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NAPLEX 21 > Asthma > Flashcards

Asthma Flashcards

1
Q

An asthma diagnosis is confirmed with _______ and pulmonary function tests

A

spirometry

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2
Q

How do you know if someone’s asthma is reversible?

A

when a patient tests their baseline, and then tests for reversibility by using a short acting dilator - if the FEV1 increases by more than 12% with the use of a bronchodilator

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3
Q

FEV1, FVC, or FEV1/FVC

How much air can be forcefully exhaled in one second

A

FEV1

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4
Q

FEV1, FVC, or FEV1/FVC

After taking a deep breath, the maximum volume of air that is exhaled (how much air is exhaled)

A

FVC

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5
Q

FEV1, FVC, or FEV1/FVC

The percentage of total air capacity (“Vital capacity”) that can be forcefully exhaled in one second (the speed of the exhale)

A

FEV1/FVC

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6
Q

What classification of asthma?

Daytime symptoms <2days/week
SABA rescue inhaler use <2 days/week

A

intermittent

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7
Q

What classification of asthma?

Daytime symptoms >2 days/week but not daily
SABA rescue inhaler use >2 days/week but not daily or >1x/day

A

mild

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8
Q

What classification of asthma?

Daytime symptoms daily
SABA rescue inhaler use daily

A

moderate

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9
Q

What classification of asthma?

Daytime symptoms - throughout the day
SABA rescue inhaler use - several times per day

A

severe

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10
Q

What do you do at each visit with the patient?

A

confirm appropriate inhaler technique

technique, priming, and cleaning

review asthma action plan

assess, step up, maintain, or step down treatment

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11
Q

What vaccines are recommended in patient with asthma?

A

annual influenza vaccine
age 2-62 = Pneumavax 23

*Prevnar 13 only if the child is not between the age of 6-18 years who require high dose oral steroids

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12
Q

When is it considered “frequent” use of an inhaler and know its time to reassess asthma control

A

using SABA >2x/week

If an ICS + formeterol is used as the rescue inhaler, worsening asthma control is indicated by the frequency of symptoms

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13
Q

What is the mainstay of treatment in asthma?

A

ICS!!!

doses are categorized as low medium or high

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14
Q

What rescue drug?

used as needed for acute asthma symptoms
combination proven to have reduced exacerbations over SABA alone

A

inhaled low dose ICS+formeterol

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15
Q

What rescue drug?

used as needed for acute asthma symptoms
quick reverse bronchoconstriction

A

inhaled SABA

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16
Q

What rescue drug?

ORAL, used during exacerbations or for severe asthma

A

systemic steroids

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17
Q

What is the first line maintenance drug in presistent asthma?

A

inhaled corticosteroids

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18
Q

What maintenance drug?

used in combination with ICS (should NEVER be used alone)
preferred added on agents to ICS

A

inhaled LABAs

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19
Q

What maintenance drug?

most commonly used in children
alternative option to LABA in combination to ICS, can also be added to ICS/LABA

A

oral leukotriene receptors antagonists (LTRAs)

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20
Q

What maintenance drug?

LEAST desirable add on treatment due to significant adverse effects – monitor serum drug concentrations

A

theophylline for oral or IV

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21
Q

What maintenance drug?

can be used as add on treatment in patients with a history of exacerbations despite ICS/LABA treatment

A

LAMA

aka inhaled anticholinergics

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22
Q

What is the name of the maintenance drug that is an injectable MAb? (SC or IV)

A

omalizumab for severe allergic asthma

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23
Q

STEP 1 of the treatment step based on asthma severity

patient has intermittent asthma - what is prescribed?

A

as needed low-dose ICS + formeterol

OR

low dose ICS taken whenever SABA is taken

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24
Q

STEP 2 of the treatment step based on asthma severity

patient has mild asthma - what is prescribed/changed?

A

from step 1: ADD AN ICS CONTROLLER —-

Daily low dose ICS

or

as needed low dose ICS + formeterol (used as the reliever if that combination is also used for maintenance. if a different LABA is used for maintenance, then a SABA would be used as the reliever)

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25
STEP 3 of the treatment step based on asthma severity patient has moderate asthma - what is prescribed/changed?
from step 2: ADD A LABA OR DAILY DOSING Low dose ICS + LABA (used as the reliever if that combination is also used for maintenance. if a different LABA is used for maintenance, then a SABA would be used as the reliever)
26
STEP 4 of the treatment step based on asthma severity patient has severe asthma - what is prescribed/changed?
from step 3: INCREASE ICS DOSE medium dose ICS + LABA
27
a patient is still having considerable symptoms after completing step 4. what do you do?
INCREASE ICS DOSE high dose ICS+LABA, refer for further assessment
28
______ are used as part of maintenance therapy beginning in stem 3 of treatment and only in combination with an ICS
LABA
29
What are some SABAs?
albuterol (ProAir HFA, ProAir RespiClick, Prevonteil HDA, Ventolin HFA) 90mcg/inh Levalbuterol (Xopenex) *racepinephrine should not be used because it is non-selective
30
What is the dosing for albuterol?
MDI/DPI: 1-2 inhalations every 4-6 hours as needed
31
What common side effects of SABAs?
nervousness tremor tachycardia palpitations cough hyperglycemia LOW POTASSIUM
32
Most albuterol inhalers contain 200inh/canister, the exception is ____________ which is available as both 200 and 60inh/canister
Ventolin HFA
33
For EIB, use 2 inhalations ____ mins prior to exercise
5 minutes
34
Salmeterol (Serevent Diskus)
LABA *also used in COPD
35
Brand: QVAR redihaler
generic: beclomethasone
36
Brand: Pulmicort Flexhaler
generic: budesonide
37
Brand: Pulmicort respules
generic: budesonide (nebulizer)
38
Brand: Flovent HFA
generic: fluticasone
39
Brand: Flovent Diskus
generic: fluticasone
40
Brand: Arnuity Ellipta
generic: fluticasone
41
Brand: Advair Diskus
generic: fluticasone + salmeterol
42
Brand: Advair HFA
generic: fluticasone + salmeterol
43
Brand: Breo Ellipta
generic: fluticasone + villanterol
44
Brand: Dulera
generic: mometasone + formeterol
45
Beclomethasone (QVAR redihaler) Budesonide (Pulmicort flexhaler) Fluticasone (Flovent HFA, Flovent Diskus, Arnuity Ellipta)
inhaled corticosteroids uses- asthma; not single ICS product is FDA approved for COPD
46
_________ are used as needed in combinations with formeterol for rescue treatment for acute symptoms, and individually or in combination with a LABA for maintenance/controller treatment
inhaled corticosteroids
47
What are side effects of ICS?
dysphonia (difficulty speaking) oral candidiasis -- RINSE!!!! (spacer with an MDI can be helpful too) cough
48
________ an MDI that does NOT need to be shaken before use
Alvesco (ciclesonide)
49
What is the only ICS available as a nebulizer solution?
budesonide (pulmicort respules)
50
breath activated aerosol with characteristics of a DPI and MDI, do not shake or use with a spacer
QVAR redihaler
51
What are the preferred combos in asthma vs the preferred combos in COPD?
asthma - ICS and ICS/LABA COPD - LABA, LAMA, LAMA/LABA
52
Tiotropium (Spirivia Respimat)
LAMA - used in asthma tiotropium ( Spiriva Handihaler, spirivia Respimat) - used in COPD
53
Budesonide/formeterol (Symbicort) Fluticasone/salmeterol (Advair Diskus, Advair HFA) Mometasone/formoterol (Dulera) Fluticasone/vilanterol (Breo Ellipta)
ICS/LABA Symbicort, Advair Diskus, Breo Ellipta -- used in COPD
54
Key differences between MDIs and DPIs -- HFA, Respimat, or no suffix (ex: Alvesco)
MDI
55
Key differences between MDIs and DPIs -- Diskus, Ellipta, Pressair, Handihaler, Neohaler, Respiclick, Flexhaler
DPI
56
Key differences between MDIs and DPIs -- dose delivery is aerosolized liquid
MDI
57
Key differences between MDIs and DPIs -- dose delivery is fine powder
DPI
58
Key differences between MDIs and DPIs -- some use a propellent (HFA)
MDI DPI -- NO PROPELLENT
59
Key differences between MDIs and DPIs -- administration is a slow deep breath while pressing the canister
MDI
60
Key differences between MDIs and DPIs -- administration is quick, forceful - breath activated devices
DPI
61
Key differences between MDIs and DPIs -- spacer can be used
MDI spacer CANNOT be used in a DPI
62
Key differences between MDIs and DPIs -- shaking is required for majority except for QVAR redihaler, Alvesco, and Respimat products
MDI DO NOT SHAKE DPI
63
Key differences between MDIs and DPIs -- Priming is done before first use and if not used for a certain period of time
MDI priming is not needed for DPI except for Flexhaler (prior to first use)
64
Montelukast dose in ages 6-14 years
5mg daily in the evening
65
Montelukast dose in ages 1-5 years
4mg daily in the evening
66
What is the boxed warning for montelukast?
neuropsychiatric events (aggressive, signs of suicidal thoughts)
67
What dosage forms does montelukast come in?
tablet chewable packet granules can be administered directly in the mouth, dissolved in breast milk or formula, or applesauce, carrots or rice or ice cream
68
_______ blocks phosphodiesterase, causing an increase in cyclic adenosine monophosphate (cAMP)
Theophylline active metabolites are caffeine and 3-methylxanthine
69
Brand: Xolair
generic: omalizumab SC -- anaphylaxis
70
What are mepolizumab (SC), reslizumab (IV - BBW anaphylaxis) and benralizumab (SC q 8 weeks)
IL 5 receptor antagonists
71
What is dupilmuab?
an IL4 and IL5 receptor antagonist
72
What is the preferred treatment for most EIB?
SABAs or low dose ICS + formeterol 5-15 minutes before exercise (effects last 2-3 hours)
73
What is used for asthma control in pregnancy?
an ICS should be continued - budesonide is preferred
74
A patient with good asthma control, how long should their albuterol inhaler last?
12 months (3-4 months with Ventolin HFA 60inh)
75
What maintenance inhaler? 1 inhalation BID 30 day supply
Advair Diskus
76
What maintenance inhaler? 1-2 inhalations BID 30 day supply
QVAR redihaler
77
What maintenance inhaler? 2 inhalations daily 30 day supply
Asmanex Twisthaler
78
What SABA rescue inhaler? 2 inhalations per dose, used twice daily (4inh/week)
albuterol MDI - 50 week supply Ventolin HFA - 15 week supply
79
If prescribed >1 inhalation of medication at a time, a patient should wait ________ between each dose
60 seconds
80
What is the order in which someone with 3 inhalers should do?
SABA first LABA or LAMA second ICS last
81
Spacers are helpful for children and anyone that has difficulty with hand-breath coordination with an ______.
MDI AeroChamber OptiHaler OptiChamber
82
What is the yellow zone of an asthma action plan?
50-80% of persona best - "caution" would require intervention
83
What is the red zone?
<50% indicates a medical alert emergency department
84
What inhaler? - shake for 5 seconds before each spray - spray 4 times away from the face - prime again if >14 days from last use or if dropped
Ventolin HFA, ProAir HFA *BREATHE IN SLOW* & hold breath for 10 seconds clean at least weekly with water, air dry
85
What inhaler? - shake for 5 seconds before each spray - spray 4 times away from the face - prime again with 1 spray if >7 days from last use or if dropped
Flovent
86
What inhaler do you not put in water?
Symbicort, Dulera
87
What DPI? breathe in quickly and deeply, do not breathe through nose rinse mouth after use this is the purple one that you hold like a burger and slide the open piece
Fluticasone/salmeterol (Advair diskus)
88
What DPI? breathe in quickly and deeply, do not breathe through nose rinse mouth after use twist the cap off, you'll hear a click noise
Budesonide (Pulmicort Flexhaler)
89
What inhaler? opening and closing the cap without inhaling a dose will waste medication and can damage your inhaler
Albuterol ProAir Respiclick, fluticasone/salmterol (AirDuo respiclick) *rinse mouth
90
What inhaler? store upright protected from light, at room temp ampules should be used within TWO WEEKS of opening the package
budesonide (Pulimicort Respules) mouth still has to be rinsed and spit out after each dose

NAPLEX 21 (60 decks)

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