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NAPLEX Prep > Asthma > Flashcards

Asthma Flashcards

(74 cards)

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1
Q

Common triggers of asthma

A

Pollution
Cigarettes
Cold air/changes in weather
Pets
Puts, pollen, cockroaches, Perfume, cosmetics
Drugs: NSAIDs, non-selective beta blockers

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2
Q

How to diagnose asthma

A

FEV1: how much air can forcefully be exhaled in 1 sec
FVC: the maximum volume of air exhaled after taking a deep breath
FEV1/FVC: the percentage of total air capacity (vital capacity) that can be forcefully exhaled in 1 sec

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3
Q

Steps to measure asthma severity

A
  1. Measure baseline FEV1 with spirometry
  2. Give albuterol
  3. Measure post-bronchodilator FEV1

An FEV1 ↑ >12% post-bronchodilator is consistent with asthma diagnosis

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4
Q

Guidelines for asthma

A

GINA

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5
Q

How to control asthma risk factors

A

Tobacco smoke
Flu vaccine
Pneumococcal vaccine

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6
Q

Types fo relievers

A

Low-dose ICS + formoterol
SABA
Systemic steroids
Inhaled Epi
SAMA

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7
Q

Types of controllers

A

ICS
LABA
LTRAs
Theophylline
LAMA
Injectable monoclonal antibodies

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8
Q

Step 1 Asthma

A

Sx <2x/month:
Rescue: SABA + low dose ICS PRN or low dose ICS-formoterol PRN

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9
Q

Step 2 Asthma

A

Sx ≥2/month or need of SABA:

Rescue: SABA or ICS SABA or Low-dose ICS-formoterol PRN

Maintenance: Low dose ICS

LTRA, Low dose ICS whenever SABA is taken

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10
Q

Step 3 Asthma

A

Sx on most days or waking at night ≥1 month/wk:

Rescue: Low-dose ICS-formoterol or SABA or ICS-SABA

Maintenance: Low-dose ICS-formoterol or Low-dose ICS-LABA

Low-dose ICS + LTRA or medium dose ICS

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11
Q

Step 4 Asthma

A

Sx daily, waking at night ≥1x/wk or initial presentation is with an exacerbation:

Rescue: Low-dose ICS-formoterol or SABA or ICS-SABA

Maintenance: Medium-dose ICS-formoterol or Medium dose ICS-LABA

High dose ICS or add tiotropium or LTRA

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12
Q

Step 5 Asthma

A

Rescue: Low-dose ICS-formoterol or SABA or ICS-SABA

Maintenance: High-dose ICS-formoterol or High dose ICS-LABA

Consider adding tiotropium, PO steroid, or injectable treatment

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13
Q

How to assess asthma control

A
  1. Daytime asthma sx >twice/wk
  2. Any nighttime awakenings due to asthma
  3. SABA reliever treatment used > twice/wk
  4. Is activity limited due to asthma

Well-controlled: no questions answered yes (Maintain current step, step down if ≥3 months)
Partially controlled: 1-2 questions answered yes (Step up 1 step)
Uncontrolled: 3-4 questions (Step up 1-2 steps)

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14
Q

MOA of beta-2 agonist

A

Relaxation of bronchial smooth muscles → bronchodilators

SABAs should only be used with ICS in step 1

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15
Q

Albuterol

A

ProAir, Proventil, Ventolin

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16
Q

Levalbuterol

A

Xopenex

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17
Q

Salmeterol

A

Severent Diskus

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18
Q

ADR of SABA

A

Nervousness, tremor, tachycardia, palpitations, cough, hyperglycemia, ↓ K

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19
Q

What is levalbuterol?

A

R-isomer or albuterol

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20
Q

How much is in an albuterol inhaler

A

200 inhalations/canister

Ventolin HFA: 200 or 60 inahlations/canister

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21
Q

Dosing of albuterol

A

1-2 inhalations Q4-6H PRN

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22
Q

BBW of LABA

A

↑ risk of asthma-related deaths who are not on controlled ICS

↑ risk of asthma-related hospitalization in children

Not for acute bronchspasms

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23
Q

Beclomethasone

A

QVAR Redihaler

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24
Q

Budesonide

A

Pulmicort

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25
Fluticasone
Flovent, Arnuity Ellipta
26
Mometasone
Asomanex
27
ADR and warning of ICS
Increased risk for fractures, growth retardation, immunosuppression Dystonia, oral candidiasis, cough
28
Counseling of ICS
Rinse mouth and spit out to prevent thrush → can use spacer
29
Counseling of QVAR Redihaler
Do not shake
30
Tiotropium
Spiriva Respimat (asthma and COPD) Spiriva Handihaler (COPD)
31
Umeclidinium
Incruse
32
Budesonide/formoterol
Symbicort, Breyna
33
Fluticasone/salmeterol
Advair
34
Mometasone/formoterol
Dulera
35
Fluticasone/vilanterol
Breo Ellipta
36
Umeclidinium/vilanterol/fluticasone
Trelegy Ellipta
37
Glycopyrrolate/formoterol/budesonide
Breztri Aerospace
38
MDI types
HFA, Respimat
39
DPI types
Dishes, Ellipta, Presser, Handihaler, Respiclick, Flexhaler
40
What products can be shaken
MDI: except QVAR Redihaler, ALvesco, Respimat, Atrovent HFA Don't shake DPI
41
What products require priming
MDI DPI: Flexhaler only
42
Dosing of Montelakast
10 mg PO QPM 6-14 YO: 5 mg PO QPM 1-5 YO: 4 mg PO QPM
43
BBW of montelakast
Neuropsychiatric events
44
Counseling on montelukast granules
Can administer directly in mouth, dissolved in 5mL of breast milk or formula, applesauce, carrots, rice, ice cream Use within 15 min of opening
45
Types of LTRAs
Montelakast Zafirlukast Zileuton
46
DDI of Zafirlukast
↑ theophylline
47
MOA of Theophylline
Blocks PDE → ↑ cAMP and release Epi → bronchodilation
48
Active metabolite of theophylline
Caffeine and 3-methylxanthine
49
Therapeutic range of theophylline
5-15 mcg/mL
50
COnvertion of aminophylline to theophylline
Amino → theophylline: multiply by 0.8 (ATM) Theophylline → Amino: divide by 0.8
51
Omalizumab
Xolair
52
MOA of omalizumab
Inhibits IgE binding to the IgE receptor on mast cells and basophils
53
How is omalizumab adminsitered? Indication?
Initiate in healthcare setting under medical supervision BBW: anaphylaxis Indication: severe allergic asthma
54
Mepolizumab
Nucala
55
Reslizumab
Cinqair
56
Benralizumab
Fasenra
57
Dupilumab
Dupixent
58
Indication of IRA
Severe eosinophilic asthma
59
BBW of resilizumab
ANaphylaxis
60
IRAs types
Mepolizumab (IL-5) Resilizumab (IL-5) Benralizumab (IL-5) Dupilizumab (IL-4 and 13)
61
MOA of Tezepelumab? Indication?
Human thymus stromal lymphopoeitin blocker: reduces multiple biomarkers of inflammation Indication: severe asthma (of any typers)
62
Monoclonal antibodies that is IV
Reslizumab (Cinqair)
63
Treatment for exercise induced asthma
SABA or low-dose ICS-formoterol taken 5-15 min before exercise is preferred
64
Tx for pregnancy
ICS
65
With good asthma control how long does a albuterol inhaler last?
12 months
66
Describe the timing of a patient using multiple inhalers
SABA → wait 60 sec, then other bronchodilators → wait 60 sec, then ICS
67
Formulation that should not use spacers
DPI
68
How often are spacers cleaned
QW
69
Counseling on Albuterol HFA
1. Shake inhaler for 5 sec before each spray 2. Breathe through mouth 3. While breathing slowly and deeply through mouth 4. Hold breath for 10 sec 5. Rinse mouth with water and spit Rinse mouthpiece only under warm running water for 30 sec and dry upside down for another 30 sec Clean QW
70
Counseling on Flovent HFA and Dulera
1. Shake inhaler for 5 sec before each spray 2. Breathe through mouth 3. While breathing slowly and deeply through mouth 4. Hold breath for 10 sec 5. Rinse mouth with water and spit Use a clean cotton swab with water → Swab opening → Wipe with tissue and dry overnight
71
Counseling on symbicort, breyna
1. Shake inhaler for 5 sec before each spray 2. Breathe through mouth 3. While breathing slowly and deeply through mouth 4. Hold breath for 10 sec 5. Rinse mouth with water and spit Wipe the inside and outside with clean dry cloth, don't use water Clean QW
72
Counseling on Advair Diskus
1. Hold diskus and push thumbgrip 2. Hold Diskus flat → slide lever away from mouthpiece 3. Breath away 4. Breathe quickly and deeply (don't breathe in through your nose) 5. Rinse mouth with water and spit out Don't wash
73
Counseling on Pulmicort Flexhaler
1. Twist off the white cover 2. Twist the brown base 3. Turn head away 4. Breathe in deeply and forcefully through inhaler 5. Rinse mouth with water and spit out the water Prime by twisting the brown base → does not need to be primed again Wipe with a dry tissue
74
Counseling on ProAir and AirDuo Respiclick
1. Open cap till you hear a click 2. Turn head 3. Breathe in quickly and deeply 4. Hold breathe for 10 sec 5. Rinse mouth if AirDuo Don't wash

NAPLEX Prep (51 decks)

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