Asthma + COPD ppt

Question 1

What should you Rx for group B (COPD)?

Answer 1

1) Anoro Ellipta: One inhalation (umeclidinium 62.5 mcg/vilanterol 25 mcg) once daily
or
2) Tiotropium (Spiriva Handihaler): one 18mcg capsule Qday + Salmeterol (Serevent) 50 mcg BID

Question 2

What should be considered for group E COPD if eosinophils are >300?

Answer 2

Triple therapy with Trelegy (one inhalation Qday)

Question 3

What should you Rx group A COPD?

Answer 3

1) Albuterol
or
2) Ipratropium (Atrovent HFA: 17 mcg/actuation)

Question 4

For COPD you should switch to ICS/LABA/LAMA in what 2 scenarios?

Answer 4

1) Dual therapy fails and eosinophils ≥ 100 / µL (0.3x109/L)
2) If monotherapy fails (LABA or LAMA) and eosinophils ≥ 300 / µL (0.3x109/L)

Question 5

What is Trelegy?

Answer 5

ICS/LABA/LAMA

Question 6

What do you do if Trelegy fails for COPD and eosinophils are <300 and FEV1 <50%?

Answer 6

Add on roflumilast (Daliresp)
or
Add on azithromycin (Zithromax)

Question 7

What do you do if Trelegy fails and eosinophils are >300?

Answer 7

Add on dupilumab (Dupixent) 300 mg IV every other week

Question 8

How should you Tx an uncomplicated moderate/severe (2-3 Sx) exacerbation of COPD?

Answer 8

1) Prednisone 40mg Qday 5-7 days
2) Azithromycin, Cefdinir, or Doxycycline (doxy best)

Question 9

How should you Tx a complicated moderate-severe (2-3 Sx) exacerbation of COPD?

Answer 9

1) Prednisone 40mg Qday 5-7 days
2) Augmentin or Levaquin

Question 10

True or false: For kids under 6, no controller treatment is necessarily indicated for Step 1 of asthma Tx

Answer 10

True

Question 11

What do you add to Tx a complicated moderate-severe (2-3 Sx) exacerbation of COPD if your pt is in long term care?

Answer 11

PO: Levaquin
IV: Piperacillin / tazobatam or cefepime

Question 12

True or false: for kids <6 in step 3, you should just double the ICS dose instead of adding a LABA

Answer 12

True

Question 13

What is Tiotropium also called and how is it dosed?

Answer 13

Spiriva Respimat 1.25 mcg/actuation: Two inhalations (2.5 mcg) Qday

Question 14

True or false: Tiotropium has anticholinergic side effects

Answer 14

True

Question 15

What asthma med should be administered at night?

Answer 15

Montelukast

Question 16

Advair: What kind of med is it? How is it administered?

Answer 16

LABA/ ICS:
-Diskus: 1 inhalation BID; 4+ y/o
-HFA: 2 puffs BID; >12 y/o

Question 17

What are the initial and daily doses for Budesonide Nebulizer Solution (Pulmicort) if the pt has been:
1) Previously treated with bronchodilators alone
2) Previously treated with inhaled corticosteroids
3) Previously treated with oral corticosteroids

Answer 17

1) Initial: 0.25 mg twice daily or 0.5 mg once daily; maximum daily dose: 0.5 mg/day
2) Initial: 0.25 mg twice daily or 0.5 mg once daily; maximum daily dose: 1 mg/day
3) Initial: 0.5 mg twice daily or 1 mg once daily; maximum daily dose: 1 mg/day

Question 18

Asmanex (mometasone furoate DPI):
1) What type of med is it?
2) What are the low, medium, and high doses for adults?

there will be a question abt this med

Answer 18

1) ICS
2) Low: 110/110-220
Medium: 220-440/ >220-440
High: >440/>440

Question 19

Symbicort Dosing:
1) What is the max daily dose in adults?
2) What abt in 12-17 y/os?
3) What abt in <12y/os?
4) What is a low-med dose in adults?
5) What abt a med-high dose?

Answer 19

1) Up to 12 inhalations/day (maintenance + relief)
2) 11 inhalations
3) 8 inhalations
4) Budesonide 80 mcg/formoterol 4.5 mcg [1-2 puffs 1-2x/day]
5) Budesonide 160 mcg/formoterol 4.5 mcg

Question 20

What is the max dose of prednisone in adults and kids?

Answer 20

60mg (5-7 days adults; 3-5 days kids)

Question 21

Albuterol 90 mcg (SABA): how is it administered?

Answer 21

1 – 2 inhalations every 4 to 6 hours as needed (don’t forget to prime inhaler)

Question 22

What are the differences between track 1 Tx for steps 1-2, and steps 3 and 4 for adult asthma?

Answer 22

Steps 1-2: PRN ICS-formoterol
Step 3: Maintenance ICS-formoterol [low dose]
Step 4: Maintenance ICS-formoterol [med. dose]

(Reliever for all track 1 steps is the ICS-formoterol)

Question 23

With adult asthma track 2, when should the switch from ICS to ICS-LABA be made?

Answer 23

Step 2: Low dose maintenance ICS
Step 3: Low dose maintenance ICS-LABA
Step 4: Med. dose maintenance ICS-LABA
(Reliever for all track 2 steps is ICS-SABA or SABA)

Question 24

When should you add on a LAMA for both tracks 1 and 2 of adult asthma Tx?

Answer 24

Step 5

Question 25

If an adult asthma pt has daily Sx or wakes up more than 1x a week at night and low lung function, or has had a recent exacerbation, what step should they be?

Answer 25

Step 4

Question 26

If an adult asthma pt has Sx most days or wakes 1x a week or more at night and low lung function, what step should they be?

Answer 26

Step 3

Question 27

If an adult asthma pt has Sx less than 3-5 days a week with normal/ mildly reduced lung function, what step are they?

Answer 27

Step 1 or 2

Question 28

What are steps 1 and 2 for kids 6-11 with asthma?

Answer 28

Step 1: PRN low dose ICS whenever SABA taken Step 2: Daily low dose ICS (daily LTRA optional) Reliever for all steps: SABA (or ICS-formoterol in steps 3-4)

Question 29

If a pt aged 6-11 has asthma Sx 2-5 days a week, what step are they? (Tx?)

Answer 29

Step 2 (Tx: daily low dose ICS + PRN SABA)

Question 30

If a pt ages 6-11 has asthma Sx most days or is waking 1 or more times a week, what step are they?

Answer 30

Step 3 (tx: low dose ICS-LABA **or** med. dose ICS + PRN SABA **or** very low-dose MART)

Question 31

What are the criteria for step 4 asthma for 6-11 year olds?

Answer 31

Waking 1x or more per wk, Sx most days, + low lung function

Question 32

List steps 1-4 for under 5 year olds with asthma

Answer 32

1) Step 1: short course ICS at viral illness onset 2) Step 2: daily low dose ICS [daily LTRA optional] 3) Step 3: double low dose ICS -consider specialist 4) Step 4: cont. controller + refer to specialist (All steps: SABA PRN)