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NAPLEX > Asthma, COPD, Cystic Fibrosis > Flashcards

Asthma, COPD, Cystic Fibrosis Flashcards

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1
Q

FEV1

A

How much air can be forcefully exhaled in one second

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2
Q

FVC

A

the maximum volume of air exhaled after taking a deep breath

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3
Q

FEV1/FVC

A

The % of total air capacity that can be forcefully exhaled in one second

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4
Q

Asthma diagnostic criteria

A

1.) measure baseline FEV1 with spirometry
2.) give albuterol
3.)Measure post-bronchodilator FEV1

FEV1 increase > 12% = asthma

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5
Q

Asthma guidelines

A

GINA
Global Initiative for Asthma

NHLBIs Expect Panel Report (EPR)

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6
Q

initial asthma treatment

A

based on frequency of daytime and nighttime symptoms

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7
Q

Symptoms of Step 1 initial asthma treatment

A

Day: less than 2x a month
Night: none

PRN low-dose ICS-formoterol or SABA + ICS together

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8
Q

Symptoms of Step 2 initial asthma treatment

A

Day: more than 2 times a month but less than 4 - 5 days a week
Night: None

Same as step 1 (except SABA taken alone) plus the option of maintenance low-dose ICS

*LTRA or low-dose ICS whenever SABA taken

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9
Q

Symptoms of Step 3 initial asthma treatment

A

Day: Most days
Night: 1 or more times a week

Same as step 2 but maintenance can also include a low-dose ICS LABA

*low dose-ICS + LTRA or medium dose ICS

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10
Q

Symptoms of Step 4 initial asthma treatment

A

Day: daily
Night: 1 or more times a week

Same PRN, maintenance is a medium-dose ICS formoterol or medium dose ICS LABA

*High-dose ICS or add on tiotropium or LTRA

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11
Q

Step 5

A

Same PRN
High dose ICS-formoterol
High dose ICS-LABA

*add tiotropium, oral steroids, or injectable treatments: omalizumab, mepolizumab, reslizumab, and tezepelumab

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12
Q

Well controlled asthma

A

no daytime symptoms, no awakenings, SABA used less than twice a week, no activity limited

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13
Q

Partially controlled astha

A

1-2 asthma control questions answered with a yes
-step up 1 step

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14
Q

Uncontrolled asthma

A

3-4 asthma control questions answered with a yes
-step up 1 to 2 steps
-consider short course of oral steroids

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15
Q

Side effects of Beta-2 agonists

A

Nervousness, tremor, tachycardia, palpitations, cough, hyperglycemia, decreased potassium

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16
Q

Black Box Warning on LABAs (salmeterol/ formoterol)

A

increased risk of asthma related deaths
-only used in combination with a ICS
-increased risk of asthma related hospitalization in pediatric and adolescent patients

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17
Q

Brand of beclomethasone

A

QVAR RediHaler

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18
Q

Brand of Budesonide

A

Pulmicort Flexhaler

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19
Q

Brand of Budesonide + formoterol

A

Symbicort

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20
Q

Brand name of fluticasone

A

Flovent HFA
Flovent Diskus
Arnuity Ellipta

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21
Q

Brane of Fluticasone + Salmeterol

A

Advair Diskus
Advair HFA

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22
Q

Brand of fluticasone + vilanterol

A

Breo Ellipta

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23
Q

brand of mometasone

A

Asmanex HFA

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24
Q

ICS Maintenance Inhalers preferred in Asthma

A

QVAR RediHaler, Pulmicort Flexhaler, Fluticasone (Flovent HFA, Diskus, and Arnuity Ellipta)

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25
DPIs Name description
Diskus Ellipta Press air HandiHaler RespiClick Flexhaler
26
MDIs Brand identifiers
HFA, Respimat, or no suffix (Symbicort, Dulera)
27
Shake MDIs prior to use except for which products?
QVAR Redihalr Alvesco Respimat products
28
Order of Use of Inhalers
SABA—> LABA or LAMA —> ICS *always waiting 60 seconds in between each
29
MOA of theophylline
blocks phosphodiesterase causing an increase in cAMP and release of EPI from adrenal medulla cells Result: bronchodilation, diuresis, CNS and cardiac stimulation
30
Therapeutic range of theophyllin
5 - 15 mcg/mL *measure peak level at steady state after 3 days or oral dosing
31
Converting aminophylline to theophylline
multiply by 0.8 or divide by 0.8 to get to aminophylline
32
That order of kinetics does theophylline follow?
saturable kinetics -starts as first order then zero order -small dose increases can result in large increases in concentration
33
Brand of levalbuterol
Xopenex *r-isomer of albuterol
34
Calculating oral loading dose of theophylline
5mg/kg IBW *or TBW if IBW is less Maintenance dose = 300 - 600mg daily
35
Theophylline is a substrate of which enzyme?
CYP1A2 inhibitors: -Cimetidine -Ciprofloxacin -fluvoxamine -propranolol -ziluetin CYP3A4 inhibitors: -clarithromycin and erythromycin Others that will increase levels: -zafirlukast -alcohol -allopurinol -disulfiram -estrogen-containing oral contraceptives -methotrexate
36
Drugs that decrease the level of theophylline
CYP3A4 inducers: -carbamazepine -fosphenytoin -phenobarbital -phenytoin -primidone -rifampin -ritonavir -levothyroxine -st. john's wort -smoking *Also, low carb, high protein diet
37
What do anticholinergics due in asthma management?
inhibit muscarinic cholinergic receptors and reduce the intrinsic vagal tone of the airway leading to bronchodilation Simpler terms: cause bronchodilation by blocking the constricting action of acetylcholine at M3 muscarinic receptor in bronchial smooth muscle
38
short acting anticholinergics
ipratropium -used in combination with SABAs in hospitalizations
39
Long acting anticholinergic (Muscarinic antagonists)
Spiriva Respimat (tiotropium) -FDA approved in ages 6 or older with history of asthma exacerbations despite ICS/LABA therapy -Not used alone in asthma! (add on with ICS)
40
Omalizumab (Xolair)
-monoclonal antibody -inhibits IgE binding (Receptor on mast and basophil cells) -for moderate-severe allergic asthma -6 years and up -positive skin test to perennial aeroallergen + inadequate control with step 5
41
Interleukin Receptor Antagonists
-Interleukin = cytokine responsible for eosinophils which are associated with inflammation and the cause of some types of asthma *Monoclonal antibodies are used to inhibit interleukin from binding to receptors
42
Monoclonal antibodies that inhibit interleukin
Mepolizumab (Nucala) -6 and up Reslizumab (Cinqair) -boxed warning for anaphylaxis -adults only Benralizumab (Fasenra) -12 and up -doses every 4 weeks x 3 then every 8 weeks Dupilumab (Dupixent) -12 and up every 2 weeks
43
Emphysema
destruction of the small passages in the lungs (alveoli)
44
Bronchitis
inflammation and narrowing of the bronchial tubes which results in mucus production and a chronic cough
45
Alpha-1 antitrypsin (AAT) deficiency
these people are at a higher risk of developing COPD since AAT helps to protect lungs from inflammation
46
What FEV1/FVC confirms a diagnosis of COPD?
a post bronchodilator FEV1/FVC less than 0.70 confirms a diagnosis of COPD
47
GOLD 1
Mild severity COPD FEV1 80% or better
48
GOLD 2
Moderate COPD -between 50 and 80% predicted FEV1
49
GOLD 3
Severe COPD between 30 and 50% predicted FEV1
50
GOLD 4
Very severe COPD FEV1 less than 30% predicted
51
Does atrovent HFA need to be shaken?
LAMA -Do not shake
52
Two commonly used COPD symptom assessment tests
Modified British Medical Research Council (mMRC) dyspnea scale -asses breathlessness (0-4) COPD Assessment Test (CAT) -comprehensive assessment (0-40)
53
Group A COPD
0-1 moderate exacerbation -no hospitalization -CAT less than 10 -mMRC 0-1 Treatment: Bronchodilator
54
Moderate COPD exacerbation
requires treatment with an oral steroid and possibly an antibiotic
55
Group B COPD
0-1 moderate exacerbation -no hospitalizations -CAT greater than 10 -mMRC greater than 2 Treatment: LAMA+LABA
56
Group E COPD
2 or more moderate exacerbations 1 or more hospitalization Treatment: LAMA + LABA *if blood eosinophil >300 consider LABA + LAMA + ICS
57
Adverse effects of ICS
-pneumonia -oral candidiasis -hoarse voice
58
Theophylline in COPD
-not recommended unless LABA not available
59
roflumilast
-phosphodiesterase-4 inhibitor -used in the most severe patients C/I: moderate to severe liver impairment Side effects: diarrhea and weight loss
60
When should antibiotics be used in COPD?
-increased sputum purulence -increased sputum volume -increased dyspnea -mechanical ventilation required
61
Atrovent HFA
Ipratropium bromide -SAMA MDI: 2 inhalations QID
62
Combivent Respimat
Ipratropium + albuterol -SAMA + SABA MDI: 1 inhalation QID
63
Tiotropium
Spiriva HandiHaler and Respimat -LAMA DPI: requires two puffs MDI: 2 inhalations daily
64
Tudorza Pressair
Aclidinium -LAMA DPI: 1 inhalation BID
65
Breztri Aerosphere
Glycopyrrolate + formoterol + budesonide LAMA + LABA + ICS
66
Trelegy Ellipta
Umeclidinium (Incruse ellipta) + Vilatnerol + Fluticasone LAMA + LABA + ICS DPI: 1 inhalation once daily
67
Formoterol
LABA Perforomist (nebulizer)
68
Vilanterol
LABA -only available in combination products (Breo, Trelegy, Anoro)

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