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Clinical Therapeutics > Asthma Quiz > Flashcards

Asthma Quiz Flashcards

1
Q

What are some examples of obstructive airway disorders?

A

Asthma, COPD

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2
Q

What type of disorder leads to a decrease in airflow?

A

Obstructive; Asthma and COPD

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3
Q

Which type of airway disorder has no change in volume of air the lungs hold?

A

Obstructive disorders; Asthma and COPD

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4
Q

What are examples of restrictive disorder?

A

Kyphosis, chest wall deformities, pleural effusions (TB, CHF), and sarcoid

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5
Q

What type of airway disorder has no change in airflow?

A

Restrictive disorders: kyphosis, chest wall deformities, pleural effusions (TB, CHF), and sarcoid

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6
Q

What type of airway disorder has a decrease in volume of air the lungs can hold?

A

Restrictive disorders; kyphosis, chest wall deformities, pleural effusions (TB, CHF), and sarcoid

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7
Q

How does asthma make it hard to breathe?

A

The muscles of bronchial tubes tighten and thicken, and the air passages become inflamed, and mucus-filled, making it difficult for air to move

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8
Q

What is a normal bronchial tube like?

A

The muscles around the bronchial tubes are relaxed and the tissue is thin, allowing for easy airflow

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9
Q

What type of airway disorder involves recurrent episodes of coughing (particularly at night or early am), wheezing, breathlessness and chest tightness?

A

Asthma

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10
Q

Asthmatic episodes

A

Usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment

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11
Q

How can you do an initial assessment for asthma?

A

FEV1 of >200mL AND >12% increase from baseline measure after SABA

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12
Q

What else can be present in the initial assessment for asthma?

A

Increased bronchial hyperresponsiveness, presence of other risk factors (atopic conditions), wheezing, coughing, chest tightness

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13
Q

What are some examples of atopic conditions?

A

Eczema, allergic rhinitis, etc.

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14
Q

What are inhaled allergens?

A

Pollen, cockroaches, animal dander, house dust mites, damp rooms-mold

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15
Q

What are inhaled irritants?

A

Perfumes, tobacco smoke, cleaning agents, airborne chemicals, wood burning stoves

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16
Q

What are the interleukin-5 antagonists?

A

Cinqair (Reslizumab) and Nucala (Mepolizumab)

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17
Q

What is the class of Xolair (Omalizumab)

A

Inhibits binding of IgE to the high-affinity IgE receptor on surface of mast cells and basophils

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18
Q

Which monoclonal antibody is indicated for 6+ years, mod-severe asthma, not controlled on ICS + skin test or perennial allergies

A

Xolair (Omalizumab)

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19
Q

Which two monoclonal antibodies have a boxed warning for anaphylaxis?

A

Xolair (Omalizumab) and Cinqair (Reslizumab)

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20
Q

Which monoclonal antibody has hypersensitivity anaphylaxis as a boxed warning?

A

Nucala (Mepolizumab)

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21
Q

Which monoclonal antibody is used for 18+ with severe asthma eosinophilia phenotype?

A

Cinqair (Reslizumab)

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22
Q

Which monoclonal antibody is used for 12+ severe asthma with an eosinophilia phenotype?

A

Nucala (Mepolizumab)

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23
Q

How do you reduce allergen exposure to animal dander?

A

Keep animals out of bedroom, seal (filter) air ducts leading to bedroom, HEPA filters

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24
Q

How do you reduce exposure to dust mites?

A

Reduce humidity to <50%, remove carpets if possible, wash bedding weekly (>130F), encase mattress, pillow, and box springs in an allergen impermeable cover

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25
Q

How do you reduce exposure to cockroaches?

A

Use poison bait or traps, do not leave food or garbage exposed

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26
Q

How do you reduce exposure to pollens and outdoor molds?

A

Use air conditioning, stay indoors when pollen counts are high

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27
Q

How do you reduce exposure to indoor molds?

A

Fix all water leaks, clean moldy surfaces, reduce humidity to <50%

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28
Q

What are some important triggers/exacerbating factors for asthma?

A

GERD, rhinitis, sulfite sensitivity, ASA/NSAIDs, menstrual cycles, BBs

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29
Q

What is the staging of asthma for EPR 1?

A

Mild asthma, moderate asthma, severe asthma

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30
Q

What is the staging of asthma for EPR 2?

A

Mild intermittent asthma, mild persistent asthma, moderate persistent asthma, severe persistent asthma

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31
Q

What is the staging of asthma for EPR3?

A

Intermittent asthma, mild persistent asthma, moderate persistent asthma, severe persistent asthma

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32
Q

The staging severity for asthma is based on what two factors?

A

Impairment and risk

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33
Q

Impairment

A

Frequency and intensity of symptoms, functional limitations, effect on quality of life

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34
Q

Risk

A

Future exacerbations, loss of pulmonary function, risk of adverse effects from meds

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35
Q

What is a peak flow meter?

A

Measures how well lungs are able to expel air (peak expiratory flow rate or PEAFR -L/min)

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36
Q

What is the clinical utility for a peak flow meter?

A

Early indicator for loss of control, may help pts identify triggers, determine how well regimen is working, may help indicate when to seek emergency care

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37
Q

How does a pt record and establish the “personal best”

A

When asthma is under “good control” over a 2-3 week period, take 3 readings daily and record highest reading

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38
Q

When do you take the daily readings to establish a personal best?

A

3 readings daily and record highest reading (mid-morning or afternoon) and record the HIGHEST VALUE obtained during 2-3 week period

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39
Q

What do you do AFTER a personal best is established?

A

Use atleast every morning upon awakening, use before any asthma meds, may use after taking a rescue med to determine impact

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40
Q

What is the GREEN zone?

A

When pt is 80-100% of personal best, can continue with regular activities, follow maintenance med plan

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41
Q

What are the directions for pts when they are in the green zone?

A

Continue with regular activity, follow maintenance med plan

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42
Q

What is the yellow zone?

A

50-80% of personal best

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43
Q

What are the directions for a pt when they are in yellow zone?

A

May require med adjustment, contact health care provider

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44
Q

What is the red zone?

A

<50% of personal best

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45
Q

What are the directions for a pt if they are in the red zone?

A

Emergency! Dial 911, contact health care provider

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46
Q

If the peak flow reading is >20% or more after using a SABA

A

Consider adjusting controller therapy

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47
Q

How often should a follow-up appointment be scheduled while gaining control for asthma?

A

Every 2-6 weeks

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48
Q

How often should a follow-up be scheduled for someone with controlled asthma?

A

Every 1-6 months

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49
Q

If a reduction in therapy in anticipated, how often should a follow-up be scheduled for asthma?

A

3 month intervals

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50
Q

What should be assessed at every follow-up for asthma?

A

Asthma control, med technique, asthma action plan, medication adherence, pt related concerns

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51
Q

What are some risk factors for death?

A

Prior severe exacerbation (intubation of ICU admission)
2+ hospitalizations or 3+ ED visits in the past year
>2 canisters of SABA per month

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52
Q

When should an asthma specialist be contacted?

A

If hospitalized, difficulties achieving or maintaining control, if immunotherapy is considered, if additional testing is indicated, if >2 oral steroids burst in past year

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53
Q

What are some other risk factors for death?

A

Poor perceived of symptoms, low SE status, illicit drug use, psyc disease, complicating co-morbidities

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54
Q

When can stepping down therapy be considered?

A

Must be “well controlled” for atleast 3 months

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55
Q

Stepping down therapy

A

Reduction should be gradual, must monitor closely, consider history or prior exacerbations

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56
Q

How often do you monitor when stepping down therapy?

A

2-6 weeks

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57
Q

Remember to use the ____ amount of meds needed for control

A

Least

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58
Q

What is ACT?

A

Asthma control test

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59
Q

An ACT score of _ means your pts asthma may not be under control?

A

<19

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60
Q

What needs to be provided to ALL pts?

A

Daily management and managing worsening asthma

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61
Q

What is included in daily management for asthma?

A

Controlled medication, environmental control measures

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62
Q

What is included for managing worsening asthma?

A

How to adjust medication, when to see medical care

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63
Q

Which domains should be assessed when monitoring asthma severity and control?

A

Impairment and future risk

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64
Q

What are the maintenance regimens?

A

ICS, long acting B2-agonists, long acting anticholinergics leukotriene antagonists, theophylline

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65
Q

What are the rescue regimens?

A

Short acting B2 agonists, short acting anticholinergics

66
Q

What are some therapeutic considerations?

A

Cost and coverage, produce availability, adverse effects, pt population, lifestyle, pt preference, ability to use device, lung fxn, cognitive fxn, dexterity and strength

67
Q

What are some advantages of an MDI without a spacer?

A

Less time (<1min), small/portable, no drug preparation, mechanical ventilation

68
Q

What are some disadvantages for an MDI without a spacer?

A

Technique/timing essential, Freon effect (

69
Q

What are some advantages of DPI?

A

Less time (<1min), less technique/timing, small/portable, usually less $$ than MDI counterpart

70
Q

What are the disadvantages of using a DPI?

A

Some dose preparation, requires breath hold, requires faster inhalation, oropharyngeal deposition, no mechanical ventilation

71
Q

What are some advantages of nebulizers?

A

Minimal technique/timing, no breath hold required, mechanical ventilation

72
Q

What are some disadvantages of nebulizers?

A

More expensive, drug prep required, admin time (5-15min), bulky and less portable, requires power source, must clean regularly!

73
Q

What are valves holding chambers used for?

A

MDIs only!!!

74
Q

VHC valve doodling chambers

A

Requires less coordination to use, improves drug deposition into lungs, decreases oropharyngeal deposition, use one actuation per inhalation!

75
Q

When should a face mask be considered if using an MDI and VHC?

A

For children <4 years

76
Q

What is the mechanism for the quick relief medication?

A

Increased adenyl cyclase -> increases CAMP which activates PKA -> Ca+ leaves the cell -> smooth muscle relaxes

77
Q

When should the quick relief medication be used?

A

Acute symptoms and exacerbations

Treatment of choice for exercise induced asthma

78
Q

What are the take home points about quick relief medications?

A

SABAs are preferred
Weekly cleaning is recommended
Regularly scheduled, daily, chronic use is not recommended

79
Q

What are some examples of quick relief medication?

A

Albuterol, Levalbuterol, Pirbuterol (discontinued)

80
Q

Should all patients with asthma have an albuterol inhaler?

A

Yes

81
Q

What are some indications for the RespiClick device?

A

Treatment or prevention of bronchospasms in 4 years+

Prevention of exercise-induced bronchospasms in 4 years +

82
Q

What are some features of the RespiClick device?

A

Dose counter, “click” open loads dose, expires 13 mos after opening, counts down by even numbers only

83
Q

Does the RespiClick need to be primed or cleaned?

A

No

84
Q

How is the RespiClick device activated?

A

Breath activated device (Dry Powder)

85
Q

What are some examples of products that have a dose counter?

A

Proair HFA, Ventolin HFA

86
Q

What are the two types of Albuterol for adults?

A

Albuterol Sulfate 0.5% solution 5mg/ml (concentrated)

Albuterol Sulfate 2.5mg/3mL (0.083%) (pre-mixed)

87
Q

Which Albuterol Rx for adults requires two prescriptions?

A

Albuterol Sulfate 0.5% solution 5mg/ml (concentrated)

88
Q

What are the SABAs via nebulizer?

A

Albuterol for adults and children, Xopenex (Levalbuterol)

89
Q

When is the nebulizer preferred?

A

When pt is unconscious

90
Q

What are examples of oral beta-2 agonists?

A

Albuterol immediate release tablets and syrup, Vospire ER extended release tablets

91
Q

When should you use inhaled corticosteroids?

A

Preferred long-term control therapy for all ages

92
Q

How often should ICS be cleaned?

A

Weekly

93
Q

What should be done after each use of ICS?

A

Rinse mouth and expectorate after using, wash around childs mouth if using a mask

94
Q

What is mild-mod asthma most managed with?

A

Low-medium ICS doses

95
Q

What do ICS do to lung function?

A

Improves lung function and reduced need for quick relief medications

96
Q

What are some examples of ICS?

A

Beclomethasone, Budesonide, Ciclesonide, Flunisolide, Fluticasone proportionate and furoate, Mometasone

97
Q

Oral candidiasis can be from ICS, how could you reduce it?

A

Spacer, rinse mouth, decrease dose/frequency if possible

98
Q

What % of pts can get oral candidiasis?

A

34%

99
Q

What % of pts can get dysphonia from ICS?

A

5-50%

100
Q

What can dysphonia be reduced by?

A

Spacer, rinse mouth, decrease dose/frequency if possible

101
Q

What can reflex cough and bronchospasms be reduced by from ICS?

A

Spacer, decreased rate or inspiration, pre-treat with albuterol

102
Q

Low dose ICS has no significant effects on

A

Bone mineral density in children
Incidence of cataracts or glaucoma
HPA axis function

103
Q

What is the preferred therapy for asthma?

A

ICS therapy

104
Q

Implications of ICS

A

Minimal effects ICS dose is recommended be used in all children with asthma, trails should be required to monitor height

105
Q

What is Arnuity or Ellipta?

A

Fluticasone Furoate

106
Q

Clinical pearls fo Arnuity/Ellipta/Fluticasone Furoate

A

1st once daily ICS, cleaning NOT required, unable to double load dose, discard 6 weeks after opening tray

107
Q

What are some potential drawbacks for Arnuity/Ellipta/Fluticasone Furoate

A

See DPI limitations, dosing may be less flexible

108
Q

What is another name of ArmonAir or RespiClick?

A

Fluticaonse Propionate

109
Q

What are some clinical pearls of ArmonAir/RespiClick/Fluticasone Proprionate

A

12+ asthma maintenance, not interchangeable with Flovent, unable to double load dose, discard 30 days after opening

110
Q

A temporary increase in anti-inflammatory therapy may be indicated to reestablish asthma control

A

“Burst”

111
Q

What MUST BE used concomitantly with anti-inflammatory medications for long-term control of asthma symptoms

A

Long acting B2 agonists

112
Q

What can be used to prevent exercise-induced bronchospasm?

A

Long acting B2 agonists

113
Q

Long acting B2 agonists do NOT eliminate the need for what?

A

An anti-inflammatory agent when used for asthma

114
Q

What should not be used to treat acute symptoms or exacerbations?

A

Long acting B2 agonists

115
Q

The use of LABAs is contraindicated without the use of what?

A

OF an asthma controlled medication such as an ICS

116
Q

LABAs should be used for what?

A

The shortest duration of time required to achieve control of asthma symptoms and D/C, if possible, once asthma control is achieved

117
Q

Pediatric and adolescent pts who required the addition of a LABA to an ICS should use what?

A

A combo product

118
Q

What is another name for Breo/Ellipta

A

Fluticasone Furoate + Vilanterol

119
Q

What are some clinical pearls for Breo/Ellipta/Fluticasone Furoate + vilanterol

A

1st once daily ICS/LABA combo, unable to double load dose, discard 6 weeks after opening tray, cleaning NOT required

120
Q

What are some potential drawbacks for Breo/Ellipta/Fluticasone furoate +vilanterol

A

See DPI limitations

121
Q

What is another name fo AidDuo/RespiClick

A

Fluticasone Propionate + Salmeterol

122
Q

What are the clinical pearls for AirDuo/RespiClick/Fluticasone propionate + salmeterol

A

12+ asthma maintenance not controlled on ICS alone, not interchangeable with Adair, unable to double load dose, discard 30 days after opening

123
Q

When should long acting antimuscarinics be used?

A

As an add-on for pts with a hx of exacerbations, once-daily, maintenances treatment of asthma in pts 6+ years

124
Q

What are the long acting antimuscarinics?

A

Spiriva, Respimat (Tiotropium)

125
Q

Clinical pearls for long acting antimuscarinics

A

Cost, expires 90 days after loading, dose = two half turns once daily, Respimat only LAMA approved for asthma

126
Q

What are some potential drawbacks for the long acting antimuscarinics?

A

Initial load and priming, coordination between dose release and inhalation

127
Q

When should Theophylline be used?

A

Alternative therapy for Step 2 care (not preferred), adjunctive therapy with ICS in patients >5 years old

128
Q

Take home points for Theophylline

A

Monitor serum Theophylline concentration, consider adverse effect profile, DDIs

129
Q

What should the serum Theophylline concentration be at?

A

5-15mcg

130
Q

What are the adverse effects similar to for Theophylline

A

Caffeine

131
Q

Smoking induces metabolism, so if a pt on Theophylline stops smoking,

A

The levels in serum will go very high

132
Q

What are some dose-related acute toxicities from Theophylline?

A

Tachyarrhythmias, CNS stimulation, seizures, hyperglycemia and hypokalemia

133
Q

What are the Theophylline drug inducers?

A

Smoking, Rifampin, Phenytoin, Omeprazole, Phenobarbital, Carbamazepine

134
Q

What are the Theophylline drug inhibitors

A

ETOH, Zileuton, Cimetidine, Zafirlukast, Propranolol, Ciprofloxacin

135
Q

Leukotrienes

A

Produced and release from multiple sources, contract smooth muscle, increase vascular permeability and mucus secretions

136
Q

When to use leukotriene inhibitors

A

Alternative therapy for Step 2 care (not preferred), adjunctive therapy with ICS

137
Q

What are some clinical pearls for leukotriene inhibitors

A

Montelukast and Zafirlukast block at recept level (LTRA)

Zileuton blocks production

138
Q

What needs to be taken on an empty stomach?

A

Zafirlukast

139
Q

Which leukotriene inhibitor must liver function be monitored?

A

Zileuton

140
Q

Which leukotriene must be administer once daily at bedtime?

A

Montelukast

141
Q

Which leukotriene inhibitors must be taken atleast 2 hour before or 2 hours after meals?

A

Zafirlukast

142
Q

What did the FDA find an association between in 2008?

A

Montelukast and behavior/mood changes, suicide

143
Q

What is an example of a mast cell stabilizer?

A

Intal (Cromoly sodium)

144
Q

Adverse effects of Intal (Cromolyn sodium)

A

Bad taste, cough/irritation

145
Q

Clinical pearls fo mast cell stabilizers

A

Long-term prevention of symptoms in mild persistent asthma, presentation treatment prior to exercise or known allergies, dosed 3-4x/day

146
Q

Mast cell stabilizers can be used for long term prevention fo what?

A

Symptoms in mild persistent asthma

147
Q

How many times a day are mast cell stabilizers dose?

A

3-4x/day

148
Q

Which vaccinations are required?

A

Influenza and pneumococcal

149
Q

What can be used to assess and monitor asthma severity and control?

A

EPR-3 table and validated questionnaires to assess impairment and risk

150
Q

Budesonide DPI

A

Pulmicort Flexhaler

151
Q

Budesonide Neb

A

Pulmicort

152
Q

Flunisolide HFA

A

Aerospan

153
Q

Fluticasone HFA

A

Flovent HFA

154
Q

Mometasone DPI

A

Asmanex, Twisthaler

155
Q

Ciclesonide HFA

A

Alvesco

156
Q

Albuterol

A

Proair HFA, Proair RespiClick, Proventil HFA, Ventolin HFA

157
Q

Levalbuterol

A

Xopenex

158
Q

Pirbuterol

A

Maxair Autohaler (Discontinued)

159
Q

Advantages Diskus

A

Fluticasone + Salmeterol

160
Q

Advair HFA

A

Fluticasone + Salmeterol

161
Q

Symbicort HFA

A

Budesonide + Formoterol

162
Q

Dulera HFA

A

Mometasone + Formoterol

Clinical Therapeutics (8 decks)

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