MTM Respiratory Disease Management 1 — Questions and Answers
Question 1: According to GINA guidelines, what is the preferred first-line controller therapy for mild persistent asthma in adults?
- Long-acting beta-agonist (LABA) alone
- Inhaled corticosteroid (ICS) (Correct answer)
- Oral leukotriene receptor antagonist (LTRA)
- Short-acting beta-agonist (SABA) as needed only
Correct answer: Inhaled corticosteroid (ICS)
Inhaled corticosteroids are the preferred first-line controller for persistent asthma due to superior anti-inflammatory efficacy over all other options.
Question 2: Which spirometry finding confirms a diagnosis of COPD per GOLD guidelines?
- FEV1/FVC ratio < 0.70 post-bronchodilator (Correct answer)
- Peak expiratory flow variability > 20%
- FVC < 80% predicted
- FEV1 < 50% predicted
Correct answer: FEV1/FVC ratio < 0.70 post-bronchodilator
GOLD guidelines define COPD by a post-bronchodilator FEV1/FVC ratio below 0.70, confirming the presence of persistent airflow limitation.
Question 3: A patient using a metered-dose inhaler (MDI) reports poor symptom control. Which inhaler technique error MOST reduces drug delivery to the lungs?
- Exhaling fully before actuation
- Inhaling too rapidly through the MDI (Correct answer)
- Holding breath for 10 seconds after inhalation
- Using a spacer device
Correct answer: Inhaling too rapidly through the MDI
Inhaling too rapidly causes turbulent airflow and oropharyngeal deposition, significantly reducing lung deposition with MDIs.
Question 4: Which combination inhaler is most appropriate as initial maintenance therapy for a COPD patient classified as GOLD Group B?
- ICS alone
- LAMA monotherapy
- LABA/LAMA combination (Correct answer)
- Triple therapy with ICS/LABA/LAMA
Correct answer: LABA/LAMA combination
GOLD guidelines recommend LABA/LAMA combination as preferred initial maintenance for Group B patients due to superior bronchodilation over monotherapy.
Question 5: An MTM pharmacist is counseling a patient who has both asthma and GERD. Which asthma medication may worsen GERD symptoms?
- Inhaled corticosteroids
- Montelukast
- Theophylline (Correct answer)
- Cromolyn sodium
Correct answer: Theophylline
Theophylline relaxes the lower esophageal sphincter, which can worsen gastroesophageal reflux disease symptoms.
Question 6: What is the mechanism of action of tiotropium (Spiriva)?
- Beta-2 receptor agonism
- Muscarinic receptor antagonism (Correct answer)
- Leukotriene receptor antagonism
- Phosphodiesterase-4 inhibition
Correct answer: Muscarinic receptor antagonism
Tiotropium is a long-acting muscarinic antagonist (LAMA) that blocks M3 receptors in bronchial smooth muscle to produce sustained bronchodilation.
Question 7: A patient requiring a short course of oral corticosteroids for an acute asthma exacerbation asks about side effects. Which adverse effect occurs MOST rapidly with short-term systemic steroid use?
- Cataracts
- Osteoporosis
- Hyperglycemia (Correct answer)
- Adrenal insufficiency
Correct answer: Hyperglycemia
Hyperglycemia is the most common and rapidly occurring adverse effect with short-term systemic corticosteroid use, relevant for both diabetic and non-diabetic patients.
MTM Respiratory Disease Management 1
According to GINA guidelines, what is the preferred first-line controller therapy for mild persistent asthma in adults?