Drugs used in management of COPD MCQs With Answer

Introduction

Understanding drugs used in the management of COPD is essential for B. Pharm students preparing for clinical pharmacy roles. This concise guide focuses on pharmacology, mechanisms of action, dosing, adverse effects, monitoring, and drug interactions of key COPD treatments: bronchodilators (short‑ and long‑acting beta2‑agonists and anticholinergics), inhaled corticosteroids, methylxanthines, PDE4 inhibitors, and adjunctive agents. Emphasis is placed on therapeutic selection for stable disease versus exacerbations, inhaler device considerations, and safety profiles. Mastery of these concepts helps in rational prescribing, counseling, and therapeutic monitoring. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which drug is a long‑acting muscarinic antagonist commonly used once daily for maintenance therapy in COPD?

• Ipratropium bromide
• Tiotropium bromide
• Albuterol
• Salmeterol

Correct Answer: Tiotropium bromide

Q2. What is the primary mechanism by which short‑acting beta2‑agonists relieve dyspnea in COPD?

• Inhibition of phosphodiesterase‑4
• Blockade of muscarinic receptors
• Stimulation of beta2 receptors to increase cAMP and cause bronchodilation
• Reduction of airway inflammation by steroid receptor activation

Correct Answer: Stimulation of beta2 receptors to increase cAMP and cause bronchodilation

Q3. Which inhaled corticosteroid is commonly combined with LABA for COPD patients with frequent exacerbations?

• Roflumilast
• Fluticasone propionate
• Theophylline
• Tiotropium

Correct Answer: Fluticasone propionate

Q4. Roflumilast, used in severe COPD with chronic bronchitis, primarily inhibits which enzyme?

• Monoamine oxidase
• Phosphodiesterase‑4 (PDE4)
• Carbonic anhydrase
• Cyclooxygenase‑2 (COX‑2)

Correct Answer: Phosphodiesterase‑4 (PDE4)

Q5. Which adverse effect is most commonly associated with systemic absorption of inhaled corticosteroids in COPD?

• Hypokalemia
• Oral candidiasis and hoarseness
• Tremor and tachycardia
• QT prolongation

Correct Answer: Oral candidiasis and hoarseness

Q6. Theophylline’s therapeutic action in COPD is mediated by which of the following mechanisms?

• Competitive antagonism at beta2 receptors
• Inhibition of adenosine receptors and nonselective phosphodiesterase inhibition increasing cAMP
• Selective muscarinic M3 receptor activation
• Inhibition of leukotriene synthesis

Correct Answer: Inhibition of adenosine receptors and nonselective phosphodiesterase inhibition increasing cAMP

Q7. Which drug interaction increases theophylline levels and risk of toxicity?

• Rifampicin coadministration
• Smoking cessation with nicotine patch
• Erythromycin coadministration
• Phenytoin coadministration

Correct Answer: Erythromycin coadministration

Q8. For acute COPD exacerbation with bronchospasm in the emergency setting, the preferred initial bronchodilator is:

• Oral prednisolone
• Intravenous roflumilast
• Inhaled short‑acting beta2‑agonist (e.g., salbutamol/albuterol)
• Long‑acting muscarinic antagonist (e.g., tiotropium)

Correct Answer: Inhaled short‑acting beta2‑agonist (e.g., salbutamol/albuterol)

Q9. Which agent is most appropriate for chronic maintenance to reduce exacerbations in a patient with severe COPD and chronic bronchitis with frequent exacerbations?

• Daily high‑dose oral theophylline without monitoring
• Roflumilast oral PDE4 inhibitor
• Short‑acting anticholinergic PRN
• Systemic corticosteroids daily long term

Correct Answer: Roflumilast oral PDE4 inhibitor

Q10. Which inhaler combination is an example of LABA plus LAMA therapy used for COPD maintenance?

• Formoterol plus tiotropium
• Salmeterol plus fluticasone
• Albuterol plus ipratropium
• Roflumilast plus theophylline

Correct Answer: Formoterol plus tiotropium

Q11. Which statement about ipratropium bromide is correct?

• It is a long‑acting beta2‑agonist.
• It is a short‑acting antimuscarinic bronchodilator suitable for relief of acute symptoms.
• It primarily reduces eosinophilic airway inflammation.
• It is an oral PDE4 inhibitor.

Correct Answer: It is a short‑acting antimuscarinic bronchodilator suitable for relief of acute symptoms.

Q12. Chronic macrolide therapy (e.g., azithromycin) in COPD is used mainly for:

• Immediate bronchodilation
• Long‑term anti‑inflammatory and exacerbation prophylaxis in selected patients
• Replacing inhaled corticosteroids
• Treatment of acute hypoxemia

Correct Answer: Long‑term anti‑inflammatory and exacerbation prophylaxis in selected patients

Q13. Which laboratory parameter is most important to monitor in a patient receiving high doses of theophylline?

• Serum theophylline concentration
• Fasting blood glucose
• Liver function tests only at baseline
• Serum magnesium concentration

Correct Answer: Serum theophylline concentration

Q14. Which adverse effect is commonly associated with inhaled long‑acting beta2‑agonists?

• Urinary retention
• Tremor and palpitations
• Seizures at therapeutic doses
• Severe hypoglycemia

Correct Answer: Tremor and palpitations

Q15. Which pharmacologic strategy is recommended first for smoking cessation in COPD patients?

• Long‑term oral corticosteroids
• Behavioral support plus pharmacotherapy (nicotine replacement, varenicline or bupropion)
• High‑dose inhaled beta2‑agonists
• Chronic macrolide therapy

Correct Answer: Behavioral support plus pharmacotherapy (nicotine replacement, varenicline or bupropion)

Q16. Which of the following is a key contraindication to using beta‑blockers in COPD patients?

• Concurrent use of inhaled corticosteroids
• Severe reactive airway disease with risk of bronchospasm using nonselective beta‑blockers
• History of hyperlipidemia
• Mild intermittent COPD controlled with SABA only

Correct Answer: Severe reactive airway disease with risk of bronchospasm using nonselective beta‑blockers

Q17. Inhaler technique counseling should emphasize which point to maximize drug delivery for DPI (dry powder inhaler) devices?

• Slow, shallow inhalation
• Rapid, forceful inhalation to disperse powder
• Priming by shaking vigorously before each use
• Exhale forcefully into the device before inhalation

Correct Answer: Rapid, forceful inhalation to disperse powder

Q18. Which drug class reduces airway inflammation by binding to intracellular glucocorticoid receptors?

• Long‑acting muscarinic antagonists
• Inhaled corticosteroids
• Short‑acting beta2‑agonists
• PDE4 inhibitors

Correct Answer: Inhaled corticosteroids

Q19. Which of the following is the principal benefit of combining inhaled corticosteroid (ICS) with LABA in COPD?

• Immediate reversal of airflow obstruction
• Reduced exacerbation frequency and improved symptoms in specific patients
• Prevention of all COPD progression
• Complete elimination of systemic steroid need

Correct Answer: Reduced exacerbation frequency and improved symptoms in specific patients

Q20. Which symptom or sign mandates caution or dose reduction when prescribing roflumilast?

• Low body mass index and weight loss
• Chronic hypertension controlled on ACE inhibitors
• Mild osteoarthritis
• Intermittent GERD

Correct Answer: Low body mass index and weight loss

Q21. A patient on inhaled salmeterol and high‑dose inhaled steroid presents with pneumonia risk concerns. Which statement is correct?

• ICS use in COPD has been associated with increased pneumonia risk in some studies
• LABA monotherapy eliminates pneumonia risk
• The combination prevents all respiratory infections
• Pneumonia risk is unrelated to inhaled therapy

Correct Answer: ICS use in COPD has been associated with increased pneumonia risk in some studies

Q22. Which inhaled drug has the fastest onset of bronchodilation suitable for rescue use?

• Salmeterol
• Formoterol
• Tiotropium
• Fluticasone

Correct Answer: Formoterol

Q23. Which agent is contraindicated or used with caution in patients with significant arrhythmias when treating COPD?

• Inhaled anticholinergics like ipratropium
• High systemic doses of theophylline
• Inhaled corticosteroids at standard doses
• Nebulized saline

Correct Answer: High systemic doses of theophylline

Q24. Which principle is correct when choosing antibiotics for acute infective COPD exacerbations?

• Antibiotics are never indicated for exacerbations
• Choice depends on severity, local resistance patterns, and risk factors for Pseudomonas
• Always use macrolide monotherapy regardless of severity
• Antibiotics should be started only after sputum culture results

Correct Answer: Choice depends on severity, local resistance patterns, and risk factors for Pseudomonas

Q25. Which monitoring is particularly important when a COPD patient is prescribed chronic systemic corticosteroids?

• Regular peak expiratory flow only
• Bone mineral density, blood glucose, and infection surveillance
• No monitoring required for long‑term oral steroids
• Weekly liver biopsy

Correct Answer: Bone mineral density, blood glucose, and infection surveillance

Q26. Which factor typically reduces theophylline clearance and may increase risk of toxicity?

• Smoking tobacco
• Coadministration of CYP1A2 inhibitors such as ciprofloxacin
• High‑protein diet
• Young age

Correct Answer: Coadministration of CYP1A2 inhibitors such as ciprofloxacin

Q27. Which medication class is recommended as first‑line long‑term bronchodilator therapy for most patients with persistent COPD symptoms?

• Long‑acting bronchodilators (LABA or LAMA)
• Systemic corticosteroids daily
• Oral antibiotics chronically
• Short‑acting bronchodilators only as needed

Correct Answer: Long‑acting bronchodilators (LABA or LAMA)

Q28. Combination inhaler therapy with LABA + ICS is most beneficial for COPD patients who:

• Have infrequent symptoms and no exacerbations
• Have a history of frequent exacerbations and elevated eosinophil counts
• Are asymptomatic smokers
• Require only rescue albuterol occasionally

Correct Answer: Have a history of frequent exacerbations and elevated eosinophil counts

Q29. Which method best reduces oropharyngeal deposition and risk of local side effects when using inhaled corticosteroids?

• Using higher doses to overcome deposition
• Rinsing mouth and gargling after inhalation
• Switching to systemic steroids for all patients
• Exhaling forcefully into the inhaler after dose

Correct Answer: Rinsing mouth and gargling after inhalation

Q30. In COPD pharmacotherapy, which statement about oxygen therapy and drug interactions is correct?

• Long‑term oxygen therapy is a drug and has no interactions with COPD medications
• Sedatives and opioids can depress ventilation and should be used cautiously with long‑term oxygen therapy
• Oxygen reverses the need for bronchodilators
• Nitric oxide inhalation is first‑line maintenance therapy

Correct Answer: Sedatives and opioids can depress ventilation and should be used cautiously with long‑term oxygen therapy

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

Mail- Sachin@pharmacyfreak.com