Brainscape's Knowledge GenomeTM

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


See full index

NAPLEX 2024 > 41. Asthma > Flashcards

41. Asthma Flashcards

1
Q

Common triggers of asthma

A

Pollution, cigarettes, cold air/changes in weather, pets, dusk, pollen, cockroaches, perfume/cosmetics
Drugs (Aspirin, NSAIDs, non-selective beta-blockers)

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

Comorbid conditions a/w asthma

A

Infections (cold/viruses), allergic rhinitis, GERD, obesity, obstructive sleep apnea, anxiety, stress, and depression

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

An asthma diagnosis is confirmed with ___

A

spirometry

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

FEV1 measures ___

A

how much air can be forcefully exhaled in one second

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

FVC measures ____

A

the max volume of air exhaled after taking a deep breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

FEV1/FVS measure ___

A

% of total air capacity (“vital capacity”) that can be forcefully exhaled in 1 second (speed of exhale)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Asthma diagnostic criteria

A

Measure baseline FEV1 with spirometry
Give albuterol
Measure post-bronchodilator FEV1

An FEV1 increase >12% post-bronchodilator is consistent with asthma diagnosis (considered “reversible”)

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

An FEV1 increase >___% post-bronchodilator (albuterol) is consistent with asthma diagnosis (considered “reversible”)

A

> 12%

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

What are the 2 major guidelines used for treating asthma?

A

Global Initiative for Asthma (GINA) - gold standard
NHLBI’s Expert Panel Report (EPR)

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

How frequent should follow up appointments be for asthma patients?

A

every 2-6 weeks after starting meds - ensure proper inhaler technique (priming, cleaning) and step up/down treatment
Decrease to 1-6 months once controlled

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

Vaccines recommended for asthma patients

A

Annual influenza
Pneumococcal vaccine

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

2 Primary rescue inhaler regiments

A

Combo of low-dose ICS + formoterol (preferred)
SABA in addition to ICS

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

In addition to treating acute asthma symptoms, relievers can be used preventively for ____

A

exercise-induced bronchospasm (EIB)

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

___ are the mainstay of maintenance treatment for asthma

A

ICS

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

How does combo med ICS + formoterol work as rescue asthma drug?

A

Formoterol = LABA with fast onset
Combination reduces the risk of exacerbations compared to SABA alone

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

How does SABA work as rescue asthma drug?

A

Quickly reverses bronchoconstriction
Note: SABAs do not treat underlying inflammation, should be used with an ICS (taken as needed at the same time as SABA or taken daily as maintenance med)

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

What is the role of systemic steroids in asthma?

A

Injections - used during exacerbations
Oral - used during exacerbations or severe asthma that is difficult to control with other drug combos

Note: use should be limited as much as possible d/t adverse effects

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

What is the role of inhaled epinephrine in asthma?

A

Not included in asthma guidelines
Available OTC, can be used intermittently for acute treatment for mild asthma only

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

What is the role of Inhaled short-acting muscarinic antagonists (SAMAs) (anticholinergics) in asthma?

A

Can be used in combo with SABA during exacerbations

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

What is the role of ICS in asthma?

A

First-line treatment for all pts; most effective anti-inflammatory drugs

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

What is the role of LABA in asthma?

A

Used in combo with ICS (should NEVER be used alone d/t risk of serious adverse outcomes)
Preferred add-on agents to ICS

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

What is the role of oral leukotriene receptor antagonist (LTRAs) in asthma?

A

Most commonly used in children
Alt option to LABA in combo with ICS; can also be added ICS/LABA treatment

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

What is the role of theophylline (PO or IV) in asthma?

A

Least desirable option for add-on treatment d/t significant adverse effects, drug interactions and the need to monitor serum drug concentrations

Requires monitoring serum drug conc!!

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

What is the role of LAMAs in asthma?

A

Can be used as add-on treatment in pts with hx of exacerbations despite ICS/LABA treatment

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

What is the role of injectable monoclonal antibodies (SC or IV) in asthma?

A

Add-on in persistent severe asthma
Omalizumab - severe allergis asthma
Mepolizumab, reslizumab, benralizumab, and dupilumab - severe eostinophilic asthma

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

Patient complains of s/sx of asthma that occurs <2x/month with no nighttime awakenings. What treatment do you recommend?

A

Step 1:
Rescue - low-dose ICS/formoterol OR
Rescue - SABA + low-dose ICS (taken together)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Patient complains of s/sx of asthma that occurs ≥2x/month but ≤4-5x/week with no nighttime awakenings. What treatment do you recommend?

A

Step 2:
Rescue - low-dose ICS/formoterol OR
Rescue - SABA // Maintenance low-dose ICS

Alternatives: PO leukotriene receptor antagonist (LTRAs) OR low-dose ICS taken whenever SABA is taken

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Patient complains of s/sx of asthma that occurs most days and night time awakenings ≥1x/week. What treatment do you recommend?

A

Step 3:
Rescue - Low-dose ISC/Formoterol // Maintenance - low-dose ICS/formoterol OR
Rescue - SABA // Maintenance - low-dose ICS/LABA

Alternatives: low-dose ICS + LTRA OR medium-dose ICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Patient complains of s/sx of asthma that occurs every day and night time awakenings ≥1x/week. What treatment do you recommend?

A

Step 4:
Rescue - low-dose ICS/Formoterol // Maintenance - Medium-dose ICS/formoterol OR
Rescue - SABA // Maintenance Medium-dose ICS/LABA

Alternatives: high-dose ICS or add on tiotropium or LTRA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Patient still complains of s/sx of asthma that occurs every day and night time awakenings ≥1x/week despite step 4 treatment regimen. What treatment do you recommend?

A

Step 5:
Rescue - low-dose ICS/Formoterol // Maintenance - High-dose ICS/formoterol OR
Rescue - SABA // Maintenance - high-dose ICS/LABA

Consider adding tiotropium, oral steroid, or injectable treatments (e.g. omalizumab, mepolizumab, reslizumab, tezepelumab)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

When would a provider consider stepping down for treatment algorithm for asthma?

A

If well-controlled for ≥3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

SABAs and LABAs should be used only in combination with ___

A

ICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Albuterol (ProAir HFA, ProAir RespiClick, Proventil HFA, Ventolin HFA) strength and dosing

A

90 mcg/inh
1-2 inhalations q4-6 hrs prn

Note: PO forms available but NOT recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Epinephrine (Asthmanefrin Refill) OTC should NOT be used since it is ____

A

non-selective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Boxed Warnings for Salmeterol (Serevent Diskus)

A

Increased risk of asthma-related deaths; only use in pts currently receiving but not adequately controlled on ICS
Increased risk of asthma-related hospitalizations in pediatric and adolescent pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Which beta-2 agonists is a maintenance inhaler only, not for acute bronchospasm?

A

Salmeterol (Serevent Diskus) - LABA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Side effects of SABAs

A

Nervousness, tremor, tachycardia, palpitations, cough, hyperglycemia, decreased K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Which types of SABA products require shake well before use?

A

MDIs (HFA products)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Levalbuterol contains __-isomer of albuterol

A

R-isomer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Most albuterol inhalers contain __ inh/canister
Exception: ____ which is available as ___inh/canister as well

A

200 inh/canister
Ventolin HFA - available in 60 inh/canister and 200 inh/canister

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

When using SABAs for exercise induced bronchoconstriction, use 2 inhalations ___ prior to exercise

A

5 min prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Warnings for ICS

A

Increased risk of fractures, growth retardation (in children) and immunosuppression

Others: high doses for prolonged periods of time can cause adrenal suppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Side effects for ICS

A

Dysphonia (difficulty speaking), oral candidiasis (thrush), cough
Others: HA, hoarseness, URTIs, hyperglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Which type of inhaler requires rinsing mouth with water to prevent thrush?

A

ICS; can use a spacer device with an MDI to decrease risk

45
Q

___ is a metered dose inhaler (MDI) ICS that does NOT need to be shaken before use

A

Alvesco (Ciclesonide)

46
Q

___ is the only ICS available as a nebulized solution

A

Budesonide, commonly used in children

47
Q

___ is a ICS breath-activated aerosol with characteristics of DPI and MDI; do NOT shake or use with spacer, does not need priming or activation

A

QVAR RediHaler (Beclomethasone)

48
Q

____ are preferred for asthma whereas ____ are preferred for COPD

A

ICS and ICS/LABA for asthma
LABA, LAMA, LAMA/LABA for COPD

49
Q

Common ICS inhalers for asthma

A

Beclomethasone (QVAR RediHaler)
Budesonide (Pulmicort Flexhaler)
Fluticasone (Flovent HFA, Flovent Diskus, Arnuity Ellipta)

Others: Ciclesonide (Alvesco), Mometasone (Asmanex HFA, Asmanex)

50
Q

Common LABA inhalers for asthma

A

Salmeterol (Serevent Diskus)

51
Q

Common LAMA inhalers for asthma

A

Tiotropioum (Spiriva Respimat only)

52
Q

Common ICS/LABA inhalers for asthma

A

Budesonide/formoterol (Smybicort)
Fluticasone/salmeterol (Advair Diskus, Advair HFA)
Mojmetasone/formoterol (Dulera)
Fluticasone/vilanterol (Breo Ellipta)

53
Q

Common LAMA/LABA/ICS inhalers for asthma

A

Umeclidinium/vilanterol/fluticasone (Trelegy Ellipta)

54
Q

Key differences between MDIs vs DPIs: Brand name identifiers

A

MDIs - HFA, Respimat, or no suffix (e.g. Symbicort, Dulera)
DPIs - Diskus, ellipta, Pressair, HandiHaler, RespiClick, Flexhaler

55
Q

Key differences between MDIs vs DPIs: Dose delivery

A

MDIs - aerosolized liquid
DPIs - fine powder

56
Q

Key differences between MDIs vs DPIs: Administration

A

MDIs - slow, deep inhalation while pressing canister (hand-breath coordination)
DPIs - quick, forceful inhalation (breath activated dose delivery; no need to press anything)

57
Q

Key differences between MDIs vs DPIs: Spacer

A

MDIs - spacers can be used; helpful in pts incapable of hand-breath coordination and decreases risk of thrush with ICS
DPIs - cannot be used

58
Q

Key differences between MDIs vs DPIs: Shaking prior use

A

MDIs - required for all products except: QVAR RediHaler, Alvesco, and Respimat products
DPIs - do not shake

59
Q

Key differences between MDIs vs DPIs: Priming

A

MDIs - prime before first use and if not used for a certain period of time
DPIs - not needed except for Flexhaler prior to first use

60
Q

Montelukast (Singulair) MOA

A

Inhibits leukotriene D4 (LTD4) to reduce airway edema, constriction, and inflammation

61
Q

Zileuton (Zyflo) MOA

A

5-lipoxygenase inhibitor, inhibits leukotriene formation

62
Q

Zafirlukast (Accolate) MOA

A

Inhibits both LTD4 and LTE4

63
Q

Boxed warning for montelukast

A

Neuropsychiatric events (e.g. serious behavior and mood-related changes, including suicidal thoughts or actions)

64
Q

Warnings for leukotriene modifying agents

A

Neuropsychiatric events - monitor for signs of aggressive behavior, hostility, agitation, hallucinations, depression, suicidal thinking

65
Q

How are montelukast granules administered

A

Directly in mouth, dissolved in small amount (5mL) of breast milk or formula, or mixed with a spoonful of applesauce, carrots, rice, or ice cream
Use within 15 min of opening packet

66
Q

Which leukotriene modifying agent requires dispensing in original container?

A

Zafirlukast (Accolate)

67
Q

Which leukotriene modifying agent is also approved for allergic rhinitis and exercise-induced bronchoconstriction?

A

Montelukast

68
Q

Montelukast (Singulair) dosing

A

10 mg daily in the evening
Age 6-14yo: 5mg daily in the evening
Age 1-5yo: 4mg daily in the evening

69
Q

Zafirlukast is a major substrate and moderate inhibitor of CYP___
Zafirlukast can increase levels of ____ and other substrates (e.g. ____)

A

2C9
Theophylline, warfarin

70
Q

Zileuton is a minor substrate of CYP1A2, 2C9, and 3A4, and weak inhibitor of 1A2
It can increase levels of ___,___,and ___

A

Theophylline, propranolol, and warfarin

71
Q

Theophylline MOA

A

Blocks phosphodiesterase, causing increase in cAMP and release of epinephrine from adrenal medulla cells&raquo_space; bronchodilation (but also causes diuresis, CNS/cardiac stimulation, and gastric acid secretion

72
Q

Why is theophylline use limited in asthma?

A

Decreased effectiveness, drug interactions, and adverse effects

73
Q

Active metabolized of theophylline are ___ and 3-methylxanthine

A

Caffeine

74
Q

Theophylline oral loading dose

A

5 mg/kg IBW (of TBW if < IBW)

75
Q

Therapeutic range of theophylline

A

5-15 mcg/mL
Measure peak level at steady state, after 3 days of oral dosing

76
Q

Side effects of theophylline

A

Toxicity - persistent vomiting, arrhythmias, seizures
Others: N/V, HA, insomnia, increased HR, tremor, nervousness

77
Q

Converting Aminophylline to Theophylline

A

ATM - aminophylline to theophylline = multiply by 0.8

78
Q

Theophylline has saturable kinetics. What does that mean?

A

In the higher end of the therapeutic range, small dose increases can result in large increases in drug conc

79
Q

Theophylline is a major substrate of CYP___. What are some inhibitors that increase theophylline levels?

A

1A2
Ciprofloxacin, zileuton (others: cimetidine, fluvoxamine, propranolol)

80
Q

What are drugs that decrease thophylline levels?

A

Carbamazepine, fosphenytoin, phenobarbital, phenytoin, primadone, rifampin, ritonavir
Others: levothyroxine, St. John’s wort and tobacco/marijuana smoking

81
Q

What are some conditions/foods that increase theophylline levels (d/t decrease theophylline clearance)?

A

CHF, liver disease (cirrhosis)
Others: acute pulmonary edema, cor pulmonale, fever, hypothyroidism, shock and high carbohydrate/low protein diet

82
Q

What are some conditions/foods that decrease theophylline levels (d/t increased theophylline clearance)?

A

Low carb/high-protein diet
Others: daily consumption of charbroiled beef, cystic fibrosis, and hyperthyroidism

83
Q

Anticholinergics MOA in asthma

A

Inhibit muscarinic cholinergic receptors and reduce intrinsic vagal tone of the airway, leading to bronchodilation

84
Q

Anticholinergics should not be used alone in asthma; they are add-on treatments to be used with ___

A

ICS

85
Q

Omalizumab MOA

A

Monoclonal antibody that inhibits IgE binding to the IgE receptor on mast cells and basophils

86
Q

Omalizumab (Xolair) indication

A

Moderate-severe persistent, allergic asthma in pts ≥6yo who have a positive skin test to a perennial aeroallergen and inadequate symptom control on Step 5 treatment

87
Q

How is Omalizumab (Xolair) administered and how frequently

A

SC every 2 or 4 weeks

88
Q

T/F: Omalizumab (Xolair) is a SC injection that is self administered at home, does not require medical supervision

A

False - needs to be initiated in healthcare setting under medical supervision (≥3 doses) and then self-administration given no anaphylaxis after ≥3 doses, can recognize/manage anaphylaxis, and proper injection technique

89
Q

Boxed warning for Omalizumab (Xolair)

A

Anaphylaxis

90
Q

___,___, and ___ are IL-5 receptor antagonists. ___ is an IL-4 and L-3 receptor antagonist. All are indicated for severe asthma with an eosinophilic phenotype. Should be added to maintenance inhaler treatment.

A

Mepolizumab, reslizumab, benralizumab = IL-5 antagonists
Dupilumab = IL-4 and IL-3 antagonist

91
Q

How is reslizumab (Cinqair) administered and how frequently

A

IV every 4 weeks
Boxed warning for anaphylaxis

92
Q

How is Mepolizumab (Nucala) administered and how frequently

A

SC once every 4 weeks

93
Q

How is Benralizumab (Fasenra) administered and how frequently

A

SC once every 4 weeks for 3 doses and then every 8 weeks

94
Q

How is dupilumab (Dupixent) administered and how frequently

A

SC every other week

95
Q

___ or ____, taken ___ before exercise, is preferred to prevent exercise-induced bronchospasm.

A

SABA or low-dose ICS/formoterol
2-3 hrs

96
Q

When using SABA or low-dose ICS/formoterol in EIB, SABA will last ___ while ICS/formoterol can last up to ____

A

2-3 hrs
up to 12 hrs

97
Q

___ can be used as an alternative to a SABA in EIB if a longer duration of symptom control is needed; should be taken 30 min before exercise.

A

Salmeterol (LABA)
Note: should never be used alone for persistent asthma if taking for asthma maintenance

98
Q

___ can be taken 2 hrs prior to exercise and lasts up to 24 hrs for EIB. It is effective only in 50% of patients. Patients taking this medication for asthma or any other indication should not take an additional dose to prevent EIB.

A

Montelukast

99
Q

If pts are using more than 1 inhaler, what is the timing and order of use?

A

Bronchodilators first and wait 60 seconds between
Ex. SABA&raquo_space; 60 second wait&raquo_space; LABA or LAMA&raquo_space; 60 seconds&raquo_space; ICS

100
Q

How often should spacers be cleaned?

A

At least once a week

101
Q

Zones of an Asthma Action Plan: Green indicates >___% of personal best

A

80-100%

102
Q

Zones of an Asthma Action Plan: Yellow indicates >___% of personal best

A

50-80%

103
Q

Zones of an Asthma Action Plan: Red indicates <___% of personal best

A

<50%

104
Q

How often should peak flow meters be cleaned?

A

at least once a week

105
Q

Which MDIs should be taken apart to rinse the mouth piece under water and airdry?
Which MDIs should NOT be put into water?

A

Ventolin HFA, ProAir HFA - mouth piece should be rinsed airdried
Flovent HFA - Do not take canister out of plastic actuator, wipe inside of mouthpiece with damp tissue and air dry
Symbicort, Dulera - do NOT put into water

106
Q

For RespiClick Inhalers (ProAir RespiClick and AirDuo RespiClick), what is the risk of opening the cap when a dose is not needed?

A

Opening and closing the cap without inhaling a dose will waste medication and damage your inhaler

107
Q

Budesonide (Pulmicort Respules) Ampules should be used within ___ of opening the aluminum package

A

2 weeks

108
Q

Which inhaler should not be washed?

A

Advair Diskus (fluticasone/salmeterol)

NAPLEX 2024 (74 decks)

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