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NAPLEX 21 > Asthma > Flashcards

Asthma Flashcards

1
Q

An asthma diagnosis is confirmed with _______ and pulmonary function tests

A

spirometry

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2
Q

How do you know if someone’s asthma is reversible?

A

when a patient tests their baseline, and then tests for reversibility by using a short acting dilator - if the FEV1 increases by more than 12% with the use of a bronchodilator

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3
Q

FEV1, FVC, or FEV1/FVC

How much air can be forcefully exhaled in one second

A

FEV1

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4
Q

FEV1, FVC, or FEV1/FVC

After taking a deep breath, the maximum volume of air that is exhaled (how much air is exhaled)

A

FVC

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5
Q

FEV1, FVC, or FEV1/FVC

The percentage of total air capacity (“Vital capacity”) that can be forcefully exhaled in one second (the speed of the exhale)

A

FEV1/FVC

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6
Q

What classification of asthma?

Daytime symptoms <2days/week
SABA rescue inhaler use <2 days/week

A

intermittent

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7
Q

What classification of asthma?

Daytime symptoms >2 days/week but not daily
SABA rescue inhaler use >2 days/week but not daily or >1x/day

A

mild

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8
Q

What classification of asthma?

Daytime symptoms daily
SABA rescue inhaler use daily

A

moderate

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9
Q

What classification of asthma?

Daytime symptoms - throughout the day
SABA rescue inhaler use - several times per day

A

severe

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10
Q

What do you do at each visit with the patient?

A

confirm appropriate inhaler technique

technique, priming, and cleaning

review asthma action plan

assess, step up, maintain, or step down treatment

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11
Q

What vaccines are recommended in patient with asthma?

A

annual influenza vaccine
age 2-62 = Pneumavax 23

*Prevnar 13 only if the child is not between the age of 6-18 years who require high dose oral steroids

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12
Q

When is it considered “frequent” use of an inhaler and know its time to reassess asthma control

A

using SABA >2x/week

If an ICS + formeterol is used as the rescue inhaler, worsening asthma control is indicated by the frequency of symptoms

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13
Q

What is the mainstay of treatment in asthma?

A

ICS!!!

doses are categorized as low medium or high

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14
Q

What rescue drug?

used as needed for acute asthma symptoms
combination proven to have reduced exacerbations over SABA alone

A

inhaled low dose ICS+formeterol

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15
Q

What rescue drug?

used as needed for acute asthma symptoms
quick reverse bronchoconstriction

A

inhaled SABA

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16
Q

What rescue drug?

ORAL, used during exacerbations or for severe asthma

A

systemic steroids

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17
Q

What is the first line maintenance drug in presistent asthma?

A

inhaled corticosteroids

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18
Q

What maintenance drug?

used in combination with ICS (should NEVER be used alone)
preferred added on agents to ICS

A

inhaled LABAs

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19
Q

What maintenance drug?

most commonly used in children
alternative option to LABA in combination to ICS, can also be added to ICS/LABA

A

oral leukotriene receptors antagonists (LTRAs)

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20
Q

What maintenance drug?

LEAST desirable add on treatment due to significant adverse effects – monitor serum drug concentrations

A

theophylline for oral or IV

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21
Q

What maintenance drug?

can be used as add on treatment in patients with a history of exacerbations despite ICS/LABA treatment

A

LAMA

aka inhaled anticholinergics

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22
Q

What is the name of the maintenance drug that is an injectable MAb? (SC or IV)

A

omalizumab for severe allergic asthma

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23
Q

STEP 1 of the treatment step based on asthma severity

patient has intermittent asthma - what is prescribed?

A

as needed low-dose ICS + formeterol

OR

low dose ICS taken whenever SABA is taken

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24
Q

STEP 2 of the treatment step based on asthma severity

patient has mild asthma - what is prescribed/changed?

A

from step 1: ADD AN ICS CONTROLLER —-

Daily low dose ICS

or

as needed low dose ICS + formeterol (used as the reliever if that combination is also used for maintenance. if a different LABA is used for maintenance, then a SABA would be used as the reliever)

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25
Q

STEP 3 of the treatment step based on asthma severity

patient has moderate asthma - what is prescribed/changed?

A

from step 2: ADD A LABA OR DAILY DOSING

Low dose ICS + LABA (used as the reliever if that combination is also used for maintenance. if a different LABA is used for maintenance, then a SABA would be used as the reliever)

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26
Q

STEP 4 of the treatment step based on asthma severity

patient has severe asthma - what is prescribed/changed?

A

from step 3: INCREASE ICS DOSE

medium dose ICS + LABA

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27
Q

a patient is still having considerable symptoms after completing step 4. what do you do?

A

INCREASE ICS DOSE

high dose ICS+LABA, refer for further assessment

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28
Q

______ are used as part of maintenance therapy beginning in stem 3 of treatment and only in combination with an ICS

A

LABA

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29
Q

What are some SABAs?

A

albuterol (ProAir HFA, ProAir RespiClick, Prevonteil HDA, Ventolin HFA) 90mcg/inh

Levalbuterol (Xopenex)

*racepinephrine should not be used because it is non-selective

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30
Q

What is the dosing for albuterol?

A

MDI/DPI: 1-2 inhalations every 4-6 hours as needed

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31
Q

What common side effects of SABAs?

A

nervousness

tremor

tachycardia

palpitations

cough

hyperglycemia

LOW POTASSIUM

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32
Q

Most albuterol inhalers contain 200inh/canister, the exception is ____________ which is available as both 200 and 60inh/canister

A

Ventolin HFA

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33
Q

For EIB, use 2 inhalations ____ mins prior to exercise

A

5 minutes

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34
Q

Salmeterol (Serevent Diskus)

A

LABA

*also used in COPD

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35
Q

Brand: QVAR redihaler

A

generic: beclomethasone

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36
Q

Brand: Pulmicort Flexhaler

A

generic: budesonide

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37
Q

Brand: Pulmicort respules

A

generic: budesonide (nebulizer)

38
Q

Brand: Flovent HFA

A

generic: fluticasone

39
Q

Brand: Flovent Diskus

A

generic: fluticasone

40
Q

Brand: Arnuity Ellipta

A

generic: fluticasone

41
Q

Brand: Advair Diskus

A

generic: fluticasone + salmeterol

42
Q

Brand: Advair HFA

A

generic: fluticasone + salmeterol

43
Q

Brand: Breo Ellipta

A

generic: fluticasone + villanterol

44
Q

Brand: Dulera

A

generic: mometasone + formeterol

45
Q

Beclomethasone (QVAR redihaler)

Budesonide (Pulmicort flexhaler)

Fluticasone (Flovent HFA, Flovent Diskus, Arnuity Ellipta)

A

inhaled corticosteroids

uses- asthma; not single ICS product is FDA approved for COPD

46
Q

_________ are used as needed in combinations with formeterol for rescue treatment for acute symptoms, and individually or in combination with a LABA for maintenance/controller treatment

A

inhaled corticosteroids

47
Q

What are side effects of ICS?

A

dysphonia (difficulty speaking)

oral candidiasis – RINSE!!!! (spacer with an MDI can be helpful too)

cough

48
Q

________ an MDI that does NOT need to be shaken before use

A

Alvesco (ciclesonide)

49
Q

What is the only ICS available as a nebulizer solution?

A

budesonide (pulmicort respules)

50
Q

breath activated aerosol with characteristics of a DPI and MDI, do not shake or use with a spacer

A

QVAR redihaler

51
Q

What are the preferred combos in asthma vs the preferred combos in COPD?

A

asthma - ICS and ICS/LABA

COPD - LABA, LAMA, LAMA/LABA

52
Q

Tiotropium (Spirivia Respimat)

A

LAMA - used in asthma

tiotropium ( Spiriva Handihaler, spirivia Respimat) - used in COPD

53
Q

Budesonide/formeterol (Symbicort)

Fluticasone/salmeterol (Advair Diskus, Advair HFA)

Mometasone/formoterol (Dulera)

Fluticasone/vilanterol (Breo Ellipta)

A

ICS/LABA

Symbicort, Advair Diskus, Breo Ellipta – used in COPD

54
Q

Key differences between MDIs and DPIs –

HFA, Respimat, or no suffix (ex: Alvesco)

55
Q

Key differences between MDIs and DPIs –

Diskus, Ellipta, Pressair, Handihaler, Neohaler, Respiclick, Flexhaler

56
Q

Key differences between MDIs and DPIs –

dose delivery is aerosolized liquid

57
Q

Key differences between MDIs and DPIs –

dose delivery is fine powder

58
Q

Key differences between MDIs and DPIs –

some use a propellent (HFA)

A

MDI

DPI – NO PROPELLENT

59
Q

Key differences between MDIs and DPIs –

administration is a slow deep breath while pressing the canister

60
Q

Key differences between MDIs and DPIs –

administration is quick, forceful - breath activated devices

61
Q

Key differences between MDIs and DPIs –

spacer can be used

A

MDI

spacer CANNOT be used in a DPI

62
Q

Key differences between MDIs and DPIs –

shaking is required for majority except for QVAR redihaler, Alvesco, and Respimat products

A

MDI

DO NOT SHAKE DPI

63
Q

Key differences between MDIs and DPIs –

Priming is done before first use and if not used for a certain period of time

A

MDI

priming is not needed for DPI except for Flexhaler (prior to first use)

64
Q

Montelukast dose in ages 6-14 years

A

5mg daily in the evening

65
Q

Montelukast dose in ages 1-5 years

A

4mg daily in the evening

66
Q

What is the boxed warning for montelukast?

A

neuropsychiatric events (aggressive, signs of suicidal thoughts)

67
Q

What dosage forms does montelukast come in?

A

tablet

chewable

packet

granules can be administered directly in the mouth, dissolved in breast milk or formula, or applesauce, carrots or rice or ice cream

68
Q

_______ blocks phosphodiesterase, causing an increase in cyclic adenosine monophosphate (cAMP)

A

Theophylline

active metabolites are caffeine and 3-methylxanthine

69
Q

Brand: Xolair

A

generic: omalizumab

SC – anaphylaxis

70
Q

What are mepolizumab (SC), reslizumab (IV - BBW anaphylaxis) and benralizumab (SC q 8 weeks)

A

IL 5 receptor antagonists

71
Q

What is dupilmuab?

A

an IL4 and IL5 receptor antagonist

72
Q

What is the preferred treatment for most EIB?

A

SABAs or low dose ICS + formeterol

5-15 minutes before exercise (effects last 2-3 hours)

73
Q

What is used for asthma control in pregnancy?

A

an ICS should be continued - budesonide is preferred

74
Q

A patient with good asthma control, how long should their albuterol inhaler last?

A

12 months (3-4 months with Ventolin HFA 60inh)

75
Q

What maintenance inhaler?

1 inhalation BID

30 day supply

A

Advair Diskus

76
Q

What maintenance inhaler?

1-2 inhalations BID

30 day supply

A

QVAR redihaler

77
Q

What maintenance inhaler?

2 inhalations daily

30 day supply

A

Asmanex Twisthaler

78
Q

What SABA rescue inhaler?

2 inhalations per dose, used twice daily (4inh/week)

A

albuterol MDI - 50 week supply

Ventolin HFA - 15 week supply

79
Q

If prescribed >1 inhalation of medication at a time, a patient should wait ________ between each dose

A

60 seconds

80
Q

What is the order in which someone with 3 inhalers should do?

A

SABA first

LABA or LAMA second

ICS last

81
Q

Spacers are helpful for children and anyone that has difficulty with hand-breath coordination with an ______.

A

MDI

AeroChamber

OptiHaler

OptiChamber

82
Q

What is the yellow zone of an asthma action plan?

A

50-80% of persona best - “caution”

would require intervention

83
Q

What is the red zone?

A

<50% indicates a medical alert

emergency department

84
Q

What inhaler?

  • shake for 5 seconds before each spray
  • spray 4 times away from the face
  • prime again if >14 days from last use or if dropped
A

Ventolin HFA, ProAir HFA

BREATHE IN SLOW & hold breath for 10 seconds

clean at least weekly with water, air dry

85
Q

What inhaler?

  • shake for 5 seconds before each spray
  • spray 4 times away from the face
  • prime again with 1 spray if >7 days from last use or if dropped
86
Q

What inhaler do you not put in water?

A

Symbicort, Dulera

87
Q

What DPI?

breathe in quickly and deeply, do not breathe through nose
rinse mouth after use
this is the purple one that you hold like a burger and slide the open piece

A

Fluticasone/salmeterol (Advair diskus)

88
Q

What DPI?

breathe in quickly and deeply, do not breathe through nose
rinse mouth after use
twist the cap off, you’ll hear a click noise

A

Budesonide (Pulmicort Flexhaler)

89
Q

What inhaler?

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

A

Albuterol ProAir Respiclick,

fluticasone/salmterol (AirDuo respiclick) *rinse mouth

90
Q

What inhaler?

store upright protected from light, at room temp

ampules should be used within TWO WEEKS of opening the package

A

budesonide (Pulimicort Respules)

mouth still has to be rinsed and spit out after each dose

NAPLEX 21 (60 decks)

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