Asthma

Question 1

Classic symptoms

Answer 1

wheezing
breathlessness
chest tightness
coughing

Question 2

Asthma is reversible (t/f)

Answer 2

TRUE

Question 3

Factors used to assess severity of asthma

Answer 3

Daytime symptoms
nighttime symptoms
rescue inhaler use
FEV1 and FVC
Exacerbation hx

Question 4

Recommended vaccines in asthma pts

Answer 4

annual influenza (> 6 mons)
PPSV 23; Prevnar x 1 (age 2- 64)

Question 5

What is considered frequent use of a rescue inhaler?

Answer 5

> 2 days/week

indicates worsening asthma control

Question 6

Treatment for mild persistent asthma

Answer 6

low dose ICS

Question 7

treatment for moderate persistent asthma

Answer 7

medium dose ICS

OR low dose ICS + LABA

Question 8

Side effects of beta-2 agonist

Answer 8

nervousness
tremor
tachycardia
palpitations
cough
hyperglycemia
hyperkalemia

Question 9

Levalbuterol is….

Answer 9

the R-isomer of albuterol

Question 10

Dose of SABA for exercise induced bronchospasm

Answer 10

2 inhalations 5 mins prior to exercise

Question 11

LABAs cannot be used alone in asthma, why?

Answer 11

Can incr the risk of asthma-related deaths if used alone

must be combined with ICS

Question 12

Role of ICS in asthma

Answer 12

anti-inflammatory effects
reduce hyperresponsiveness
block late phase reactants to allergens

Question 13

Side effects of ICS

Answer 13

Dysphonia
oral candidiasis
cough
headach 
hoarseness

Question 14

Which ICS is available as a nebulized solution?

Answer 14

Budesonide (available generic)

Question 15

high doses of prolonged ICS therapy can lead too…

Answer 15

adrenal suppression
incr risk of fracture
growth retardation in kids

Question 16

Only LABA approved for asthma

Answer 16

Salmeterol

1 inh BID

Question 17

Meter dose inhaler identifiers

Answer 17

HFA, Respimat, or no abbreviations

Question 18

Dry powder inhaler identifiers

Answer 18

Diskus, ellipta, pressair, neohaler, etc

Question 19

Most MDIs need to be shaken except for:

Answer 19

Qvar
Alvesco
Respimat products

Question 20

Montelukast brand

Answer 20

Singulair

Question 21

Singulair MOA

Answer 21

leukotriene receptor antagonist

leukotrienes mediate airway inflammation

Question 22

Pediatric dosing of singulair

1-5 y/o and 6-14

Answer 22

1-5 y/o: 4 mg qpm

6-14 y/o: 5 mg qpm

Question 23

Zafirlukast

Answer 23

Accolate

Leukotriene receptor antagonist

Question 24

Zileuton

Answer 24

Zyflo

inhibits leukotriene formation

Question 25

Zafirlukast metabolism

Answer 25

major substrate of 2C9 | moderate inhibitor of 2C9 (incr theophylline, warfarin, carvedilol, etc)

Question 26

Theophylline MOA

Answer 26

blocks phosphodiesterase --> incr cAMP --> bronchodilation

Question 27

side effects of theophylline

Answer 27

``` n/v HA incr HR insomnia tremor and nervousness ```

Question 28

therapeutic levels of theophylline

Answer 28

5-15 mcg/ml | measure peak level at steady state

Question 29

Active metabolites of theophylline

Answer 29

caffeine | 3-methylxanthine

Question 30

IV version of theophylline

Answer 30

aminophylline | contains 80% theophylline

Question 31

Theophylline metabolism

Answer 31

1A2 major substrate 3A4 minor substrate A LOT of drug interactions

Question 32

LAMA agent approved in asthma pts 6 or older that are not controlled on ICS/LABA

Answer 32

tiotropium (Spiriva)

Question 33

Xolair

Answer 33

omalizumab

Question 34

Xolair MOA

Answer 34

monoclonal antibody | inhibits IgE binding to mast cells

Question 35

Xolair indication

Answer 35

for mod-severe persistent allergic asthma

Question 36

Xolair dosing

Answer 36

dose and frequency is base on serum IgE levels and body weight ususally given q 2 or 4 weeks

Question 37

What class of agents are reserved for severe asthma with an eosinophilic phenotype?

Answer 37

interleukin-5 (IL-5) receptor antagonist

Question 38

IL-5 receptor antagonist:

Answer 38

Mepolizumab (Nucala) -subcutaneous Reslizumab (Cinqair) - IV (BBW for anaphylaxis)

Question 39

Singulair can also be used for exercised induced bronchospasm (t/f)

Answer 39

True take 2 hrs prior to exercise not as effective as SABA

Question 40

How long should a pt wait if they have to use 2 inhalations?

Answer 40

60 seconds

Question 41

Spacers can be used with all types of inhalers (t/f)

Answer 41

false only MDIs not DPIs

Question 42

When should pts use a peak flow meter?

Answer 42

Every day | every morning upon awakening and before using any meds

Question 43

When do pts need to prime albuterol inhalers?

Answer 43

new inhaler | > 14 days after from last use

Question 44

Breathing technique for MDIs

Answer 44

slowly and deeply

Question 45

Breathing technique for DPIs

Answer 45

quickly and deeply

Question 46

Common side effects of singulair

Answer 46

HA dizziness abdominal pain

Question 47

Singulair granules can be taken...

Answer 47

directly in the mouth dissolved in baby formula or breast milk with applesauce, mashed carrots, rice, ice cream