Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ND Ontario Prescribing Exam > Respiratory Disorders > Flashcards

Respiratory Disorders Flashcards

1
Q

Which of the following is INCORRECT regarding asthma therapy in infants and children?
a) Adult doses of inhaled medication may be required in children
b) Formoterol, a LABA, has a similar onset of action to salbutamol
c) Children on ICS therapy have restricted height as adults
d) Montelukast may allow a lower dose of an ICS
e) Use of salbutamol >4 times per week indicates suboptimal asthma control

A

C. Drug deposition with an MDI and spacer device can be as little as 10 to 20% of that in adults, resulting in adult doses. There is an initial decrease in growth rate, but it is not sustained with long-term therapy; ICS use doesn’t affect final adult height. Formoterol, though it is long-acting, has a rapid onset and can be used as prn therapy. Leukotriene Receptor Antagonists (LTRAs) such as zafirlukast and montelukast, have steroid-sparing properties allowing improved control of asthma at a reduced dose of ICS (page 633, CTC, 7th edn). Use of salbutamol on a prn basis provides valuable information on asthma control and use of 4 or more times per week indicates suboptimal control.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which of the following is CORRECT regarding the treatment of asthma in children?
a) Inhaled corticosteroids (ICS) can be safely stopped once symptoms are under control
b) Salbutamol prevents exercise-induced bronchospasm for up to 10 hours
c) Formoterol can be used to treat bronchospasm
d) Montelukast will allow an ASA-sensitive asthmatic to take ibuprofen safely
e) Long-acting theophylline is an effective agent for routine maintenance in asthma

A

C. Regular use of an ICS reduces mortality and asthma exacerbations, improves pulmonary function and controls symptoms; cessation may result in the return of airway hyperactivity to previous levels (page 633, CTC, 7th edn). Salbutamol is a SABA that only prevents exercise-induced bronchospasm for 2-4 hours. Formoterol is a LABA that has a rapid onset of action similar to salbutamol which makes it an effective treatment for bronchospasm. Even though montelukast may provide bronchoprotection in an ASA-sensitive asthmatic, NSAIDs should still be avoided in these patients. Theophylline is only used as add-on therapy because of its potential for toxicity and the large number of drug interactions involving this agent (page 632, CTC, 7th edn).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Red Flags by condition and drug induced conditions: Allergic Rhinitis

ANTIHISTAMINES (1ST GEN)

A

Avoid in narrow-angle glaucoma (↑ IOP), urinary obstruction, bladder neck obstruction, urinary retention, GI obstruction. Observe children for paradoxical excitation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Red Flags by condition and drug induced conditions: Allergic Rhinitis

INT Antihistamines –
1st Gen (Diphenhydramine, Chlorpheniramine)

A

● Additive CNS depressant (alcohol, sedatives, tranquilizers, barbiturates)
● ↑ Anticholinergic effects of TCAs, scopolamine
● If combined w/phenothiazines (anti-emetics, antipsychotics, antihistmaines), monitor for ventricular arrhythmia
● Moderate CYP3A4 inhibitors may ↑ levels (grapefruit, erythromycin)
● AVOID w/strong inhibitors (clarithromycin, ketoconazole)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Red Flags by condition and drug induced conditions: Allergic Rhinitis

INT DECONGESTANTS (Phenylephrine, Pseudoephedrine)

A
    • ↓ Antihypertensive effect of ß-blockers
    • DO NOT use w/MAOI, or w/in 14days of discontinuation
    • SNRIs may ↑ tachycardic and vasopressive effects
      ● Hyperthyroidism
      ● Ischemic ht dz
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Red Flags by condition and drug induced conditions: Allergic Rhinitis

INT DEXTROMETHORPHAN

A
  • Caution w/CNS depressants
  • Do NOT use with MAOI, or for 2 weeks following discontinuation
    • SSRIs may enhance adverse effects (nausea, drowsiness, dizziness) and serotonin syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Red Flags by condition and drug induced conditions: Allergic Rhinitis

Decongestants

A

Use with caution in those with HTN, hyperthyroid or ischemic heart disease (although may be fine if the condition is controlled)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Red Flags by condition and drug induced conditions: Asthma

Theophylline

A

Very narrow therap window; therap drug monitoring
Theophylline (10-20mcg/ml – therap. range)
Serum concentrations should be monitored when cimetidine, propranol, allopurinol, erythromycin, phenytoin caused by drug pharmacokinetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Red Flags by condition and drug induced conditions: Asthma

Theophylline INTX WITH QUINOLONES

A

Ciprofloxacin will increase the level or effect of theophylline by affecting hepatic enzyme CYP1A2 metabolism. Serious - Use Alternative. Concomitant use of theophylline and ciprofloxacin has decreased theophylline clearance and increased plasma levels and symptoms of toxicity. Serious and fatal reactions have included cardiac arrest, seizure, status epilepticus, and respiratory failure. If concomitant use cannot be avoided, monitor theophylline levels and adjust dosage as needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Red Flags by condition and drug induced conditions: Asthma

THEOPHYLLINE INTX WITH FLUVOXAMINE

A

fluvoxamine will increase the level or effect of theophylline by affecting hepatic enzyme CYP1A2 metabolism. Serious - Use Alternative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Red Flags by condition and drug induced conditions: Asthma

Drug induced
Asthma/ SOB

A

● Aspirin
● NSAIDs (cyclooxygenase inhibitors)
● Sulfites
● benzalkonium chloride
β-blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the main cause of COPD?

A

Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the manifestations of COPD?

A

-partially reversible airway limitation
-increasing frequency and severity of exacerbations
-acute SOB
-activity limitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

T/F: exercise should be limited in a COPD patient?

A

F: they should increase exercise and use SABA if needed prior to activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the goals of therapy for COPD?

A

-prevent progression
- decrease breathlessness
-reduce exacerbations
-improve QOL
-reduce disability
-reduce mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which of the following is a risk factor for COPD?
a. smoking
b. exposure to occupational dust/chemicals/pollution
c.alpha1-antityrpsin deficiency
d. family history
e. all of the above

A

E – all of the above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which of the following is NOT a co-morbidity or suggestive of systemic manifestation of COPD?
a. CVD
b. Osteoporosis
c. Pulmonary embolism
d. Malignancy
e. Anxiety

A

e- anxiety (depression is a co-morbidity) also:
- altered nutrition, metabolic syndrome, pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

T/F: physical exam is the gold standard for diagnosis for COPD?

A

F – it is an insensitive method of dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which of the following is INCORRECT?:
a. Early clinical findings of COPD are hyperinflation, hypoxemia and pulmonary hypertension
b. Spirometry is the gold standard for diagnosis
c. Post-bronchodilator of FEV1 <80% & FEV1/GVC <0.7 are both necessary to diagnose COPD
d. Chest x-ray should be done to rule out lung cancer, TB, bronchiectasis
e. CBC should be done for polycythemia indicated anemia or chronic hypoxia

A

A – these are LATE clinical findings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What should be tested in COPD patients <45 yoa or with a strong family history of COPD?

A

Alpha1-antitrypsin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

T/F: if a patient has COPD, there is no point in recommending smoking cessation?

A

F: always recommend and look at using Nortryptline (SSRIs are ineffective)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What should NOT be used as a monotherapy for COPD patients?
a. LABA
b. SABA
c. ICS
d. All of the above

A

C: ICS may increase risk of pneumonia and should be combined with a LABA (although CTC says there is still an increased risk)
* Recall in asthma that a LABA can’t be used on it’s own

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the best initial drug therapy for COPD?
a. LABA (salmeterol/formoterol)
b. SABA (salbutamol)
c. ICS
d. oral steroids
e. LAMA/tiotropium

A

B: SABA should be used as needed and supplemented with LABA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

T/F: ICS has the same anti-inflammatory effects in COPD patients as it does in asthma patients

A

F: it does not affect the neutrophilic response as significantly as in asthma and should be combined with a LABA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

T/F: a SABA (salbutamol) is recommended in all stages of disease for symptom relief

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the duration of action of a SABA?

A

4-6hrs

27
Q

What has a slower onset, but lasts up to 8hrs and can be 2x-3x dose without notable side effects?
a. LAMA/tiotropium
b. LABA
c. Ipratropium bromide (short acting anticholinergic)

A

C

28
Q

T/F: combining Ipratropium + Salbutamol produces a greater degree of bronchodilation, but has increase side effects

A

F: it does produce greater benefit than monotherapy, BUT has lower or similar incidence of S/E of either drug alone

29
Q

T/F: oral B2-agonists (vs inhaled) are a good treatment option for COPD

A

F: increased side effects and NO role in COPD

30
Q

Name the 2 classes of Long Acting bronchodilators that are available

A
  1. Long acting muscarinic antagonists (anti-cholinergics) – LAMA
  2. Long-acting B2 agonists (LABA)
31
Q

What is the first line for managing persistent symptoms and moderate to severe airflow
a. Tiotropium bromide (LAMA)
b. Salbutamol (SABA)
c. Budenoside
d. amoxicillan

A

a. compared with ipratropium, it deposits well in airway and 1 dose lasts for 24hrs

32
Q

What are the concerns when using LAMAs (tio and ipratropium)?
* further study concluded these were not risks, but did find that ipratropium has increased cardiovascular events*

A

Increased risk of CV death, MI or stroke

33
Q

Which LAMA has a faster onset than tiotropium and is in phase III of studies?

A

Glycopyrronium bromide

34
Q

T/F: Inhaled LABA’s offer sustained improvements in pulmonary function, dyspnea and QOL compared with SABAs

A

T

35
Q

Which LABA (salmeterol or formoterol) has the advantage of a rapid onset and 12 hrs duration?
a. Salmeterol
b. Formoterol
c. Indacterol

A

B. formoterol (Fast acting)
Salmeterol (Slow acting)

36
Q

T/F: Indacaterol is a rapid acting, ultra long acting B2-adrenergic agonist and requires BID dosing

A

F: it is the first to ONLY require QD dosisng
-use for those who can’t adhere to BID dosing or can’t tolerate anticholinergics

37
Q

Which of the following is false regarding the LAMA+LABA combo therapy?
a. It should be used if disability persists despite monotherapy in mod/severe disease and persistent symptoms with infrequent exacerbations (<1/year for 2 consec. Years)
b. It has an unacceptable safety profile
c. It offers superior bronchodilation vs. monotherapy
d. Cardiovascular safety was questionable after a 24 and 52 week study
e. Both b & d

A

e.it has an acceptable safety profile and cardiovascular studies showed safety

38
Q

T/F: ICS is not recommended as a monotherapy, but the combination of LABA + ICS is safe

A

F: there was also an increase in pneumonia, but no increase in morbidity and mortality – so they do recommend this combo

39
Q

What are the drugs used in triple therapy for those with severe symptoms and repeated exacerbations (>1/year for 2 consec years

A

ICS/LABA added to tiotropium

40
Q

Which of the following is TRUE regarding triple therapy
a. It is commonly prescribed
b. There is strong evidence to support its use clinically
c. It is clinically superior to dual bronchodilator therapy or ICS/LABA therapy

A

a-it IS commonly prescribed, but there is insufficient evidence proving that it is superior

41
Q

Which of the following statements is false regarding Rofumilast
a. It suppreses the release of inflammatory mediators by inhibiting cAMP breakdown
b. It is an add-on therapy with bronchodilators for severe COPD
c. It improve quality of life and decreases exacerbations by 23%
d. It is CONTRAINDICATED in those with history of depression or suicidal ideation
e. It can cause weight loss, nausea and diarrhea

A

c.while it does decrease exacerbations, it has NO impact on QOL

42
Q

T/F: theophylline is not often used because of its narrow therapeutic index, significant drug interactions and required serum monitoring to minimize adverse effects

A

True

43
Q

Theophylline serum levels shoud be kept between _______ to minimize adverse effects

A

55-85 umol/L

44
Q

Which of the following is false regarding oxygen therapy?
a. Does not reduce the risk of death in patients
b. It may prolong life by 6-7 years
c. Flow rates should be increased by 3or4 L/min during exercise and sleep
d. It may worsen hypercarbic hypoxia in patients with hypoventilation a-it does reduce the risk of death

A

c. Flow rates should be increased by 1-2L /min

45
Q

What is the overall benefit for the influenza vaccine in COPD patients
a. 0.5 RR
b. 0.25RR
c. 0.75RR

A

C. 0.75RR (reduces chances by 25%)

46
Q

T/F: the pneumococcal vaccine should be given to COPD patients to prevent pneumonia and repeated every 5-10years in high risk patients

A

T: although our class notes say NO DIFFERENCE in RR of exacerbations per year, and NO difference in MORTALITY

47
Q

T/F: ICS has only modest benefit in preventing exacerbations and its effects have been overstated in regards to prevention of exacerbations

A

T: in course notes pack

48
Q

T/F: each agent on its own has benefit and the benefit increases when you continue to add new, proven therapies

A

F: on their own, have benefit, but the benefits decrease as you add in more therapies

49
Q

Which of the following is true regarding acute exacerbations:
a. they are the most frequent cause of med visits, hospitalizations, & death in COPD
b. it is not advised to increase the dose/frequency of existing bronchodilator treatment during an exacerbation
c. antibiotics offer no benefit in an acute exacerbation
d. systemic corticosteroids should be avoided in COPD patients due to the risk of fracture

A

a. true
b. it IS advised to increase doses/frequency of SABA/ipratropium
c. ABX help with purulent discharge
d. Use systemic corticosteroids short term

50
Q

T/F: systemic corticosteroids should always been weaned vs. abrupt discontinuation

A

F: no need to wean if used <2 weeks (textbook), <3 weeks (course notes)

51
Q

Which is FALSE regarding Oral-steroids
a. a 14 day course of 30-40mg/day is recommended during exacerbations
b. a 5 day course offers equivalent benefit
c. it improves lung function, shortens hospital stay and reduces risk of relapse
d. it can be used as maintenance therapy for COPD patients

A

D. there is NO role for oral CS in maintenance therapy for COPD

52
Q

Which of the following is FALSE regarding antibiotic therapy:
a. Bacterial infections are the most common cause of exacerbations
b. Viruses are the most common cause and should be treated with anti-virals for the flu in flu season
c. Routine use of acute exacerbations is NOT recommended because of inconclusive evidence and ABX resistence
d. ABX is indicated if pt requires invasive mechanical intervention, or has

A

a. Viruses are the most common cause of exacerbations

53
Q

When are ABX is indicated for COPD patients?

A

indicated if pt requires invasive mechanical intervention, or has 2/3 of:
increased dyspnea
increase sputum
increase sputum purulence

54
Q

What are the most common bacterial infections in COPD?

A

H. influenza
Moraxella catarrhalis
S. pneumonia

55
Q

When should you re-evaluate a COPD patient on ABX and consider a change in your prescription?

A

If no change in 24-36 hours

56
Q

What antibiotics are recommended for H. influenza, M. catarrhalsi or s.pneumoniae?
a. Amoxicillin
b. Doxycycline
c. TMP/SMX
d. Extended spectrum macrolide
e. All of the above

A

E. all of the above

57
Q

What is the gold standard test to assess oxygenation during an acute exacerbation

A

Arterial blood gas

58
Q

What is the therapeutic order of treatment suggested by James?

A
  1. SABA for sx
  2. LABA or tiotrop.
    Then:
  3. ICS or ABX
59
Q

What does James recommend for an exacerbation

A
  1. Salbutamol (SABA)
  2. Steroids (prednisone)
  3. Any ABX
59
Q

What does James recommend for an exacerbation

A
  1. Salbutamol (SABA)
  2. Steroids (prednisone)
  3. Any ABX
60
Q

T/F: continuous macrolides are recommended in severe COPD to prevent exacerbations

A

F: not recommended d/t ABX resistance and s/e such as hearing loss

61
Q

What does the evidence show to be the best long acting treatment for COPD?
a. LAMA
b. LABA
c. SABA
d. Tiotropium

A

D – tiotropium

62
Q

T/F: Salbutamol (SABA) has little effect vs. placebo on dyspnea and wheezing

A

F: 57% of patients preferred SABA vs. 9% of placebo.
Absolute difference of 48%

ND Ontario Prescribing Exam (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions