortality and improves quality of life
C) It increases exercise capacity without training
D) It is only needed for short-term use
E) It is effective for all patients regardless of condition
B) It reduces mortality and improves quality of life
Explanation: Long-term oxygen therapy (greater than 15 hours/day) has been shown to significantly reduce mortality rates and enhance the quality of life for patients with chronic respiratory failure.
p.20
Pharmacologic Therapy for COPD
What is the primary goal of pharmacotherapy in tobacco use disorder?
A) To eliminate all cravings immediately
B) To reduce withdrawal symptoms and cravings
C) To increase nicotine intake
D) To promote smoking
E) To provide a sedative effect
B) To reduce withdrawal symptoms and cravings
Explanation: The primary goal of pharmacotherapy for tobacco use disorder is to alleviate withdrawal symptoms and cravings, making it easier for individuals to quit smoking.
p.26
Nonpharmacologic Therapy for COPD
What is the minimum duration of oxygen administration recommended for long-term therapy?
A) 5 hours/day
B) 10 hours/day
C) 15 hours/day
D) 20 hours/day
E) 24 hours/day
C) 15 hours/day
Explanation: Long-term oxygen therapy is defined as oxygen administration for greater than 15 hours/day, which is crucial for patients with chronic respiratory failure.
p.27
Treatment Goals for COPD
What is the target oxygen saturation level for patients receiving long-term oxygen therapy?
A) At least 85%
B) At least 90%
C) At least 95%
D) At least 80%
E) At least 75%
B) At least 90%
Explanation: The goal of long-term oxygen therapy is to achieve an oxygen saturation level of at least 90% (0.90) and/or a Pao2 of at least 60 mm Hg, ensuring adequate oxygenation for patients.
p.39
Pharmacologic Therapy for COPD
Which of the following is NOT a side effect of anticholinergics?
A) Metallic taste
B) Constipation
C) Blurred vision
D) Increased appetite
E) Tachycardia
D) Increased appetite
Explanation: Increased appetite is not listed as a side effect of anticholinergics, while metallic taste, constipation, blurred vision, and tachycardia are common side effects.
p.48
Treatment Goals for COPD
What is the primary goal of considering a step-down in therapy for certain COPD patients?
A) To increase medication dosage
B) To reduce medication side effects
C) To improve lung function
D) To prevent all exacerbations
E) To switch to a different medication class
B) To reduce medication side effects
Explanation: The primary goal of considering a step-down in therapy, such as ICS withdrawal, is to minimize potential side effects in stable COPD patients who are not frequent exacerbators and have low eosinophil counts.
p.36
Pharmacologic Therapy for COPD
Which of the following LAMAs allows for once-daily dosing due to its long half-life?
A) Aclidinium
B) Glycopyrrolate
C) Tiotropium
D) Ipratropium
E) Umeclidinium
C) Tiotropium
Explanation: Tiotropium has a long half-life that allows for once-daily dosing, making it convenient for patients. Umeclidinium and revefenacin also have this property.
p.8
Pathophysiology of COPD
What results from mucus, inflammatory debris, and disrupted tissue repair in the airways?
A) Widening of small airways
B) Improved airflow
C) Narrowing of small airways
D) Increased lung volume
E) Enhanced oxygen exchange
C) Narrowing of small airways
Explanation: The accumulation of mucus, inflammatory debris, and disrupted tissue repair leads to the narrowing of small airways, which is a significant factor in the progression of COPD.
p.41
Pharmacologic Therapy for COPD
What serious adverse effects can occur with theophylline use?
A) Skin rash and itching
B) Seizures and arrhythmias
C) Weight loss and dehydration
D) Fatigue and malaise
E) Cough and wheezing
B) Seizures and arrhythmias
Explanation: Seizures and arrhythmias are serious dose-related adverse effects of theophylline, highlighting the importance of monitoring patients for these potentially severe reactions.
p.25
Pharmacologic Therapy for COPD
Which pharmacological option was found to be more effective than single NRT or bupropion SR?
A) Nicotine patch
B) Varenicline
C) Bupropion SR
D) Combination NRT
E) Nicotine gum
B) Varenicline
Explanation: Varenicline was found to be more effective than single NRT or bupropion SR, highlighting its superior efficacy in aiding smoking cessation.
p.15
Etiology and Risk Factors of COPD
Who are considered high-risk patients in COPD management?
A) Patients with no history of exacerbations
B) Patients with a history of two or more exacerbations per year
C) Patients who are non-smokers
D) Patients with mild symptoms
E) Patients with a single exacerbation requiring outpatient treatment
B) Patients with a history of two or more exacerbations per year
Explanation: High-risk patients in COPD management are those with a history of two or more exacerbations per year, as they require more intensive treatment to prevent further complications.
p.26
Nonpharmacologic Therapy for COPD
Which patients are most likely to benefit from long-term oxygen therapy?
A) Patients with mild asthma
B) Patients with chronic respiratory failure
C) Patients with seasonal allergies
D) Patients recovering from surgery
E) Patients with acute bronchitis
B) Patients with chronic respiratory failure
Explanation: Long-term oxygen therapy is specifically indicated for patients with chronic respiratory failure, as it helps manage their condition effectively.
p.64
Pharmacologic Therapy for COPD
What is the recommended method of administering bronchodilators?
A) Only orally
B) Via MDI with or without a spacer or nebulizer
C) Only through intravenous injection
D) Only through inhalation of vapors
E) Only via subcutaneous injection
B) Via MDI with or without a spacer or nebulizer
Explanation: Bronchodilators can be administered via metered-dose inhalers (MDI) with or without a spacer or nebulizer, which are common methods for delivering medication in COPD management.
p.48
Pharmacologic Therapy for COPD
What does ICS stand for in the context of COPD treatment?
A) Inhaled Corticosteroids
B) Intravenous Corticosteroids
C) Inhaled Cortical Stimulants
D) Intranasal Corticosteroids
E) Intermittent Corticosteroids
A) Inhaled Corticosteroids
Explanation: ICS refers to Inhaled Corticosteroids, which are commonly used in the management of COPD to reduce inflammation and prevent exacerbations.
p.34
Pharmacologic Therapy for COPD
What advice should be given to patients using a SABA as a rescue medication?
A) Use it as often as possible
B) Avoid using it altogether
C) Avoid excessive use
D) Use it only at night
E) Use it only during exercise
C) Avoid excessive use
Explanation: Patients should be advised to avoid excessive use of their SABA, as over-reliance on rescue medications can indicate inadequate control of their condition.
p.23
Pharmacologic Therapy for COPD
What are some warnings associated with Varenicline?
A) Gastrointestinal issues
B) Seizures and cardiovascular adverse events
C) Liver failure
D) Allergic reactions
E) Respiratory distress
B) Seizures and cardiovascular adverse events
Explanation: Warnings for Varenicline include the risk of seizures and cardiovascular adverse events, such as angina, which are important considerations for patient safety.
p.22
Pharmacologic Therapy for COPD
How does bupropion help with nicotine dependence?
A) By increasing serotonin levels
B) By blocking dopamine receptors
C) By reducing nicotine reinforcement, withdrawal, and craving
D) By enhancing opioid effects
E) By promoting alcohol consumption
C) By reducing nicotine reinforcement, withdrawal, and craving
Explanation: Bupropion's mechanisms, including its action as a nicotinic antagonist, may help explain its effectiveness in reducing nicotine reinforcement, withdrawal symptoms, and cravings.
p.67
Management of COPD Exacerbations
When are antibiotics recommended for patients with respiratory issues?
A) Only for patients with a cough
B) For patients with increased sputum purulence and either increased sputum volume or increased dyspnea
C) For all patients with respiratory infections
D) Only for patients requiring hospitalization
E) For patients with a fever
B) For patients with increased sputum purulence and either increased sputum volume or increased dyspnea
Explanation: Antibiotics are recommended for patients exhibiting increased sputum purulence along with either increased sputum volume or increased dyspnea, or for those with all three symptoms, indicating a more severe respiratory condition.
p.22
Pharmacologic Therapy for COPD
In which patients is bupropion contraindicated?
A) Patients with anxiety disorders
B) Patients with seizure disorders
C) Patients with chronic pain
D) Patients with hypertension
E) Patients with insomnia
B) Patients with seizure disorders
Explanation: Bupropion is contraindicated in patients with seizure disorders, eating disorders, and those withdrawing from alcohol or sedative-hypnotics due to the risk of seizures.
p.67
Pharmacologic Therapy for COPD
What is the preferred route for administering antibiotics in respiratory exacerbations?
A) Intravenous
B) Topical
C) Oral
D) Inhalation
E) Subcutaneous
C) Oral
Explanation: The oral route is preferred for administering antibiotics in patients experiencing respiratory exacerbations, as it is generally more convenient and effective for outpatient management.
p.44
Pharmacologic Therapy for COPD
For which patients is Roflumilast indicated?
A) Patients with mild asthma
B) Patients with severe COPD associated with chronic bronchitis
C) Patients with acute bronchitis
D) Patients with pneumonia
E) Patients with lung cancer
B) Patients with severe COPD associated with chronic bronchitis
Explanation: Roflumilast is indicated for patients suffering from severe COPD that is associated with chronic bronchitis and a history of exacerbations.
p.40
Pharmacologic Therapy for COPD
What important drug interaction should be considered when prescribing Theophylline?
A) Alcohol consumption
B) Caffeine intake
C) Tobacco smoke
D) Antidepressants
E) Antihistamines
C) Tobacco smoke
Explanation: Tobacco smoke is an important drug interaction that induces the metabolism of Theophylline, increasing its clearance and potentially affecting its therapeutic efficacy.
p.44
Pharmacologic Therapy for COPD
What is a significant drawback of PDE-4 inhibitors compared to ICS and LABA?
A) They are less effective
B) They are more expensive
C) They have fewer side effects
D) They are first-line agents
E) They are easier to administer
B) They are more expensive
Explanation: PDE-4 inhibitors, such as Roflumilast, are noted to be more expensive and have more frequent side effects compared to inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA).
p.23
Pharmacologic Therapy for COPD
What happens if a patient relapses while on Varenicline?
A) It has no effect
B) It increases withdrawal symptoms
C) It prevents reinforcing effects of nicotine
D) It causes immediate addiction
E) It leads to increased cravings
C) It prevents reinforcing effects of nicotine
Explanation: Varenicline helps to prevent the reinforcing effects of nicotine if a patient relapses, which can aid in reducing the likelihood of continued smoking.
p.51
Vaccination Recommendations for COPD Patients
What is the primary purpose of the pneumococcal conjugate vaccine (PCV13)?
A) To prevent influenza
B) To prevent pneumococcal infections
C) To treat respiratory diseases
D) To enhance immune response to COVID-19
E) To provide general immunity
B) To prevent pneumococcal infections
Explanation: The primary purpose of the pneumococcal conjugate vaccine (PCV13) is to prevent pneumococcal infections, which can lead to serious health complications, especially in older adults.
p.55
Pharmacologic Therapy for COPD
Which class of medications is commonly used as maintenance therapy for COPD?
A) Antibiotics
B) Corticosteroids
C) Long-acting bronchodilators
D) Antihistamines
E) Antidepressants
C) Long-acting bronchodilators
Explanation: Long-acting bronchodilators are a key component of maintenance therapy for COPD, helping to open the airways and improve airflow over an extended period.
p.44
Pharmacologic Therapy for COPD
What is the primary action of Phosphodiesterase - 4 (PDE - 4) inhibitors?
A) Increase inflammation
B) Inhibit breakdown of cAMP
C) Promote mucus production
D) Enhance bronchoconstriction
E) Decrease oxygen levels
B) Inhibit breakdown of cAMP
Explanation: PDE-4 inhibitors work by reducing inflammation through the inhibition of the breakdown of cyclic adenosine monophosphate (cAMP), which plays a crucial role in inflammatory processes.
p.5
Etiology and Risk Factors of COPD
Which of the following is a risk factor linked to environmental conditions?
A) Regular exercise
B) Environmental air pollution
C) Balanced diet
D) Sufficient sleep
E) Hydration
B) Environmental air pollution
Explanation: Environmental air pollution is a significant risk factor for respiratory diseases, as exposure to pollutants can lead to chronic respiratory conditions and exacerbate existing health issues.
p.26
Nonpharmacologic Therapy for COPD
How long should exercise training be conducted in pulmonary rehabilitation?
A) 2 weeks
B) 4 weeks
C) 6 weeks
D) 8 weeks
E) 10 weeks
C) 6 weeks
Explanation: Exercise training for at least 6 weeks is recommended as part of pulmonary rehabilitation to help improve the physical condition of patients with chronic respiratory issues.
p.55
Pharmacologic Therapy for COPD
Which of the following is NOT a goal of pharmacotherapy in COPD?
A) Reducing symptoms
B) Preventing exacerbations
C) Improving exercise tolerance
D) Curing the disease
E) Enhancing quality of life
D) Curing the disease
Explanation: The goals of pharmacotherapy in COPD include reducing symptoms, preventing exacerbations, improving exercise tolerance, and enhancing quality of life, but there is currently no cure for COPD.
p.62
Management of COPD Exacerbations
Which of the following indicates a life-threatening exacerbation of COPD?
A) Normal respiratory rate
B) Mental status changes
C) Mild wheezing
D) Stable hemodynamics
E) Improved oxygen saturation
B) Mental status changes
Explanation: Mental status changes are a sign of a life-threatening exacerbation of COPD, indicating severe respiratory distress and potential complications.
p.28
Pharmacologic Therapy for COPD
Which of the following is NOT typically part of the pharmacotherapy treatment algorithm for COPD?
A) Long-acting beta-agonists
B) Inhaled corticosteroids
C) Oral contraceptives
D) Short-acting bronchodilators
E) Phosphodiesterase-4 inhibitors
C) Oral contraceptives
Explanation: Oral contraceptives are not part of the pharmacotherapy treatment algorithm for COPD, as they are unrelated to the management of respiratory conditions. The algorithm focuses on medications that directly affect lung function and symptoms.
p.52
Treatment Goals for COPD
Can augmentation therapy be considered for patients with an FEV1 greater than 65%?
A) No, it is not allowed
B) Yes, it can be considered
C) Only in emergencies
D) Only for patients over 50
E) Only if they have other conditions
B) Yes, it can be considered
Explanation: Augmentation therapy can be considered even in patients with an FEV1 greater than 65%, indicating its potential utility across a broader range of lung function.
p.55
Pharmacologic Therapy for COPD
What is the primary purpose of maintenance medications for COPD?
A) To cure the disease
B) To manage symptoms and prevent exacerbations
C) To increase lung capacity
D) To eliminate the need for oxygen therapy
E) To reduce the risk of lung cancer
B) To manage symptoms and prevent exacerbations
Explanation: Maintenance medications for COPD are designed to help manage symptoms and prevent exacerbations, improving the quality of life for patients with chronic obstructive pulmonary disease.
p.62
Management of COPD Exacerbations
What is a common sign of a severe COPD exacerbation?
A) Decreased heart rate
B) Use of accessory muscles to breathe
C) Increased appetite
D) Improved oxygen saturation
E) Normal respiratory rate
B) Use of accessory muscles to breathe
Explanation: During severe COPD exacerbations, patients often use accessory muscles to breathe, indicating increased respiratory effort and distress.
p.4
Etiology and Risk Factors of COPD
What role does early childhood lung infections play in COPD?
A) They have no effect
B) They increase the risk of developing COPD
C) They cure COPD
D) They only affect adults
E) They are beneficial for lung health
B) They increase the risk of developing COPD
Explanation: Early childhood lung infections are listed as a factor that can increase the risk of developing COPD, indicating their long-term impact on lung health.
p.28
Pharmacologic Therapy for COPD
Which of the following is likely included in the pharmacotherapy treatment algorithm for COPD?
A) Antidepressants
B) Bronchodilators
C) Antihistamines
D) Antibiotics
E) Antivirals
B) Bronchodilators
Explanation: Bronchodilators are a key component of the pharmacotherapy treatment algorithm for COPD, as they help to open the airways and improve breathing in patients with this condition.
Which assessment tool is more focused on the overall impact of COPD on daily life?
A) mMRC
B) CAT
C) FEV1
D) Spirometry
E) Peak Flow Meter
B) CAT
Explanation: The COPD Assessment Test (CAT) is designed to evaluate the overall impact of COPD on a patient's daily life, making it a comprehensive tool for understanding the disease's effects.
What classification system is used for COPD?
A) WHO classification
B) GOLD classification
C) NIH classification
D) CDC classification
E) AHA classification
B) GOLD classification
Explanation: The GOLD classification is specifically used to categorize the severity of COPD, helping guide treatment decisions based on the patient's condition.
p.54
Pharmacologic Therapy for COPD
What is a key consideration when using β-blockers in COPD patients?
A) They should only be used for respiratory issues
B) They can be used to treat cardiovascular comorbidities
C) They should be avoided at all costs
D) They are only effective in mild cases
E) They must be combined with steroids
B) They can be used to treat cardiovascular comorbidities
Explanation: It is important to note that β-blockers can be continued in COPD patients, particularly when they are used to manage cardiovascular comorbidities, highlighting their potential dual benefit.
p.52
Pharmacologic Therapy for COPD
Is augmentation therapy recommended for individuals with AAT deficiency who do not have lung disease?
A) Yes, it is always recommended
B) Yes, but only for mild cases
C) No, it is not recommended
D) Yes, but only for severe cases
E) It depends on the patient's age
C) No, it is not recommended
Explanation: Augmentation therapy is not recommended for individuals with AAT deficiency who do not have lung disease, emphasizing the therapy's specific application to those with lung-related complications.
p.33
Pharmacologic Therapy for COPD
Which of the following is a long-acting β2-agonist?
A) Levalbuterol
B) Terbutaline
C) Arformoterol
D) Albuterol
E) Salbutamol
C) Arformoterol
Explanation: Arformoterol is a long-acting β2-agonist (LABA) used for continuous bronchodilator therapy in COPD patients, while levalbuterol, terbutaline, and albuterol are short-acting agents.
p.44
Pharmacologic Therapy for COPD
What should Roflumilast not be combined with?
A) ICS
B) LABA
C) Theophylline
D) Antibiotics
E) Antihistamines
C) Theophylline
Explanation: It is advised that Roflumilast should not be combined with theophylline, as this could lead to adverse effects or reduced efficacy.
What does the COPD Assessment Test (CAT) measure?
A) The effectiveness of medication
B) The quality of life in COPD patients
C) The lung capacity of patients
D) The frequency of exacerbations
E) The age of onset of COPD
B) The quality of life in COPD patients
Explanation: The CAT is a tool used to measure the impact of COPD on a patient's quality of life, providing insights into how the disease affects daily activities and overall well-being.
p.35
Pharmacologic Therapy for COPD
Which of the following adverse effects is associated with β2-agonist use?
A) Hyperkalemia
B) Hypokalemia
C) Insomnia
D) Drowsiness
E) Constipation
B) Hypokalemia
Explanation: Hypokalemia is a known adverse effect of β2-agonists, which can lead to decreased potassium levels in the blood, potentially causing complications.
p.40
Pharmacologic Therapy for COPD
What is the primary action of Theophylline in the treatment of respiratory conditions?
A) It acts as a selective phosphodiesterase inhibitor
B) It decreases intracellular cAMP
C) It increases intracellular cAMP within airway smooth muscle
D) It causes bronchoconstriction
E) It is an anti-inflammatory agent
C) It increases intracellular cAMP within airway smooth muscle
Explanation: Theophylline is a nonselective phosphodiesterase inhibitor that increases intracellular cAMP, leading to bronchodilation and potentially improving inspiratory function.
p.35
Pharmacologic Therapy for COPD
Which of the following β2-agonists is NOT a long-acting agent?
A) Salmeterol
B) Formoterol
C) Indacaterol
D) Albuterol
E) Vilanterol
D) Albuterol
Explanation: Albuterol is a short-acting β2-agonist, while the others listed are long-acting agents, highlighting the difference in their duration of action.
p.6
Pathophysiology of COPD
What results from the imbalance between proteinases and antiproteinases in the lungs?
A) Improved lung function
B) Obstruction of airways
C) Increased lung volume
D) Enhanced gas exchange
E) Decreased inflammation
B) Obstruction of airways
Explanation: The imbalance between proteinases and antiproteinases contributes to pathologic changes in the airways and lung parenchyma, leading to obstruction, which is a hallmark of COPD.
p.33
Pharmacologic Therapy for COPD
Which of the following is NOT a long-acting β2-agonist (LABA)?
A) Salmeterol
B) Formoterol
C) Albuterol
D) Indacaterol
E) Vilanterol
C) Albuterol
Explanation: Albuterol is a short-acting β2-agonist, while salmeterol, formoterol, indacaterol, and vilanterol are examples of long-acting β2-agonists (LABAs).
p.20
Pharmacologic Therapy for COPD
Which of the following is NOT a first-line medication for tobacco use disorder?
A) Nicotine replacement therapy (NRT)
B) Varenicline
C) Bupropion sustained-release (SR)
D) Methadone
E) None of the above
D) Methadone
Explanation: Methadone is not a first-line medication for tobacco use disorder; it is primarily used for opioid addiction. The first-line options include NRT, Bupropion SR, and Varenicline.
p.55
Pharmacologic Therapy for COPD
What role do inhaled medications play in the management of COPD?
A) They are only used in emergency situations
B) They provide immediate relief of symptoms
C) They are used for long-term control of symptoms
D) They are ineffective in COPD management
E) They are only prescribed for acute exacerbations
C) They are used for long-term control of symptoms
Explanation: Inhaled medications are crucial in the long-term management of COPD, providing ongoing control of symptoms and improving lung function.
p.64
Management of COPD Exacerbations
What is the role of increased doses or frequency of bronchodilators during an exacerbation?
A) To reduce side effects
B) To provide additional benefit
C) To prevent the need for hospitalization
D) To replace other medications
E) To enhance the effect of corticosteroids
B) To provide additional benefit
Explanation: Increased doses and/or frequency of bronchodilators may provide additional benefit during a COPD exacerbation, helping to alleviate symptoms more effectively.
p.5
Etiology and Risk Factors of COPD
Which of the following is a childhood-related risk factor for respiratory issues?
A) Maternal smoking
B) Regular vaccinations
C) Healthy eating habits
D) Outdoor play
E) Good hygiene practices
A) Maternal smoking
Explanation: Maternal smoking is a significant risk factor that can adversely affect respiratory health in children, increasing the likelihood of developing asthma and other respiratory conditions.
p.33
Pharmacologic Therapy for COPD
What type of therapy do most COPD patients require on a scheduled basis?
A) Antibiotic therapy
B) Continuous bronchodilator therapy
C) Steroid therapy
D) Antiviral therapy
E) Oxygen therapy
B) Continuous bronchodilator therapy
Explanation: Most COPD patients need continuous bronchodilator therapy on a scheduled basis every day, specifically using long-acting agents to manage their condition effectively.
p.6
Pathophysiology of COPD
What is a primary consequence of repeated exposure to noxious particles and gases in the lungs?
A) Increased lung capacity
B) Chronic inflammation
C) Enhanced oxygen exchange
D) Decreased respiratory rate
E) Improved lung elasticity
B) Chronic inflammation
Explanation: Repeated exposure to noxious particles and gases leads to chronic inflammation in the lungs, which is a key factor in the pathophysiology of Chronic Obstructive Pulmonary Disease (COPD).
What is the first step in the treatment of COPD?
A) Prescribing antibiotics
B) Assessing COPD severity
C) Recommending surgery
D) Providing oxygen therapy
E) Initiating pulmonary rehabilitation
B) Assessing COPD severity
Explanation: The first step in the treatment of COPD involves assessing the severity of the condition, which is crucial for determining the appropriate management strategy.
p.40
Pharmacologic Therapy for COPD
Why is Theophylline's use limited in clinical practice?
A) It has a wide therapeutic index
B) It has no drug interactions
C) It has a narrow therapeutic index and multiple drug interactions
D) It is only effective in children
E) It is a first-line treatment for all patients
C) It has a narrow therapeutic index and multiple drug interactions
Explanation: Theophylline's limited use is due to its narrow therapeutic index, which increases the risk of toxicity, along with multiple drug interactions and potential adverse effects.
p.52
Treatment Goals for COPD
In which FEV1 range is augmentation therapy considered most beneficial?
A) 10% to 20%
B) 20% to 34%
C) 35% to 49%
D) 50% to 64%
E) Greater than 80%
C) 35% to 49%
Explanation: Augmentation therapy appears to be most beneficial in patients with an FEV1 of 35% to 49% predicted, indicating its targeted application in moderate lung impairment.
What defines GOLD 4, Very Severe COPD?
A) FEV1 greater than 80%
B) FEV1 between 50% and 79%
C) FEV1 between 30% and 49%
D) FEV1 less than 30%
E) FEV1 between 70% and 80%
D) FEV1 less than 30%
Explanation: GOLD 4, or Very Severe COPD, is defined by an FEV1 of less than 30% predicted, indicating a critical level of airflow limitation.
p.67
Pharmacologic Therapy for COPD
What factors should be considered when selecting an antimicrobial regimen for respiratory exacerbations?
A) Patient's age and weight
B) Severity of exacerbation and local resistance patterns
C) Duration of symptoms
D) Patient's previous antibiotic use
E) Cost of medication
B) Severity of exacerbation and local resistance patterns
Explanation: When selecting an antimicrobial regimen, it is important to consider the severity of the exacerbation and local resistance patterns to ensure effective treatment.
p.67
Management of COPD Exacerbations
In which situation should antibiotics be administered to patients?
A) Patients with mild symptoms
B) Patients requiring mechanical ventilation
C) Patients with a common cold
D) Patients with allergies
E) Patients with stable COPD
B) Patients requiring mechanical ventilation
Explanation: Antibiotics are indicated for patients who require mechanical ventilation, as this suggests a severe respiratory condition that may involve bacterial infection.
p.22
Pharmacologic Therapy for COPD
What is one of the metabolites of bupropion known for its action?
A) Serotonin reuptake inhibitor
B) Nicotinic antagonist
C) GABA agonist
D) MAO inhibitor
E) Opioid receptor agonist
B) Nicotinic antagonist
Explanation: One of the metabolites of bupropion acts as a nicotinic antagonist, which may help in reducing nicotine reinforcement and cravings.
p.32
Pharmacologic Therapy for COPD
Which type of bronchodilator is preferred for monotherapy in stable COPD?
A) Short-acting β2-agonists
B) Long-acting bronchodilators
C) Anticholinergics
D) Methylxanthines
E) Inhaled corticosteroids
B) Long-acting bronchodilators
Explanation: Monotherapy with long-acting bronchodilators is preferred in the management of stable COPD, as they provide sustained relief of symptoms.
p.26
Nonpharmacologic Therapy for COPD
What is the primary goal of pulmonary rehabilitation?
A) To increase medication dosage
B) To improve lung function in patients with FEV1 less than 50%
C) To eliminate the need for surgery
D) To provide immediate relief from symptoms
E) To prevent all respiratory diseases
B) To improve lung function in patients with FEV1 less than 50%
Explanation: Pulmonary rehabilitation is particularly effective for patients with an FEV1 less than 50% predicted, aiming to enhance their lung function and overall health.
p.32
Pharmacologic Therapy for COPD
What is the preferred route of administration for COPD pharmacologic therapy?
A) Oral
B) Intravenous
C) Inhalation
D) Subcutaneous
E) Topical
C) Inhalation
Explanation: The inhalation route is preferred for administering medications in COPD therapy, as it allows for direct delivery to the lungs and improves the effectiveness of the treatment.
p.39
Pharmacologic Therapy for COPD
What is a potential cardiovascular safety concern regarding tiotropium and ipratropium?
A) Increased cardiovascular risk
B) Decreased heart rate
C) No increased cardiovascular risk
D) Increased blood pressure
E) Heart failure
C) No increased cardiovascular risk
Explanation: The cardiovascular safety of tiotropium and ipratropium indicates that there is no increased cardiovascular risk associated with these medications, making them safer options for patients with cardiovascular concerns.
p.27
Management of COPD Exacerbations
What is the significance of peripheral edema in COPD patients regarding oxygen therapy?
A) It indicates good lung function
B) It suggests the need for long-term oxygen therapy
C) It is unrelated to oxygen levels
D) It indicates a need for surgery
E) It suggests a viral infection
B) It suggests the need for long-term oxygen therapy
Explanation: Peripheral edema in COPD patients may indicate congestive heart failure, which, along with other factors, can suggest the need for long-term oxygen therapy to manage their condition effectively.
p.41
Pharmacologic Therapy for COPD
Which of the following is NOT a common adverse effect of theophylline?
A) Tachycardia
B) Tremor
C) Nausea
D) Insomnia
E) Irritability
C) Nausea
Explanation: While nausea is a dose-related adverse effect, it is not listed among the most common adverse effects of theophylline, which include tachycardia, tremor, insomnia, and irritability.
p.6
Pathophysiology of COPD
What can lead to an imbalance in proteinases and antiproteinases in the lungs?
A) Increased production of protective antiproteinases
B) Decreased exposure to pollutants
C) Increased production or activity of destructive proteinases
D) Enhanced lung repair mechanisms
E) Improved immune response
C) Increased production or activity of destructive proteinases
Explanation: An increased production or activity of destructive proteinases, along with reduced production or inactivation of protective antiproteinases, leads to an imbalance that is detrimental to lung health in COPD.
p.40
Pharmacologic Therapy for COPD
What is a significant adverse effect of Theophylline?
A) Weight gain
B) Sedation
C) Bronchospasm
D) Nausea and vomiting
E) Increased appetite
D) Nausea and vomiting
Explanation: Theophylline can cause several adverse effects, with nausea and vomiting being significant due to its narrow therapeutic index and potential for toxicity.
p.60
Management of COPD Exacerbations
What is a common factor in classifying the severity of COPD exacerbations?
A) Patient's age
B) Patient's clinical status
C) Duration of symptoms
D) Previous exacerbation history
E) Geographic location
B) Patient's clinical status
Explanation: The classification of COPD exacerbations—mild, moderate, or severe—is based on the patient's clinical status, which helps determine the appropriate level of care and treatment needed.
p.39
Pharmacologic Therapy for COPD
What serious condition can be precipitated by anticholinergics?
A) Asthma
B) Narrow-angle glaucoma
C) Hypertension
D) Diabetes
E) Osteoporosis
B) Narrow-angle glaucoma
Explanation: Anticholinergics can precipitate symptoms of narrow-angle glaucoma, which is a significant concern for patients with this condition.
p.52
Pharmacologic Therapy for COPD
What is the primary goal of α1 - Antitrypsin Augmentation Therapy?
A) To cure lung disease
B) To maintain adequate plasma levels of the enzyme
C) To reduce inflammation in the lungs
D) To increase lung capacity
E) To prevent infections
B) To maintain adequate plasma levels of the enzyme
Explanation: The primary goal of α1 - Antitrypsin Augmentation Therapy is to maintain adequate plasma levels of the enzyme, which is crucial for patients with α1-antitrypsin deficiency and associated lung disease.
p.54
Pharmacologic Therapy for COPD
Which type of β-blockers appears to be safe for COPD patients?
A) Non-selective β-blockers
B) β1-selective agents
C) β2-selective agents
D) All β-blockers
E) None of the β-blockers
B) β1-selective agents
Explanation: β1-selective agents are noted to be particularly safe for COPD patients, allowing for their continued use, especially when treating cardiovascular comorbidities.
p.32
Pharmacologic Therapy for COPD
Which of the following is NOT a type of bronchodilator used in stable COPD?
A) β2-agonists
B) Anticholinergics
C) Methylxanthines
D) Corticosteroids
E) Long-acting bronchodilators
D) Corticosteroids
Explanation: Corticosteroids are not classified as bronchodilators; they are anti-inflammatory medications. The bronchodilators used in stable COPD include β2-agonists, anticholinergics, and methylxanthines.
p.22
Pharmacologic Therapy for COPD
Which of the following conditions is NOT a contraindication for bupropion?
A) Seizure disorders
B) Eating disorders
C) Alcohol withdrawal
D) Chronic migraines
E) Sedative-hypnotic withdrawal
D) Chronic migraines
Explanation: Chronic migraines are not listed as a contraindication for bupropion; however, seizure disorders, eating disorders, and withdrawal from alcohol or sedative-hypnotics are contraindicated due to the risk of seizures.
p.25
Pharmacologic Therapy for COPD
How does the effectiveness of varenicline compare to combination NRT?
A) Varenicline is less effective
B) Varenicline and combination NRT are equally effective
C) Combination NRT is more effective
D) They have no effect on smoking cessation
E) Varenicline is only effective in the short term
B) Varenicline and combination NRT are equally effective
Explanation: The text states that varenicline and combination NRT were found to be equally effective, indicating that both options are viable for improving smoking cessation rates.
p.6
Pathophysiology of COPD
What are the primary areas affected by chronic inflammation in COPD?
A) Only the central airways
B) The central and peripheral airways, lung parenchyma, and pulmonary vasculature
C) Only the peripheral airways
D) The heart and lungs
E) The skin and lungs
B) The central and peripheral airways, lung parenchyma, and pulmonary vasculature
Explanation: Chronic inflammation in COPD affects multiple areas, including the central and peripheral airways, lung parenchyma, and pulmonary vasculature, leading to significant pathologic changes.
p.8
Pathophysiology of COPD
What leads to chronic cough and sputum production in COPD?
A) Increased lung elasticity
B) Mucus hypersecretion and ciliary dysfunction
C) Decreased airway resistance
D) Improved gas exchange
E) Enhanced pulmonary function
B) Mucus hypersecretion and ciliary dysfunction
Explanation: Mucus hypersecretion and ciliary dysfunction are responsible for chronic cough and sputum production, which are common symptoms in patients with COPD.
p.51
Vaccination Recommendations for COPD Patients
What should be considered before administering PCV13 to older patients?
A) Previous vaccinations
B) Patient's weight
C) Patient's travel history
D) Family medical history
E) Patient's occupation
A) Previous vaccinations
Explanation: Before administering PCV13 to patients 65 years and older, it is important to consider whether they have previously received the vaccine, as this influences the appropriateness of the vaccination.
p.25
Pharmacologic Therapy for COPD
According to a meta-analysis, which of the following improves smoking cessation rates?
A) Only varenicline
B) Only bupropion SR
C) NRT, bupropion SR, and varenicline
D) Only combination NRT
E) None of the above
C) NRT, bupropion SR, and varenicline
Explanation: The meta-analysis concluded that NRT, bupropion SR, and varenicline all improve smoking cessation rates, indicating the effectiveness of these pharmacological options.
p.28
Pharmacologic Therapy for COPD
What edition of the Pharmacotherapy Principles and Practice discusses the treatment algorithm for COPD?
A) 4th edition
B) 5th edition
C) 6th edition
D) 7th edition
E) 8th edition
C) 6th edition
Explanation: The pharmacotherapy treatment algorithm for COPD is discussed in the 6th edition of Pharmacotherapy Principles and Practice, published by McGraw-Hill in 2022.
p.6
Pathophysiology of COPD
What role does oxidative stress play in the pathogenesis of COPD?
A) It reduces inflammation
B) It enhances proteinase activity
C) It has no effect on lung function
D) It improves airway resistance
E) It decreases lung capacity
B) It enhances proteinase activity
Explanation: Oxidative stress is important in the pathogenesis of COPD as it can enhance the activity of destructive proteinases, contributing to lung damage and obstruction.
p.33
Pharmacologic Therapy for COPD
What is the purpose of short-acting β2-agonists in COPD treatment?
A) To provide continuous therapy
B) To manage chronic symptoms
C) To serve as 'rescue' therapy for acute symptoms
D) To prevent exacerbations
E) To replace long-acting agents
C) To serve as 'rescue' therapy for acute symptoms
Explanation: Short-acting β2-agonists are used as 'rescue' therapy to quickly relieve acute symptoms in COPD patients.
p.62
Management of COPD Exacerbations
What might peripheral edema indicate during a COPD exacerbation?
A) Improved lung function
B) Fluid retention due to heart failure
C) Increased physical activity
D) Normal respiratory function
E) Decreased blood pressure
B) Fluid retention due to heart failure
Explanation: Peripheral edema during a COPD exacerbation may indicate fluid retention, often associated with heart failure or severe respiratory distress.
p.7
Pathophysiology of COPD
How does inflammation in COPD differ from that in asthma?
A) COPD has no inflammation
B) Asthma is mediated by neutrophils
C) COPD is mediated by eosinophils
D) Asthma is mediated by eosinophils and mast cells
E) COPD has less inflammation than asthma
D) Asthma is mediated by eosinophils and mast cells
Explanation: The inflammation in COPD is mediated by neutrophils, macrophages, and CD8+ T lymphocytes, while asthma inflammation is primarily mediated by eosinophils and mast cells, highlighting a key difference between the two conditions.
Which of the following tools is specifically designed for assessing COPD symptoms?
A) Asthma Control Test
B) mMRC
C) Beck Depression Inventory
D) Visual Analog Scale
E) Pittsburgh Sleep Quality Index
B) mMRC
Explanation: The modified Medical Research Council Questionnaire (mMRC) is specifically tailored for assessing symptoms related to Chronic Obstructive Pulmonary Disease (COPD), making it a relevant tool for this condition.
p.62
Management of COPD Exacerbations
Which of the following is NOT a sign of a severe COPD exacerbation?
A) Tachypnea
B) Hypoxemia
C) Hypercarbia
D) Increased energy levels
E) Cyanosis
D) Increased energy levels
Explanation: Increased energy levels are not associated with severe COPD exacerbations; instead, patients typically exhibit signs like tachypnea, hypoxemia, hypercarbia, and cyanosis.
p.7
Pathophysiology of COPD
What role does AAT (alpha-1 antitrypsin) play in the lungs?
A) It promotes inflammation
B) It inhibits proteolytic enzymes
C) It enhances proteinase activity
D) It destroys alveolar walls
E) It increases mucus production
B) It inhibits proteolytic enzymes
Explanation: AAT is an antiproteinase that inhibits proteolytic enzymes such as trypsin and elastase. A deficiency in AAT leads to unopposed proteinase activity, resulting in lung damage and conditions like emphysema.
p.62
Management of COPD Exacerbations
What does hypoxemia refer to in the context of COPD exacerbations?
A) Low blood pressure
B) Low oxygen levels in the blood
C) High carbon dioxide levels in the blood
D) High blood sugar levels
E) Normal oxygen levels in the blood
B) Low oxygen levels in the blood
Explanation: Hypoxemia is characterized by low oxygen levels in the blood, which is a critical sign during COPD exacerbations.
p.36
Pharmacologic Therapy for COPD
Which of the following medications is a new addition to the list of long-acting muscarinic antagonists?
A) Ipratropium
B) Aclidinium
C) Revefenacin
D) Tiotropium
E) Umeclidinium
C) Revefenacin
Explanation: Revefenacin is noted as a new addition to the list of long-acting muscarinic antagonists (LAMAs), expanding the options available for COPD management.
p.64
Pharmacologic Therapy for COPD
What should be done with long-acting anticholinergics if ipratropium is used?
A) They should be increased in dosage
B) They should be continued
C) They should be discontinued
D) They should be switched to short-acting agents
E) They should be used only at night
C) They should be discontinued
Explanation: Long-acting anticholinergics should be discontinued if ipratropium is used, as this is part of the recommended pharmacologic management strategy.
p.52
Pharmacologic Therapy for COPD
How often are transfusions of pooled human AAT administered in augmentation therapy?
A) Daily
B) Weekly
C) Monthly
D) Bi-weekly
E) Yearly
B) Weekly
Explanation: Augmentation therapy consists of weekly transfusions of pooled human AAT, which is essential for maintaining the necessary enzyme levels in the plasma.
p.64
Pharmacologic Therapy for COPD
What is the purpose of maintenance bronchodilator therapy in COPD?
A) To cure the disease
B) To manage symptoms and prevent exacerbations
C) To replace the need for oxygen therapy
D) To increase lung capacity permanently
E) To eliminate the need for any medication
B) To manage symptoms and prevent exacerbations
Explanation: Maintenance bronchodilator therapy is intended to manage symptoms and prevent exacerbations in COPD patients, ensuring better control of the disease over time.
