Week 8 Pulmonary Disease

Question 1

According to the EPR 3, step 1 treatment for intermittent asthma in adults and children

Answer 1

SABA as needed

Question 2

Mechanism of Action: Beta adrenergic agents

Answer 2

Relax smooth muscle by directly stimulating beta adrenergic receptors in the airway

Question 3

Mechanism of Action: Corticosteroids

Answer 3

Decrease airway inflammation, attenuate airy hyper responsiveness, and minimize mucus production and secretion

Question 4

Mechanism of Action: Anticholinergics / Muscarinic Antagonists

Answer 4

Inhibit the effects of acetylcholine on muscarinic receptors and protect against cholinergic mediated bronchoconstriction

Question 5

Mechanism of Action: Leukotrine receptor antagonists (montelukast, zafirlukast)

Answer 5

Competitively antagonize the effects of leukotriene D4 resulting in decreased inflammation

Question 6

Theophylline (a methylxanthine) has limited use because it has a ________________ therapeutic index

Answer 6

Narrow

Question 7

Mechanism of Action: Phosphodiesterase-4 inhibitors

Answer 7

Reduce inflammation by inhibiting the breakdown of cAMP

Question 8

Another name for anticholinergic

Answer 8

Long or short acting muscarinic antagonists

Question 9

The preferred combination inhaler for COPD

Answer 9

LABA / LAMA

Question 10

Most common pathogen in community acquired pneumonia

Answer 10

Streptococcus pneumonia

Question 11

Encourage patients to rinse mouth with water after using this class of inhaler

Answer 11

ICS - inhaled corticosteroid

Question 12

Physical assessment technique which will help identify consolidation with pneumonia

Answer 12

percussion and egophony

Question 13

Assessment tools that can be used to determine symptom severity in COPD

Answer 13

Modified MRC or CAT

Question 14

Severity of symptoms in an individual who needs to stop for breath when walking on their own on the level

Answer 14

High symptom severity

Question 15

Recommended first treatment for Group A COPD

Answer 15

SABA or SAMA prn

Question 16

Recommended treatment of COPD in group D if exacerbations on LABA + LAMA

Answer 16

LABA + LAMA + ICS

Question 17

According to EPR 3 Step 2 preferred management in adults involves adding

Answer 17

A low dose ICS

Question 18

According to EPR 3, Step 3 preferred treatment for adults recommends

Answer 18

Adding a LABA or increasing ICS to medium dose ICS

Question 19

Empiric CAP antibiotic treatment for recommended for a previously healthy adult outpatient

Answer 19

macrolides or doxycline

Question 20

Empiric CAP monotherapy antibiotic treatment for a patient with DM or COPD

Answer 20

Flouroquinalones

Question 21

The two interferon gamma release assay (IGRA) tests available for TB

Answer 21

Quantiferon TB Gold In-Tube (QFT-GIT) and T-Spot

Question 22

12 week direct observed therapy for latent TB includes these two drugs

Answer 22

Isoniazid and Rifapentin

Question 23

Isoniazid can cause hepatitis. Patients should be educated to avoid

Answer 23

Alcohol

Question 24

Adverse effects of Rifampin include

Answer 24

Orange discoloration of urine, tears, saliva and can interfere with contr

Question 25

The most serious problem with treatment of TB is

Answer 25

patient nonadherence

Question 26

The only two SABA that can be prescribed for children younger than age 4 are…

Answer 26

Albuterol and metaproterenol

Question 27

How pulmonary function and response to bronchodilators should be monitored

Answer 27

With use of a peak flow meter

Question 28

What should be done for a patient on digitalis before they are started on a beta agonist?

Answer 28

An ECG for baseline and routinely during therapy to detect cardiac arrhythmias that may occur.

Question 29

Proper inhaler use involves…

Answer 29

First, exhale and tilt head slightly back and place inhaler mouthpiece either 2 inches from the open mouth or between the open lips. While inhaling, the pt should press down on the canister, breathe in slowly and deeply, and hold his or her breath for 10 seconds (count of 10) or as long as comfortable. If 2 puffs prescribed, wait 1 minute between inhalation’s.

Question 30

Key points to cover regarding nebulizer use with a patient…

Answer 30

Accurate measurement of the medication and appropriate cleaning of the device.

Question 31

Overuse of beta2-agonist bronchodilators can lead to…

Answer 31

P.350

Seizures, hypokalemia, anginal pain, and hypertension

Question 32

Lifestyle management of asthma includes all of the following EXCEPT:
A) self-monitor respiratory status with a peak flow meter
B) avoid/stop smoking
C) avoid environmental triggers for asthma at home, work, and school
D) eat three meals a day focusing on high antioxidant foods (e.g., blueberries, spinach, kale, etc.)

Answer 32

D) while beneficial in general, eating a well balanced diet is not a focus for lifestyle management of asthma.

P. 350

Question 33

Theophylline is chemically similar to what common psychoactive drug?

Answer 33

Caffeine

Question 34

Anticholinergics are use primarily in:

A) asthma
B) COPD
C) CHF
D) none of the above

Answer 34

B) inhaled anti-cholinergics are used primarily to treat COPD, although ipratropium may be used in combination with albuterol as the emergent treatment of an asthma exacerbation or when a patient is intolerant to beta2 agonists.