Pharm Exam 4 Pulmonary

Question 1

What are the risk factors for COPD?

Answer 1

Genetics: Alpha-1 antitrypsin deficiency
Older age and being female
issues in lung development like low birth weight or frequent childhood lung infections
exposure to particles
poverty

Question 2

What is the gold standard for COPD maintenance treatment?
What should be added if there is a productive cough?

Answer 2

LAMA/LABA combo
Add inhaled steroids for productive cough

Question 3

Four classes of asthma severity

Answer 3

intermittent, mild persistent, moderate persistent, and severe persistent

Question 4

Signs of poor asthma control (4)

Answer 4

-awakens at night with symptoms
-urgent care visits
-increased need for SABA
-uses more than 1 SABA inhaler a month

Question 5

What is PEF?

Answer 5

Peak expiratory flow, maximum rate of flow during expiration

Question 6

Leukotriene receptor antagonists
three most common (z-, -kast, -ton)
effects
side effects

Answer 6

-zileuton (zyflo)
zafirlukast (accolate)
montelukast (singulair)
-reduce bronchoconstriction, edema, and mucous secretion
-depression, suicidal ideation/behavior in kids/teens

Question 7

SABAs (-terol)
-Most common
-Effects
-onset, peak, duration
-side effects

Answer 7

-albuterol and levalbuterol
-stimulates beta 2 receptors to dilate airways and stimulates ciliary movement and increases secretions
-O 5-15 mins, P 1-1.5 hours, D 3-6 hours
-tachycardia, angina, nausea, anxiety, sweating, headaches, metallic taste

Question 8

Effect of bronchodilators and meaning of SABA/LABA

Answer 8

alter smooth muscle and allow for opening of airway
beta2-adrenergic agonist, short or long-acting

Question 9

What is the first line of treatment for asthma and what are the effects?

Answer 9

inhaled glucosteroids
decrease inflammatory mediators, decreased activity of inflammatory cells, decreased airway edema, increase number of beta 2 receptors.

Question 10

Effect of antimuscarinics/anticholinergics and meaning of SAMA/LAMA

Answer 10

Block cholinergic/acetylcholine receptors that contract airways
antimuscarinics, short or long acting

Question 11

FEV1/FVC ratio needed for diagnosis

Answer 11

x<.7

Question 12

Anticholinergic bronchodilator
-most common
-effect
-uses
-combined with?
- onset, peak, duration
-administration
-side effects

Answer 12

-ipratropium (atropine derivative)
- dries up excessive mucus by blocking muscarinic receptors to achieve bronchodilation
-chronic bronchitis, emphysema, and sometimes asthma
-often combined with albuterol (combivent)
- O 5-15 minutes, P 1-2 hours, D 3-6 hours.
-inhaler or nebulizer
- blurred vision, dry mouth, flushing, confusion, hyperthermia, vision change, urinary retention

Question 13

Exercise-induced asthma
-cause
-duration
-treatment
-dosing

Answer 13

-bronchospasm secondary to loss of heat and or water from lung
-starts during or immediately after exercise, peaks in 5-10 minutes, and resolves in 20-30 minutes
-SABA or cromolyn
-SABA right before exercise and cromolyn 15 mins before

Question 14

Oral steroids (-sone)
-use
-treatment length
-side effects

Answer 14

• moderate or severe persistent asthma or for management of acute exacerbations
  -as brief as possible
  -short term: GI upset and insomnia
  -long term: adrenal suppression, osteoporosis, hyperglycemia, peptic ulcer disease, moon face

Question 15

-Four common inhaled glucosteroids
-Side effects

Answer 15

beclomethasone (qvar)
fluticasone (flovent and flonase)
triamcinoclone (azmacort)
flunisolide (aerobid)
thrush and dysphonia (voice changes)

Question 16

What are the main treatment categories for COPD?

Answer 16

smoking cessation, vaccinations, meds, education, exercise, and manage comorbidities

Question 17

What is the rescue treatment for COPD?

Answer 17

Fast acting bronchodilators like albuterol and levalbuterol
Fast acting anticholinergic like ipratropium bromide

Question 18

Glucocorticoid/LABA combos and there use

Answer 18

fluticasone/salmeterol (advair)
budesonide/formoterol (symbicort)
mometasone/formoterol (dulera)
long term maintenance in adults and children, not initial therapy

Question 19

Four main types of meds for COPD

Answer 19

Bronchodilators (SABA/LABA)
Antimuscarinics (SAMA/LAMA)
Methylxanthines
Inhaled corticosteriods

Question 20

What do leukotrienes do?

Answer 20

smooth muscle constriction, blood vessel permeability, and inflammatory responses through recruitment of eosinophils etc.

Question 21

LABAs (-terol)
-most common
-onset, peak, duration
-dosing
-who is should not be used for
-side effects

Answer 21

-salmeterol/Serevent
-O 20 mins, P 3-4 hours, D 12 hours
-dosed BID 12 hours apart
-not for children under 12
-tachycardia, angina, nausea, anxiety, sweating, headaches, metallic taste

Question 22

Which types of meds can be put in a nebulizer?

Answer 22

beta agonists, corticosteroids, anticholinergics, and others