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Pharm Exam 3 > ch 62 > Flashcards

ch 62 Flashcards

1
Q

sense of breathlessness and tightness in chest, wheezing, dyspnea, and cough are symptoms of

A

asthma

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2
Q

chronic cough, excessive sputum, wheezing, dyspnea, poor exercise tolerance are symptoms of

A

COPD

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3
Q

What is the most common cause of COPD

A

cigarette smoking

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4
Q

Does drug therapy slow the progression of COPD

A

No drug therapy does not slow disease progression, reduce hospitalizations or prolong life.

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5
Q

Chronic, progressive, largely irreversible disorder characterized by airflow restrictions and inflammation

A

COPD

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6
Q

chronic inflammatory disorder of the airways

A

Ashtma

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7
Q

How does asthma work (pharm)

A

The inflammatory process begins with binding of allergen molecules (ie) house dust mite feces) to IgE antibodies on mast cells. This causes mast cells to release an assortment of mediators such as histamine, leukotrienes, prostaglandins and interleukins ->

cause bronchoconstriction and promote infiltration and activation of inflammatory cells. -> These also release mediators -> cause airway inflammation with edema, mucus plugging and smooth muscle hypertrophy -> obstruct airflow

this produces a state of bronchial hyperreactivity where mild triggers such as cold air, exercise, tobacco smoke -> cause intense bronchoconstriction

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8
Q

symptoms of COPD result largely from a combo of what 2 processes

A

Chronic bronchitis
Emphysema

both are an exaggerated inflammatory reaction to cigarrette smoke

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9
Q

what piece of COPD is defined by chronic cough and excessive sputum

A

Chronic bronchitis

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10
Q

what results from hypertrophy of mucus secreting glands in the epithelium of the larger airways

A

chronic bronchitis

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11
Q

what piece of COPD is defined as enlargement of the air space within the bronchioles and alveoli brought on deterioration of the walls of these air spaces

A

emphysema

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12
Q

what is the big difference and similarity of COPD and asthma

A

Both are inflammatory

COPD is restrictive

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13
Q

diagnosis of COPD requires

A

spirometry testing to measure the degree of airway obstruction

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14
Q

what spirometry is needed to confirm COPD diagnosis

A

a postchonchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of less than 0.7 is needed to confirm

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15
Q

Preventative drugs for relief of asthma

A

inhaled glucocorticoids
leukotriene receptor antagonists
cromolyn

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16
Q

what genetic alteration can also cause COPD

A

A-1 antitrypsin deficiency

Antitrypsin is a protease inhibitor that protects the lungs from enzymatic destruction by proteases

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17
Q

Out of COPD and asthma, which one is immune mediated?

A

both

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18
Q

2 main pharm classes for asthma and COPD

A

Bronchodilators

Anti-inflammatory agents

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19
Q

The principal antiinflammatory drugs are the

A

Glucocorticoids

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20
Q

The principal bronchodilators are the

A

B2 agonists

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21
Q

What are the 3 advantages for administering drugs by inhalation

A

1) Therapeutic effects are enhanced by delivering drugs directly to their site of action
2) Systemic effects are minimized
3) relief of acute attacks is rapid

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22
Q

When 2 inhalations from a MDI is needed, how long should you wait in between each

A

1 min

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23
Q

How much of a MDI vs DPI actually reaches the lungs

A

10% for MDI (80% affects oropharynx and 10% is exhaled)

20% for Dry powder inhaler

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24
Q

what device is attached directly to the MDI to increase delivery of drug to the lungs and decrease deposition of drug on the oropharyngeal mucosa

A

Spacers

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25
Q

what type of delivery system converts a drug solution into a mist that is finer than the inhalers

why is this beneficial

A

Nebulizers - less drug deposit on the oropharynx and increased drug delivery to lungs

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26
Q

what component of COPD gives a wet cough and which for dry cough

A

Wet - Chronic bronchitis

dry - Emphysema

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27
Q

How much medicine from MDI reaches the lungs when using an inhaler

A

21% - lungs

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28
Q

when you have a sudden death in an asthmatic - is this in your worse asthmatics or your mild?

A

usually mild cases because they aren’t on anything to decrease the inflammation

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29
Q

what populations are the MDIs not as good for and why

A

younger and older due to the lack of hand-breath coordination

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30
Q

preferred long term treatment for children of all ages for asthma

A

inhaled glucocorticoids

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31
Q

What is recommended for administration of inhaled glucocorticoids in children younger than 4 years

A

face mask

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32
Q

What leukotriene modifier is approved for children 1-5 years old

A

Montelukast is the only one approved. (evidence supporting these drugs is lower than the inhaled glucocorticoids)

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33
Q

what type of treatment for a pregnant asthmatic

A

Inhaled glucocorticoids

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34
Q

uncontrolled asthma in pregnancy is associated with

A

greater fetal risks

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35
Q

What Leukotriene receptor antagonists are approve have the better safety profile for someone who is pregnant

A

Montelukast

Zafirlukast

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36
Q

What glucocorticoids are approved for breastfeeding

A

only inhaled

systemic is contraindicated

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37
Q

Glucocorticoids and older adults

A

inhaled is safer than systemic

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38
Q

What are the most effective drugs available for long term control of airway inflammation?

A

Glucocorticoids (Budesonide, fluticasone)

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39
Q

what is the last ditch effort for CoPD

A

anti-inflammatories - inflammation is not really the problem

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40
Q

how do glucocorticoids work

A

1) Decreased synthesis and release of inflammatory mediators
2) Decreased infiltration and activity of inflammatory cells
3) Decreased edema of airway mucosa

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41
Q

glucocorticoids and B2

A

may increase the number of bronchial B2 receptors as well as increasing responsiveness to B2 agonists

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42
Q

how are glucocorticoids used in asthma and copd

A

to control inflammation

especially effective for asthma prophylaxis
management of COPD exacerbations

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43
Q

first line therapy for management of the inflammatory component of asthma

A

inhaled glucocorticoids

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44
Q

what route of glucocorticoids are very effective and much safer

A

inhaled as opposed to systemic (oral or IV)

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45
Q

Most patients with persistent asthma should use ____ daily

A

inhaled glucocorticoid

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46
Q

when are oral glucocorticoids used

A

for patients with moderate to severe persistent asthma or for management of acute exacerbations of asthma or COPD

only prescribed when symptoms cannot be controlled with safer meds (inhaled glucocorticoids or inhaled B2 agonists)

treatment should be as brief as possible

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47
Q

adverse effects of inhaled glucocorticoids

A

oropharyngeal candidiasis
dysphonia (hoarseness, difficulty speaking)
adrenal suppression
slow growth in children and adolescents (but do not decrease final adult height)

less is known regarding suppression of growth and development on brain, lungs and other organs because having asthma alone can affect organ growth.

long term use can promote bone loss
prolonged therapy with high dosing might increase risk for cataracts and glaucoma

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48
Q

how can you minimize oropharyngeal candidiasis and dysphonia with inhaled glucocorticoids

A

rinse mouth with water and gargle after each administration

Use a spacer

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49
Q

How do you treat oropharyngeal candidiasis when using an inhaled glucocorticoid

A

antifungal drugs

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50
Q

who are at increased risk for adrenal suppression when on glucocorticoids

A

children, especially those with a low body mass index (BMI)

young children who have used inhaled glucocorticoids for longer than 6 months

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51
Q

what signs should you monitor for looking for adrenal insufficiency

A

hypoglycemia
hypotension
mental status alteration

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52
Q

ways to minimize bone loss with long term use of inhaled glucocorticoids

A

1) use the lowest dose that controls symptoms
2) ensure adequate intake of calcium and vitamin D
3) participate in weight bearing exercises

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53
Q

glucocorticoids are intended for ____ therapy

A

preventive therapy not for aborting an ongoing attack

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54
Q

administration instructions when pt is on a inhaled glucocorticoid and a SABA

A

Take the SABA 5 min before the inhaled glucocorticoid to enhance delivery of the glucocorticoid to the airways

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55
Q

What should pt monitor with asthma

A 
Monitor and record
Peak expiratory flow (PEF)
symptom frequency and intensity
nighttime awakenings
effect on normal activity 
SABA use
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56
Q

what should pt be advised to wear if they are at risk of adrenal insufficiency associated with long term systemic use

A

a medical alert bracelet

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57
Q

When used acutely (less than ___ days), even at very high doses, oral glucocorticoids do not cause significant adverse effects.

A

10

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58
Q

Potential adverse effects of oral glucocorticoids

A 
adrenal suppression
osteoporosis
hyperglycemia
peptic ulcer disease
and in young patients - growth suppression
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59
Q

why does prolonged glucocorticoid use put the pt at high risk for adrenal suppression

A

the adrenal cortex decreases their endogenous production of glucocorticoids of its own.

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60
Q

If a pt develops adrenal suppression secondary to prolonged glucocorticoid use, what are the precautions

A

Do not stop glucocorticoid therapy suddenly - fatal - must be gradually tapered to allow the adrenal cortex to ramp up production

During times of sever physical stress when the body would normally increase production - the systemic

glucocorticoids will need to be increased (stress dose) or they could die

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61
Q

your continuing a pt on glucocorticoids but you want to switch them from oral to inhaled. What considerations need to be made

A

adrenal suppression. inhaled is not systemic and if their adrenals are suppressed - must be given supplemental oral and tapered.

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62
Q

___________ are required for recovery of adrenocortical function

A

several months

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63
Q

inhaled glucocorticoid formulated for nebulized dosing

A

Budesonide suspension (Pulmicort respules)

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64
Q

What is Budesonide suspension (Pulmicort respules) approved for

A

maintenance therapy of persistent asthma in children 1-8 years old.

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65
Q 
Budesonide suspension (Pulmicort respules) improvement after start of treatment should begin in
max benefits may take?
A

2-8 days

max benefits may take 4-6 weeks to develop

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66
Q

name the oral glucocorticoids approved for therapy of asthma

A

Methylprednisolone
Prednisone
Prednisolone

dosage is all the same for these

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67
Q

How is dosing done for oral glucocorticoids to keep the pt free of adrenal suppression symptoms

A

Highest dose on day one then tapered down with gradually decreasing dosing

for long term treatment - alternate day dosing is often used

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68
Q

what should be monitored for adrenal supression

A

hypoglycemia
hypotension
mental status changes

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69
Q

When should you check for adrenal suppression

A

when a child is on inhaled glucocorticoids for longer than 6 months

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70
Q

contraindication for inhaled glucocorticoids

A

pt with persistently positive sputum cultures for Candida Albicans (not contraindicated in oral )

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71
Q

What should pt be taught to monitor with asthma

A 
Monitor peak expiratory flow
symptom frequency and intensity
nighttime awakenings
effect on normal activity
SABA use
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72
Q

Beclomethasone dipropionate (QVAR)
Budesonide (Pulmicort Flexhaler, Pulmicort respules)
Ciclesonide (Alvesco)
Flunisolide (Aerospan)
Fluticasone propionate (Flovent HFA, Flovent Diskus)
Mometasone Furoate (Asmanex Twisthaler)

A

Inhaled glucocorticoids

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73
Q

Methylprednisolone
Prednisolone (Flo-pred)
Prednisone

A

oral glucocorticoids

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74
Q

Montelukast, oral (Singulair)
Zafirlukast, oral (Accolate)
Zileuton, oral (Zyflo)

A

Leukotriene Receptor Antagonists (LTRAs)

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75
Q

Albuterol (ProAir HFA, ProAir RespiClick, Proventil HFA, Ventolin HFA)

Levalbuterol (Xopenex, Xopenex HFA)

A

Bronchodilators
B2 adrenergic agonist

SABA (short acting Beta2 Agonist)

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76
Q 
Arformoterol (Brovana)
Formoterol (Foradil Aerolizer)
Indacaterol (Arapta Neohaler)
Olodaterol (Striverdi Respimat)
Salmeterol (Serevent Diskus)
A

Inhaled Long Acting B2 Agonist

LABA

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77
Q

Albuterol, oral (VoSpire ER)

Terbutaline

A

Oral LABA

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78
Q

Aminophylline, oral

Theophylline, oral (Theo-24)

A

Methylxanthines

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79
Q 
Aclidinum bromide, inhaled 
Glycopyrronium bromide, inhaled
Ipratropium, inhaled (Atrovent HFA)
Tiotropium, inhaled (Spiriva)
Umeclidinium, inhaled
A

Anticholinergics

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80
Q

This med group suppresses the effects of leukotrienes which in ______, these drugs can decrease bronchoconstriction and inflammatory responses

A

Leukotriene receptor antagonists (LTRAs)

Asthma

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81
Q

Which LTRAs block leukotriene synthesis

A

Zileuton

inhibits 5-lipoxygenase (enzyme that converts arachidonic acid into leukotrienes)

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82
Q

Which LTRAs block leukotriene receptors

A

Zafirlukast

Montelukast

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83
Q

When are LTRAs used

A

Second line therapy when an inhaled glucocorticoid cannot be used and as add on therapy when an inhaled glucocorticoid alone is inadequate in asthma

84
Q

Adverse effects of LTRAs

A

neuropsychiatric effects, including depression, suicidal thinking and suicidal behavior

85
Q

LTRA ______approved for asthma prophylaxis and maintenance therapy for what ages

A

Zileuton

adults and children 12 and older

86
Q

Can Zileuton be used to abort an ongoing asthma attack

A

No, effects are seen within 1-2 hrs of dosing

87
Q

Zileuton inhibits what enzyme

A

5-lipoxygenase

88
Q

Zileuton metabolism

A

rapidly metabolized by liver

89
Q

Adverse effects of Zileuton

A

can injure the liver (watch ALT- will be increased with injury)

neuropsychiatric effects

90
Q

What is the recommended schedule for monitoring ALT (alanine aminotransferase) activity when taking Zileuton

A

once a month for 3 months
once every 2-3 months for the remainder of the 1st yr
periodically afterwards

91
Q

drug to drug interactions for Zileuton

A

metabolized by Cytochrome P450

using together with Theophylline can markedly increase theophylline levels

can increase levels of

  • Warfarin
  • Propanolol
92
Q

which LTRA is approved in adults and children 5 years and older

A

Zafirlukast

93
Q

Which LTRAs are block leukotriene receptors

A

Zafirlukast (Accolate)

Montelukast (Singulair)

94
Q

Which LTRAs are metabolized by cytochrome P450

A

all of them

95
Q

Which LTRA does not increase theophylline or warfarin levels

A

Montelukast (Singulair)

96
Q

Which LTRAs have the adverse side effect of Churg-Strauss syndrome?

A

Zafirlukast (Accolate)

Montelukast (Singulair)

97
Q

What seems to contribute to Churg-Strauss Syndrome

A

in most cases symptoms developed when glucocorticoids were withdrawn.

98
Q

What is Churg-Strauss Syndrome symptoms

A

potentially fatal disorder
weight loss
flulike symptoms
pulmonary vasculitis

99
Q

Which LTRA does not seem to cause liver injury

A

Montelukast (Singulair)

100
Q

What LTRA does food affect absorption?

what does that look like?

A

food reduces absorption by 40%

Administer drug at least 1 hour before meals or 2 hours after

101
Q

What LTRA has the longest half life that is increased in older adults

A

Zafirlukast

10 hours but may be as long as 20 hours in older adults

102
Q

Adverse effects of Zafirlukast

A 
headache
GI disturbances
Arthralgia
myalgia
neuropsychiatric effects
Churg-Strauss syndrome
liver injury
103
Q

In Zafirlukast rarely pt have developed clinical signs of liver injury mainly in what population

A

females

104
Q

Which LTRA can increase levels of propanolol

A

Zileuton

105
Q

Which LTRA has GI adverse effects listed along with arthralgias and myalgias

A

Zafirlukast

106
Q

Which LTRA is the most commonly used

A

Montelukast (Singulair)

107
Q

indications for Montelukast (Singulair)

A

1) Prophylaxis and maintenance therapy for asthma in pt at least 1 year old
2) prevention of exercise induced bronchoconstriction in pt at least 15 years old
3) relief of allergic rhinitis

108
Q

which LTRA has the fastest symptom improvement

A

Zileuton (1-2 hours) - not a rescue

109
Q

which LTRA is highly bound (more than 99%) to plasma proteins

A

Montelukast (Singulair)

110
Q

Rule of 2s

A

Asthma are you in control?

111
Q

anticonvulsant that induces P450

A

Phenytoin

112
Q

When glucocorticoids create problems, what is an alternative drug for management of inflammation in asthma

A

Cromolyn administered by nebulizer

113
Q

Disadvantages of Cromolyn

A

max effects take several weeks to develop

Dosing is 4 xs / day

114
Q

Advantage of Cromolyn

A

safest of all antiasthma medications. Significant effects occur in fewer than 1 in 10,000 patients (occasionally a cough or bronchospasm occurs)

115
Q

Bronchodilators are used in patients with

A

asthma and copd

116
Q

Short acting B2 agonists are approved for children ages

A

2 and older (used in younger)

117
Q

Anticholinergics in children

A

ages 11 and older

118
Q

Methylxanthines and children

A

all children and even neonates

119
Q

bronchodilator approved in neonates

A

Methylxanthines

120
Q

Bronchodilators and pregnancy

A

B2 agonists may cause uterine relaxation, benefits greater than risks

inhaled anticholinergics are among the safer drugs for pregnant women

Methylxanthines are a no

121
Q

Breastfeeding and bronchodilators

A

B2 agonists okay
inhaled anticholinergics okay
methylxanthines are no

122
Q

Older adults and bronchodilators

A

B2 agonists and inhaled anticholinergics are a risk vs benefit

systemic anticholinergics are a no go

methylxanthines are no

123
Q

How do B2 agonists work in lungs

A

smooth muscle - promote bronchodilation which relieves bronchospasm

Suppress histamine release in lung

increase ciliary motility

124
Q

All oral B2 agonists are _____ acting

A

long

125
Q

when are SABAs taken

A

PRN to abort an asthma attack

in patients with EIB (exercise induced bronchospasm) they are taken before exercise to prevent an attack from occurring

hospitalized patients undergoing a severe acute attack - nebulized SABA is treatment of choice

126
Q

_______ are preferred over _____ for patients with stable COPD

A

LABAs are preferred over SABAs in patients with stable COPD.

127
Q

LABAS in asthma

A

not first line therapy
if used they must ALWAYS be combined with a glucocorticoid. LABA monotherapy associated with death in asthma patients. FDA recommends both drugs in the same inhaler.

128
Q

oral B2 agonists are ____ line drugs

A

second line -

129
Q

Adverse effects of inhaled SABAS

A

tachycardia
angina
tremor

130
Q

oral B2 agonist adverse effects

A

selectivity is relative, not absolute
excessive dosing can cause angina and tachydysrhythmias

Pt report chest pain and changes in HR or rhythm

131
Q

what type of schedule should LABAS and oral B2 agonists have

A

fixed schedule not PRN and always in combo with inhaled glucocorticoid

oral B2 agonists also fixed

sustained release preps swallowed intact without crushing or chewing

132
Q

Nebulizer delivers dose slowly over several minutes which does what in the lungs

A

as the bronchi gradually dilate, the drug gains deeper and deeper access to the lungs

133
Q

What 3 single agent inhaled LABAS are approved for treatment of asthma

A

salmeterol
formoterol
arformoterol

134
Q

B2 agonist MDI, DPI dosing schedule

A

initial dosing is 1-2 inhalations spaced 1 min apart 3-4 times per day

135
Q

what LABA is approved for asthma but only comes in a combo with glucocoritcoid

A

Vilanterol (fluticasone/vilanterol -Breo Ellipta)

umeclidinium/vilanterol - Anoro Ellipta

136
Q

How often do you use a LABA

A

every 12 hours

137
Q

What oral B2 agonists are approved for long term control of asthma

A

Albuterol and Terbutaline

Dosing is 3-4 times per day

138
Q

contraindications for systemic B2 agonists (oral, parenteral)

A

Tachydysrhythmias or tachycardia associated with digitalis toxicity

Use with caution in patients with diabetes (hyperglycemia - breaks down glycogen to glucose in liver and skeletal muscles), hyperthyroidism, organic heart disease, HTN, angina

139
Q

theophylline

caffeine

A

Methylxanthines

140
Q

what do Methylxanthines do

A 
CNS excitation
Bronchodilation
cardiac stimulation
vasodilation
diuresis
141
Q

Theophylline is used in ____ for ____

A

asthma
bronchodilation

sometimes in COPD

narrow therapeutic range

142
Q

Metabolism of Theophylline

A

smoking tobacco or marijuana accelerates metabolism and decreases half life

Metabolism is slowed in certain pathologies - heart disease, liver disease, prolonged fever

CYP (cimetidine, fluoroquinolone abx decrease metabolism)
(phenobarbital accelerate metaoblism)

143
Q

Symptoms of Theophylline tox

A 
nausea
vomiting
diarrhea
insomnia
restlessness
severe dysrhythmias (V-fib)
convulsions that are highly resistant to treatment
death from cardiopulmonary collapse
144
Q

Treatment of Theophylline tox

A

Stop med
get a serum level
Absorption decreased with charcoal with a cathartic in event of acute overdose.
Ventricular dysrhythmias respond to lidocaine or amiodarone.
IV benzos such as diazepam may help control seizures

145
Q

Theophylline and caffeine

A

similar properties
caffeine can intensify the adverse effects of theophylline on the CNS and heart

can compete for drug metabolizing enzymes causing theophylline levels to rise

Pt on theophylline should avoid caffeine containing beverages and other sources of caffeine

146
Q

Drugs that reduce theophylline levels

A

Cyp accelerators
phenobarbital
phenytoin
rifampin

also smoking and second hand smoke (tobacco or marijuana - result in decreased drug levels

if a pt stops smoking but drug amount is not decreased, at risk for tox

147
Q

Drugs that increase theophylline levels

A 
Cimetidine
fluoroquinolone abx (ciprofloxacin)
148
Q

Theophylline pt ed

A

if miss a dose, do not double next dose

swallow enteric coated and SR formulations without crushing or chewing

Do not drink caffeine

call for nausea, vomiting, abd discomfort, diarrhea, insomnia, restlessness, palpitations- theophylline tox

Do not smoke tobacco or marijuana

149
Q

Anticholinergic drugs are only approved for ______ (resp )

A

COPD

150
Q

Short acting inhaled anticholinergic that is approved for COPD but often used off label for asthma

A

Ipratropium (Atrovent)

151
Q

What are the LAMAS approved for COPD

A

Long acting muscarinic antagonists
Aclidinium
Tiotropium
Umeclidinium

152
Q

Atrovent works by

A

blocking muscarinic cholinergic receptors in the bronchi to prevent bronchoconstriction

effective against allergen induced asthma and EIB

153
Q

Most common adverse effects of Atrovent

A

dry mouth
irritation of pharynx
may raise intraocular pressure in pt with glaucoma

154
Q

Tiotropium

A

LAMA - long acting muscarinic antagonist

approved for maintenance therapy of bronchospasm associated with COPD

155
Q

How often do you take Tiotropium

A

once a day

156
Q

Adverse effects of Tiotropium

A

dry mouth

systemic anticholinergic effects (constipation, urinary retention, tachycardia, blurred vision) are minimum

157
Q

Aclidinium
Tiotropium
Umeclidinium

A

Long Acting Muscarinic Antagonist (LAMA)

158
Q

dry mouth pt education for Tiotropium

A 
suck on sugarless hard candy for relief
high intake of candy contain sorbitol and xylitol can cause diarrhea.
saliva substitutes (Aquoral, Biotene) are available OTC
159
Q

Aclidinium

A

LAMA indicated for management of bronchospasm associated with COPD.

160
Q

Peak levels of Aclidinium occur within ____ min of drug delivery

A

10 - however it is intended only for maintenance therapy and not for acute symptom relief

161
Q

adverse effects of Aclidinium

A

headache
nasopharyngitis
cough
theoretical muscarinic that have not been reported

162
Q

Umeclidinium (Incruse Ellipta)

A

Newest LAMA
management of bronchospasm associated with COPD

available single agent
also available combo (LABA vilanterol as Anoro Ellipta)

163
Q

what food allergy may cause a hypersensitivity for Umeclidinium (Incruse Ellipta)

A

Contains lactose

those with a milk protein allergy

164
Q

Glucocorticoid/LABA combos

A

used in asthma and COPD

Glucocorticoids - anti-inflammatory
LABAs - Bronchodilation

165
Q

B2 agonist/Anticholinergic Combos

A

optimized/enhanced bronchodilation

only for COPD

B2 agonists promote by stimulating adrenergic receptors which relaxes smooth muscle in the airways

Cholinergic antagonists do this by blocking cholinergic receptors which relaxes smooth muscle tone by preventing stim of cholinergic receptors

166
Q

Single most useful test of lung function

A

FEV1

167
Q

How do you do the FEV1

A

pt inhales completely and then exhales as completely and forcefully as possible into the spirometer

results are compared to a predictive normal value based on age, sex, height, weight

168
Q

Pt with ______ pulmonary disease will have a decreased FEV1

A

obstructive

169
Q

the total volume of air the patient can exhale after a full inhalation (pulmonary function test)

A

FEV1

170
Q

what is used to distinguish obstructive from restrictive pulmonary disease

A

FEV1 divided by FVC

171
Q

For obstructive pulmonary disease the FEV1/FVC will be

A

decreased < 0.7

172
Q

For restrictive pulmonary disease the FEV1/FVC will be

A

normal or increased (1+)

173
Q

Obstructive is you cant breathe ___

A

out

174
Q

Restrictive is you cant breathe __-

A

in

175
Q

Maximal rate of airflow during expiration

A

PEF (peak expiratory flow)

176
Q

what is PEF used for

A

monitor but not diagnose asthma

177
Q

To determine PEF

A

the patient exhales as forcefully as possible into a peak flowmeter

178
Q

PEF and FEV1

A

results are approx equal but FEV1 is more accurate because it measures airflow in the large and small airways whereas PEF measures airflow in large airways only

PEF is home device and should be done every morning to identify when pt are developing complications before the symptoms arise

179
Q

What are the four classes of asthma severity

A

1) intermittent
2) mild persistent
3) moderate persistent
4) severe persistent

180
Q

The classification of asthma severity has 2 domains

A

impairment

risk

181
Q

As your asthma symptoms worsen and you climb the classifications of severity your FEV1 ____ and your FEV1/FVC ____

A

decreases

drops

182
Q

all asthma pt starting with step 1 need

A

inhaled SABA PRN

183
Q

All asthma pt except for step 1 need

A

SABA PRN

inhaled glucocorticoid

184
Q

When you move an asthma pt up a step

A

dosage of the control medication is increased or another control med is added or both

185
Q

After a asthma pt has a period of sustained control

A

moving down a step should be trialed

186
Q

A pt diagnosed with intermittent asthma

A

PRN use of SABA

187
Q

Pt with moderate persistent asthma

A

SABA PRN
inhaled glucocorticoid
LABA

188
Q

drugs for severe asthma exacerbation

A

O2 for hypoxemia
systemic glucocorticoid to reduce airway inflammation
neb high dose SABA to relieve airflow obstruction
neb Atrovent to further reduce airflow obstruction
After discharge oral glucocorticoid taking for 5-10 days

189
Q

Exercise induced Bronchospasm usually starts
peaks?
resolves?

A

either during or immediately after exercise, peaks 5-10 min and resolves 20-30 min later

190
Q

To prevent EIB

A

SABA or cromolyn

SABA preferred and give right before exercise
Cromolyn 15 min before

191
Q

asthma triggers and allergens

A 
house dust mite
warm-blooded pets
cockroaches
molds
tobacco smoke
wood smoke
household sprays
192
Q

rule of 2s

A

if your not in control

nighttime awakenings 2/month
use SABA 2/week
refilling your SABA more than 2/year

193
Q

classification of COPD by severity

A

1) mild
2) moderate
3) severe
4) very severe

194
Q

Treatment goals of COPD

A

reduce symptoms
improve the patients health status
increase exercise tolerance
reduce risks and mortality

195
Q

COPD class

few symptoms, low risk
mild/moderate airflow limitation + low symptom scores + 1 or fewer exacerbations per year

A

Group A

196
Q

COPD class

increased symptoms, low risk
mild/moderate airflow limitation + low symptom scores +1 or fewer exacerbations per year

A

Group B

197
Q 
COPD class
few symptoms , high risk

severe/very severe airflow limitation + high symptoms scores + 2 or more exacerbations per year

A

Group C

198
Q 
COPD class
increased symptoms , high risk

severe/very severe airflow limitation + high symptoms scores + 2 or more exacerbations per year

A

Group D

199
Q

FEV1/FVC >= 80%

A

mild COPD

200
Q

FEV1/FVC 50-79%

A

moderate COPD

201
Q

FEV1/FVC 30% - 49%

A

Severe COPD

202
Q

FEV1/FVC <30%

A

Very Severe COPD

203
Q

Group A COPD treatment

A

SABA

consider LAMA or LABA

204
Q

Group B COPD treatment

A

SABA

LAMA or LABA or a combination of LAMA/LABA for management of persistent symptoms

205
Q

Group C COPD treatment

A

SABA
LAMA
management of persistent symptoms - combo LAMA/LABA (preferred) or LABA/IGC

206
Q

Group D COPD treatment

A 
SABA
LAMA or LAMA/LABA or ICG/LABA
management of persistent - Combo - LAMA/LABA/IGC 
if they continue, consider adding
-Roflumilast
-Azithromycin
207
Q

Managing of COPD exacerbations

A

LAMAS have demonstrated better outcomes for exacerbations than LABAS

systemic glucocorticoids

Abx for s/s of infection

oxygen - to maintain sats of 88% - 92%

Pharm Exam 3 (19 decks)

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