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NAPLEX STUDY > Asthma, COPD, smoking cessation > Flashcards

Asthma, COPD, smoking cessation Flashcards

1
Q

Drugs that can cause PAH

A

cocaine
SSRI use during pregnancy (increase the risk of persistent PPHN)
weight loss drugs
methamphetamines/amphetamines

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2
Q

diagnosis

A

right heart catheterization is required to confirm PAH

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3
Q

Responder

A

-if MAP falls by at least 10 mmHg
-initially treated with CCB such as nifedipine, diltiazem, and amlodipine

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4
Q

non-responder

A

-prostacyclin analogs and receptor agonists
-endothelin receptor antagonists
-PDE-5 inhibitors
-soluble guanylate cyclase (sGC) stimulator

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5
Q

Prostacyclin analogs and receptor agonists

A

epoprostenol (Flolan, Velteri)
-continuous IV infusion
-vasodilation reactions (hypotension, flushing)
-risk of sepsis and blood stream infections from chronic infusions
-potent vasodilator; avoid interruption and sudden large dose reductions
-protect from light

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6
Q

Endothelian receptor antagonists

A

-bosenten, ambrisentan
-REMS: teratogenic and must have a negative pregnancy test before initiation and monthly thereafter
-hepatotoxicity with bosentan

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7
Q

PDE-5 inhibitors (PAH)

A

-Sildenafil (Revatio), Tadalafil (Adcirca)
-contraindication: use with nitrates and riociguat
-hearing loss, vision loss, hypotension, priapism

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8
Q

soluble guanylate cyclase stimulator

A

-riociguat (adempas)
-REMS: teratogenic and must have a negative pregnancy test before initiation and monthly thereafter
-contraindications: use with PDE-5 inhibitors
-hypotension

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9
Q

drugs that can cause pulmonary fibrosis

A

amiodarone/dronedarone
bleomycin
busulfan
carmustine
lomustine

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10
Q

FEV1

A

how much air can be forcefully exhaled in one second

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11
Q

FVC

A

after taking a deep breath, the maximum volume of air that is exhaled

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12
Q

FEV1/FVC

A

the percentage of air capacity that can be forcefully echaled in one second

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13
Q

asthma relievers

A

low-dose ICS + formoterol
inhaled SABA
systemic steroids
inhaled epi
inhaled SAMA

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14
Q

asthma controllers

A

ICS (first line for all patients)
LABAs (only to be used in combo)
oral leukotriene receptor antagonists (LTRAs)
theophylline (serum conc monitoring)
LAMAs
mAbs

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15
Q

Asthma: step 1: symptoms < 2x/month

A

PRN ICS + formoterol or SABA + low dose ICS

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16
Q

Asthma: step 2: symptoms or need for SABA > 2x/month

A

Rescue: PRN ICS + formoterol OR SABA w/ controller
Controller: low dose ICS

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17
Q

Asthma: step 3: symptoms on most days or waking at night > 1x/week

A

1: low dose ICS-formoterol (as rescue and controller)
2. SABA + low-dose ICS-LABA

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18
Q

Asthma: step 4: symptoms daily, waking at night > 1x a week, or initial presentation is with an exacerbation

A
  1. low dose ICS-formoterol + medium dose ICS-formoterol
  2. SABA + medium dose ICS-LABA`
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19
Q

Asthma: step 5

A
  1. low dose ICS-formoterol + high-dose ICS-formoterol
  2. SABA + high dose ICS-LABA
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20
Q

Asthma: SABA

A

albuterol (ProAir HFA)
-MDI/DPI
-nebs
-PO
-nervousness, tremor, tachycardia, palpitations, cough, hyperglycemia, decrease K

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21
Q

Asthma: ICS Inhalers

A

Salmeterol (serevent diskus), beclomethasone (QVAR Redihaler)
Budesonie (Pulmicort)
Budesonide + formoterol (symbicort)
Fluticasone (Flovent HFA/Diskus, Annuity)
Fluticasone + salmoterol (Advair Diskus)
Fluticasone + vilanterol (Breo Ellipta)
Mometasone + formoterol (Dulera)

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22
Q

Asthma: ICS

A

-increased risk of asthma-related events
-increased risk of hospitalizations in pediatric and adolescent patients
-dysphonia, oral candidiasis, cough
-rinse mouth

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23
Q

Controller inhalers: ICS

A

Asthma: Beclomethasone, Budesonide, Fluticasone
COPD: no single agent is FDA approved

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24
Q

Controller inhalers: LABA

A

Asthma and COPD: Salmeterol (Serevent Diskus)

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25
Q

Controller inhalers: LAMA

A

Asthma and COPD: tiotropium (sprivia respimat)

26
Q

Controller inhalers: ICS/LABA

A

Asthma and COPD: symbicort, advair diskus, and breo ellipta
Asthma only: mometasone/formoterol (Dulera)

27
Q

Controller inhalers: LAMA/LABA

A

Asthma: no FDA approval combination
COPD: anoro, stiolto, bevsi

28
Q

Controller inhalers: LAMA/LABA/ICS

A

asthma and COPD: trelegy ellipta (umeclidinium/vilanterol/fluticasone)

29
Q

MDIs

A

-HFAs, respimat, or no suffix
-aerolized liquid
-slow deep inhalation while pressing the canister
-a spacer can be used
-all products require shaking prior to use
-priming required before first use and if has not been used in a long time

30
Q

DPIs

A

-diskus, ellipta, pressair, handihaler
-fine powder
-quick, forceful inhalation
-spacer cannot be used
-do not shake
-no need for priming unless it is flexhaler

31
Q

LTRA: Montelukast

A

-dosed in the evening
-boxed warning for neuropsychiatric events
-granules can be mixed with food, breast milk/formula

32
Q

Theophylline

A

-loading dose based on IBW
-the therapeutic range is 5-15 mcg/mL (measuring peak levels at steady state, after 3 days of oral dosing)
-converting aminophylline to theophylline * 0.8; to convert theophylline to aminophylline, divide by 0.8
-has saturable kinetics (first order > zero order)

33
Q

Omalizumab (Xolair)

A

-inhibits IgE binding
-for moderate-severe persistent allergic asthma in patients > 6
-initiated in a healthcare setting under medical supervision
-administered every 2-4 weeks

34
Q

interleukin receptor antagonists

A

-mepolizumab, reslizumab, and benralizumab (IL-5 receptor antagonists)
-Dupixent (IL-4 and IL-3 receptor antagonist)

35
Q

exercised induced bronchospasm

A

SABA or low-dose ICS+formoterol taken 5-15 min before exercises

36
Q

COPD GOLD

A

GOLD 1: mild; FEV1 > 80%
GOLD 2: moderate; 50% < FEV1 < 80%
GOLD 3: severe; 30% < FEV1 < 50%
GOLD 4: very severe; FEV1 < 30%

37
Q

COPD: Group A

A

CAT < 10
mMRC 0-1
0-1 exacerbations leading to hospitalization

38
Q

COPD: Group B

A

CAT > 10
mMRC > 2
0-1 exacerbations leading to hospitalization

39
Q

COPD: Group C

A

CAT < 10
mMRC 0-1
> 2 or > 1 exacerbation leading to hospitalization

40
Q

COPD: Group D

A

CAT > 10
mMRC > 2> 2 or > 1 exacerbation leading to hospitalization

41
Q

COPD Group A treatment

A

-bronchodilator: SABA PRN or SAMA PRN
-LABA or LAMA

42
Q

COPD Group B treatment

A

LAMA or LABA

43
Q

COPD Group C treatment

A

LAMA

44
Q

COPD Group D treatment

A

LAMA or LAMA + LABA (if highly symptomatic) or LABA + ICS (if eosinophils > 300 cells)

45
Q

COPD: SAMA inhalers

A

-ipratropium bromide (atrovent) +/- albuterol (combivent respimat)

46
Q

COPD: LAMA

A

-tiotropium (spirivia handihaler/respimat)

47
Q

COPD: LABA

A

-salmeterol (serevent diskus) +/- fluticasone (advair diskus)
-formoterol +/- budesonide (symbicort)
-vilanterol + fluticasone (breo)

48
Q

COPD: PD4 inhibitor

A

Roflumilast (Daliresp)
-CI: moderate-severe liver impairment
-diarrhea and weight loss

49
Q

pack year smoking hx

A

= cigarette packs/day x number of years smoked

50
Q

Nicotine patch (NicoDerm CQ)

A

initial dose based on the # of cigarettes smoked/day

51
Q

Nicotine gum (Nicorette) and Nicotine lozenges (nicorette mini)

A

initial dose based on timing of the first cigarette smoked upon waking

52
Q

NRT

A

-avoid in immediate post MI, arrhythmias, severe angina and pregnancy
-insomina, headache dizziness
-patch: vivid dreams
-combination with patch + gum/lozenge is most effective
-gum/lozenge: can delay/reduce weight gain, do not eat/drink 15 min before or during use

53
Q

nicotine patch initial dosing: > 10 cigarettes/day

A

21 mg x 6 weeks then 14 mg x2 weeks then 7 mg x2 weeks

54
Q

nicotine patch initial dosing: < 10 cigarettes/day

A

14 g x6 weeks then 7 mg x2 weeks

55
Q

nicotine gum/lozenge initial dosing: first cigarette < 30 min upon waking

A

4 mg Q1-2H x6 weeks then 4 mg Q2-4H x3 weeks then 4 mg Q4-8H x3 weeks

56
Q

nicotine gum/lozenge initial dosing: first cigarette > 30 min upon waking

A

2 mg Q1-2H x6 weeks then 2 mg Q2-4H x3 weeks then 2 mg Q4-8H x3 weeks

57
Q

Bupropion SR (Zyban)

A

-start 1 week before the quit date
-boxed warning: suicidal thinking and behavior in children, adolescents, and young adults
-CI: seizure disorder, anorexia/bulimia, use of MAOi, linezolid or IV methylene blue

58
Q

Varenicline (Chantix)

A

-start 1 week before the quit date
-serious neuropsychiatric events
-nausea, insomnia, abnormal dreams, HA

59
Q

smoking cessation patient and they are worried about weight gain

A

gum, lozenge and bupropion

60
Q

smoking cessation and they have depression

A

buproprion

61
Q

smoking cessation and they suffer from seziures

A

do not use bupropion and varenicline

62
Q

Patch and vivid dreams

A

can remove patch at bedtime (16 hours)

NAPLEX STUDY (25 decks)

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