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NAPLEX review 2024 RXPrep Book > Pulmonary conditions & tobacco cessation: Asthma > Flashcards

Pulmonary conditions & tobacco cessation: Asthma Flashcards

1
Q

Classic symptoms of asthma

A

breathlessness
wheezing
chest tightness
coughing

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2
Q

Common asthma triggers

A

Pollution
cigarettes
coldair/changes in weather
pets
dust/pollen
perfume
Drugs: aspirin, NSAIDs, beta-blockers

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3
Q

FEV1

A

how much air can be forcefully exhaled in 1 second

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4
Q

FVC

A

max volume of air exhaled after taking deep breath

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5
Q

FEV1/FVC

A

percent of total air that can be forcefully exhaled in 1 second

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6
Q

GINA Step 1

A

Daytime symptoms: < 2 X/month
Nighttime symptoms: none

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7
Q

GINA Step 2

A

Daytime symptoms > 2X/month, < 4-5 days/week
Night: none

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8
Q

GINA Step 3

A

Daytime symptoms: most days
Night: > 1/week

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9
Q

GINA Step 4/5

A

Daytime symptoms:daily
Night > 1/week

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10
Q

General asthma treatment approach

A

Start with which ever step based on symptoms
follow up 2-6 wks
counsel on appropriate technique
control risk factors
assess if need to step up therapy/down or maintain

once controlled can decrease visits 1-6 months

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11
Q

SABA…

A

short acting beta 2 agonist

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12
Q

ICS…

A

inhaled corticosteroid + relieved (formoterol preferred)

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13
Q

LABA….

A

Long acting beta 2 agonist

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14
Q

When are systemic steroids used in Asthma?

A

during exacerbations or severe asthma that is difficult to control

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15
Q

MART is…

A

maintenance and reliever therapy

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16
Q

Step 1 therapy

A

Rescue inhalers only:
As needed low-dose ICS-formoterol
or
SABA + low dose ICS

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17
Q

Step 2 therapy

A

Rescue: As needed low-dose ICS-formoterol
or
Rescue: SABA & Maintenance: Low dose ICS

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18
Q

Step 3 therapy

A

Rescue: Low dose ICS-formoterol & Maintenance same
or
Rescue: SABA + Maintenance: low dose ICS-LABA

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19
Q

Step 4 therapy

A

Rescue: Low dose ICS-formoterol & Maintenance: Medium dose ICS-formoterol
or
Rescue: SABA & Maintenance: Medium dose ICS-LABA

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20
Q

STEP 5 therapy

A

Rescue: Low dose ICS-formoterol & Maintenance: High dose ICS-formoterol
or
Rescue: SABA & Maintenance: High-dose ICS-LABA

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21
Q

Asthma variability of control

A

well = keep current therapy
Partly = Step up 1 step
Uncontrolled = Step up 1-2 steps, maybe short course oral steroid

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22
Q

SABA (albuterol) side effects

A

nervousness
tremor
tachycardia
palpitations
cough
hyperglycemia
decrease K

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23
Q

LABA (salmeterol = servant) Boxed warnings

A

inc risk of asth related deaths, only use if not well controlled on ICS
inc risk of asthma related hhospitalizations

24
Q

ICS warnings

A

high doses for long time can cause adrenal suppresion
inc risk of fractures, growth retardation and immunosuppression

25
Q

ICS Side effects

A

Difficulty speaking
oral candidiasis = thrush
cough

26
Q

ICS notes

A

rinse mouth with water and spit out after each use to prevent thrush, can use a spacer device to decrease risk

27
Q

Which ICS doesnt need to be shaken before use?

A

Alvesco (ciclesonide)

28
Q

Inhalers preferred for Asthma maintenance

A

ICS and ICS/LABA combo

29
Q

Inhalers preferred for COPD maintenance

A

LABA,LAMA or LAMA/LABA

30
Q

How to inhale a MDIs

A

slow, deep inhalation while pressing the canister

31
Q

How to inhale DPIs

A

quick, forceful inhalation

32
Q

Can you use spacer with DPI?

A

no

33
Q

Do you shake DPI?

A

no, unlike MDI

34
Q

Do you prime DPI?

A

no

35
Q

Montelukas (Singulair) boxed warnings

A

neuropsychiatric events

36
Q

LTRAs

A

Montelukas = LTD4
Zarfirlukast = LTD4 & LTE4
Zileuton = inhibit leukotriene formation

37
Q

Montelukast notes

A

montelukast granules = can admin directly to mouth, dissolve in milk/applesauce/carrots/rice or ice cream ONLY, use within 15min of opening packet

38
Q

Zafirlukast notes

A

dispense in original container

39
Q

Use of Theophylline is due to…

A

limited decrease of effectiveness, drug interactions and adverse effects

40
Q

Theophylline dosing

A

oral loading dose: 5mg/kg IBW
maintenance is 300-600mg/day

41
Q

Theophylline levels

A

5-15 mcg/mil

42
Q

Theophylline side effects

A

N/V/HA/insomnia

Toxicity = vomiting, arrhythmias, seizures

43
Q

Aminophylline to théophylline conversion =

A

multiple by 0.8

44
Q

Anticholinergics use in Asthma?

A

not used as stand alone therapy, usually add on treatments with ICS

45
Q

Omalizumab (Xolair) boxed warnings

A

anaphylaxis from 1st dose up to 1yr after

46
Q

Interleukin receptor antagonists are indicated for management of severe asthma with…..

A

eosinophilic phenotype

47
Q

IL-5 receptor antagonists…..

A

Mepolizumab
reslizumab
benralizumab

48
Q

IL-4 and IL-3 antagonists…

A

Dupilumab

49
Q

Dupilumab (Dupixent) info

A

> 12yrs or older, given SC every other week

50
Q

Benralizumab (Fasenra) info

A

> 12yrs or older, SC every 4 weeks for 3 doses, then Q 8 weeks

51
Q

Reslizumab (Cinqair) info

A

adults only, IV Q 4 weeks

52
Q

Mepolizumab (Nucala)

A

> 6yrs older, SC every 4 weeks

53
Q

Preventing exercise induced bronchospasm

A

SABA or low-dose ICS + formoterol 5-15 min before exercise preferred

54
Q

How long to wait inbetween inhalers if using more than 1?

A

60 seconds between each one

bronchodilators should be used first

55
Q

Asthma action plan

A

Green = 80-100% personal best = all good continue maintenance
Yellow = 50-80% personal best = worsening lung function, caution.
Red = < 50% personal best = medical alert, go to ED

56
Q
A

NAPLEX review 2024 RXPrep Book (77 decks)

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