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NAPLEX > Asthma, COPD, Cystic Fibrosis > Flashcards

Asthma, COPD, Cystic Fibrosis Flashcards

1
Q

FEV1

A

How much air can be forcefully exhaled in one second

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2
Q

FVC

A

the maximum volume of air exhaled after taking a deep breath

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3
Q

FEV1/FVC

A

The % of total air capacity that can be forcefully exhaled in one second

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4
Q

Asthma diagnostic criteria

A

1.) measure baseline FEV1 with spirometry
2.) give albuterol
3.)Measure post-bronchodilator FEV1

FEV1 increase > 12% = asthma

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5
Q

Asthma guidelines

A

GINA
Global Initiative for Asthma

NHLBIs Expect Panel Report (EPR)

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6
Q

initial asthma treatment

A

based on frequency of daytime and nighttime symptoms

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7
Q

Symptoms of Step 1 initial asthma treatment

A

Day: less than 2x a month
Night: none

PRN low-dose ICS-formoterol or SABA + ICS together

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8
Q

Symptoms of Step 2 initial asthma treatment

A

Day: more than 2 times a month but less than 4 - 5 days a week
Night: None

Same as step 1 (except SABA taken alone) plus the option of maintenance low-dose ICS

*LTRA or low-dose ICS whenever SABA taken

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9
Q

Symptoms of Step 3 initial asthma treatment

A

Day: Most days
Night: 1 or more times a week

Same as step 2 but maintenance can also include a low-dose ICS LABA

*low dose-ICS + LTRA or medium dose ICS

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10
Q

Symptoms of Step 4 initial asthma treatment

A

Day: daily
Night: 1 or more times a week

Same PRN, maintenance is a medium-dose ICS formoterol or medium dose ICS LABA

*High-dose ICS or add on tiotropium or LTRA

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11
Q

Step 5

A

Same PRN
High dose ICS-formoterol
High dose ICS-LABA

*add tiotropium, oral steroids, or injectable treatments: omalizumab, mepolizumab, reslizumab, and tezepelumab

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12
Q

Well controlled asthma

A

no daytime symptoms, no awakenings, SABA used less than twice a week, no activity limited

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13
Q

Partially controlled astha

A

1-2 asthma control questions answered with a yes
-step up 1 step

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14
Q

Uncontrolled asthma

A

3-4 asthma control questions answered with a yes
-step up 1 to 2 steps
-consider short course of oral steroids

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15
Q

Side effects of Beta-2 agonists

A

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

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16
Q

Black Box Warning on LABAs (salmeterol/ formoterol)

A

increased risk of asthma related deaths
-only used in combination with a ICS
-increased risk of asthma related hospitalization in pediatric and adolescent patients

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17
Q

Brand of beclomethasone

A

QVAR RediHaler

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18
Q

Brand of Budesonide

A

Pulmicort Flexhaler

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19
Q

Brand of Budesonide + formoterol

A

Symbicort

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20
Q

Brand name of fluticasone

A

Flovent HFA
Flovent Diskus
Arnuity Ellipta

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21
Q

Brane of Fluticasone + Salmeterol

A

Advair Diskus
Advair HFA

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22
Q

Brand of fluticasone + vilanterol

A

Breo Ellipta

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23
Q

brand of mometasone

A

Asmanex HFA

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24
Q

ICS Maintenance Inhalers preferred in Asthma

A

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

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25
Q

DPIs Name description

A

Diskus
Ellipta
Press air
HandiHaler
RespiClick
Flexhaler

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26
Q

MDIs Brand identifiers

A

HFA, Respimat, or no suffix (Symbicort, Dulera)

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27
Q

Shake MDIs prior to use except for which products?

A

QVAR Redihalr
Alvesco
Respimat products

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28
Q

Order of Use of Inhalers

A

SABA—> LABA or LAMA —> ICS
*always waiting 60 seconds in between each

29
Q

MOA of theophylline

A

blocks phosphodiesterase causing an increase in cAMP and release of EPI from adrenal medulla cells

Result: bronchodilation, diuresis, CNS and cardiac stimulation

30
Q

Therapeutic range of theophyllin

A

5 - 15 mcg/mL

*measure peak level at steady state after 3 days or oral dosing

31
Q

Converting aminophylline to theophylline

A

multiply by 0.8 or divide by 0.8 to get to aminophylline

32
Q

That order of kinetics does theophylline follow?

A

saturable kinetics
-starts as first order then zero order
-small dose increases can result in large increases in concentration

33
Q

Brand of levalbuterol

A

Xopenex

*r-isomer of albuterol

34
Q

Calculating oral loading dose of theophylline

A

5mg/kg IBW

*or TBW if IBW is less

Maintenance dose = 300 - 600mg daily

35
Q

Theophylline is a substrate of which enzyme?

A

CYP1A2

inhibitors:
-Cimetidine
-Ciprofloxacin
-fluvoxamine
-propranolol
-ziluetin

CYP3A4 inhibitors:
-clarithromycin and erythromycin

Others that will increase levels:
-zafirlukast
-alcohol
-allopurinol
-disulfiram
-estrogen-containing oral contraceptives
-methotrexate

36
Q

Drugs that decrease the level of theophylline

A

CYP3A4 inducers:
-carbamazepine
-fosphenytoin
-phenobarbital
-phenytoin
-primidone
-rifampin
-ritonavir
-levothyroxine
-st. john’s wort
-smoking

*Also, low carb, high protein diet

37
Q

What do anticholinergics due in asthma management?

A

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

Simpler terms: cause bronchodilation by blocking the constricting action of acetylcholine at M3 muscarinic receptor in bronchial smooth muscle

38
Q

short acting anticholinergics

A

ipratropium
-used in combination with SABAs in hospitalizations

39
Q

Long acting anticholinergic
(Muscarinic antagonists)

A

Spiriva Respimat (tiotropium)
-FDA approved in ages 6 or older with history of asthma exacerbations despite ICS/LABA therapy
-Not used alone in asthma! (add on with ICS)

40
Q

Omalizumab (Xolair)

A

-monoclonal antibody
-inhibits IgE binding (Receptor on mast and basophil cells)
-for moderate-severe allergic asthma
-6 years and up
-positive skin test to perennial aeroallergen + inadequate control with step 5

41
Q

Interleukin Receptor Antagonists

A

-Interleukin = cytokine responsible for eosinophils which are associated with inflammation and the cause of some types of asthma

*Monoclonal antibodies are used to inhibit interleukin from binding to receptors

42
Q

Monoclonal antibodies that inhibit interleukin

A

Mepolizumab (Nucala)
-6 and up
Reslizumab (Cinqair)
-boxed warning for anaphylaxis
-adults only
Benralizumab (Fasenra)
-12 and up
-doses every 4 weeks x 3 then every 8 weeks
Dupilumab (Dupixent)
-12 and up every 2 weeks

43
Q

Emphysema

A

destruction of the small passages in the lungs (alveoli)

44
Q

Bronchitis

A

inflammation and narrowing of the bronchial tubes which results in mucus production and a chronic cough

45
Q

Alpha-1 antitrypsin (AAT) deficiency

A

these people are at a higher risk of developing COPD since AAT helps to protect lungs from inflammation

46
Q

What FEV1/FVC confirms a diagnosis of COPD?

A

a post bronchodilator FEV1/FVC less than 0.70 confirms a diagnosis of COPD

47
Q

GOLD 1

A

Mild severity COPD
FEV1 80% or better

48
Q

GOLD 2

A

Moderate COPD
-between 50 and 80% predicted FEV1

49
Q

GOLD 3

A

Severe COPD
between 30 and 50% predicted FEV1

50
Q

GOLD 4

A

Very severe COPD
FEV1 less than 30% predicted

51
Q

Does atrovent HFA need to be shaken?

A

LAMA
-Do not shake

52
Q

Two commonly used COPD symptom assessment tests

A

Modified British Medical Research Council (mMRC) dyspnea scale
-asses breathlessness (0-4)
COPD Assessment Test (CAT)
-comprehensive assessment (0-40)

53
Q

Group A COPD

A

0-1 moderate exacerbation
-no hospitalization
-CAT less than 10
-mMRC 0-1

Treatment: Bronchodilator

54
Q

Moderate COPD exacerbation

A

requires treatment with an oral steroid and possibly an antibiotic

55
Q

Group B COPD

A

0-1 moderate exacerbation
-no hospitalizations
-CAT greater than 10
-mMRC greater than 2

Treatment: LAMA+LABA

56
Q

Group E COPD

A

2 or more moderate exacerbations
1 or more hospitalization

Treatment: LAMA + LABA
*if blood eosinophil >300 consider LABA + LAMA + ICS

57
Q

Adverse effects of ICS

A

-pneumonia
-oral candidiasis
-hoarse voice

58
Q

Theophylline in COPD

A

-not recommended unless LABA not available

59
Q

roflumilast

A

-phosphodiesterase-4 inhibitor
-used in the most severe patients

C/I: moderate to severe liver impairment

Side effects: diarrhea and weight loss

60
Q

When should antibiotics be used in COPD?

A

-increased sputum purulence
-increased sputum volume
-increased dyspnea
-mechanical ventilation required

61
Q

Atrovent HFA

A

Ipratropium bromide
-SAMA
MDI: 2 inhalations QID

62
Q

Combivent Respimat

A

Ipratropium + albuterol
-SAMA + SABA
MDI: 1 inhalation QID

63
Q

Tiotropium

A

Spiriva HandiHaler and Respimat
-LAMA
DPI: requires two puffs
MDI: 2 inhalations daily

64
Q

Tudorza Pressair

A

Aclidinium
-LAMA
DPI: 1 inhalation BID

65
Q

Breztri Aerosphere

A

Glycopyrrolate + formoterol + budesonide
LAMA + LABA + ICS

66
Q

Trelegy Ellipta

A

Umeclidinium (Incruse ellipta)
+ Vilatnerol + Fluticasone
LAMA + LABA + ICS
DPI: 1 inhalation once daily

67
Q

Formoterol

A

LABA
Perforomist (nebulizer)

68
Q

Vilanterol

A

LABA
-only available in combination products (Breo, Trelegy, Anoro)

NAPLEX (7 decks)

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