Pulm

Question 1

If a patient is found to be a responder during the diagnosis of PAH. What medications should be tried?

Answer 1

CCB - Nifedipine, Diltiazem, and Amlodipine

Question 2

If a patient is found to be a NON - responder during the diagnosis of PAH what therapies could be trialed?

Answer 2

PDE-5
Endothelin Receptor Antag
Soluble Guanylate Cyclase Stimulator
Prostacyclin Analogue

Question 3

prostacyclin analogues MOA:

Answer 3

potent vasodilators and inhibitors of platelet aggregation.

Question 4

Prostacyclin Analogues ( Remodulin and Veletri) are dosed in:

Answer 4

ng/kg/min

Question 5

Veletri or Flolan:

Answer 5

Epoprostenol

Question 6

Remodulin:

Answer 6

Treprostinil

Question 7

SE of Prostacyclin Analogues

Answer 7

hypotension, flushing, jaw pain

Question 8

Flolan requires ____ for stability

Answer 8

ice packs

Question 9

Endothelin Receptor Antagonist Drugs:

Answer 9

-entan
Bosentan
Ambrisentan
Macitentan

Question 10

Bosentan

Answer 10

tracleer

Question 11

Ambrisentan

Answer 11

Letairis

Question 12

Endothelial receptor antagonists (bosentan, ambrisentan, macitentan) are:

Answer 12

teratogenic BBW in place for them. Need pregnancy test prior to starting and monthly thereafter

Question 13

PDE-5 Inhibitors:

Answer 13

increased cGMP concentrations lead to pulmonary vasculature relaxation and vasodilation

Question 14

Revatio

Answer 14

Sildenafil

Question 15

Adcirca

Answer 15

Tadalafil

Question 16

What are some warnings/se associated with PDE-5’s?

Answer 16

headaches, vision loss, hearing loss, NAION (nonarteritic anterior ischemic optic neuropathy)

Question 17

Soluble Guanylate cyclase stimulator:

Answer 17

Riociguat (Adempas)

Question 18

Adempas MOA:

Answer 18

Riociguat is a soluble guanylate cyclase stimulator. It sensitizes sGC to endogenous nitric oxide and directly stimulates the receptor.

Increased cGMP leading to relaxation

Question 19

What is the BBW associated with Adempas?

Answer 19

Riociguat is teratogenic!! Has a REMS program in place due to this.
Women must have a negative pregnancy test prior, during, and 1 month after.

Question 20

Other than pregnancy, what is another CI for Adempas (Riociguat)?

Answer 20

Use with PDE-5’s or Nitrates

Question 21

What drugs contribute to Pulmonary Fibrosis? (6ish)

Answer 21

Amiodarone / Dronedarone
Bleomycin
Busulfan
Carmustine
Lomustine

Question 22

FEV1 =

Answer 22

how much air can be forcefully exhaled in one second

Question 23

FVC =

Answer 23

After take a deep breath, the maximum volume of air that is exhaled

Question 24

When classifying asthma severity….

When a patient has <2x/month day sx’s and no nighttime symptoms that are:

Answer 24

Step 1

Question 25

When classifying asthma severity.... When a patient has >2 day time sx's a month but less than 4-5 times a week:

Answer 25

Step 2

Question 26

When classifying asthma severity.... When a patient has Daytime sx's most days and Nighttime symptoms >/= 1/wk they are:

Answer 26

Step 3

Question 27

When classifying asthma severity.... When a patient has daily day symptoms and over once a weekly night time sx's they are:

Answer 27

Step 4 and 5

Question 28

Step 1 asthma therapy:

Answer 28

PRN ICS-Formoterol OR SABA + ICS

Question 29

Step 2 Asthma therapy:

Answer 29

PRN ICS-Formoterol pr SABA + Maintenance ICS

Question 30

Step 3 asthma therapy:

Answer 30

PRN ics-formoterol or SABA + Maintenance ICS- LABA

Question 31

Step 4 asthma therapy:

Answer 31

ICS Formoterol + MD ICS Formoterol OR SABA + MD ICS -LABA

Question 32

Step 5 asthma therapy:

Answer 32

ICS-formoterol + HD ICS-formoterol OR SABA + HD ICS-LABA

Question 33

How many doses does an albuterol inhaler contain?

Answer 33

200 EXCEPT Ventolin HFA has a 60 dose option

Question 34

What are the SE of SABAs?

Answer 34

decreased potassium Hyperglycemia Nervousness Tremor Tachycardia

Question 35

LABA Name for asthma :

Answer 35

Salmeterol (Servant)

Question 36

What is the LABA BBW:

Answer 36

Increased risk of asthma related deaths. should only be used in a patient already receiving an ICS. Also increases hospitalization in pediatric and adolescents

Question 37

SE with ICS:

Answer 37

Dysphonia , oral candidiasis, cough

Question 38

Pulmicort Respules should:

Answer 38

only be used with a jet nebulizer.

Question 39

QVAR redihaler:

Answer 39

Breath activated. DO NOT SHAKE or use with a spacer DOES NOT NEED PRIMING

Question 40

What LAMA is used in Asthma?

Answer 40

Tiotropium (Spiriva)

Question 41

What ICS/LABAs are used in Asthma?

Answer 41

Dulera - mometasone/formoterol Breo Ellipta - fluticasone/vilanterol Symbicort - budesonide/formoterol Advair - fluticasone/salmeterol

Question 42

In what type of inhaler can a spacer be used\?

Answer 42

MDI- hfs, Respimat! NO TO DPIs

Question 43

While shaking is not required for DPI's it is required for MDI's... EXCEPT

Answer 43

QVAR Redihaler, Alvesco, and Respimat Products

Question 44

What is the goal therapeutic range for theophylline?

Answer 44

5 - 15 mcg/mL (dosed off IBW)