Incentivized Exam Review 2 - 2013

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Incentivized Exam Review 2 - 2013
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2013-04-16 03:27:01
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  1. How much is the selling price of Xyzal Oral Solution?
    - 222.00
    - 244.00
    - 266.75
    - 288.00
    266.75
  2. How much is the selling price of Xyzal 5mg tablet?

    - 24.75
    - 26.00
    - 27.00
    - 27.25
    27.00
  3. How much is the selling price of Xyzal OralDrops?

    - 245.00
    - 250.00
    - 255.00
    - 260.00
    245.00
  4. How much is the selling price of Avamys 120D as of Jan. 27, 2013?

    - 747.75
    - 768.25
    - 772.50
    - 797.75
    797.75
  5. Each spray of Fluticasone Furoate Avamys delivers ___ ug of micronized FF.
    27.5 ug
  6. What study has a conclusion that FF is associated to more symptom days than MF?
    Gueron et al
  7. How much does Avamys 120 spray cost (as of Jan 27, 2013)?
    797.75
  8. How much is the daily cost of Avamys 120D for ADULTS based on the January 2013 price?
    26.59 per day
  9. Which study showed that Avamys does not cause damage to nasal mucosa in long-term use?
    Fokkens, 2012
  10. Which study showed high affinity and selectivity to h1 receptor?
    Salter
  11. In which study did Levocetirizine have a long term study of 18 months continuous use from 1-2 yrs old?
    Simmons 2007/2008 on EPAAC
  12. Oral Antihistamines works by binding to the ________ on target tissues.
    This prevents histamine from attaching to these receptors so allergic symptomes caused by histamine are significantly reduced or completely blocked
    H1-receptors
  13. žAccording to ARIA, What are symptoms that are:

    > 4 days / week and  >4 weeks

    Intermittent Symptoms
    Persistent Symptoms
    Mild Symptoms
    Moderate-Severe Symptoms
    Persistent Symptoms
  14. žARIA classification of Allergic Rhinitis with symptoms of (what severity?)

    -Normal sleep; Normal daily activities, sports, leisure; Normal work and school; and No troublesome symptoms
    Mild Symptoms
  15. Each spray of Avamys suspension delivers ____of micronized fluticasone furoate as an ex device dose.
    27.5 ug
    55 ug
    110 ug
    27.5 ug
  16. What is a very common adverse effect of Avamys with short and long term use?

    Nasal Ulceration
    Epistaxis
    Dry Mouth
    Headache
    Epistaxis
  17. What is the recommended storage temperature for Avamys?


    Not exceeding 20 degree C
    Not exceeding 25 degree C
    Not exceeding 30 degree C
    Not exceeding 30 degree C
  18. Avamys should be shaken vigorously with cap for about ____ seconds for 1st time use. This is important as Fluticasone furoate (Avamys) is very thick and becomes liquid when you shake it well. It will only spray when it becomes liquid.
    10 seconds
  19. Levocetirizine is the ____ of Cetirizine

    Right enantiomer
    Left enantiomer
    Eutomer
    Right Enantiomer
  20. Levocetirizine (Xyzal) is _____ bound to
    plasma protein


    70%

    80%

    90%

    100%
    90%
  21. Indication of Levocetirizine based on CPI


    Allergic Rhinitis

    Chronic Idiopathic Urticaria

    Both A and B
    Both A and B
  22. Dosage adjustment is required for patients on Xyzal with renal impairment? True or False
    True: Adjustment of the dose is recommended in elderly patients with moderate to severe renal impairment
  23. Due to the presence of lactose, patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take the?


    Levocetirizine (xyzal) oral drops

    Levocetirizine (Xyzal) oral
    solution

    Levocetirizine (Xyzal) oral tablet

    Both A and B
    Levocetirizine (Xyzal) oral tablet
  24. The administration of levocetizine (Xyzal) to infants and toddlers aged less than 2 years is not recommended. True or False.
    True due to limited data in this population
  25. What is the longest safety study of Avamys
    for pediatric patients?
    Maspero 12-week safety study
  26. Based on the BSACI guidelines, which among the symptoms of AR is INS the most effective?
    Nasal congestion
  27. How much are Avamys and Nasonex in Mercury (SRP)?
    • Avamys 120D: P797.75
    • Avamys 60D:  P582.50
    • Nasonex: P1,123.75
  28. Based on 2008 BSACI (British Society of Allergy & Clinical Immunology) Guidelines, ______ has no effect on sneezing & nasal itch and ______ has least effect on nasal obstruction.
    LRTA has no effect on sneezing & nasal itch and OAH has least effect on nasal obstruction.
  29. OAH has least effect on nasal obstruction. True or False.
    True
  30. Who is the main author of the study showing Levocetirizine caused greater wheal inhibition of 40.2% at 32h after dosage, compared with 24.3% inhibition caused by Cetirizine?
    Devalia (2001 )
  31. Based on CPI, what are the “common” adverse events of Xyzal?
    • Headache
    • Dry mouth
    • Somnolence
    • Fatigue
  32. Clinicians do not administer and patients do not use decongestants regularly. ARIA suggests a very short course (not longer than ____ days and preferably shorter) for intranasal decongestant.
    5
  33. What are the suggested retail price of all formats of Xyzal in Mercury Drug?
    Xyzal Oral Solution PhP266.75,

    Xyzal Drops PhP243.25,

    Xyzal 5mg tablet PhP27.00
  34. Xyzal 5mg tablets should be stored at what temperature?
    Below 25°C
  35. What is the proper handling and storage of Xyzal oral drops and solution?
    • For unopened, oral drops & solution last for 2 years and last for 3 months when
    • opened. It should be kept at 30°C
  36. Which specialty/specialties  produce/s  70% of skin and nasal Rx?

    A.      Dermatologists

    B.      General Practitioners

    C.      Pulmonologists

    D.      Pediatricians

    E.       Internal Medicine
    • General Practitioners
    • Pediatricians
  37. Which study compares Xyzal vs Desloratadine on the treatment of CIU patients lasting for 4 week treatment?
    Potter 2008
  38. Which study compares receptor occupancy & wheal & flare inhibition of Xyzal vs Desloratadine?
    Gillard 2005
  39. Which study shows that Desloratadine has an onset of action of 3 hours for patients with SAR?
    Day 2004
  40. Which study compares ETAC & EPAAC which that levocetirizine has better safety profile than cetirizine (headache, nervousness, somnolence & fatigue)?
    Pampura 2011
  41. Which study shows that levocetirizine has faster onset of action vs deslo, fexo & cetirizine?
    Simmons 2002
  42. Which study shows higher wheal inhibition of levocetirizine vs. cetirizine?
    Devalia 2001
  43. What is the longest safety study (18 months) of Xyzal for the treatment of atopic dermatitis?
    Simmons 2008 (EPAC)
  44. Which study compares Levocetirizine vs Desloratadine on the control of pruritus & wheals?
    Anuradha 2010
  45. What are the important pediatric studies of Xyzal?
    • Hampel 2010 : as young as 6 months
    • Pampura 2011 : ETAC vs EPAAC
    • Simmons 2008: longest safety study (18 months; as young as 12-24 months)
  46. What is the first study of Avamys which showed its long-term (1 year), safety & efficacy (adults & adolescents as patient subjects)?
    Rosenblut
  47. What is the spray volume per actuation of Avamys as compared to Nasonex?
    50ul for Avamys vs 100ul for Nasonex
  48. Levocetirizine is eliminated unchanged in the urine in proportion of ___.
    85%
  49. What is the cellular trademark of inflammation and is responsible for tissue hyperreactivity & chronic inflammation?          
                                                                       Basophils
    Mast Cells
    Eosinophils
    Dendritic Cells
    Eosinophils
  50. What is the general pediatric dosage of Xyzal?
    0.125 mg/kg/dose
  51. True or False. Levocetirizine must be taken orally, and should be taken with food.
    False. With or without food
  52. The OAH Market consists of _____% Nasal & _____% Skin allergies.
    • 57% Nasal
    • 43% Skin
  53. What are the 2 Xyzal Key strategies for 2013 that is needed to grab the Nasal & Skin Market?
    Differentiate XYZAL as the fastest-acting OAH for BOTH nasal and skin allergies by...
    (1) building MD positive clinical experience and(2) ensuring strong familiarity with proper administration of the wet formats.
  54. Levocetirizine has a dissociation  half-time more than __ higher than dextrocetirizine
    20
  55. Pediatricians and GPs contribute about ___% of Nasal and Skin RX for OAH.  Pulmonologists yield the highest Nasal RX per doctor, while Dermatologists have the highest RX per doctor for skin indications. 
    70
  56. What are the treatment goals of ARIA?
    Alleviate symptom severityReduce the risk of developing associated disordersControl underlying inflammation
  57. Persistent Allergic Rhinitis symptom is classified as:


    >4 days/week and >4 weeks

    <4 days /week or <4 weeks

    >4 days/week but <4 weeks

    <4 days/week but >4 weeks
    >4 days/week and >4 weeks
  58. Intermittent Allergic Rhinitis symptom is classified as…

    >4 days/week and >4 weeks

    <4 days /week or <4 weeks

    >4 days/week but <4 weeks

    <4 days/week but >4 weeks
    <4 days /week or <4 weeks
  59. Based on ARIA Guideline, Intranasal
    steroids are given for persistent and moderate-severe intermittent AR while OAH
    can be given only for mild-intermittent AR.

    True or False.
    False
  60. What is the recommendation of
    ARIA for patients with seasonal AR?

    OAH

    LTRA

    Intranasal Glucocorticosteroid

    Decongestant
    • OAH
    • Intranasal Glucocorticosteroid
  61. Which of the following are characteristics of an OAH?

    Effective within few hours of dosing

    Have an excellent safety record but must be administered continuously to be effective.

    Better compared to INS in relieving nasal itching

    Most common effect is dry mouth

    Effective on Rhinitis and Asthma
    • Effective within few hours of dosing
    • Better compared to INS in relieving nasal itching
  62. Based on the study of Nolte, et al, how many of moderate to severe AR patients were undertreated?

    32%

    85%

    83%

    63%
    83%
  63. Based on the study of Nolte, et al, how many of moderate to severe AR patients were undaignosed?

    32%

    85%

    83%

    63%
    32%
  64. “In this population, a large proportion of patients were unaware of having asthma or rhinitis. The pharmaceutical treatment and management practice were inadequate. The study emphasizes the need for additional intervention.” This is the study conclusion
    of…

    Derendorf, et al

    Nolte, et al

    Navarro, et al
    Nolte, et al
  65. “It could be argued that the newer agents, fluticasone propionate, mometasone furoate, ciclesonide, and fluticasone furoate, come remarkably close to the pharmacokinetic/pharmacodynamic
    criteria for the ideal INS.” This is the study conclusion of…

    Derendorf, et al

    Nolte, et al

    Navarro, et al
    Derendorf, et al
  66. “Physicians prefer and more often use combination treatment with oral AH and ICS, regardless of the frequency and intensity of AR.” This is the study conclusion of…

    Derendorf, et al

    Nolte, et al

    Navarro, et al
    Navarro, et al
  67. What is the adult daily treatment cost of Avamys?

    25.00

    26.59

    27.00

    53.59

    59.00
    26.59
  68. What is the pedia daily treatment cost of Avamys?

    17.73

    13.30

    18.75

    21.29
    13.30
  69. What is the pedia combined Avamys and Xyzal daily treatment cost?

    18.75

    21.29

    31.03

    40.04
    31.03
  70. What is the adult combined Avamys and Xyzal daily treatment cost?

    26.59

    34.00

    53.59

    59.00
    53.59
  71. Which of the following are an “early phase” symptoms of the allergic process?

    Sneezing

    Congestion

    Rhinorrhea

    Smell disturbance
    • Sneezing
    • Congestion
    • Rhinorrhea
  72. Which of the following are “late phase” symptoms of the allergic process?

    Sneezing

    Congestion

    Rhinorrhea

    Smell disturbance
    • Congestion
    • Smell disturbance
  73. According to ARIA Guidelines (2010), how many patients who consult doctors are suffering from moderate-severe allergic rhinitis?

    2 out of 10

    4 out of 5

    7 out of 8

    9 out 10
    9 out 10
  74. According to the National Nutrition and Health Survey (2008), how many among Filipino adults suffer from AR?

    2 out of 10

    4 out of 5

    7 out of 8

    9 out 10
    2 out of 10
  75. According to ARIA Guidelines (2010), patients with allergic rhinitis are at risk of which of the following complications?

    Otitis media

    Sinusitis

    Asthma

    Lymphoid hypertrophy
    • Otitis media
    • Sinusitis
    • Asthma
    • Lymphoid hypertrophy
  76. Which of the following symptoms characterizes moderate-severe allergic
    rhinitis?

    Abnormal sleep

    Impairment of daily activities

    Troublesome symptoms

    Problems caused at school or work
    Abnormal sleep

    • Impairment of daily
    • activities

    Troublesome symptoms

    Problems caused at school or work
  77. Which of the following causes Urticaria due to physical stimuli?

    Food

    Cold

    Parasitic

    Dermographism

    Insects
    • Cold
    • Dermographism
  78. Which of the following causes Urticaria due to chemical stimuli?

    Food

    Cold

    Parasitic

    Dermographism

    Insects
    • Food
    • Insect
  79. Which of the following causes Urticaria due to infection?

    Food

    Cold

    Parasitic

    Dermographism

    Insects
    Parasitic
  80. What is the step-up treatment plan for Urticaria?
    Standard dose of non-sedating H1 antihistamine

    Higher dose of H1 antihistamine

    Add second non-sedating H1 antihistamine (regular or required)

    Consider sedating antihistamine at night

    Consider adding or substituting with second-line agent (ie, anti-leukotriene)

    Add or substitute other second-line agents (ie, cyclosporin or a low-dose corticosteroid)
  81. For the Oral Drops of Xyzal, what is the dosing for a 2-6 year old child?

    5 drops

    10 drops

    15 drops

    20 drops
    5 drops
  82. For the Oral Drops of Xyzal, what is the dosing for a 6-12 year old child?

    5 drops

    10 drops

    15 drops

    20 drops
    20 drops
  83. The following are common side effects of Xyzal except?

    Headache

    Somnolence

    Dizziness

    Fatigue
    Dizziness
  84. What is the WHEN MESSAGE for Xyzal?
    For nasal and skin allergy patients
  85. What is the WHY MESSAGE for Xyzal?
    • Xyzal gives faster allergy relief vs. other 
    • antihistamines
  86. What is the HOW MESSAGE for Xyzal?
    Adult and children above 6 years old – 5mg tablet OD

    Children – 0.125mg/kg/dose, BID
  87. What is the equation for deriving the daily
    treatment cost of Avamys 120D for Pedia patients?

    Avamys 120D Price Php797.75 / 120 Actuations)
    x 2 sprays X 2 nostrils = Php26.59 per day 
     
    Avamys 120D Price Php797.75 / 120 Actuations)
    x 1 spray X 2 nostrils = Php13.30 per day 

    Avamys 120D Price Php797.75 / 120 Actuations)
    x 2 sprays X 2 nostrils x 2 times = Php 53. 18 per day 

    Avamys 120D Price Php797.75 / 120 Actuations)
    x 1 spray X 2 nostrils x 2 times= Php Php26.59 per day
    • Avamys 120D Price Php797.75 / 120 Actuations) x
    • 1 spray X 2 nostrils = Php13.30 per day
  88. According to National Nutrition and Health
    Survey (2008), what is the prevalence of Allergic rhinitis in Filipino
    adults?
    2 out of 10
  89. Adults are recommended to take which of the following doses? 

    5mg once daily = 1 tablet or 10 oral drops or
    10mL solution 

    5mg once daily = 1 tablet or 20 oral drops or
    10mL solution 

    5mg once daily = 1 tablet or 20 oral drops or
    20mL solution

    5mg once daily = 1 tablet or 10 oral drops or
    20mL solution
    • 5mg once daily = 1 tablet or 20 oral drops or
    • 10mL solution
  90. Which of the studies below found that the order of treatment preferred by the physicians is Combination OAH+INS > OAH Mono > INS Mono > Other Drugs? 

    a. study by Derendorf et al 

    b. study by Nolte et al 

    c. study by Navarro et al 

    d. study by Gillard et al
    study by Navarro et al
  91. Xyzal Oral Drops:
    5mg / mL
    10 mL bottle
    1 mL = ? drops
    20
  92. Xyzal Oral Solution
    ____ mg / mL
    75 ml bottle
    0.5
  93. Your paediatrician is asking the computation of the dosing of Xyzal. You told her that it is 0.125mg / kg
    / dose. What is the dosing for a 20kg child?

    a. 0.5 mL Oral Drops or 10 drops 
    b. 0.5ml Oral Drops or 20 drops 
    c. 1 ml Oral Drops or 25 drops 
    d. 1ml oral Drops or 10 drops
    0.5 mL Oral Drops or 10 drops
  94. True or False: In a bioavailability study, intranasal doses of up to 24 times the
    recommended daily adult dose were studied over 3 days with no adverse systemic
    effects observed.
    True
  95. The primary function of this cell is to produce anti-bodies:
    B-Lymphocytes
  96. What are the 3 cells which act mainly in the late phase of the allergic process?
    Eosinophils, Basophils and Neutrophils
  97. When the IgE binds to the mast cells it causes the release of mediators
    (histamines, cutokines, prostaglandins etc.) that results to  _________ of the nasal mucosa.
    inflammation
  98. Pruritus is an itch or sensation that makes the person wants to scratch. It is a complex process that involves the stimulation of free _________ found superficially in the skin.
    nerve endings
  99. What is the common symptom of Xyzal overdose among children and adults?
    Drowsiness

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