NAECB Asthma Medication 2 — Questions and Answers
Question 1: Which inhaled corticosteroid (ICS) is approved for use in children as young as 12 months for asthma maintenance?
- Fluticasone propionate (Flovent)
- Budesonide (Pulmicort Respules) (Correct answer)
- Mometasone furoate (Asmanex)
- Ciclesonide (Alvesco)
Correct answer: Budesonide (Pulmicort Respules)
Budesonide (Pulmicort Respules) is approved for children 12 months to 8 years via nebulizer.
Question 2: A patient on high-dose ICS plus LABA still has uncontrolled asthma. Which biologic targets IL-5 to reduce eosinophil levels?
- Omalizumab (Xolair)
- Mepolizumab (Nucala) (Correct answer)
- Dupilumab (Dupixent)
- Tezepelumab (Tezspire)
Correct answer: Mepolizumab (Nucala)
Mepolizumab (Nucala) is an anti-IL-5 monoclonal antibody that reduces eosinophil production.
Question 3: What is the recommended maximum daily dose of albuterol (levalbuterol excluded) via MDI for an adult with acute asthma exacerbation in the ED?
- 4 puffs every 4 hours
- 2 puffs every 20 minutes for 3 doses (Correct answer)
- 8 puffs every 6 hours
- 6 puffs every 2 hours
Correct answer: 2 puffs every 20 minutes for 3 doses
In acute exacerbations, albuterol MDI is typically dosed as 2–4 puffs every 20 minutes for 3 doses (first hour).
Question 4: Which leukotriene receptor antagonist (LTRA) is approved for both asthma and allergic rhinitis in patients as young as 6 months?
- Zafirlukast (Accolate)
- Zileuton (Zyflo)
- Montelukast (Singulair) (Correct answer)
- Pranlukast
Correct answer: Montelukast (Singulair)
Montelukast is approved for perennial allergic rhinitis in patients ≥6 months and asthma in patients ≥1 year.
Question 5: A patient using a spacer with MDI has poor technique. Which error MOST reduces drug delivery to the lungs?
- Inhaling too slowly
- Actuating the inhaler before beginning to inhale (Correct answer)
- Holding breath for only 5 seconds
- Exhaling completely before inhaling
Correct answer: Actuating the inhaler before beginning to inhale
Actuating the inhaler before inhaling causes most drug to deposit in the spacer walls rather than reaching the lungs.
Question 6: Which mechanism explains why theophylline has fallen out of favor for asthma management?
- It only works as a bronchodilator in children
- Its narrow therapeutic index and significant drug interactions make it high-risk (Correct answer)
- It requires IV administration exclusively
- It causes irreversible bronchoconstriction at high doses
Correct answer: Its narrow therapeutic index and significant drug interactions make it high-risk
Theophylline has a narrow therapeutic window (10–20 mcg/mL) and interacts with many drugs, increasing toxicity risk.
Question 7: Tiotropium (Spiriva Respimat) is approved as add-on therapy for asthma in patients aged ≥6 years. What is its mechanism of action?
- Long-acting beta-2 agonist
- Long-acting muscarinic antagonist (LAMA) (Correct answer)
- Phosphodiesterase-4 inhibitor
- IgE-binding monoclonal antibody
Correct answer: Long-acting muscarinic antagonist (LAMA)
Tiotropium is a long-acting muscarinic antagonist (LAMA) that blocks M3 receptors causing bronchodilation.
NAECB Asthma Medication 2
Which inhaled corticosteroid (ICS) is approved for use in children as young as 12 months for asthma maintenance?