Week 2

Question 1

Characterized by infection of the tracheobronchial tree that results in hyperemic and edematous mucous membranes, yielding an increase in bronchial secretions .

Answer 1

Acute bronchitis

Question 2

Most common virus causing acute bronchitis:

Answer 2

Rhinovirus

Question 3

Hallmark of acute bronchitis:

Answer 3

Dry/nonproductive cough

Question 4

General treatment for acute bronchitis:

Answer 4

Symptomatic and supportive care, antitussives, bronchodilators

Question 5

Productive cough and sputum production for 3 months per year for at least 2 consecutive years

Answer 5

Chronic bronchitis

Question 6

3 cardinal symptoms of COPD exacerbations:

Answer 6

1. Increase in dyspnea
2. Increase in sputum production
3. Increase or presence of sputum purulence

Question 7

An infection in the lungs that leads to consolidation of the usually air-filled alveoli.

Answer 7

CAP

Question 8

Most common pathogen of CAP:

Answer 8

S. Pneumoniae

Question 9

Diagnostic criteria for CAP:

Answer 9

Patients present with cough, fever, dyspnea, malaise, pleuritic chest pain, CXR

Question 10

Antibiotic treatment for patients with CAP without recent antibiotic use or existing Comorbidity:

Answer 10

Macrolides- azithromycin or clarithro

Or doxy

Question 11

Antibiotics in treatment of CAP in patients of comorbidity:

Answer 11

High-dose amoxicillin, augmentin, or 2nd/3rd generation cephalosporin plus a macrolide, or a fluoroquinolone alone.

Question 12

With CAP what antibiotic can be used in patients allergic to azithromycin?

Answer 12

Doxycycline

Question 13

What antibiotic should not be used in CAP treatment:

Answer 13

Cipro

Question 14

In children, antibiotics are typically not required; however, if needed what do you use?

Answer 14

Amoxicillin

Question 15

Characterized by airway narrowing and Airway hyper-responsiveness.

Answer 15

Asthma

Question 16

Airflow obstruction is present when the FEV1/FVC ratio is less than:

Answer 16

0.70

Question 17

All patients with asthma, regardless of severity, require:

Answer 17

Short-acting beta2-adrenergic agonist (SABA) bronchodilator for quick relief of acute symptoms

Question 18

When can treatment be stepped down with asthma?

Answer 18

When symptoms have been well controlled for 3 months

Question 19

How to step down asthma treatment:

Answer 19

1. Oral corticosteroids are reduced and d/c’d first
2. Dose of inhaled corticosteroids May then be reduced by 50%
3. Long-term control regimen may be stopped if the person with asthma has been free of symptoms for 6-12 months and has no risk of exacerbations

Question 20

MOA of beta2-adrenergic agonist:

Answer 20

Stimulate the beta2-adrenergic receptors, increasing production of the cAMP. Increased cAMP relaxes the airway smooth muscle and increases bronchial ciliary activity.

Question 21

All beta2-adrenergic agonists have:

Answer 21

Slight CV stimulatory effects including increased HR, cardiac contractility, and increased cardiac conductivity

Question 22

Examples of SABAS:

Answer 22

Albuterol and levalbuterol

Question 23

Example of long-term beta2-adrenergic agonist:

Answer 23

Salmeterol- used in chronic maintenance

Formoterol- quicker onset of action

Both have duration of action of 12 hours.
Both are beta2 selective.

Question 24

Contraindications with beta2-adrenergic agonist:

Answer 24

Use in caution in patients with CV disease, arrhythmia, DM, glaucoma, hyperthyroidism, or seizure disorder

Question 25

Adverse events with both SABAS and LABAs:

Answer 25

Tachycardia, skeletal muscle tremor, nervousness, dizziness, hypokalemia, and hyperglycemia.

Question 26

What antibiotic given for H. Flu bronchitis?

Answer 26

Amoxicillin

Question 27

What antibiotic given for m. Catarrhalis bronchitis?

Answer 27

Augmentin

Question 28

What antibiotic given for m. Pneumoniae bronchitis?

Answer 28

Macrolides or doxy

Question 29

How long to treat with antibiotics for CAP?

Answer 29

At least 5 days and must be afebrile 48-72 hours prior to stopping.

Question 30

When to order an CXR?

Answer 30

``` Any pt with at least one of the following: 1. Temp greater than 100 2. Heart rate over 100 3. RR over 20 Any patient with at least 2 of the following: 1. Decreased BS 2. Crackles 3. Absence of asthma ```

Question 31

Hospital admission criteria: CURB-65

Answer 31

``` C: confusion- perform mini mental U: uremia- BUN greater than 20 R: RR greater than 30 B: low BP- systolic less than 90; diastolic less than 60 65: 65 years of age and older ``` Typically need 2 of these for admission

Question 32

Asthma classification with exacerbations 2 times a week or less:

Answer 32

Intermittent

Question 33

Asthma classification with more than 2 exacerbations a week but not daily:

Answer 33

Mild persistent

Question 34

Asthma classification with daily symptoms and daily use of SABA:

Answer 34

Moderate persistent

Question 35

Asthma classification with symptoms throughout the day and use of SABA several times daily:

Answer 35

Severe persistent

Question 36

Bronchodilators in asthma are:

Answer 36

Relievers

Question 37

Anti-inflammatory agents in asthma are:

Answer 37

Controllers

Question 38

Drug/drug interactions with beta2-adrenergic agonist:

Answer 38

MAOIs or tricyclic antidepressants increase BP and risk of stroke. Must be discontinued at least 14 days prior to initiating a beta2-adrenergic agonist.

Question 39

The most potent airway smooth muscle relaxant that is not beta2 selective:

Answer 39

Epinephrine

Question 40

LABAs in asthma must always be used with:

Answer 40

ICS

Question 41

What is safest SABA in kids under 4 and infants?

Answer 41

Albuterol

Question 42

Most potent ICS:

Answer 42

Flovent

Question 43

ICS with beta2-agonist have what type of effect:

Answer 43

Synergistic

Question 44

ICS are indicated for all persons with persistent asthma t/f?

Answer 44

True Low dose- mild persistent Med dose- moderate persistent High dose- severe persistent

Question 45

Timing of inhalers:

Answer 45

Administer beta agonist first: opens the airway

Question 46

MOA of inhaled steroids in asthma:

Answer 46

Anti-inflammatory action- binds to glucocorticoid receptors in the airway Also inhibits mucus secretions in airways

Question 47

A chemical mediator that can cause inflammatory changes in the lungs.

Answer 47

Leukotriene

Question 48

MOA of leukotriene receptor antagonists:

Answer 48

Reduce inflammatory symptoms of asthma triggered by allergic and environmental stimuli.

Question 49

Are leukotriene modifiers used for acute attacks?

Answer 49

No

Question 50

Examples of leukotriene modifiers:

Answer 50

Singulair (montelukast) Accolate (zafirlukast) Zileuton (zyflo)

Question 51

Adverse events of leukotriene modifiers:

Answer 51

HA*, churg-Strauss syndrome, systemic vasculitis, and behavioral changes

Question 52

Montelukast is approved for ages: Zafirlukast is approved for ages: Zileuton is approved for ages:

Answer 52

Greater than 1 year of age Greater than 5 Greater than 12

Question 53

MOA of mast cell stabilizers:

Answer 53

Prevent release of inflammatory and bronchoconstricting substances from mast cells.

Question 54

Examples of a mast cell stabilizer:

Answer 54

Cromolyn (intal) inhalation, prophylactic, take daily, good for kids

Question 55

Methylxanthines MOA:

Answer 55

Relax smooth bronchial muscle, enhance diaphragmatic contractility, and have alight anti-inflammatory effect.

Question 56

Examples of methylxanthines:

Answer 56

Theophylline and aminophylline

Question 57

Methylxanthines are contraindicated in:

Answer 57

Use in caution In patients with Tachyarrhythmias, PUD, seizure disorders, and hyperthyroidism.

Question 58

Adverse events of methylxanthines:

Answer 58

Tachyarrhythmias*, HA*, restlessness, insomnia, tremor, N/V*, gastroesophageal reflux, and peptic ulcer aggravation.

Question 59

Monitor serum levels in methylxanthines due to:

Answer 59

Narrow therapeutic window

Question 60

Immunomodulators:

Answer 60

Omalizumab (Xolair)

Question 61

Xolair MOA:

Answer 61

Decreases binding of IgE on surface of the mast cells which decreases allergic response

Question 62

Xolair indications:

Answer 62

Patients with severe allergies and severe persistent asthma

Question 63

Xolair is given:

Answer 63

SubQ every 2-4 weeks

Question 64

Adverse events of Xolair?

Answer 64

High risk of anaphylaxis

Question 65

What to do for exercise induced bronchospasm?

Answer 65

SABA 15 minutes prior to exercise | A mast cell stabilizer of short acting anticholinergic can be given when SABA is ineffective

Question 66

Mild-intermittent asthma managed with:

Answer 66

SABA

Question 67

Mild persistent asthma (step 2) managed with:

Answer 67

Low dose ICS | Alternative: cromolyn, montelukast

Question 68

Moderate persistent (step 3-4) asthma managed with

Answer 68

Low to medium dose ICS plus LABA or medium dose ICS

Question 69

Severe persistent (5-6) asthma managed with:

Answer 69

High dose ICS plus LABA

Question 70

Xolair May be added for what type of asthma?

Answer 70

Confirmed allergic asthma

Question 71

Systemic corticosteroids are used In asthma for:

Answer 71

Treatment of acute asthma exacerbation

Question 72

Systemic corticosteroids used in exacerbation administration info:

Answer 72

40-60 mg daily x 5 days Administer at 3 pm Can cause insomnia

Question 73

SABA can be given how frequently during an exacerbation:

Answer 73

2-6 puffs every 20 minutes

Question 74

Diagnostic criteria for COPD:

Answer 74

A post-bronchodilator FEV1/FVC less than 70% signifies a fixed airway obstruction

Question 75

A post-bronchodilator FEV1/FVC with asthma will:

Answer 75

Increase by greater than 12% or 200 ml

Question 76

Group A treatment in COPD:

Answer 76

Bronchodilators

Question 77

Group B treatment in COPD:

Answer 77

Initial- LAMA or LABA | If continued breathlessness- 2 bronchodilators (LABA and LAMA)

Question 78

Group C therapy in COPD:

Answer 78

Initial- LAMA | Persistent exacerbations- add LABA or LABA and ICS

Question 79

Group D treatment in COPD:

Answer 79

Initial- LABA/LAMA combo or LAMA and LABA/ICS

Question 80

Phosphodiesterase 4 inhibitors MOA:

Answer 80

inhibits phosphodiesterase 4, this inhibition increases cellular cAMP, modifying the inflammatory response. Causes bronchodilation with anti-inflammatory effects

Question 81

Phosphodiesterase 4 inhibitors include:

Answer 81

Daxas (dalisrep)

Question 82

Adverse events with phosphodiesterase 4 inhibitors:

Answer 82

Increase risk of suicide and weight loss

Question 83

COPD exacerbation cardinal signs:

Answer 83

Increase in dyspnea Increase in sputum volume Increase in sputum purulence**

Question 84

Treatment if COPD exacerbation:

Answer 84

Increasing dose/frequency of SABA or SAMA 5 day course of oral steroids: 40mg Antibiotics 5-10 days

Question 85

Antibiotics for COPD exacerbation:

Answer 85

1st line- macrolides Augmentin Doxycycline

Question 86

Do not take oral steroids with:

Answer 86

Antacids due to decreases absorption

Question 87

What beta2 agonist is ok in pregnancy?

Answer 87

Terbutaline

Question 88

Salmeterol should never:

Answer 88

Be used in children under 4 or as monotherapy

Question 89

Beta agonists can increase the QT prolongation when given with what drugs?

Answer 89

Loop/thiazide diuretics, other sympathomimetics