NAPLEX Question of the Week: COPD

Hope everyone has been studying hard and for many readers you have taken and passed the NAPLEX! I've been in Zimbabwe for the past 2 weeks on a mission trip and am back ready to write our question for this week on COPD.

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YG is a 65 year old male presents to his pulmonologist after a recent COPD exacerbation (3rd of year) for long-term management. His PMH consists of severe COPD (FEV1 40%), hypertension, hyperlipidemia, GERD, and hypothyroidism. His current medications include Advair 50/500mcg Diskus 1 inhalation BID, Spiriva 18mcg 1 inhalation daily,  Zestoretic 20/12.5 mg daily, Protonix 40mg daily, and Synthroid 125mcg daily. Due to his continued frequent exacerbations, his pulmonologist elects to initiate Daliresp therapy.

Which of the following are true regarding Daliresp? Select all that apply.

A. It can be administered as an oral tablet.

B. It has an indication for treating acute bronchospasm associated with COPD exacerbation

C. Patients should be counseled regarding risks of psychiatric events including suicidal ideation

D. Similar to systemic corticosteroids weight gain is a primary adverse effect

E. It exerts its pharmacologic effect through selective phosphodiesterase inhibition

Answer with Rationale:

The correct answers are A, C, and E. Daliresp (roflumilast) is a phosphodiesterase-4 inhibitor (answer E) that is indicated for decreasing the risk of a COPD exacerbation. It is dosed generally as 500mcg PO daily (answer A) which differentiates it from most COPD therapies which are inhaled. One of the major adverse effects with therapy is psychiatric events including suicidal ideation (Answer C). Patients should be counseled to report worsening or new insomnia, depression, or suicidal thoughts to their healthcare provider as this likely would necessitate stopping therapy. Answer B is incorrect as while it prevents exacerbations, it does not treat acute shortness of breath associated with an exacerbation. Answer D is incorrect as significant weight loss has been reported with Daliresp therapy, not weight gain. Nearly 20% of patients in clinical trials receiving Daliresp therapy lost between 5-10% of body weight compared with 7% of comparator arm. 

As you may have noticed, I wrote each drug in the question in brand name only. Questions on the exam can appear in either brand, generic, or mixed so it is best to know both for the test, especially the top 300 drugs that are dispensed in the United States.

Until next week!



Christopher M. Bland

Clinical Professor, University of Georgia College of Pharmacy

Dr. Christopher M. Bland is a Clinical Professor at the University of Georgia College of Pharmacy at the Southeast GA campus in Savannah, GA. Dr. Bland has over 20 years of academic and clinical experience in a number of clinical areas. He is a Fellow of both the Infectious Diseases Society of America as well as the American College of Clinical Pharmacy. He is co-founder of the Southeastern Research Group Endeavor, SERGE-45, with over 80 practitioners across 14 states involved. Dr. Bland serves as Associate Editor for the NAPLEX Review Guide 4th edition as well as Editor-In-Chief for the Question of the Week. He has provided live, interactive reviews for more than 10 Colleges/Schools of Pharmacy over the course of his career.