(Test Bank) Apea Pharm-Respiratory, Eyes, Throat & Ear

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APEA PHARM -Respiratory, eyes, throat & ear -Test bank -with 100% verified answers -2022 -2023 RESPIRATORY 1. When used in the treatment of chronic obstructive pulmonary disease (COPD), macrolides: inhibit bacterial protein synthesis. Macrolides such as erythromycin (Erytab) and azithromycin (Zithromax) inhibit bacterial protein synthesis and growth by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA -dependent protein synthesis to arrest. Macrolides exert several immune -modulatory and anti -inflammatory effects. Penicillins inhibit bacterial cell wall synthesis while fluoroquinolones prevent bacterial DNA from replicating. 2. As a result of its pharmacological effects, theophylline at serum concentrations within the 10 to 20 mcg/mL range modestly increases plasma glucose, uric acid, free fatty acids, total cholesterol, HDL, HDL/LDL ratio, and urinary free cortisol excretion. 3. Doxycycline (Doryx) may cause esophageal irritation and ulceration. The patient should be instructed to drink fluids liberally. The patient should avoid excessive sunlight or artificial ultraviolet light while receiving doxycycline and to discontinue therapy if phototoxicity occurs. The use of doxycycline might increase the incidence of vaginal candidiasis. 4. Tiotropium (Spiriva HandiHaler), a long-acting antimuscarinic antagonist, enhances the effectiveness of pulmonary rehabilitation in increasing exercise performance. total cholesterol and uric acid levels. Theophylline (Theo -24) may have an effect on the serum concentrations of: may cause esophageal irritation and ulceration. Doxycycline (Doryx), for the treatment of pneumonia,: Tiotropium (Spiriva HandiHaler). Which of the following medications, when combined with pulmonary rehabilitation, enhances exercise performance? 5. Most cases of acute bronchitis are viral and resolve without treatment within a couple of weeks. Management of cough is recommended with antitussives. Because of the risk of antibiotic resistance and Clostridium difficile infection, antibiotics should not be routinely used in the treatment of acute bronchitis. Decongestants and antihistamines are ineffective unless there is confirmed sinusitis or underlying allergy. The FDA has recommended that cough and cold preparations not be used in children younger than 6 years. 6. Robitussin DM is a combination of dextromethorphan and guaifenesin for the treatment of cough. It can be purchased over the counter. It is not recommended for children younger than 6 years. 7. The use of dextromethorphan, a cough suppressant, is contraindicated in patients with difficulty clearing secretions or with Parkinson 's disease. Dextromethorphan decreases the sensitivity of cough receptors and interrupts cough impulse transmission by depressing the medullary cough center through sigma receptor stimulation. Also, due to serotonergic effects, caution should be used when administering to patients who are taking certain selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs) (i.e. venlafaxine [Effexor]). 8. The main side effect is dryness of mouth. Inhaled anticholinergic drugs are poorly absorbed, which limits the troublesome systemic effects observed with atropine. Extensive use of this class of agents in a wide range of doses and clinical settings has shown them to be very safe. 9. Sulfamethoxazole/trimethoprim (Bactrim) is an alternative choice for patients in whom a macrolide is contraindicated. 10. antitussives. The initial recommended treatment for uncomplicated acute bronchitis in adults is: hypertension . Dextromethorphan, a cough suppressant, is safe to administer to patients who have: guaifenesin. Robitussin DM is a combination of dextromethorphan and: dry mouth. The main side effect related to the use of long-acting antimuscarinic antagonists is: sulfamethoxazole/trimethoprim (Bactrim). Treatment of Bordetella pertussis in a patient with a hypersensitivity to macrolides is: Because tetracyclines depress plasma prothrombin activity, patients who are on anticoagulant therapy may require downward adjustment of their anticoagulant dosage. The combination of warfarin (Coumadin) and doxycycline (Doryx) may cause an increase in the INR and subsequent risk of bleeding. Hepatic metabolism is inhibited and alteration of vitamin K-producing gut flora may occur. 11. Approximately 50% to 70% of the amoxicillin and approximately 25% to 40% of the clavulanic acid are excreted unchanged in urine. Neither component in amoxicillin/clavulanate (Augmentin) is highly protein - bound. Amoxicillin diffuses readily into most body tissues and fluids, with the exception of the brain and spinal fluid. The half -life of amoxicillin after the oral administration of Augmentin is 1.3 hours and that of clavulanic acid is 1 hour. 12. Budesonide (Pulmicort) is an inhaled corticosteroid used in the treatment of asthma. The mechanism of action of inhaled glucocorticoids is to decrease the activity of inflammatory cells and mediators. 13. For complaints of dysphonia related to the use of mometasone (Asmanex Twisthaler), the nurse practitioner should advise the patient to use a spacer when taking the medication. Using a spacer causes less deposition of the droplets in the mouth, which can cause dysphonia. If the asthma is well controlled, stopping the medication is not appropriate. The use of an oropharyngeal analgesic (i.e., Chloraseptic spray) would not help with inhibit dysphonia. 14. Montelukast (Singulair) blocks or inhibits the action of leukotrienes. In asthma, leukotriene -mediated effects include airway edema, smooth muscle contraction, and altered cellular activity associated with the inflammatory process. In allergic rhinitis, cysteinyl leukotriene receptors are released from the nasal mucosa after allergen exposure during both early - and late-phase reactions and are associated with symptoms of allergic rhinitis. the warfarin (Coumadin) dose may need to be decreased. A patient who is receiving warfarin (Coumadin) requires the initiation of doxycycline (Doryx) for the treatment of pneumonia. The nurse practitioner knows that: utilize a spacer for administration. For complaints of dysphonia related to the use of mometasone (Asmanex Twisthaler), the patient should be advised to: is primarily excreted unchanged in the urine. Amoxicillin/clavulanate (Augmentin), a beta-lactam antibiotic,: budesonide (Pulmicort) An example of an inhaled glucocorticoid used in the treatment of asthma is: leukotrienes. Montelukast (Singulair) blocks or inhibits the action of: 15. The principal action of beta2 -agonists is to relax airway smooth muscle by stimulating beta2 -adrenergic receptors, which increase cyclic AMP and produce functional antagonism to bronchoconstriction. There are short -acting (SABA) and long -acting (LABA) beta2 -agonists. Twice -daily LABAs significantly improve FEV1 and lung volumes, dyspnea, health status, exacerbation rate and number of hospitalizations, but they have no effect on mortality or rate of decline of l ung function. Stimulation of beta2 -adrenergic receptors can produce resting sinus tachycardia, cardiac rhythm disturbances, and exaggerate somatic tremor, regardless of route of administration. 16. Theophylline should be used with extreme caution in patients with active peptic ulcer disease, seizure disorder or cardiac arrhythmias (not including bradyarrhythmias) due to the increased risk of exacerbation of these conditions. 17. Inhaled antimuscarinic agents block the bronchoconstrictor effects of acetylcholine on M3 muscarinic receptors expressed in airway smooth muscle. There are short -acting antimuscarinics (SAMAs) and long - acting antimuscarinic antagonists (LAMAs). A greater effect on exacerbation rates for LAMA treatment (tiotropium) versus LABA treatment has been shown. In haled anticholinergic drugs are poorly absorbed, which limits the troublesome systemic effects observed with atropine. LABAs have proven to be very safe. 18. Short -acting beta-2 agonists (SABAs) are the most commonly used preexercise medications for exercise - induced asthma. SABAs include albuterol, levalbuterol (Xopenex FHA) and pirbuterol (Maxair). Fluticasone (Flovent) is an inhaled steroid. Salmeterol (Serevent) is a long -acting beta -2 agonist (LABA). Budesonide (Pulmicort) is an inhaled steroid. 19. Long -acting beta2 -agonists have no effect on reduction of exacerbations. Which statement is NOT true about beta2 -agonists? atrial fibrillation. Caution is advised when theophylline (Theo -24) is prescribed for patients with a history of: reduce exacerbation rates better than beta2 -agonists. Inhaled antimuscarinic agents, such as ipratropium bromide (Atrovent HFA),: albuterol. The beta2 adrenergic receptor agonist most commonly used to prevent bronchospasm associated with exercise -induced asthma is: vomiting. The most common symptom of theophylline toxicity is: a capsule that contains a dry powder is activated inside the inhaler. With the use of tiotropium (Spiriva HandiHaler), the patient should be instructed that: The most common symptom of theophylline toxicity (acute or chronic) is severe and protracted vomiting. Seizures, hypotension, and significant dysrhythmias usually are observed when serum levels approach 80 mcg/mL. Seizures are more common with acute overdo se than with chronic overdose. In chronic exposures, seizures may develop at lower serum concentrations. Cardiac dysrhythmias are more common following a chronic overdose rather than acute overdose and with lower serum concentrations. 20. The brand name for albuterol (inhaled) is Ventolin and ProAir Ventolin HFA. The generic name of Advair is fluticasone propionate/salmeterol; Flovent is fluticasone propionate; and Serevent is salmeterol. 21. Tiotropium (Spiriva HandiHaler) comes in a dry powder contained in a capsule that is put into a special inhaler. Spiriva capsules should only be administered via the HandiHaler device and should not be used for administering other medications. Remind patients that the contents of Spiriva capsules are for oral inhalation only and must not be swallowed. Spiriva Respimat delivers a slow moving mist that makes it easier for the patient to inhale the medication, compared to the Spiriva HandiHaler. 22. Additional monitoring of blood glucose may be warranted for diabetic patients receiving sulfamethoxazole and trimethoprim (Bactrim), especially if they are on oral hypoglycemics including glipizide and glyburide. CBC should be considered due to potential for aplastic anemia, thrombocytopenia, leukopenia, neutropeni a, hemolytic anemia, and megaloblastic anemia. Urinalysis with microscopic examination and renal function tests should be performed during therapy in patients with impaired renal function. 23. Patients should not take short -acting anticholinergic agents if the chronic obstructive pulmonary disease is already being treated with tiotropium (Spiriva), which is a long-acting anticholinergic. 24. tetracycline. Doxycycline (Vibramycin), for the treatment of pneumonia, is classified as a: Ventolin. The brand name for albuterol (inhaled) is: elevated liver enzymes. A patient with pertussis is allergic to macrolide antibiotics and is being treated with trimethoprim sulfamethoxazole. She does NOT need to be monitored for: short -acting anticholinergic agent. Patients who are already on tiotropium (Spiriva) for chronic obstructive pulmonary disease should not take a(n): Doxycycline (Vibramycin), demeclocycline (Declomycin) and minocycline (Minocin) are tetracycline derivatives. Doxycycline (Vibramycin) is the preferred treatment of pneumonia caused by Mycoplasma pneumoniae. 25. With acute exacerbation of bronchitis, inhaled steroid use should be transitioned to a higher dose. Higher doses of inhaled corticosteroids are used during transition from systemic to inhaled corticosteroid therapy or in mild exacerbation. With mild exacerbation the maintenance dose should be increased. 26. Amoxicillin (Amoxil) should be the first-line choice in previously healthy children with suspected bacterial community -acquired pneumonia (CAP) secondary to Streptococcus pneumoniae. Amoxicillin provides appropriate coverage for Streptococcus pneumoniae, the most prominent invasive pathogen. Alternatives, in the case of non-IgE penicillin allergy, are second - and third -generation cephalosporins. Macrolide antibiotics should be considered when an atypical pathogen is suspected. 27. Long -acting muscarinic antagonists (LAMAs) are more effective in reducing exacerbations and hospitalizations compared to long -acting bronchodilators. Inhaled corticosteroids, when combined with long - acting beta agonists, are beneficial for reduction of exacerbations. A short -acting bronchodilator is indicated in symptom management of an exacerba tion. 28. Penicillin is a beta-lactam antibiotic. The drug interactions of most concern with the beta-lactam antibiotics are those with oral contraceptive products, methotrexate and valproic acid. In the case oral contraceptives, even though a small percentage of women may potentially experience decreased effectiveness of these birth control products while taking beta -lactam ant ibiotic, alternative birth control methods should be considered while taking these antibiotics. Anti -diarrheal medicine should not be taken because it may worsen or prolong diarrhea. Most penicillins are safe to use during pregnancy. Penicillins may cause false readings with some urine glucose tests. 29. transitioned to a higher dose. With acute exacerbation of bronchitis, inhaled steroid use should be: amoxicillin (Amoxil). For previously healthy children with mild to moderate symptoms of suspected bacterial community -acquired pneumonia secondary to Streptococcus pneumoniae, the first-line therapy is: A long -acting muscarinic antagonist. Which medication has the greatest effect on the reduction of emphysema exacerbations? that additional protection against pregnancy is necessary if they are taking an oral contraceptive. A patient with bacterial sinusitis taking an oral penicillin should be instructed: The principal initial bronchodilator in the treatment of chronic bronchitis is a short -acting bronchodilator or short -acting antimuscarinic antagonist. Short -acting beta agonists such as albuterol (ProAir HFA) are the initial choices for as needed use. Short -acting antimuscarinic antagonist agents (i.e. ipratropium bromide [Atrovent]) may also be utilized on an as needed basis. 30. The use of inhaled corticosteroids in the management of persistent asthma in children between the ages of 5-11 is beneficial and recommended. However, medium doses of inhaled corticosteroids may cause local adverse effects (i.e. candidiasis) or a transient slowing of growth. Monitoring of growth should be performed in all children. 31. Theophylline (Theo -24) is classified as a xanthine. It is used in the treatment of asthma. It causes bronchodilation by relaxing smooth muscles of the bronchi and pulmonary blood vessels. 32. Tiotropium (Spiriva HandiHaler) is contraindicated in patients with a hypersensitivity to tiotropium, ipratropium, or any components of this product. No dosage adjustment is required for geriatric, hepatically impaired, or renally impaired patients. Some inhaled medicines, including Spiriva HandiHaler, may cause paradoxical bronchospasm. No adverse reactions have been noted with the combined use of Spiriva HandiHaler and short -acting and long -acting sympathomimetic (beta -agonists) bronchodilators, methylxanthines, and oral and inhaled steroids. 33. Amoxicillin should be used with caution with warfarin (Coumadin). The combination will increase the INR and thus increase the risk of bleeding, possibly due to altered vitamin K production by gut flora. Amoxicillin can be co- administered with lisinopril (Zestril), fexofenadine (Allegra), and furosemide (Lasix). 34. albuterol (ProAir HFA). The initial bronchodilator in the treatment of chronic bronchitis is: is contraindicated in patients with hypersensitivity to ipratropium (Atrovent HFA). Tiotropium (Spiriva HandiHaler), used in the treatment of chronic bronchitis,: Budesonide (Pulmicort Flexhaler) inhaled In children between the ages of 5-11, the long-term use of which asthma medication may cause a transient slowing of growth? Theophylline (Theo -24) Which medication is classified as a xanthine? warfarin (Coumadin). A patient with sinusitis is treated with amoxicillin. Caution is advised with concomitant use of: 35. Peak blood levels for sulfamethoxazole and trimethoprim occur 1 to 4 hours after oral administration. The mean serum half -lives of sulfamethoxazole and trimethoprim are 10 and 8 to 10 hours, respectively. During administration of 800 mg sulfamethoxazole and 160 mg trimethoprim bid, the mean steady -state plasma concentration of trimethoprim was 1.72 µg/mL. These steady -state levels were achieved after 3 days of drug administration. 36. The treatment of choice in the outpatient setting for an adult with community -acquired pneumonia caused by Mycoplasma pneumoniae or Chlamydophila pneumoniae is a macrolide or a tetracycline. If those are contraindicated, an alternative would be a fluoroquinolone. 37. For asthma symptoms occurring daily with nighttime symptoms greater than one time per week, the preferred treatment is a long-acting bronchodilator and an inhaled corticosteroid. 38. Doxycycline (Vibramycin) is the preferred treatment of pneumonia caused by Mycoplasma pneumoniae. It is classified as a tetracycline. 39. Levofloxacin is classified as a fluoroquinolone. Levofloxacin tablets are indicated for the treatment of community -acquired pneumonia due to Streptococcus pneumoniae (excluding multi -drug-resistant isolates fluoroquinolone. Levofloxacin, for the treatment of community acquired pneumonia, is classified as a: [MDRSP]), Haemophilus influenzae, Haemophilus parainfluenzae, Mycoplasma pneumoniae, or Chlamydophila pneumoniae. Mycoplasma pneumoniae. Doxycycline (Vibramycin) is the preferred treatment of pneumonia caused by: 3 hours. The peak blood levels for trimethoprim and sulfamethoxazole contained in Bactrim DS are approximately: macrolide. The treatment of choice in the outpatient setting for an adult with community -acquired pneumonia caused by Mycoplasma pneumoniae or Chlamydophila pneumoniae is a: long-acting bronchodilator and an inhaled corticosteroid. For asthma symptoms occurring daily with nighttime symptoms greater than one time per week, the preferred daily treatment is a: corticosteroids. The mainstay of treatment in the management of mild and moderate croup is The mainstay of treatment in the management of mild and moderate croup is symptomatic relief, which includes corticosteroids (inhaled or oral). Antibiotics, beta -2 agonists and decongestants have not been studied, and their use is discouraged. 40. Benzonatate (Tessalon Perles) capsules act peripherally by anesthetizing the stretch receptors located in the respiratory passages, lungs, and pleura by dampening their activity and thereby reducing the cough reflex. It is approved for the relief of cough in adults and children older than 10 years. Benzonatate capsules should be swallowed whole. Severe hypersensitivity reacti ons (including bronchospasm, laryngospasm and cardiovascular collapse) have been reported from sucking or chewing the capsule instead of swallowing it. This is thought to be related to a local anesthetic property of the drug. The most common side effects of benzonatate are sedation, headache and dizziness. 41. Montelukast (Singulair) is more than 99% bound to plasma proteins, extensively metabolized and eliminated via bile. 42. In the treatment of pneumonia, a macrolide such as clarithromycin should NOT be coadministered with: atorvastatin. The combination of certain macrolides, such as clarithromycin, and certain HMG -CoA reductase inhibitors, such as atorvastatin, is not advisable because it can lead to debilitating myopathy and rhabdomyolysis due to inhibition of the 3A4 enzymes. 43. The use of short -acting bronchodilators is NOT recommended in children younger than 4 years. Albuterol (ProAir HFA) inhalation aerosol is indicated for the prevention and relief of bronchospasm in patients 4 years and older with reversible obstructive airway disease, and for the prevention of exercise -induced bronchospasm in patients 4 years and older. Albuterol, like all other beta -adrenergic agonists, can produce a clinically significant cardiovascular effect and should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythm ias, and hypertension. symptomatic relief that includes: should be swallowed whole. Benzonatate (Tessalon Perles), a non-narcotic antitussive,: bile. Montelukast (Singulair) is more than 99% bound to plasma proteins, extensively metabolized and eliminated via: a 3-year-old with bronchospasms. Albuterol (ProAir HFA) is NOT recommended for use in the treatment of: 44. Which of the following is NOT a potential side effect of albuterol (ProAir HFA)? Gastroesophageal reflux disease Paradoxical bronchospasm, prolongation of the QTc interval and tremor are potential side effects of albuterol (ProAir HFA). Other side effects include nervousness, headache, tachycardia, palpitations, dizziness, weakness, muscle cramps, hypokalemia and hyperglycemia. 45. Macrolides should be avoided in patients who have hepatic dysfunction because the risk of hepatotoxicity is increased. Macrolides are safe to use during pregnancy and in those with penicillin allergies; however, they should be used with caution in patients with renal insufficiency. 46. Levofloxacin (Levaquin) is associated with potentially serious side effects, including: spontaneous tendon rupture. Levofloxacin (Levaquin) is associated with potentially serious side effects including tendinitis and tendon rupture, peripheral neuropathy, central nervous system effects including convulsions, toxic psychoses, and increased intracranial pressure. 47. Ipratropium bromide (Atrovent HFA) is an anticholinergic (parasympatholytic) agent that appears to inhibit vagally -mediated reflexes by antagonizing the action of acetylcholine, the transmitter agent released at the neuromuscular junctions in the lung to produce bronchodilation. Atrovent HFA does not exhibit anti - inflammatory properties. Glucocorticoids (i.e. fluticasone propionate [Flovent HFA]), cromolyn sodium (Intal) and xanthines (i.e. theophylline [Theo -24]) all exhibit anti-inflammatory properties. 48. Fluticasone/salmeterol is a combination inhaler that is branded as Advair Diskus. It is a combination of an inhaled corticosteroid and a long -acting bronchodilator. Symbicort is a combination of budesonide and formoterol. Spiriva is a short -acting antimuscarinic antagonist agent. Budesonide (Pulmicort) is an inhaled corticosteroid. 49. have hepatic dysfunction. For the treatment of chronic bronchitis, macrolides are contraindicated in patients who: Ipratropium bromide (Atrovent HFA) Which asthma medication does NOT directly exhibit an anti- inflammatory action? Advair Diskus. Fluticasone/salmeterol is a combination inhaler that is branded as: The primary antibiotic option for suspected pneumocystis pneumonia (PCP) in an adult or adolescent patient with HIV infection is sulfamethoxazole/trimethoprim (Bactrim). Secondary options include dapsone, pyrimethamine (Daraprim), leucovorin and atovaquone (Mepron). 50. For asthma symptoms requiring use of a short -acting bronchodilator more than 2 times a week, the preferred addition to the treatment regimen is: low-dose inhaled corticosteroid. For asthma symptoms requiring use of a short -acting bronchodilator more than 2 times a week, the preferred addition to the treatment regimen is a low-dose inhaled corticosteroid. Second -line options instead of a low- dose inhaled corticosteroid are cromolyn, a leukotriene -receptor antagonist or theophylline. 51. The brand name of Tessalon Perles is benzonatate. Benzonatate is an non-narcotic antitussive used in the treatment of cough. Benzocaine is an anesthetic; guaifenesin is a expectorant; and phenylephrine is a decongestant. 52. Theophylline (Theo -24) use is complicated by its interaction with various drugs and its narrow therapeutic range. Toxicity is increased by erythromycin (Ery -Tab), cimetidine (Tagamet), and fluoroquinolones, such as ciprofloxacin (Cipro). Phenobarbital, phenytoin (Dilantin), and rifampin (Rifadin) can potentially decrease the effectiveness of theophylline. 53. Macrolide antibiotics are primarily used to treat lower respiratory tract infections caused by atypical pathogens (e.g., Mycoplasma pneumoniae, Bordetella pertussis). They have limited activity against gram -positive pathogens like Streptococcus pneumoniae. Macrolide -resistant strains of Streptococcus are common. Macrolides are bacteriostatic, but at high doses may be bactericidal. They are considered bacteriostatic but may be bactericidal at higher concentrations. Macrolide -resistant strains of group A streptococcus (GAS) are common. 54. sulfamethoxazole/trimethoprim (Bactrim). The primary antibiotic option for suspected pneumocystis pneumonia (PCP) in a patient with HIV infection is: benzonatate. The generic name for Tessalon Perles, used to treat cough, is: cimetidine. Toxic effects of theophylline (Theo -24) may be increased by: mainly inhibit growth of gram -positive cocci and atypical pathogens. When used in the treatment of lower respiratory tract infections, macrolides: Montelukast (Singulair) is indicated for the prophylaxis and treatment of chronic asthma in adults and children 12 months and older. Other indications for Singulair are: prevention of exercise -induced bronchoconstriction (EIB) in patients 6 years and older; seasonal allergic rhinitis in patients 2 years and older; and perennial allergic rhinitis in patients 6 months and older. The safety and effectiveness in pediatric patients younger than 12 months with asthma, 6 months with perennial allergic rhinitis, and 6 years with exercise -induced bronchoconstriction have not been established. 55. In Augmentin, clavulanate binds to beta lactamase, hindering enzymatic activity. This protects other beta- lactam antibiotics from beta lactamase catalysis, thereby enhancing their antibacterial effects. This agent is used in conjunction with beta lactamase susceptible antibiotics, such as penicillins and cephalosporins, to treat infections caused by beta lactamase -producing organisms. 56. The treatment of choice in adults with B-lactamase producing Haemophilus influenzae community acquired pneumonia is cefixime (Suprax). Amoxicillin is recommended in the presence of non -B-lactamase producing Haemophilus influenzae. Alternate antibiotics include fluoroquinolones (ie. moxifloxacin [Avelox]), doxycycline, azithromycin and clarithromycin. 57. Albuterol (ProAir HFA) is a short -acting bronchodilator used in the treatment of asthma. Albuterol causes bronchodilation by stimulating beta 2 receptors in the lungs. 58. Bactrim DS can be used to treat a patient with pneumonia. The "DS" in trimethoprim - sulfamethoxazole (Bactrim DS) stands for: double strength. The "DS" in trimethoprim -sulfamethoxazole (Bactrim DS) stands for double strength. In Bactrim DS, each tablet contains 800 mg sulfamethoxazole and 160 mg trimethoprim. In Bactrim, each tablet contains 400 mg of sulfamethoxazole and 80 mg of trimethoprim. Diethylstilbestrol (DES) is a synthetic form of estrogen. indicated for the treatment of chronic asthma in adults and children 12 months and older. Montelukast (Singulair), a leukotriene inhibitor, is: bind to beta lactamase, hindering enzymatic activity. In Augmentin, amoxicillin and clavulanate are combined. The action of clavulanate is to: Cefixime (Suprax). In adults with community -acquired pneumonia in which B-lactamase producing Haemophilus influenzae is identified as the causative organism, the outpatient treatment of choice is: stimulating beta 2 receptors. Albuterol (ProAir HFA), used in the treatment of asthma, causes bronchodilation by: 59. Ipratropium (Atrovent HFA) is a short -acting antimuscarinic antagonist. It works by blocking the action of acetylcholine and thus causes mild bronchodilation and prevents bronchoconstriction. Albuterol (ProAir HFA) is a short -acting beta agonist (SABA); budesonide (Pulmicort) is an inhaled corticosteroid; and montelukast (Singulair) is a leukotriene receptor agonist. 60. 61. Neuropsychiatric changes have been reported in association with leukotriene antagonists such as montelukast (Singulair). These changes may include dream abnormalities, insomnia, anxiety, depression, suicidal thinking, and in rare cases, suicide. Therefore, caution is advised when prescribing montelukast to patients with active or preexisting anxiety or depression, or symptoms that suggest psychiatric disorders. 62. The combination of short -acting bronchodilators and potassium -wasting medications may increase the occurrence of hypokalemia. Consider monitoring potassium levels. 63. The antibiotic of choice in the management of Bordetella pertussis in all age groups is a macrolide. Azithromycin and clarithromycin are preferred in infants younger 1 month who are not allergic. The choice of macrolide should take into account effectiveness, safety, tolerability and ease of adherence. azithromycin (Zithromax). The antibiotic of choice in the management of Bordetella pertussis in all age groups is: Ipratropium (Atrovent HFA). Which of the following medications is classified as a short -acting antimuscarinic antagonist (SAMA)? Which of the following is an adrenergic drug that acts on the sympathetic nervous system? Epinephrine Epinephrine is an adrenergic drug. Adrenergic drugs are also called adrenergic amines or sympathomimetic drugs. They work by stimulating the sympathetic nervous system (SNS). Adrenergic drugs cause increased blood pressure, vasoconstriction, bronchial dilatation, and increased heart rate. Atropine, scopolamine, and pilocarpine are all parasympathomimetic drugs that stimulate the parasympathetic nervous system. They are also known as cholinergics because of the action on the neurotransmitter acetylcholine. depression. Leukotriene antagonists such as montelukast (Singulair) should not be prescribed if the patient has preexisting: potassium -wasting medications Potential drug-drug interactions may occur when albuterol is combined with: 64. Which of the following would NOT be a potential adverse reaction of an intramuscular corticosteroid? anuria. Anuria has not been reported as a potential side effect of intramuscular corticosteroids. Reactions that may occur include anaphylaxis, angioedema, convulsions, depression, emotional instability, euphoria, headache, insomnia, mood swings, neuritis, neuropathy, paresthesia, personality changes, bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory collapse, congestive heart failure, and tachycardia. 65. Most inhalers have a dose counter. Putting the canister in water to see if it floats is not a reliable test. Some inhalers will float when they are full. Instruct the patient to hold the breath for 5 -10 seconds after they have deeply inhaled the medication. This lets the medicine reach deep into the lungs. Patients should be instructed to rinse their mouth with water, gargle, and spit after using the medication. This helps reduce side effects related to the medication, such as oral candidiasis. 66. Long -acting bronchodilators (LABAs), such as salmeterol (Serevent Diskus), are indicated in the treatment of moderate persistent asthma in 5 -11- year-olds, when combined with a low -dose inhaled steroid. They are indicated as concomitant therapy with a long -term asthma control medication, such as an inhaled corticosteroid, in patients aged 4 years and older with reversible obstructive airway disease. This is due to increased asthma -related deaths related to salmeterol use. 67. Minor side effects of macrolides include nausea, vomiting, diarrhea, and tinnitus. Serious side effects, including allergic reaction and cholestatic hepatitis (inflammation and congestion of bile ducts in the liver), are generally associated only with the use of erythromycin. 68. float the canister in water to determine whether it is empty. Patient instructions for the use of inhaled steroids would NOT include to: moderate persistent asthma in 5 -11-year-olds, when combined with low-dose inhaled steroid. Long -acting bronchodilators, such as salmeterol (Serevent Diskus), are indicated in the treatment of: nausea and vomiting. When prescribing a macrolide such as erythromycin for a patient with strep pharyngitis, the patient should be informed that they may experience: doxycycline (Vibramycin). The recommended treatment for community -acquired pneumonia secondary to an atypical pathogen in a previously healthy patient who has a macrolide allergy is: