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NAPLEX > Ch 41: Asthma > Flashcards

Ch 41: Asthma Flashcards

1
Q

Albuterol brand name

A

ProAir HFA, ProAir RespiClick, Proventil HFA, Ventolin HFA

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2
Q

Levalbuterol brand name

A

Xopenex, Xopenex HFA

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3
Q

Epinephrine (OTC) brand name

A

Primatene Mist

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4
Q

Salmeterol brand name

A

Severent Diskus

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5
Q

Beclomethasone brand name

A

QVAR RediHaler

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6
Q

Budesonide brand name

A

Pulmicort Flexhaler, Pulmicort Respules

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7
Q

Budesonide + Formoterol brand name

A

Symbicort

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8
Q

Fluticasone brand name

A

Flovent HFA, Flovent Diskus, Arnuity Ellipta

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9
Q

Fluticasone + salmeterol brand name

A

Advair Diskus, Advair HFA

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10
Q

Fluticasone + vilanterol brand name

A

Breo Ellipta

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11
Q

Mometasone + Formoterol brand name

A

Dulera

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12
Q

An asthma diagnosis is confirmed with

A

spirometry

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13
Q

Spirometry and pulmonary function tests test for reversibility (i.e, if the FEV1 increases by more than __% with the use of a bronchodilator)

A

12%

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14
Q

FEV1 measures

A

how much air can be forcefully exhaled in one second

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15
Q

FVC test

A

after taking a deep breath, the max volume of air that is exhaled (how much air is exhaled)

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16
Q

FEV1/FVC

A

the percentage of total air capacity (“vital capacity”) that can be forcefully exhaled in one second (the speed of the exhale)

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17
Q

Common asthma triggers

A

genetics, pollution, cigarettes, cold air/changes in weather, pets, dust/pollen/cockroaches, perfume & cosmetics, drugs (ASA, NSAIDs, non-selective BB - propranolol, nadolol, timolol, pindolol), infections (colds and viruses), allergic rhinitis, GERD, obesity, OSA, anxiety, stress, depression

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18
Q

Intermittent asthma is defined as daytime symptoms < / = __ days/week & SABA rescue inhaler use < / = __ days/week

A

2

2

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19
Q

Mild asthma is defined as daytime symptoms > __ days per week, but not daily & SABA rescue inhaler use > __ days/week, but not daily or > __ x/day

A

2
2
1

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20
Q

Moderate asthma is defined as daytime symptoms how many times per week & SABA rescue inhaler use ___

A

daily

daily

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21
Q

Severe asthma is defined as daytime symptoms ___ & SABA rescue inhaler use ___

A

throughout the day

several times per day

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22
Q

Which vaccines should people with asthma receive

A 
Annual influenza vaccine
Pneumovax 23 (age 2-64)
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23
Q

Which controller is first-line for all patients

A

ICS (need anti-inflammation in asthma)

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24
Q

Which drug classes are controllers

A 
ICS
LABA
LTRAs
LAMAs
Injectable MABs
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25
Q

Which drug classes are relievers

A

ICS + formoterol

SABAs

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26
Q

LABAs are used in combination with:

A

ICS

NEVER use LABAs alone

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27
Q

Which MAB is used for severe allergic asthma

A

Omalizumab

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28
Q

Albuterol MDI/DPI dose

A

1-2 inhalations Q4-6H PRN

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29
Q

SABA SE

A

Nervousness, tremor, tachycardia, palpitations, cough, hyperglycemia, ↓ K

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30
Q

Levalbuterol contains __ isomer of albuterol

A

R

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31
Q

Most albuterol inhalers contain __ inhalations/canister, with the exception of ___ which also has __ inhalations/canister

A

200 inhalations/canister

Ventolin: 200 inhalations/canister AND 60 inhalations/canister

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32
Q

SABAs or low-dose ICS + formoterol should be used in exercise-induced bronchospasm ___ min prior to exercise.

The effects of the SABA will last __-__ hours

A

5

2-3 hours

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33
Q

Which drugs are SABAs

A

Albuterol
Levalbuterol
Racepinepherine
Epinephrine

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34
Q

Which drug is a LABA

A

Salmeterol

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35
Q

Salmeterol BW

A

↑ risk of asthma related deaths when used as monotherapy

ONLY use with ICS

36
Q

ICS SE

A

Dysphonia (difficulty speaking), oral thrush, cough

37
Q

Which ICS is the only one available as a nebulized solution

A

budesonide

38
Q

Pulmicort Respules can only be used with

A

a jet nebulizer

39
Q

Which MDIs should not be shaken

A

Alvesco (ciclesonide)
Qvar RediHaler
Respimat products

40
Q

Which drugs are ICS

A

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

41
Q

Which drug is a LAMA for asthma

A

Tiotropium (Spirivia Respimat)

**for COPD - Respimat or HandiHaler

42
Q

Brand name identifiers for MDIs

A

HFA, RespiMat

43
Q

Brand name identifiers for DPIs

A

Diskus, Ellipta, Pressair, Handihaler, Neohaler, Respiclick, Flexhaler

44
Q

Which DPI needs to be primed before first use

A

Flexhaler

45
Q

Montelukast MOA

A

Inhibits leukotriene D4 (LTD4)

46
Q

Zileuton MOA

A

Inhibits leukotriene formation

47
Q

Montelukast formulations

A

tablet, chewable tab, packet

48
Q

Montelukast dosing

A

10 mg daily in the evening
Age 6-14 years: 5 mg daily in the evening
Age 1-5 years: 4 mg daily in the evening

49
Q

Montelukast BW

A

neuropsychiatric events

50
Q

Which formulation of montelukast can be administered directly into the mouth, dissolved in breast milk or formula or mixed with applesauce, carrots, rice or ice cream; should be used within __ min

A

granules

15

51
Q

How must zafirlukast be administered

A

in original container

52
Q

Theophylline MOA

A

Blocks phosphodiasterase, causing an increase in cAMP and release of epi from adrenal medulla cells, resulting in bronchodilation

53
Q

Active metabolite of theophylline

A

caffeine

54
Q

Theophylline therapeutic range

A

5-15 mcg/mL

55
Q

Theophylline is dosed based on

A

IBW (or TBW if < IBW)

56
Q

Theophylline toxicity can present as

A

persistent vomiting, arrhythmias, seizures

57
Q

How to convert aminophylline to theophylline

A

ATM x 0.8

58
Q

A small increase in theophylline dose can result in

A

large increase in Theophylline concentration

59
Q

Which drugs can increase theophylline levels

A

cipro, zileuton, zafirlukast

60
Q

Which drugs can decrease theophylline levels

A

carbamazepine, fosphenytoin, phenobarbital, phenytoin, primidone, rifampin, ritonavir

61
Q

Which conditions can increase theophylline levels

A

CHF, liver disease

62
Q

Which conditions/food can decrease theophylline levels

A

high-protein diet

63
Q

Omalizumab MOA

A

Inhibits IgE binding to the IgE receptor on mast cells and basophils

64
Q

Omalizumab indication

A

moderate-severe persistent, allergic asthma with a positive skin test to a perennial aeroallergen

65
Q

Omalizumab brand name

A

Xolair

66
Q

Omalizumab formulation & administration

A

SC injection; must be administered in a healthcare setting under medical supervision d/t BW of anaphylaxis

67
Q

Which drugs are IL-5 receptor antagonists

A

Mepolizumab (SC), reslizumab (IV), and benralizumab (SC)

68
Q

Which drug is an IL-4 & IL-3 receptor antagonists

A

Dupilumab (SC)

69
Q

Which ICS is is preferred in asthma control in pregnant patients

A

Budesonide

70
Q

For a patient with good asthma control, how long should their albuterol inhaler last

A

about 12 months

71
Q

If a patient is prescribed > 1 inhalation of medication at a time, how long should the patient wait between each inhalation

A

60 seconds

72
Q

If using more than 1 inhaler, what is the correct sequence of inhalers

A

SABA → Other Bronchodilators (LABA or LAMA) → ICS

73
Q

Spacers should NEVER be used with

A

a DPI

74
Q

How often must a spacer be cleaned

A

at least once a week

75
Q

What are common spacer names

A

AeroChamber, OptiHaler, OptiChamber

76
Q

Spacers reduce the risk of

A

thrush from steroid inhalers

77
Q

The patient’s best peak expiratory flow rate (PEFR) is called

A

personal best (PB)

78
Q

The patient’s personal best from a PEFR takes into account their:

A

height, gender and age

79
Q

Peak flow meter technique

A
  • Use every morning upon awakening and before the use of any asthma meds
  • Move indicator to bottom. Stand up straight and exhale
  • Inhale as deeply as possible. Place lips firmly around the mouthpiece
  • Blow out as hard & as fast as possible. Write down the PEFR
  • Repeat steps 2 more times, and record the highest value
80
Q

Green zone of an asthma action plan (> 80-100% of PB) indicates

A

all clear - good control

81
Q

Yellow zone of an asthma action plan (> 50-80% of PB) indicates

A

Caution - worsening lung fxn

82
Q

Red zone of an asthma action plan (< 50% of PB) indicates

A

Medical alert - possibly needs to go to the emergency department

83
Q

When using an MDI, the inhaler should be shaken for how long immediately before each spray

A

5 seconds

84
Q

When using an MDI, how long should a patient hold their breath for after pressing down on the canister to deliver a dose

A

up to 10 seconds

85
Q

Which inhalers should not be put into water

A

Symbicort, Dulera

86
Q

What is an important counseling point for the ProAir RespiClick and AirDuo RespiClick

A

Opening and closing the cap without inhaling a dose will waste medication and can damage your inhaler

87
Q

The ampules in Budesonide (Pulmicort Respules) should be used within __ weeks of opening the aluminum package

A

2

NAPLEX (74 decks)

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