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NAPLEX STUDY > Asthma, COPD, smoking cessation > Flashcards

Asthma, COPD, smoking cessation Flashcards

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1
Q

Drugs that can cause PAH

A

cocaine
SSRI use during pregnancy (increase the risk of persistent PPHN)
weight loss drugs
methamphetamines/amphetamines

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2
Q

diagnosis

A

right heart catheterization is required to confirm PAH

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3
Q

Responder

A

-if MAP falls by at least 10 mmHg
-initially treated with CCB such as nifedipine, diltiazem, and amlodipine

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4
Q

non-responder

A

-prostacyclin analogs and receptor agonists
-endothelin receptor antagonists
-PDE-5 inhibitors
-soluble guanylate cyclase (sGC) stimulator

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5
Q

Prostacyclin analogs and receptor agonists

A

epoprostenol (Flolan, Velteri)
-continuous IV infusion
-vasodilation reactions (hypotension, flushing)
-risk of sepsis and blood stream infections from chronic infusions
-potent vasodilator; avoid interruption and sudden large dose reductions
-protect from light

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6
Q

Endothelian receptor antagonists

A

-bosenten, ambrisentan
-REMS: teratogenic and must have a negative pregnancy test before initiation and monthly thereafter
-hepatotoxicity with bosentan

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7
Q

PDE-5 inhibitors (PAH)

A

-Sildenafil (Revatio), Tadalafil (Adcirca)
-contraindication: use with nitrates and riociguat
-hearing loss, vision loss, hypotension, priapism

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8
Q

soluble guanylate cyclase stimulator

A

-riociguat (adempas)
-REMS: teratogenic and must have a negative pregnancy test before initiation and monthly thereafter
-contraindications: use with PDE-5 inhibitors
-hypotension

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9
Q

drugs that can cause pulmonary fibrosis

A

amiodarone/dronedarone
bleomycin
busulfan
carmustine
lomustine

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10
Q

FEV1

A

how much air can be forcefully exhaled in one second

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11
Q

FVC

A

after taking a deep breath, the maximum volume of air that is exhaled

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12
Q

FEV1/FVC

A

the percentage of air capacity that can be forcefully echaled in one second

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13
Q

asthma relievers

A

low-dose ICS + formoterol
inhaled SABA
systemic steroids
inhaled epi
inhaled SAMA

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14
Q

asthma controllers

A

ICS (first line for all patients)
LABAs (only to be used in combo)
oral leukotriene receptor antagonists (LTRAs)
theophylline (serum conc monitoring)
LAMAs
mAbs

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15
Q

Asthma: step 1: symptoms < 2x/month

A

PRN ICS + formoterol or SABA + low dose ICS

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16
Q

Asthma: step 2: symptoms or need for SABA > 2x/month

A

Rescue: PRN ICS + formoterol OR SABA w/ controller
Controller: low dose ICS

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17
Q

Asthma: step 3: symptoms on most days or waking at night > 1x/week

A

1: low dose ICS-formoterol (as rescue and controller)
2. SABA + low-dose ICS-LABA

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18
Q

Asthma: step 4: symptoms daily, waking at night > 1x a week, or initial presentation is with an exacerbation

A
  1. low dose ICS-formoterol + medium dose ICS-formoterol
  2. SABA + medium dose ICS-LABA`
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19
Q

Asthma: step 5

A
  1. low dose ICS-formoterol + high-dose ICS-formoterol
  2. SABA + high dose ICS-LABA
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20
Q

Asthma: SABA

A

albuterol (ProAir HFA)
-MDI/DPI
-nebs
-PO
-nervousness, tremor, tachycardia, palpitations, cough, hyperglycemia, decrease K

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21
Q

Asthma: ICS Inhalers

A

Salmeterol (serevent diskus), beclomethasone (QVAR Redihaler)
Budesonie (Pulmicort)
Budesonide + formoterol (symbicort)
Fluticasone (Flovent HFA/Diskus, Annuity)
Fluticasone + salmoterol (Advair Diskus)
Fluticasone + vilanterol (Breo Ellipta)
Mometasone + formoterol (Dulera)

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22
Q

Asthma: ICS

A

-increased risk of asthma-related events
-increased risk of hospitalizations in pediatric and adolescent patients
-dysphonia, oral candidiasis, cough
-rinse mouth

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23
Q

Controller inhalers: ICS

A

Asthma: Beclomethasone, Budesonide, Fluticasone
COPD: no single agent is FDA approved

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24
Q

Controller inhalers: LABA

A

Asthma and COPD: Salmeterol (Serevent Diskus)

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25
Controller inhalers: LAMA
Asthma and COPD: tiotropium (sprivia respimat)
26
Controller inhalers: ICS/LABA
Asthma and COPD: symbicort, advair diskus, and breo ellipta Asthma only: mometasone/formoterol (Dulera)
27
Controller inhalers: LAMA/LABA
Asthma: no FDA approval combination COPD: anoro, stiolto, bevsi
28
Controller inhalers: LAMA/LABA/ICS
asthma and COPD: trelegy ellipta (umeclidinium/vilanterol/fluticasone)
29
MDIs
-HFAs, respimat, or no suffix -aerolized liquid -slow deep inhalation while pressing the canister -a spacer can be used -all products require shaking prior to use -priming required before first use and if has not been used in a long time
30
DPIs
-diskus, ellipta, pressair, handihaler -fine powder -quick, forceful inhalation -spacer cannot be used -do not shake -no need for priming unless it is flexhaler
31
LTRA: Montelukast
-dosed in the evening -boxed warning for neuropsychiatric events -granules can be mixed with food, breast milk/formula
32
Theophylline
-loading dose based on IBW -the therapeutic range is 5-15 mcg/mL (measuring peak levels at steady state, after 3 days of oral dosing) -converting aminophylline to theophylline * 0.8; to convert theophylline to aminophylline, divide by 0.8 -has saturable kinetics (first order > zero order)
33
Omalizumab (Xolair)
-inhibits IgE binding -for moderate-severe persistent allergic asthma in patients > 6 -initiated in a healthcare setting under medical supervision -administered every 2-4 weeks
34
interleukin receptor antagonists
-mepolizumab, reslizumab, and benralizumab (IL-5 receptor antagonists) -Dupixent (IL-4 and IL-3 receptor antagonist)
35
exercised induced bronchospasm
SABA or low-dose ICS+formoterol taken 5-15 min before exercises
36
COPD GOLD
GOLD 1: mild; FEV1 > 80% GOLD 2: moderate; 50% < FEV1 < 80% GOLD 3: severe; 30% < FEV1 < 50% GOLD 4: very severe; FEV1 < 30%
37
COPD: Group A
CAT < 10 mMRC 0-1 0-1 exacerbations leading to hospitalization
38
COPD: Group B
CAT > 10 mMRC > 2 0-1 exacerbations leading to hospitalization
39
COPD: Group C
CAT < 10 mMRC 0-1 > 2 or > 1 exacerbation leading to hospitalization
40
COPD: Group D
CAT > 10 mMRC > 2> 2 or > 1 exacerbation leading to hospitalization
41
COPD Group A treatment
-bronchodilator: SABA PRN or SAMA PRN -LABA or LAMA
42
COPD Group B treatment
LAMA or LABA
43
COPD Group C treatment
LAMA
44
COPD Group D treatment
LAMA or LAMA + LABA (if highly symptomatic) or LABA + ICS (if eosinophils > 300 cells)
45
COPD: SAMA inhalers
-ipratropium bromide (atrovent) +/- albuterol (combivent respimat)
46
COPD: LAMA
-tiotropium (spirivia handihaler/respimat)
47
COPD: LABA
-salmeterol (serevent diskus) +/- fluticasone (advair diskus) -formoterol +/- budesonide (symbicort) -vilanterol + fluticasone (breo)
48
COPD: PD4 inhibitor
Roflumilast (Daliresp) -CI: moderate-severe liver impairment -diarrhea and weight loss
49
pack year smoking hx
= cigarette packs/day x number of years smoked
50
Nicotine patch (NicoDerm CQ)
initial dose based on the # of cigarettes smoked/day
51
Nicotine gum (Nicorette) and Nicotine lozenges (nicorette mini)
initial dose based on timing of the first cigarette smoked upon waking
52
NRT
-avoid in immediate post MI, arrhythmias, severe angina and pregnancy -insomina, headache dizziness -patch: vivid dreams -combination with patch + gum/lozenge is most effective -gum/lozenge: can delay/reduce weight gain, do not eat/drink 15 min before or during use
53
nicotine patch initial dosing: > 10 cigarettes/day
21 mg x 6 weeks then 14 mg x2 weeks then 7 mg x2 weeks
54
nicotine patch initial dosing: < 10 cigarettes/day
14 g x6 weeks then 7 mg x2 weeks
55
nicotine gum/lozenge initial dosing: first cigarette < 30 min upon waking
4 mg Q1-2H x6 weeks then 4 mg Q2-4H x3 weeks then 4 mg Q4-8H x3 weeks
56
nicotine gum/lozenge initial dosing: first cigarette > 30 min upon waking
2 mg Q1-2H x6 weeks then 2 mg Q2-4H x3 weeks then 2 mg Q4-8H x3 weeks
57
Bupropion SR (Zyban)
-start 1 week before the quit date -boxed warning: suicidal thinking and behavior in children, adolescents, and young adults -CI: seizure disorder, anorexia/bulimia, use of MAOi, linezolid or IV methylene blue
58
Varenicline (Chantix)
-start 1 week before the quit date -serious neuropsychiatric events -nausea, insomnia, abnormal dreams, HA
59
smoking cessation patient and they are worried about weight gain
gum, lozenge and bupropion
60
smoking cessation and they have depression
buproprion
61
smoking cessation and they suffer from seziures
do not use bupropion and varenicline
62
Patch and vivid dreams
can remove patch at bedtime (16 hours)

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