Raus Respiratory Care Pharmacology 9th Edition By Gardenhire – Test Bank

Raus Respiratory Care Pharmacology 9th Edition By Gardenhire – Test Bank

Chapter 11: Corticosteroids in Respiratory Care

Gardenhire: Rau’s Respiratory Care Pharmacology, 9th Edition

MULTIPLE CHOICE

1. A significant side effect of corticosteroid use is inhibition of

a.

IgE.

b.

PDE.

c.

HPA axis.

d.

SRS-A.

ANS: C

When the body produces endogenous glucocorticoids, there is a normal feedback mechanism within the hypothalamic-pituitary–adrenal (HPA) axis to limit production. As glucocorticoid levels increase, the release of corticotropin-releasing factor (CRF) and adrenocorticotropic hormone (ACTH) is inhibited, and further adrenal production is stopped. Because the body cannot distinguish between its own endogenous glucocorticoids and exogenous glucocorticoid drugs, steroid administration can inhibit the hypothalamus and pituitary glands, decreasing adrenal production. Immunoglobulin E (IgE), phosphodiesterase (PDE), and slow-reacting substance of anaphylaxis (SRS-A) are not involved in this process.

REF: p. 184

2. Which of the following is produced in the hypothalamus?

a.

Glucocorticoids

b.

Corticotropin-releasing factor

c.

Mineralocorticoids

d.

Sex hormones

ANS: B

Three types of corticosteroid hormones are produced by the adrenal cortex: glucocorticoids, mineralocorticoids, and sex hormones. Corticotropin-releasing factor (CRF) is released from the hypothalamus.

REF: p. 184

3. Corticosteroids normally produced by the body are known as

a.

endogenous.

b.

exogenous.

c.

extrinsic.

d.

intrinsic.

ANS: A

Endogenous corticosteroids are produced inside the human body, whereas exogenous corticosteroids are produced outside the body.

REF: p. 184

4. Which of the following are examples of steroids or steroid combinations available for inhalation?
5. AeroSpan
6. Flovent
7. Qvar
8. Advair

a.

1, 2, and 3 only

b.

1 and 2 only

c.

2 and 3 only

d.

1, 2, 3, and 4

ANS: D

Brand names of corticosteroids available by aerosol for oral inhalation include Qvar, AeroSpan, Asmanex, Flovent, Pulmicort, and Advair. Interleukins are cytokines released by the human body.

REF: p. 185

5. The rise and fall of levels of glucocorticoids in the body follow what kind of rhythm?

a.

Weekly

b.

Monthly

c.

Circadian

d.

No set rhythm

ANS: C

The production of the body’s own glucocorticoids follows a rhythmic cycle, termed a diurnal or circadian rhythm.

REF: p. 187

6. The inflammatory process includes which of the following activities?
7. Mediator cascade
8. Increased vascular permeability
9. Leukocytic infiltration
10. Phagocytosis

a.

1 and 2 only

b.

2 and 3 only

c.

1, 2, and 4 only

d.

1, 2, 3, and 4

ANS: D

The process of inflammation is caused by the following four major categories of activity:

1. Mediator cascade
2. Increased vascular permeability
3. Leukocytic infiltration
4. Phagocytosis

REF: p. 188

7. The major cells responsible for an inflammatory response in asthma are

a.

macrophages and mast cells.

b.

mast cells and eosinophils.

c.

T lymphocytes and macrophages.

d.

basophils and SRS-A.

ANS: B

Mast cells and eosinophils are considered the major effector cells of the inflammatory response, regardless of whether asthma is allergic or nonallergic.

REF: p. 188

8. The early phase of an asthmatic reaction occurs during what time frame?

a.

15 minutes to 1 hour

b.

2–4 hours

c.

6–8 hours

d.

24 hours

ANS: A

The early-phase reaction, during which IgE-dependent activation of mast cells releases inflammatory mediators such as histamine, prostaglandin D₂, and leukotriene C₄, peaks at about 15 minutes and then declines over the next hour.

REF: p. 189

9. The product combining an inhaled steroid and a bronchodilator is

a.

dulera.

b.

flovent.

c.

fluticasone.

d.

qvar.

ANS: A

Dulera is the corticosteroid Mometasone furoate and the LABA formoterol fumarate HFA. Flovent is the corticosteroid fluticasone propionate. Fluticasone is a corticosteroid. Qvar is the corticosteroid beclomethasone dipropionate.

REF: p. 185

10. Side effects of systemic steroid treatment include which of the following?
11. HPA suppression
12. Cough
13. Dysphonia
14. Psychiatric reactions

a.

1 and 4 only

b.

2 and 3 only

c.

1, 2, and 3 only

d.

1, 2, 3, and 4

ANS: A

Side effects of systemic steroid treatment include suppression of the hypothalamic-pituitary–adrenal (HPA) axis, leading to inhibition of adrenocorticotropin hormone (ACTH) release and cortisol secretion from the adrenal gland. Psychiatric reactions include insomnia, mood changes, and manic-depressive or schizophrenic psychoses. Dysphonia and cough are possible side effects of the administration of aerosolized corticosteroids.

REF: p. 195

11. Which of the following are side effects of aerosolized steroid use?
12. Cough
13. Osteoporosis
14. Dysphonia
15. Oral thrush

a.

1 and 2

b.

1, 3, and 4

c.

2, 3, and 4

d.

all of the above

ANS: B

Cough, dysphonia, and oral thrush are potential local side effects seen with the administration of aerosolized corticosteroids. No data have shown clearly the effect of inhaled glucocorticoids on bone density and osteoporosis.

REF: p. 195

12. In chronic obstructive pulmonary disease (COPD), the primary inflammatory cells are

a.

eosinophils.

b.

T lymphocytes.

c.

macrophages.

d.

neutrophils.

ANS: D

Eosinophils predominate in asthma, and neutrophils are mostly seen in COPD. Oral and inhaled corticosteroids do not influence the inflammatory changes driven by neutrophils.

REF: p. 198 | p. 199

13. The steroids responsible for secondary male sex characteristics are known as

a.

glucocorticoids.

b.

mineralocorticoids.

c.

androgenic.

d.

exogenous.

ANS: C

Androgenic corticosteroids, such as testosterone, cause secondary sex characteristics to appear. Mineralocorticoids help with such tasks as regulating body water by increasing the amount of sodium reabsorption in the renal tubules. Exogenous steroids are steroids produced outside the body and introduced orally, intravenously, subcutaneously, or by inhalation.

REF: p. 184

14. Corticosteroids are used with asthmatics and patients with chronic obstructive pulmonary disease (COPD) to achieve which effect?

a.

Antiinflammatory

b.

Breakdown of secretions

c.

Reduced surface tension

d.

Immunosuppression

ANS: A

A major therapeutic effect seen with analogues of the natural (endogenous) adrenocortical hormone hydrocortisone is an antiinflammatory action. Glucocorticoid analogues of natural (endogenous) hydrocortisone are used for this effect in treating asthma, which is an inflammatory process in the lungs. Corticosteroids are not mucoactive drugs, and they do not reduce surface tension as do surfactant agents. A side effect of systemic steroids may be immunosuppression, but this is not their intended use in asthma or COPD.

REF: p. 197 | p. 198

15. Use of oral steroids for long periods can cause

a.

HPA suppression.

b.

increased adrenal cortex activity.

c.

bronchospasm.

d.

increased ACTH levels.

ANS: A

One of the most significant side effects of treatment with glucocorticoid drugs (exogenous corticosteroids) is adrenal suppression or, more generally, hypothalamic-pituitary–adrenal (HPA) suppression. When the body produces endogenous glucocorticoids, there is a normal feedback mechanism within the HPA axis to limit production. As glucocorticoid levels increase, release of corticotropin-releasing factor (CRF) and adrenocorticotropin hormone (ACTH) is inhibited, and further adrenal production of glucocorticoids is stopped.

REF: p. 184

16. Corticosteroids are available for use in the United States in which of the following dosage forms?

a.

DPI

b.

MDI

c.

Nebulizer solution

d.

All of the above

ANS: D

Several aerosol steroid agents, all of which are glucocorticoids, are available for inhalational use in the United States at the time of this edition. Originally in the United States, all orally inhaled corticosteroids were available as metered dose inhaler (MDI) formulations. More recently, three dry powder inhalers (DPIs), the Diskhaler (fluticasone), Turbuhaler (budesonide), and Twisthaler (mometasone furoate) have been introduced, along with the only approved nebulizer formulation (Pulmicort Respules [budesonide]). At the time of this edition, all of the MDI formulations are available with hydrofluoroalkane (HFA) propellant (beclomethasone, flunisolide, fluticasone, and ciclesonide) with the exception of triamcinolone.

REF: p. 185 | p. 186

17. Which of the following is a common side effect of inhaled corticosteroids?

a.

Tachycardia

b.

Bradycardia

c.

Oral candidiasis

d.

Immunosuppression

ANS: C

Two of the most common side effects caused by topical application of inhaled steroids in the respiratory tract are oropharyngeal candidiasis (oral thrush) and dysphonia. Inhaled steroids exhibit no reported effect on the heart, and although immunosuppression has been reported with the use of systemic steroids, this effect does not pose much of an issue with topical use.

REF: p. 195 | p. 196

18. A patient has been taking oral prednisone for 1 week following a severe episode of asthma. The physician decides to switch the patient to aerosolized beclomethasone (Qvar). What is the best way to accomplish this?

a.

Stop the oral drug and begin the aerosol

b.

Begin the aerosol and gradually taper off of the oral dose

c.

Keep the patient on the full-strength oral dose, and add the aerosol as well for stronger results

d.

You cannot stop oral steroids once they are begun

ANS: B

If a patient has received oral corticosteroids and adrenal suppression has occurred, weaning from the exogenous corticosteroids through use of tapered dose therapy allows time for recovery of the body’s own adrenal secretion. Aerosolized corticosteroids do not deposit sufficient amounts of drug to replace the missing output of a suppressed adrenal gland. A patient with adrenal suppression cannot be abruptly withdrawn from oral corticosteroids and placed on an aerosol dosage. The aerosol should be started and the oral agent slowly tapered off at the same time.

REF: p. 187

19. A patient complains of oral thrush and hoarseness since she has been using fluticasone by MDI. The physician asks you to make a suggestion to help her without discontinuing the drug. You suggest

a.

inhale with a higher inspiratory flow rate.

b.

switch to a DPI.

c.

add a spacer and rinse the mouth after use.

d.

pause 5 minutes between puffs.

ANS: C

The use of a spacer device and gargling after treatment can reduce oropharyngeal deposition of the steroid and the incidence or severity of such infections. A higher inspiratory flow rate, or use of a DPI, would act only to increase oropharyngeal impaction. Pausing between puffs would have no effect on impaction.

REF: p. 195 | p. 196

20. Use of systemic corticosteroids may cause which of the following side effects?
21. Fluid retention
22. Increased white blood cell count
23. HPA suppression
24. Increased endogenous steroid production

a.

1 and 4 only

b.

1, 2, and 4 only

c.

2 and 4 only

d.

1, 2, and 3 only

ANS: D

Suppression of the hypothalamic-pituitary–adrenal (HPA) axis by exogenous steroids may occur, causing inhibition of adrenocorticotropic hormone (ACTH) release and cortisol secretion from the adrenal gland. The length of time to recover from this suppression varies with patient, dose, and duration of treatment. Corticosteroids given systemically can increase the white blood cell count, with an increase in neutrophils and a decrease in lymphocytes and eosinophils. Fluid retention can occur as a result of the sodium-sparing effects of glucocorticoids, giving a puffy appearance. Systemic use of exogenous steroids would inhibit endogenous steroid production.

REF: p. 195 | p. 196

21. Your patient tells you that she is having chest tightness and wheezing four to six times per week, plus she wakes up with chest tightness and wheezing about once per week. She uses albuterol each time, with relief. She is taking no other medication except her albuterol MDI. What other medication would you suggest be prescribed to her?

a.

Levalbuterol MDI

b.

Salmeterol MDI

c.

Beclomethasone MDI

d.

Oral tobramycin

ANS: C

The patient exhibits no clinical signs of infection that would call for an antibiotic such as tobramycin (and if she did, tobramycin is unsuitable for oral administration because of its high first-pass effect). Because she is already taking a bronchodilator, the National Asthma Education and Prevention Program (NAEPP) guidelines call for the addition of an inhaled steroid. General clinical indications for use of inhaled corticosteroids are as follows:

• Orally inhaled agents: Maintenance control therapy of chronic asthma, identified as step 2 care or greater by the NAEPP Expert Panel Report 2 Guidelines for the Diagnosis and Management of Asthma—Update on Selected Topics.
• Step 2 asthma: Symptoms more than 2 days per week but less than once a day or symptoms more than 2 nights per month with forced expiratory volume in 1 second (FEV₁) or peak expiratory flow (PEF) 80% predicted or greater but PEF variability at 20–30%.
• Inhaled agents can be used together with systemic corticosteroids in severe asthma and may allow systemic dose reduction or elimination for asthma control.

REF: p. 184

22. Causes of airway inflammation include which of the following?
23. HPA suppression
24. Trauma
25. Chronic bronchitis
26. Asthma

a.

1 and 4 only

b.

3 and 4 only

c.

2, 3, and 4 only

d.

1, 2, 3, and 4

ANS: C

Inflammation can occur in the lungs in response to various causes, including direct trauma (gunshot wound, stabbing), indirect trauma (blunt chest injury), inhalation of noxious or toxic substances (chlorine gas, smoke), respiratory infections and systemic infections producing septicemia and septic shock with acute respiratory distress syndrome (ARDS), and allergenic or nonallergenic stimulation in asthma. The two most common inflammatory diseases of the airway seen in respiratory care are chronic bronchitis, usually caused by tobacco smoking, and asthma, which can be caused by a range of triggers and involves a complex pathophysiology.

REF: p. 188

23. Your patient has an elevated white blood cell (WBC) count but no signs or symptoms of infection. She uses albuterol and salmeterol and is currently taking a glucocorticoid. What is the most likely cause of her elevated WBC count?

a.

Albuterol

b.

Salmeterol metered dose inhaler

c.

Glucocorticoid

d.

None of the above

ANS: C

The patient exhibits no clinical signs of infection. Leukocytes, such as monocytes, macrophages, neutrophils, and basophils, are also essential to the inflammatory response and are attracted to an area of injury by the chemotactic factors identified among the mediators of inflammation. Neutrophils usually adhere (“marginate”) to the capillary endothelium of storage sites in the lung. Glucocorticoids cause depletion of these stores and reduce their accumulation at inflammatory sites and in exudates. This is termed demargination and can increase the number of neutrophils in circulation as the cells leave their storage sites. An overall increase in the WBC count can be seen in patients receiving glucocorticoids.

REF: p. 195 | p. 196

24. Beneficial effects of glucocorticoids on b-adrenergic receptors include

a.

restoration of responsiveness.

b.

increase in the number of b receptors on the cell surface.

c.

increasing affinity of the receptor for b agonists.

d.

all of the above.

ANS: D

A very beneficial effect of glucocorticoids is their ability to restore responsiveness to b-adrenergic stimulation. This effect can be seen within 1–4 hours after intravenous administration of glucocorticoids and is the rationale for administering a bolus of steroid in status asthmaticus as part of acute treatment. Although steroid action is slow, the sooner glucocorticoids are given, the sooner the asthmatic begins to respond to b-adrenergic drugs, and supported ventilation may be avoided. Glucocorticoids enhance b-receptor stimulation by increasing the number and availability of b receptors on the cell surfaces and by increasing affinity of the receptor for b agonists.

REF: p. 194

25. What is the generic name of Pulmicort?

a.

Fluticasone propionate

b.

Mometasone furoate

c.

Flunisolide hemihydrate HFA

d.

Budesonide

ANS: D

DRUG

BRAND NAME

FORMULATION AND DOSAGE

Beclomethasone dipropionate HFA

Qvar

MDI: 40 mg/puff and 80 mg/puff

Adults³12 yr: 40-80 mg twice daily^† or 40-160 mg twice daily^‡

Children³5 yr: 40-80 mg twice daily

Flunisolide hemihydrate HFA

AeroSpan

MDI: 80 mg/puff

Adults³12 yr: 2 puffs bid, adults no more than 4 puffs daily

Children 6-11 yr: 1 puff daily, no more than 2 puffs daily

Fluticasone propionate

Flovent HFA

MDI: 44 mg/puff, 110 mg/puff, and 220 mg/puff

Adults³12 yr: 88 mg bid^†, 88-220 mg bid^‡, or 880 mg bid^§

Children 4-11 yr: 88 mg bid^¶

Flovent Diskus

DPI: 50 mg, 100 mg, and 250 mg

Adults: 100 mg bid^†, 100-250 mg bid^‡, 1000 mg bid^§

Children 4-11 yr: 50-100 mg twice daily

Fluticasone furoate

Arnuity Ellipta

DPI: 100  mg and 200 mg

Adults and children ³12 yr: 100 mg or 200  mg once daily

Budesonide

Pulmicort Flexhaler

DPI: 90 mg/actuation and 180 mg/actuation

Adults: 180-360 mg bid^†, 180-360 mg bid^‡, 360-720 mg bid^§

Children³6 yr: 180-360 mg bid

Pulmicort Respules

SVN: 0.25 mg/2 mL, 0.5 mg/2 mL, 1 mg/2 mL

Children 1-8 yr: 0.5 mg total dose given once daily or twice daily in divided doses^†,‡; 1 mg given as 0.5 mg bid or once daily^§

Mometasone furoate

Asmanex Twisthaler

DPI: 110 mg/actuation and 220 mg/actuation

Adults and children³12 yr: 220-880 mg daily

Asmanex HFA

Children 4-11 yr: 110 mg daily

MDI: 100 mg/actuation and 200 mg/actuation

Adults and children³12 yr: 100-200 mg bid

Ciclesonide

Alvesco

MDI: 80 mg/puff and 160 mg/puff

Adults³12 yr: 80-160 mg twice daily^†, or 80-320 mg twice daily^‡

REF: p. 185

26. What is the generic name of Asmanex HFA?

a.

Fluticasone propionate

b.

Mometasone furoate

c.

Flunisolide hemihydrate HFA

d.

Budesonide

ANS: B

DRUG

BRAND NAME

FORMULATION AND DOSAGE

Beclomethasone dipropionate HFA

Qvar

MDI: 40 mg/puff and 80 mg/puff

Adults³12 yr: 40-80 mg twice daily^† or 40-160 mg twice daily^‡

Children³5 yr: 40-80 mg twice daily

Flunisolide hemihydrate HFA

AeroSpan

MDI: 80 mg/puff

Adults³12 yr: 2 puffs bid, adults no more than 4 puffs daily

Children 6-11 yr: 1 puff daily, no more than 2 puffs daily

Fluticasone propionate

Flovent HFA

MDI: 44 mg/puff, 110 mg/puff, and 220 mg/puff

Adults³12 yr: 88 mg bid^†, 88-220 mg bid^‡, or 880 mg bid^§

Children 4-11 yr: 88 mg bid^¶

Flovent Diskus

DPI: 50 mg, 100mg, and 250 mg

Adults: 100 mg bid^†, 100-250 mg bid^‡, 1000 mg bid^§

Children 4-11 yr: 50-100 mg twice daily

Fluticasone furoate

Arnuity Ellipta

DPI: 100 mg and 200 mg

Adults and children ³12 yr: 100 mg or 200 mg once daily

Budesonide

Pulmicort Flexhaler

DPI: 90 mg/actuation and 180 mg/actuation

Adults: 180-360 mg bid^†, 180-360 mg bid^‡, 360-720 mg bid^§

Children³6 yr: 180-360 mg bid

Pulmicort Respules

SVN: 0.25 mg/2 mL, 0.5 mg/2 mL, 1 mg/2 mL

Children 1-8 yr: 0.5 mg total dose given once daily or twice daily in divided doses^†,‡; 1 mg given as 0.5 mg bid or once daily^§

Mometasone furoate

Asmanex Twisthaler

DPI: 110 mg/actuation and 220 mg/actuation

Adults and children³12 yr: 220-880 mg daily

Asmanex HFA

Children 4-11 yr: 110 mg daily

MDI: 100 mg/actuation and 200 mg/actuation

Adults and children³12 yr: 100-200 mg bid

Ciclesonide

Alvesco

MDI: 80 mg/puff and 160 mg/puff

Adults³12 yr: 80-160 mg twice daily^†, or 80-320 mg twice daily^‡

REF: p. 185

27. What is the generic name of Flovent HFA?

a.

Beclomethasone dipropionate HFA

b.

Fluticasone propionate

c.

Mometasone furoate

d.

Flunisolide hemihydrate HFA

ANS: B

DRUG

BRAND NAME

FORMULATION AND DOSAGE

Beclomethasone dipropionate HFA

Qvar

MDI: 40 mg/puff and 80 mg/puff

Adults³12 yr: 40-80 mg twice daily^† or 40-160 mg twice daily^‡

Children³5 yr: 40-80 mg twice daily

Flunisolide hemihydrate HFA

AeroSpan

MDI: 80 mg/puff

Adults³12 yr: 2 puffs bid, adults no more than 4 puffs daily

Children 6-11 yr: 1 puff daily, no more than 2 puffs daily

Fluticasone propionate

Flovent HFA

MDI: 44 mg/puff, 110 mg/puff, and 220 mg/puff

Adults³12 yr: 88 mg bid^†, 88-220 mg bid^‡, or 880 mg bid^§

Children 4-11 yr: 88 mg bid^¶

Flovent Diskus

DPI: 50 mg, 100 mg, and 250 mg

Adults: 100 mg bid^†, 100-250 mg bid^‡, 1000 mg bid^§

Children 4-11 yr: 50-100 mg twice daily

Fluticasone furoate

Arnuity Ellipta

DPI: 100 mg and 200 mg

Adults and children ³12 yr: 100ìg or 200 mg once daily

Budesonide

Pulmicort Flexhaler

DPI: 90 mg/actuation and 180 mg/actuation

Adults: 180-360 mg bid^†, 180-360 mg bid^‡, 360-720 mg bid^§

Children³6 yr: 180-360 mg bid

Pulmicort Respules

SVN: 0.25 mg/2 mL, 0.5 mg/2 mL, 1 mg/2 mL

Children 1-8 yr: 0.5 mg total dose given once daily or twice daily in divided doses^†,‡; 1 mg given as 0.5 mg bid or once daily^§

Mometasone furoate

Asmanex Twisthaler

DPI: 110 mg/actuation and 220 mg/actuation

Adults and children³12 yr: 220-880 mg daily

Asmanex HFA

Children 4-11 yr: 110 mg daily

MDI: 100 mg/actuation and 200 mg/actuation

Adults and children³12 yr: 100-200 mg bid

Ciclesonide

Alvesco

MDI: 80 mg/puff and 160 mg/puff

Adults³12 yr: 80-160 mg twice daily^†, or 80-320 mg twice daily^‡

REF: p. 185

28. What is the generic name of AeroSpan?

a.

Beclomethasone dipropionate HFA

b.

Fluticasone propionate

c.

Mometasone furoate

d.

Flunisolide hemihydrate HFA

ANS: D

DRUG

BRAND NAME

FORMULATION AND DOSAGE

Beclomethasone dipropionate HFA

Qvar

MDI: 40 mg/puff and 80 mg/puff

Adults³12 yr: 40-80 mg twice daily^† or 40-160 mg twice daily^‡

Children³5 yr: 40-80 mg twice daily

Flunisolide hemihydrate HFA

AeroSpan

MDI: 80 mg/puff

Adults³12 yr: 2 puffs bid, adults no more than 4 puffs daily

Children 6-11 yr: 1 puff daily, no more than 2 puffs daily

Fluticasone propionate

Flovent HFA

MDI: 44 mg/puff, 110 mg/puff, and 220 mg/puff

Adults³12 yr: 88 mg bid^†, 88-220 mg bid^‡, or 880 mg bid^§

Children 4-11 yr: 88 mg bid^¶

Flovent Diskus

DPI: 50 mg, 100 mg, and 250 mg

Adults: 100 mg bid^†, 100-250mg bid^‡, 1000 mg bid^§

Children 4-11 yr: 50-100 mg twice daily

Fluticasone furoate

Arnuity Ellipta

DPI: 100 mg and 200 mg

Adults and children ³12 yr: 100mg or 200 mg once daily

Budesonide

Pulmicort Flexhaler

DPI: 90 mg/actuation and 180 mg/actuation

Adults: 180-360 mg bid^†, 180-360 mg bid^‡, 360-720 mg bid^§

Children³6 yr: 180-360 mg bid

Pulmicort Respules

SVN: 0.25 mg/2 mL, 0.5 mg/2 mL, 1 mg/2 mL

Children 1-8 yr: 0.5 mg total dose given once daily or twice daily in divided doses^†,‡; 1 mg given as 0.5 mg bid or once daily^§

Mometasone furoate

Asmanex Twisthaler

DPI: 110 mg/actuation and 220 mg/actuation

Adults and children³12 yr: 220-880 mg daily

Asmanex HFA

Children 4-11 yr: 110 mg daily

MDI: 100 mg/actuation and 200 mg/actuation

Adults and children³12 yr: 100-200mg bid

Ciclesonide

Alvesco

MDI: 80 mg/puff and 160 mg/puff

Adults³12 yr: 80-160 mg twice daily^†, or 80-320 mg twice daily^‡

REF: p. 185

29. What is the generic name of QVAR?

a.

Beclomethasone dipropionate HFA

b.

Fluticasone propionate

c.

Mometasone furoate

d.

Flunisolide hemihydrate HFA

ANS: A

DRUG

BRAND NAME

FORMULATION AND DOSAGE

Beclomethasone dipropionate HFA

Qvar

MDI: 40 mg/puff and 80 mg/puff

Adults³12 yr: 40-80 mg twice daily^† or 40-160 mg twice daily^‡

Children³5 yr: 40-80 mg twice daily

Flunisolide hemihydrate HFA

AeroSpan

MDI: 80 mg/puff

Adults³12 yr: 2 puffs bid, adults no more than 4 puffs daily

Children 6-11 yr: 1 puff daily, no more than 2 puffs daily

Fluticasone propionate

Flovent HFA

MDI: 44 mg/puff, 110 mg/puff, and 220 mg/puff

Adults³12 yr: 88 mg bid^†, 88-220 mg bid^‡, or 880 mg bid^§

Children 4-11 yr: 88 mg bid^¶

Flovent Diskus

DPI: 50 mg, 100 mg, and 250 mg

Adults: 100 mg bid^†, 100-250 mg bid^‡, 1000 mg bid^§

Children 4-11 yr: 50-100 mg twice daily

Fluticasone furoate

Arnuity Ellipta

DPI: 100 mg and 200 mg

Adults and children ³12 yr: 100mg or 200 mg once daily

Budesonide

Pulmicort Flexhaler

DPI: 90 mg/actuation and 180 mg/actuation

Adults: 180-360 mg bid^†, 180-360 mg bid^‡, 360-720 mg bid^§

Children³6 yr: 180-360 mg bid

Pulmicort Respules

SVN: 0.25 mg/2 mL, 0.5 mg/2 mL, 1 mg/2 mL

Children 1-8 yr: 0.5 mg total dose given once daily or twice daily in divided doses^†,‡; 1 mg given as 0.5 mg bid or once daily^§

Mometasone furoate

Asmanex Twisthaler

DPI: 110 mg/actuation and 220 mg/actuation

Adults and children³12 yr: 220-880 mg daily

Asmanex HFA

Children 4-11 yr: 110 mg daily

MDI: 100 mg/actuation and 200 mg/actuation

Adults and children³12 yr: 100-200 mg bid

Ciclesonide

Alvesco

MDI: 80 mg/puff and 160 mg/puff

Adults³12 yr: 80-160 mg twice daily^†, or 80-320 mg twice daily^‡

REF: p. 185

30. What is the generic name of Dulera?

a.

Budesonide/formoterol fumarate HFA

b.

Fluticasone propionate/salmeterol

c.

Mometasone furoate/formoterol fumarate HFA

d.

Beclomethasone/formoterol fumarate HFA

ANS: C

DRUG

BRAND NAME

FORMULATION AND DOSAGE

Beclomethasone dipropionate HFA

Qvar

MDI: 40 mg/puff and 80 mg/puff

Adults³12 yr: 40-80 mg twice daily^† or 40-160 mg twice daily^‡

Children³5 yr: 40-80 mg twice daily

Flunisolide hemihydrate HFA

AeroSpan

MDI: 80 mg/puff

Adults³12 yr: 2 puffs bid, adults no more than 4 puffs daily

Children 6-11 yr: 1 puff daily, no more than 2 puffs daily

Fluticasone propionate

Flovent HFA

MDI: 44 mg/puff, 110 mg/puff, and 220 mg/puff

Adults³12 yr: 88 mg bid^†, 88-220 mg bid^‡, or 880 mg bid^§

Children 4-11 yr: 88 mg bid^¶

Flovent Diskus

DPI: 50 mg, 100 mg, and 250 mg

Adults: 100 mg bid^†, 100-250 mg bid^‡, 1000 mg bid^§

Children 4-11 yr: 50-100 mg twice daily

Fluticasone furoate

Arnuity Ellipta

DPI: 100 mg and 200 mg

Adults and children ³12 yr: 100mg or 200 mg once daily

Budesonide

Pulmicort Flexhaler

DPI: 90 mg/actuation and 180 mg /actuation

Adults: 180-360 mg bid^†, 180-360 mg bid^‡, 360-720 mg bid^§

Children³6 yr: 180-360 mg bid

Pulmicort Respules

SVN: 0.25 mg/2 mL, 0.5 mg/2 mL, 1 mg/2 mL

Children 1-8 yr: 0.5 mg total dose given once daily or twice daily in divided doses^†,‡; 1 mg given as 0.5 mg bid or once daily^§

Mometasone furoate

Asmanex Twisthaler

DPI: 110 mg/actuation and 220 mg/actuation

Adults and children³12 yr: 220-880 mgÊg daily

Asmanex HFA

Children 4-11 yr: mg daily

MDI: 100 mg/actuation and 200 mg/actuation

Adults and children³12 yr: 100-200 mg bid

Ciclesonide

Alvesco

MDI: 80 mg/puff and 160 mg/puff

Adults³12 yr: 80-160 mg twice daily^†, or 80-320 mg twice daily^‡

REF: p. 185

31. What is the generic name of Symbicort?

a.

Budesonide/formoterol fumarate HFA

b.

Fluticasone propionate/salmeterol

c.

Mometasone furoate/formoterol fumarate HFA

d.

Beclomethasone/formoterol fumarate HFA

ANS: A

DRUG

BRAND NAME

FORMULATION AND DOSAGE

Beclomethasone dipropionate HFA

Qvar

MDI: 40 mg/puff and 80 mg/puff

Adults³12 yr: 40-80 mg twice daily^† or 40-160 mg twice daily^‡

Children³5 yr: 40-80 mg twice daily

Flunisolide hemihydrate HFA

AeroSpan

MDI: 80 mg/puff

Adults³12 yr: 2 puffs bid, adults no more than 4 puffs daily

Children 6-11 yr: 1 puff daily, no more than 2 puffs daily

Fluticasone propionate

Flovent HFA

MDI: 44 mg/puff, 110 mg/puff, and 220 mg/puff

Adults³12 yr: 88 mg bid^†, 88-220 mg bid^‡, or 880 mg bid^§

Children 4-11 yr: 88 mg bid^¶

Flovent Diskus

DPI: 50 mg, 100 mg, and 250 mg

Adults: 100 mg bid^†, 100-250 mg bid^‡, 1000 mg bid^§

Children 4-11 yr: 50-100 mg twice daily

Fluticasone furoate

Arnuity Ellipta

DPI: 100 mg and 200 mg

Adults and children ³12 yr: 100ìg or 200 mg once daily

Budesonide

Pulmicort Flexhaler

DPI: 90 mg/actuation and 180 mg/actuation

Adults: 180-360 mg bid^†, 180-360 mg bid^‡, 360-720 mg bid^§

Children³6 yr: 180-360 mg bid

Pulmicort Respules

SVN: 0.25 mg/2 mL, 0.5 mg/2 mL, 1 mg/2 mL

Children 1-8 yr: 0.5 mg total dose given once daily or twice daily in divided doses^†,‡; 1 mg given as 0.5 mg bid or once daily^§

Mometasone furoate

Asmanex Twisthaler

DPI: 110 mg/actuation and 220 mg/actuation

Adults and children³12 yr: 220-880 mg daily

Asmanex HFA

Children 4-11 yr: 110 mg daily

MDI: 100 mg/actuation and 200 mg/actuation

Adults and children³12 yr: 100-200 mg bid

Ciclesonide

Alvesco

MDI: 80 mg/puff and 160 mg/puff

Adults³12 yr: 80-160 mg twice daily^†, or 80-320 mg twice daily^‡

REF: p. 185

32. What is the generic name of Advair HFA?

a.

Budesonide/formoterol fumarate HFA

b.

Fluticasone propionate/salmeterol

c.

Mometasone furoate/formoterol fumarate HFA

d.

Beclomethasone/formoterol fumarate HFA

ANS: B

DRUG

BRAND NAME

FORMULATION AND DOSAGE

Beclomethasone dipropionate HFA

Qvar

MDI: 40 mg/puff and 80 mg/puff

Adults³12 yr: 40-80 mg twice daily^† or 40-160 mg twice daily^‡

Children³5 yr: 40-80 mg twice daily

Flunisolide hemihydrate HFA

AeroSpan

MDI: 80 mg/puff

Adults³12 yr: 2 puffs bid, adults no more than 4 puffs daily

Children 6-11 yr: 1 puff daily, no more than 2 puffs daily

Fluticasone propionate

Flovent HFA

MDI: 44 mg/puff, 110 mg/puff, and 220 mg/puff

Adults³12 yr: 88 mg bid^†, 88-220 mg bid^‡, or 880 mg bid^§

Children 4-11 yr: 88 mg bid^¶

Flovent Diskus

DPI: 50 mg, 100 mg, and 250 mg

Adults: 100 mg bid^†, 100-250 mg bid^‡, 1000 mg bid^§

Children 4-11 yr: 50-100 mg twice daily

Fluticasone furoate

Arnuity Ellipta

DPI: 100 mg and 200 mg

Adults and children ³12 yr: 100mg or 200 mg once daily

Budesonide

Pulmicort Flexhaler

DPI: 90 mg/actuation and 180 mg/actuation

Adults: 180-360 mg bid^†, 180-360 mg bid^‡, 360-720 mg bid^§

Children³6 yr: 180-360 mg bid

Pulmicort Respules

SVN: 0.25 mg/2 mL, 0.5 mg/2 mL, 1 mg/2 mL

Children 1-8 yr: 0.5 mg total dose given once daily or twice daily in divided doses^†,‡; 1 mg given as 0.5 mg bid or once daily^§

Mometasone furoate

Asmanex Twisthaler

DPI: 110 mg /actuation and 220mg/actuation

Adults and children³12 yr: 220-880 mg daily

Asmanex HFA

Children 4-11 yr: 110 mg daily

MDI: 100 mg/actuation and 200 mg/actuation

Adults and children³12 yr: 100-200 mg bid

Ciclesonide

Alvesco

MDI: 80 mg/puff and 160 mg/puff

Adults³12 yr: 80-160 mg twice daily^†, or 80-320 mg twice daily^‡

REF: p. 185