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WorksheetsRespiratory Pharmacology Worksheet
Total questions: 96
Worksheet time: 56mins
A patient with acute bronchospasm arrives to the ED. Which medication is the best immediate rescue choice?
Albuterol inhaler (SABA)
Salmeterol inhaler (LABA)
Tiotropium (LAMA)
Theophylline oral
Which statement best distinguishes formoterol from albuterol?
Formoterol has a faster onset than albuterol.
Formoterol is a long-acting beta2 agonist; albuterol is short-acting.
Albuterol is used only for maintenance; formoterol is rescue therapy.
Formoterol has more anticholinergic effects than albuterol.
A patient with COPD is prescribed ipratropium. What patient teaching is most important?
This is inhaled anticholinergic; rinse mouth after use.
It may cause dry mouth and urinary retention.
It is a rescue medication for acute bronchospasm.
It increases heart rate and tremor.
Which pair is most similar in mechanism?
Ipratropium and tiotropium
Albuterol and ipratropium
Theophylline and tiotropium
Formoterol and ipratropium
Theophylline toxicity is MOST likely when the patient:
Drinks cola and coffee frequently.
Uses an inhaled corticosteroid.
Is taking ciprofloxacin.
Is elderly and on low protein diet.
A nurse teaching about inhaled corticosteroids for asthma should include which statements?
They control airway inflammation long-term.
Rinse your mouth after use to prevent thrush.
They are the first-line rescue medication for an asthma attack.
Long-term use may cause decreased bone density.
A patient on a LABA (salmeterol) alone for asthma has worsening symptoms. What is the most appropriate action?
Stop salmeterol immediately — it causes paradoxical bronchospasm.
Add an inhaled corticosteroid and reassess.
Switch to theophylline.
Increase the salmeterol dose above recommended max.
A 68-year-old with COPD has trouble using a metered-dose inhaler (MDI) and poor dexterity. Which drug/device combination is best?
Tiotropium via HandiHaler (dry powder capsule)
Albuterol MDI without spacer
Ipratropium nebulizer treatment PRN only
Theophylline oral tablets only
A patient is being started on theophylline. Which baseline test is most important?
Serum theophylline level after steady state achieved
Liver function tests and medication interaction review
Pulmonary function testing
Chest x-ray
A child in respiratory distress who has used albuterol multiple times and now is drowsy, with low oxygen saturation. The nurse should:
Continue albuterol and observe.
Give nebulized ipratropium and call respiratory therapy/physician.
Administer oral theophylline.
Give a LABA.
Which medication has the LEAST systemic bioavailability when inhaled?
Ipratropium bromide
Theophylline oral
Albuterol oral syrup
Tiotropium (inhaled)
SATA: Which drugs may cause tachycardia or tremor as side effects?
Albuterol
Formoterol
Tiotropium
Theophylline
A patient uses a LABA for COPD. Which statement is true?
LABAs are used for long-term control and are NOT rescue agents.
LABAs should always be combined with a SAMA.
LABAs cause immediate bronchodilation within seconds.
LABAs require frequent daily dosing every 3–4 hours.
Which medication is contraindicated as monotherapy in asthma due to risk of increased asthma-related death?
Formoterol (LABA)
Albuterol (SABA)
Ipratropium (SAMA)
Theophylline
A patient complains of dry mouth and blurred vision after starting inhaled ipratropium. These are most consistent with:
Anticholinergic effects.
Beta2-agonist effects.
Corticosteroid adverse effects.
Theophylline toxicity.
A 55-year-old with severe COPD on tiotropium and formoterol presents with urinary retention and constipation. Which drug is the most likely contributor?
Tiotropium
Formoterol
Albuterol PRN
Theophylline
Which of the following is an advantage of inhaled versus oral bronchodilators?
Less systemic side effects at therapeutic doses.
Faster hepatic metabolism.
More potent central nervous system stimulation.
Longer half-life.
SATA: Indications for theophylline include:
Long-term control of COPD/asthma when inhaled agents are inadequate.
First-line acute asthma rescue in ED.
Use in patients who cannot take inhaled therapy.
Use with caution due to narrow therapeutic index and many interactions.
A patient on theophylline develops arrhythmia. The nurse knows this may be due to:
Theophylline lowering the seizure threshold and causing cardiac irritability at toxic levels.
Theophylline causing cholinergic overstimulation.
Lack of anticholinergic effects.
Excess inhaled corticosteroid use.
A patient asks to compare ipratropium and tiotropium. Which statement is correct?
Both are antimuscarinic bronchodilators; tiotropium is longer acting (once daily).
Ipratropium is a LABA; tiotropium is a SABA.
Tiotropium is only oral; ipratropium is inhaled.
Both are systemic phosphodiesterase inhibitors.
A patient with peptic ulcer disease is prescribed famotidine. What is the primary mechanism?
H2 receptor blockade reducing gastric acid secretion
Proton pump inhibition of H+/K+ ATPase
Mucosal coating to protect ulcers
Antibiotic eradication of H. pylori
Which medication is ideal to coat and protect an active duodenal ulcer and should be taken on an empty stomach?
Sucralfate
Omeprazole
Famotidine
Bismuth subsalicylate
Which are true about proton pump inhibitors (PPIs) such as omeprazole?
They irreversibly inhibit the gastric H+/K+ ATPase.
Long-term use increases risk of C. difficile infection and fractures.
They should be taken before meals for best effect.
They increase gastric pH immediately within seconds.
A nurse teaching about sucralfate should include which instruction?
Take on an empty stomach and avoid antacids within 30 minutes.
It is a systemic antacid—do not use in renal failure.
A patient with GERD has nighttime heartburn despite twice-daily famotidine. What is an appropriate next step?
Switch to a PPI like omeprazole.
Increase famotidine to three times daily.
Start sucralfate overnight.
Add theophylline.
A patient on chronic PPI therapy reports muscle weakness and polyuria. Lab shows hypomagnesemia. What is the best nurse action?
Notify prescriber—PPIs can cause hypomagnesemia; consider alternative or supplementation.
Instruct patient to double PPI dose.
Stop calcium and potassium supplementation.
Increase dietary fiber.
Which medication is MOST useful as adjunct therapy for H. pylori eradication?
Bismuth subsalicylate
Sucralfate
SATA: Which patient history would alert the nurse to use PPIs cautiously?
History of osteoporosis with prior low-trauma fractures.
Recurrent C. difficile infections.
Asthma well controlled on inhaled steroids.
Long-term use of clopidogrel (possible interaction).
A patient on omeprazole and clopidogrel asks if the drugs interact. The nurse should reply:
Omeprazole can reduce clopidogrel activation via CYP2C19—discuss benefits/risks with prescriber.
There is no interaction—continue both without concern.
Omeprazole increases clopidogrel effect and causes bleeding.
Stop clopidogrel immediately.
An elderly patient with acute GI bleed is hypotensive and tachycardic. Which is highest priority?
Which gastric medication is most appropriate for immediate neutralization of stomach acid?
Antacids (not on sheet; if present choose appropriate)
Famotidine
Omeprazole
Sucralfate
A patient with renal failure should use which gastric med with caution?
Sucralfate (aluminum content may accumulate)
Omeprazole (renally eliminated)
Famotidine (safe in renal failure)
Theophylline
Which statement distinguishes famotidine from omeprazole?
Famotidine blocks histamine receptors on parietal cells; omeprazole blocks proton pumps.
Famotidine is irreversible; omeprazole reversible.
Omeprazole increases histamine release.
Famotidine causes magnesium depletion.
A patient needs short-term relief of heartburn and asks how fast famotidine works compared with a PPI. The nurse replies:
Famotidine reduces acid within hours; PPIs take longer to achieve maximal effect.
Famotidine is faster and stronger than PPI.
PPIs act instantly to neutralize acid.
Both have identical onset.
A patient on sucralfate complains of constipation. The nurse should:
Offer stool softener and increase fluids/fiber.
Stop sucralfate immediately.
Switch to omeprazole.
Assume it is not related.
Which medication requires administration before meals for best effect?
Omeprazole (take before breakfast)
Sucralfate (empty stomach)
Famotidine (any time)
Theophylline
A pregnant patient with severe GERD asks which gastric med is preferred. Which is safest?
H2 blockers (famotidine) are often preferred over PPIs in pregnancy when needed.
High-dose PPI is always safest.
Sucralfate is absolutely contraindicated.
Avoid all gastric meds.
Teachings common to H2 blockers and PPIs include:
Both reduce acid and relieve heartburn.
Both require tapering to avoid rebound acid hypersecretion.
Both may increase risk of infections with long-term use.
Both increase gastric motility.
Peginterferon alfa-2a (Pegasys) is prescribed for chronic hepatitis. Which is a common side effect?
Flu-like symptoms (fever, myalgias) and depression.
Hyperglycemia and weight gain.
Bradycardia and hypertension.
Renal failure.
Ribavirin requires special counseling because:
It is teratogenic — strict contraception is required for both partners.
It causes hyperkalemia.
It causes pulmonary fibrosis in all users.
It is safe in pregnancy.
Tenofovir alafenamide is used for hepatitis B. What nursing monitoring is most important?
Renal function and bone density over time.
LFTs only.
Pulmonary function tests.
Regular EKGs.
When combining peginterferon and ribavirin therapy, the nurse should monitor for:
Anemia
Depression and mood changes
Weight gain due to fluid retention
Cytopenias (low neutrophils/platelets)
Lactulose is given for hepatic encephalopathy. Its primary mechanism is:
Acidify the colon, convert ammonia to ammonium for excretion.
Stimulate hepatic regeneration.
Bind bile acids to reduce jaundice.
Directly correct coagulopathy.
A patient on lactulose develops severe diarrhea and dehydration. The nurse should:
Notify prescriber to reduce dose and monitor electrolytes.
Stop and switch to sucralfate.
Increase lactulose to resolve encephalopathy.
Add magnesium antacid.
Which statement compares tenofovir and ledipasvir-sofosbuvir (Harvoni)?
Tenofovir treats hepatitis B; ledipasvir-sofosbuvir treats hepatitis C.
Both are used for hepatitis B only.
Ledipasvir-sofosbuvir causes renal failure in all patients.
Tenofovir requires interferon coadministration.
Case: A pregnant woman with hepatitis C asks about ledipasvir-sofosbuvir safety. What is the appropriate response?
Discuss risks and benefits—direct-acting antivirals have evolving data in pregnancy; consult hepatology and obstetrics.
Assure it’s completely safe; take without consult.
Stop all meds immediately.
Start peginterferon instead.
SATA: Important patient teaching for peginterferon includes:
Expect flu-like symptoms especially early in therapy.
Report mood changes or suicidal ideation.
No contraception is required.
Blood counts will be monitored frequently.
Which lab must be monitored with ribavirin therapy?
Hemoglobin/hematocrit due to hemolytic anemia risk.
Serum calcium only.
TSH exclusively.
Creatine kinase.
Which medication lowers blood ammonia in hepatic encephalopathy?
Lactulose
Peginterferon
Tenofovir
Omeprazole
Which of these are true about interferon therapy?
Dose reductions may be needed for severe cytopenias.
Interferons are immunomodulatory with antiviral activity.
They are safe in severe uncontrolled depression.
They require monitoring for thyroid dysfunction.
A patient on ledipasvir-sofosbuvir reports fatigue and headache. The nurse should:
Reassure that these are common and monitor.
Discontinue medication immediately.
Administer theophylline.
Give high-dose steroids.
Which antiviral for hepatitis B is most associated with bone density loss and nephrotoxicity if used long term?
Tenofovir (especially TDF formulation; TAF has less but still monitor)
Ribavirin
Ledipasvir-sofosbuvir
Lactulose
A patient on peginterferon reports suicidal thoughts. The nurse should:
Immediately notify the prescriber and implement safety precautions.
Tell the patient it will pass.
Which pairing is correct?
Lactulose — hepatic encephalopathy; Peginterferon — hepatitis B or C (depending on regimen); Tenofovir — hepatitis B.
Ribavirin — treat hyperlipidemia.
Tenofovir — first-line for hepatitis C.
Ledipasvir-sofosbuvir — used for hepatic encephalopathy.
SATA: Potential adverse effects of ribavirin include:
Hemolytic anemia
Teratogenicity
Photosensitivity
Gastrointestinal upset
A patient on tenofovir asks why bone density is monitored. The nurse should explain:
Tenofovir can cause bone mineral density loss; monitoring and supplementation may be needed.
Tenofovir increases bone growth.
Bone monitoring is unnecessary.
Tenofovir causes hypercalcemia.
Which drug requires strict contraception for male and female patients during and for months after therapy?
Ribavirin
Tenofovir
Peginterferon
Lactulose
Which are true about ledipasvir-sofosbuvir (direct acting antivirals for hepatitis C)?
They can cure hepatitis C in many patients.
They have significant drug interactions (e.g., with amiodarone).
They commonly require interferon coadministration.
They are oral once-daily regimens (for many genotypes).
A patient with new DVT is started on enoxaparin. Which nursing instruction is essential?
Give subcutaneous injections in the abdomen, rotate sites, do not rub the area.
Take oral enoxaparin with meals.
Which is the mechanism of action of unfractionated heparin (UFH)?
Potentiates antithrombin III leading to inhibition of thrombin and factor Xa.
Directly inhibits vitamin K epoxide reductase.
Blocks platelet ADP receptors.
Inhibits HMG-CoA reductase.
Which are true regarding warfarin therapy?
Requires INR monitoring.
Is teratogenic—avoid in pregnancy.
Vitamin K reverses its effects.
Has no dietary interactions.
A patient on warfarin has an elevated INR of 9 with minor bleeding. The nurse expects:
Hold warfarin and give oral vitamin K as ordered.
Increase warfarin dose.
Give aspirin to counteract effect.
Continue current dosing.
Compare aspirin and clopidogrel: which statement is correct?
Both inhibit platelet aggregation but via different mechanisms—aspirin inhibits COX-1 (TXA2), clopidogrel blocks the P2Y12 ADP receptor.
Both are direct thrombin inhibitors.
Clopidogrel is an anticoagulant that elevates INR.
Aspirin requires INR monitoring.
SATA: Which antiplatelet/anticoagulant combinations increase bleeding risk and require careful assessment?
A. Aspirin + clopidogrel
B. Warfarin + NSAID
C. Enoxaparin + aspirin
D. Heparin + acetaminophen
A patient in ACS receives aspirin in the ED. The priority rationale is:
Which lab reflects warfarin anticoagulant effect?
INR (prothrombin time standardized)
aPTT only
Platelet count
D-dimer
A patient on enoxaparin has new onset severe back pain and lower limb weakness. The nurse should suspect:
Spinal epidural hematoma — stop anticoagulant and notify prescriber immediately.
Normal back strain.
Heparin allergy rash.
Deep vein thrombosis.
Which is a major difference between UFH and LMWH (enoxaparin)?
LMWH has more predictable pharmacokinetics and usually does not require routine aPTT monitoring.
UFH is given orally.
LMWH has a shorter half-life and less anti-Xa activity.
UFH is teratogenic.
SATA: Indications for aspirin include:
Primary prevention for some patients (individualized)
Acute management of suspected myocardial infarction (chewable)
Deep vein thrombosis treatment as monotherapy in acute DVT
Antiplatelet therapy after stent placement in combination with P2Y12 inhibitors
A patient taking clopidogrel is scheduled for surgery. Preoperative instruction should include:
Discuss holding clopidogrel 5-7 days before surgery per surgeon guidance.
Continue clopidogrel without change.
Double the dose before surgery.
Switch to aspirin the day before.
Which medication requires anti-Xa monitoring in special populations (e.g., renal failure, obesity)?
Unfractionated heparin
Warfarin
Aspirin
Clopidogrel
Bleeding precautions the nurse should teach patients on anticoagulants include:
Use soft toothbrush, electric razor.
Avoid NSAIDs unless approved.
Immediately stop all medications if bruising occurs.
Report signs of bleeding (gum bleeding, black stools, hematuria).
A patient on warfarin is started on a broad-spectrum antibiotic. The nurse should anticipate:
Possible increase in INR due to decreased vitamin K–producing gut flora.
No interaction.
Decreased warfarin effect.
Immediate need for heparin bridge.
A patient on enoxaparin develops sudden hemoptysis and hypotension. The nurse’s first action is:
Stop enoxaparin, call rapid response/physician, prepare for reversal/bleeding control.
Give another dose of enoxaparin.
Increase oral warfarin.
Reassure the patient and observe.
Compare warfarin and enoxaparin: which statement is true?
Warfarin is oral, has delayed onset, requires INR monitoring; enoxaparin is parenteral with more predictable dosing.
Both are direct thrombin inhibitors taken orally.
Enoxaparin increases INR naturally.
Warfarin has no dietary interactions.
SATA: Which increase warfarin effect (increase INR) and bleeding risk?
Broad-spectrum antibiotics (e.g., metronidazole)
Diet high in leafy green vegetables
Amiodarone
Acute alcohol use
A patient is prescribed aspirin for secondary prevention post-MI but has a documented aspirin allergy (anaphylaxis). Which is the best alternative antiplatelet?
Clopidogrel (if no allergy to thienopyridines)
Warfarin
Enoxaparin long term
Increase beta blocker
Which medication is a statin and works by inhibiting HMG-CoA reductase?
Atorvastatin
Ezetimibe
Gemfibrozil
Omega-3 acid ethyl esters
A patient taking atorvastatin reports new muscle pain and dark urine. What is the priority nursing action?
Stop the statin and notify prescriber to check creatine kinase and renal function (possible rhabdomyolysis).
Continue and reassure patient.
Add gemfibrozil to treat muscle pain.
Increase statin dose.
Compare ezetimibe and statins: which is correct?
Ezetimibe reduces intestinal cholesterol absorption; statins reduce hepatic cholesterol synthesis.
Both are HMG-CoA reductase inhibitors.
Ezetimibe increases liver enzyme levels more than statins.
Ezetimibe causes renal toxicity.
Bempedoic acid is a newer agent for LDL lowering. Which statement is true?
It inhibits ATP citrate lyase upstream of HMG-CoA reductase.
It is a statin.
It dramatically increases triglycerides.
It cannot be combined with statins.
A patient on gemfibrozil and atorvastatin should be monitored because:
Gemfibrozil increases the risk of statin-induced myopathy/rhabdomyolysis.
Combination reduces cholesterol too quickly.
Gemfibrozil reverses statin effects.
No monitoring needed.
Which lipid-lowering agents are best for severe hypertriglyceridemia?
Fibrates (gemfibrozil)
Omega-3 fatty acids (fish oil)
Statins primarily for LDL, less effective for very high TGs alone
Ezetimibe primarily lowers LDL but not TGs
A patient with very high LDL on maximal statin therapy is started on ezetimibe. The nurse should explain:
Ezetimibe adds LDL lowering via gut cholesterol absorption inhibition.
It replaces statin therapy entirely.
It requires INR monitoring.
It causes immediate weight loss.
A middle-aged patient with familial hypercholesterolemia on atorvastatin complains of new muscle weakness after starting a fibrate. Which is the likely cause?
Statin-fibrate interaction leading to increased myopathy risk.
Atorvastatin overdose.
Gemfibrozil reduces statin absorption causing weakness.
Ezetimibe side effect.
Patient teaching for statins includes:
Take statin at night (some) to align with cholesterol synthesis rhythm.
Report unexplained muscle pain or dark urine.
Which medication lowers LDL by blocking absorption at the brush border?
Ezetimibe
Atorvastatin
Gemfibrozil
Bempedoic acid
A patient taking omega-3 acid ethyl esters (fish oil) should be taught:
It may reduce triglycerides but can increase bleeding risk at high doses.
It is a primary agent for LDL lowering.
It causes severe hypoglycemia.
It requires INR monitoring with warfarin (no interaction).
Which drug is contraindicated to combine with statins due to high myopathy risk:
Gemfibrozil
Ezetimibe
Bempedoic acid
Fish oil
SATA: Indications for statin therapy include:
Primary and secondary prevention of atherosclerotic cardiovascular disease.
Severe hypertriglyceridemia as first-line monotherapy.
Familial hypercholesterolemia.
After lifestyle modifications are insufficient.
A patient on high-intensity statin therapy who develops elevated transaminases (>3× ULN) should have:
Statin held and evaluated for alternative causes; consider switching/lowering dose.
Immediate doubling of dose.
Noted and continue without change.
Start gemfibrozil.
Compare bempedoic acid and ezetimibe: which is true?
Risk reduction counseling for all lipid-lowering drugs should include:
Continue lifestyle modifications (diet, exercise).
Avoid abrupt discontinuation of therapy without consulting provider.
Expect immediate symptom relief of chest pain.
Report unexplained bruising or bleeding (if on combination therapy with anticoagulants).
A patient on atorvastatin asks about pregnancy. The nurse should advise:
Statins are contraindicated in pregnancy—stop and consult prescriber if pregnancy planned or discovered.
Continue statin—benefits outweigh risks.
Switch to gemfibrozil in pregnancy.
Increase dose.
A patient presents with muscle pain and markedly elevated CK and renal dysfunction. The nurse recognizes:
Possible rhabdomyolysis—stop statin, aggressive IV fluids, notify prescriber.
Mild expected side effect—reassure and continue.
Normal—no action.
Give fibrate immediately.
SATA: Which lipid agents can increase risk of myopathy when combined with statins?
Gemfibrozil
Niacin (if present)
Ezetimibe (lower risk)
High-dose fibrates
