# A client with severe COPD is starting roflumilast 500 mcg PO daily. Which adverse effect should the nurse teach the client to monitor for and report?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391796&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A client with severe COPD is starting roflumilast 500 mcg PO daily. Which adverse effect should the nurse teach the client to monitor for and report?

## Option

1. Elevated blood glucose levels, increased thirst and urination, blurred vision, and unexplained weight loss.
2. Weight loss, mood changes including new depression or suicidal ideation, GI symptoms (nausea, diarrhea, headache) **✔ Correct answer**
3. Ringing or buzzing in the ears, dizziness, hearing loss, and balance issues, which may indicate ototoxicity.
4. Elevated blood pressure, headache, palpitations, and vision changes indicative of hypertensive crisis.

**Correct answer: 2**

## Explanation

Correct (2): Roflumilast (PDE4 inhibitor) has notable adverse effects: weight loss (often >5% body weight), neuropsychiatric symptoms including depression and suicidal ideation, and GI symptoms (nausea, diarrhea, headache). Monitor weight, mood, and bowel pattern. Contraindicated in moderate-severe liver disease. (1,3,4) Not key roflumilast effects.

## In-depth explanation

Memory Tip Roflumilast = "Roflu-MIND-and-WEIGHT" — psychiatric and weight effects. Used in severe COPD with chronic bronchitis and history of exacerbations as ADD-ON.

## Clinical scenario

Scenario 64-year-old male with severe COPD and frequent exacerbations starting roflumilast 500 mcg PO daily. Outpatient teaching.

## Key concepts

- **Roflumilast** — Phosphodiesterase-4 (PDE4) inhibitor; reduces exacerbations in severe COPD with chronic bronchitis.
- **Roflumilast adverse effects** — Weight loss, mood changes (depression, suicidal ideation), GI symptoms, headache.
- **PDE4 inhibitor** — Decreases inflammatory cell activity in airways; oral once-daily.

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