Final Exam Pulm

Question 1

Categories of Rx used to treat asthma

Answer 1

Bronchodilating agents, anti-inflammatory agents

Question 2

Bronchodilating agents

Answer 2

Sympathomimetic (B2 agonists), methylxanthines, antimuscarinic

Question 3

Asthma anti-inflammatory agents

Answer 3

Corticosteroids, leukotrine pathway inhibitors

Question 4

MOA B2 agonist

Answer 4

Inhaled - agonizes B2 on smooth muscle in lung - AC - cAMP - bronchodilation

Question 5

Short acting B2 agonist

Answer 5

Rescue therapy - Albuterol, levalbuterol

Question 6

LABA

Answer 6

Long acting B2 agonist - maintenance therapy; Advair, Symbicort

Question 7

Characteristics of levalbuterol

Answer 7

Onset 15 min; DOA 4h; more selective - less tachycardia

Question 8

LABA characteristics

Answer 8

Salmeterol/Formoterol WITH steroid - never used as monotherapy (BBW - increased risk for asthma related events)

Question 9

Methylxanthine

Answer 9

Theophylline (Theo-Dur)

Question 10

Characteristic of Theophylline

Answer 10

Requires therapeutic drug monitoring, PO, add-on for maintenance therapy in refractory cases

Question 11

Antimuscarinic agents for asthma

Answer 11

Ipratropium bromide, tiotropium

Question 12

Ipratropium bromide characteristics

Answer 12

Short acting - reserved for acute episodes or intolerant to albuterol, anticholinergic (dry mouth), does NOT enter CNS

Question 13

Combivent

Answer 13

Ipratropium/albuterol - enhanced effect of ipratropium

Question 14

COPD maintenance therapy

Answer 14

Combivent, Tiotropium (long acting antimuscarinic)

Question 15

PO Corticosteroids are used when?

Answer 15

Short, acute episodes and refractory disease

Question 16

Inhaled corticosteroids are used when?

Answer 16

Maintenance therapy in moderate to severe asthma

Question 17

Type of drug - corticosteroid

Answer 17

NOT bronchodilator, anti-inflammatory (inhibit production of cytokines)

Question 18

Side effects of corticosteroids

Answer 18

Thrush (oral candidiasis) and hoarseness; rinse mouth after inhaled neb

Question 19

Inhaled corticosteroids

Answer 19

Budenoside, Fluticasone

Question 20

Advair, Symbicort

Answer 20

Reserved for severe disease, LABA + corticosteroid

Question 21

Anti-inflammatory that is not corticosteroid

Answer 21

Leukotrine pathway inhibitor

Question 22

Montelukast

Answer 22

Maintenance therapy - improve control/reduce frequency of exacerbations; PO.

Question 23

AE Zyflo

Answer 23

Liver toxicity (leukotrine pathway inhibitor)

Question 24

COPD treatment - maintenance therapy

Answer 24

Spiriva (tiotropium) - antimuscarinic

Question 25

COPD corticosteroids

Answer 25

Significantly higher dose than for asthma

Question 26

COPD additional treament

Answer 26

Antibiotics if exacerbation caused by infection

Question 27

First step to asthma Tx

Answer 27

Assess compliance, administration, environment - ALWAYS

Question 28

What prompts re-eval in asthma pt?

Answer 28

SABA > 2 days/week

Question 29

After tx change for asthma, when do you reassess?

Answer 29

2-6 weeks

Question 30

1st line medication - Asthma

Answer 30

SABA for rescue

Question 31

2nd step asthma tx

Answer 31

Low dose inhaled steroid

Question 32

Step 2 Tx Asthma Alt

Answer 32

Leukotrine inhibitor (Singulair)

Question 33

Step 3 Asthma Tx

Answer 33

Medium dose inhaled steroid OR LABA/steroid combo

Question 34

Step 4 Asthma tx

Answer 34

Medium dosed inhaled steroid + LABA

Question 35

Step 5 Asthma Tx

Answer 35

Consult asthma specialist (add PO steroids/high dose inhaled steroids/antibody)

Question 36

Asthma Therapy -SimpleSteps

Answer 36

1. Everyone - SABA 2. Low dose inhaled steroid (fluticasone) or Singulair (LI) 3. Increase inhaled steroid, + LI, or escalate to LABA (not first tx) 4. PO steroid or IgE antibody

Question 37

Asthma mnemonic

Answer 37

A-adrenergics (LABA SABA), S-steroids, T-theophylline, H-Higher than 2d/w SABA? +Tx, M-Montelukast, A-anticholinergics