A 68 year old male with a significant past medical history for hypertension, hyperlipidemia, hypothyroidism, GERD, COPD, and narrow angle glaucoma presents for his outpatient visit with his pulmonologist for management of his COPD. Which of the following therapies if prescribed could potentially worsen her glaucoma? Select all that apply.
A. Anoro Ellipta
B. Breo Ellipta
C. Incruse Ellipta
D. Trelegy Ellipta
E. Arnuity Ellipta
Answers with rationale: The correct answers are A, C, and D.
Each of these Ellipta products contains different types of single or combination medications used for both asthma and COPD, such as corticosteroids, long-acting beta agonists, or of most importance for our question: long-acting muscarinic antagonists or LAMAs. LAMAs have a warning/precaution for worsening of narrow-angle glaucoma and thus any product containing a LAMA would possess this risk. Anoro Ellipta (umeclidinium and vilanterol), Incruse Ellipta (umeclidinium), and Trelegy Ellipta (fluticasone furoate, umeclidinium, and vilanterol) each contain umeclidinium and therefore could worsen the narrow angle glaucoma. Breo Ellipta (fluticasone furoate/vilanterol) and Arnuity Ellipta (fluticasone furoate) would not be expected to worsen this condition.
Area 2.2 specifically in the NAPLEX newly released competency statements addresses brand, generic, or biosimilar names and thus knowledge of not only generic but brand names is important when preparing for the exam. The Ellipta devices are associated with confusion at times among both providers and patients and therefore careful attention when dispensing is critical to ensure accuracy.
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