Asthma:

Question 1

Goal of treatment for asthma:

Answer 1

1. reverse bronchial obstruction
2. reverse/prevent wheezing
3. have minimal SE to drugs

*For pediatric patients, the goal is to be able to participate in normal activities (gym class, recess, etc).

Question 2

Initial treatment for asthma

Answer 2

Step 1: Bronchodilator (SABA).
Albuterol PRN

Question 3

Treatment for persistent mild asthma

Answer 3

Albuterol PRN
+ Inhaled corticosteroid (fluticasone budesonide)
OR

+leukotriene antagonist (Singulair)

Question 4

Examples of LABAs

Answer 4

Long acting bronchodilators. Example advair (fluticasone), Dulera (mom/form), Symbicort

• do not add a LABA without patient taking ICS or have it be a combo LABA (dulera, Symbicort)

Question 5

Examples of leukotriene antagonists

Answer 5

Singulair

Question 6

Treatment for EIA

Answer 6

leukotriene antagonists

Question 7

Monitor _______ with leukotriene antagonists

Answer 7

Neuropsychiatric events

Question 8

Treatment for acute asthma exacerbation

Answer 8

1. IV steriods
2. Mg sulfate
3. oxygen

Question 9

Explain the SMART trial

Answer 9

The SMART trial found that respiratory deaths increased in the population of asthma patients receiving salmeterol verses placebo.
*Study terminated early due to findings.
*LABA should NEVER be prescribed in mono therapy for asthma. LABA +

Question 10

Albuterol

Answer 10

First line for Asthma & COPD because it has fewer cardiac ADRs

Question 11

Spiriva

Answer 11

anticholinergic medication used for pt’s with emphesema and COPD.
“Take everyday no matter how you feel!”

bronchial smooth muscle relaxation

Question 12

Treatment for acute COPD exacerbation

Answer 12

Steriod
short term vs long term abx

Question 13

Theophylline

Answer 13

Used 2nd/3rd line for COPD. reduce exacerbations and hospitalizations

*can be used to treat apnea in premature infants

Question 14

contraindications to SABA/LABA

Answer 14

1. cardiac arrhythmias
   2.diabetes

Question 15

Rare allergic reactions, especially in pt’s allergic to soybeans, legumes in what medication:

Answer 15

Inhaled anticholinergics
(tiotropium bromide- Spiriva)

Question 16

ADR of theophylline

Answer 16

Toxic at levels greater than 20mcg. Seizures.
ADR: irritable, restlessness, insomnia, reflux, heartburn

Question 17

Contraindications for corticosteriods

Answer 17

Cushing’s syndrome, pregnancy, herpes, TB

Question 18

Step up therapy for asthma should occur if:

Answer 18

Breathing not controlled and using rescue inhaler 2 or more days/week.
Can step up and down.

Question 19

Asthma drug of choice for pregnancy

Answer 19

Beta agonists (SABA, LABA)

Question 20

How to diagnose COPD

Answer 20

Force expiratory volume (FEV1) and forced vital capacity (FVC) is less than 70%

Question 21

COPD antibiotics

Answer 21

Typically amoxicillin-clavulanic

Question 22

COPD pneumococcal vaccine ever _____ years

Answer 22

6 years, regardless of age

Question 23

Generations of antihistamines

Answer 23

1st generation- benadryl
ADR: Drowsiness
2nd generation- non sedating. Fexofenadine, loratadine, Zyrtec
ADR: Dry mouth

Question 24

most common pathogen of pneumonia

Answer 24

strep pneumonia
*resolution of fever after 2-4 days of abx.

Question 25

CAP treatment

Answer 25

1. healthy adult with no risk factors: oral macrolide (azithromycin)

2.adults with comorbidities or risk of drug resistance: Fluoroquinolone (levofloxacin)

3.adults over 60 with comorbidities: ceftriaxone 1g daily IV or IM

*pregnancy: Azithromycin

Question 26

Infants 4-16 weeks with pneumonia

Answer 26

Consider chlamydial pneumonia (tx azithromycin)