Final Resp /PNA/TB/Asthma/TB

Question 1

What percent with FEV1 indicates COPD

Answer 1

FEV1 <70%

Question 2

FEV1 definition

Answer 2

How much air you exhale in 1 second

Question 3

FVC1

Answer 3

Amount of air you exhale in 1 breath

Question 4

SABA Meds

Answer 4

Albuterol/Levalbuterol
Use prn /emergency

Question 5

Acute Bronchitis

When does acute bronchitis usually come

Answer 5

Inflammation of trachea, bronchi, bronchioles.

Cough with NO evidence of pneumonia

Self Limited

Usually comes after a resp infx (URI)

Question 6

What bacterial infection is common I smokers (Acute Bronchitis)

What type of cough is acute bronchitis and how long it last?
Is there pulmonary consolidation?
S/S?

What lab can you get?

Answer 6

H. Influenzae
After URI
Dry, non productive then purulent.
The cough Lasts 1-2 weeks

No pulmonary consolidation

S/S: cough and normal vital signs.

Get CBC (check WBC) , CXR mb if you think PNA.

Question 7

ACUTE BRONCHITIS MEDS
Wheezing?
Nightime relief

Who are they c/I

Answer 7

Wheezing: Bronchodilator: SABA ALBUTEROL

Night time Relief: Cough suppressant
Antitussive :
Dexomethorphan or Dex/Guafinisen

C/I Parkinson, can’t clear secretions, Preg Cat C, SSRI takers.

Question 8

What medications do you give if you have chronic bronchitis but then develops acute bronchitis ?

Answer 8

Give ABX

Question 9

If an elderly person starts to cough and has had for several weeks, what should you consider?

Answer 9

Think Pertussis and get CXR bc maybe PNA.

Question 10

Defintion of ASTHMA
(RIH)

What part of body is affected

Answer 10

1 REVERSIBLE airway obstruction
2 INFLAMMATION
3 Airway Hyperresponsiveness

Because of many triggers, allergy, environmental

The bronchial mucosa

Question 11

What happens when mast cells activate in the lungs?

What do mast cells release when activated?

Answer 11

Broncho constriction , mast cells release leukotrienes (they the ones that cause broncho constriction)

Question 12

S/S of ASTHMA

When time of day is it worse?

Answer 12

Wheezing, chest tightness, cough, difficult breathing, cough,

Response to a trigger

Worse at night

Question 13

What is silent chest in wheezing

Answer 13

Severe asthma attack (status asthmaticus. Wheezing absent
Decreased tactile remits
Medical emergency

Intubate

Question 14

What is a diagnostic test for ASTHMA

FVC vs FEV

Answer 14

SPIROMETRY

The lower the score, the more constriction

Question 15

FVC: Forced Vital Capacity

Answer 15

How much air Is blown out

Question 16

FEV: Forced expiratory volume

Answer 16

How quick it is done

Question 17

Asthma Severity

Intermittent

PEF

Medication used

STEP 1 NAEPP

Answer 17

Exercise induced asthma girlies

PEF > 80%

SABA <2 days/week

Albuterol PRN

Question 18

Asthma Severity

Mild Persistent
How many excaerbations a year
PEF %

Medication used

STEP 2 NAEPP

Answer 18

Symptoms >2x/week + Wake up @ night 3-4x/ month

2 exacerbations / year using oral
glucocorticoids

Minor limitation
PEF > 80%

Question 19

Asthma Severity

Moderate Persistent
PEF:

Medication used (used daily)

STEP 3 NAEPP

Answer 19

Daily symptoms and night awakening

PEF > 60%

SABA needed Daily

Question 20

Asthma Severity
Severe Persistent
PEF:
Medication used
STEP 4-6 NAEPP

Answer 20

Continued symptoms and night time symptoms (day and night) no rest
need SABA multiple times/day

PEF <60%

Severe limitation

Question 21

Step 1 NAEPP

Answer 21

Just PRN Albuterol and Levalbuterol

Question 22

Step 2 NAEPP
BBF

Answer 22

Daily: Low dose Inhaled Corticosteroid
Beclomethasone (Vanceril)
Budesonide (Pulmicort)
Fluticasone ( Flovent)

PRN: SABA/ICS

Question 23

Step 3 NAEPP
S: B/F
Daily:
PRN:

Answer 23

Daily:
Low Dose ICS/Formeterol
Symbicort: Budesonide/ Formeterol

PRN: ICS/Formeterol (MART)

Question 24

Step 4 NAEPP
*asthma specialist

Daily:
PRN:

Answer 24

Daily:
Medium ICS/Formoterol (Symbicort)

PRN: ICS/Formeterol (MART)

Question 25

Step 5 NAEPP *Asthma specialist

Answer 25

Daily: Medium to high dose ICS LABA LAMA PRN: SABA

Question 26

Step 6 NAEPP *asthma specialist

Answer 26

Daily: HIGH dose ICS/LABA + OCS PRN: SABA

Question 27

SABA Does it have anti inflammatory effect? AE:

Answer 27

Does not have anti inflammatory effect Not used alone for chronic asthma AE: Inc HR, Low sugar, low Postassum, Mag PRN use

Question 28

Inhaled Corticosteroid What does it prevent Is this short or long term?

Answer 28

Long term steroid therapy , dc inflammation , reduce hyper responsiveness PREVENT ATTACKS Meds: -side, -sone

Question 29

LABA How long does bronchodilator last What medication you use it with

Answer 29

12 hours of bronchodilation Maintenance, use with corticosteroid Salmeterol (Serevent Arformoterol (Brovana)

Question 30

LAMA How long does bronchodilator last s/e M:ASTT

Answer 30

12-24 hours Control lung inflammation and then long term , do not take alone Anoro Ellipta Spiriva Respimat Trilogy Ellipta Turdoza Presser s/e: dry mouth, constipation, urinary retention

Question 31

Systemic Glucocorticoids How long do you take med for ?

Answer 31

Severe/Acute Exacerbations Systemic steroid therapy Prednisone Short Term course; 5-10 days

Question 32

What time do you give Leukotriene Modifiers? Theophylline at what # can cause ventricular arrhythmia ? What is the normal value

Answer 32

Give @ night, and it peaks late at night into early AM >35 mcg/mL 5-15 Is nl range

Question 33

Omalizumab (Xolair) BBW FOR WHAT!!! What is dosing measured with

Answer 33

Anaphylaxis after 1st dose so stay ready! Let patient know, Based on IgE level and body weight

Question 34

How do patient at home check status of Asthma? How often should moderate-severe check? What is normal PEF

Answer 34

PEF Meters Morning , evening, exacerbation, before taking medication 80-100

Question 35

FENO Fractional Exhaled Nitric Oxide Testing, how should you use this test What # is a diagnostic test What other diagnosis should you rule out that can cause increased FENO level

Answer 35

Helps dx asthma if uncertain and used as conjunction FENO level > 50 ppb Allergic Rhinitis and Atopy