E3: Pulmonary

Question 1

Is spirometry recommended for children?

Answer 1

-Not if under 5 years old and during acute asthma exacerbations

Question 2

What is the treatment for acute bronchospasm/asthma exacerbation?

Answer 2

Provide small volume nebulizer (SVN) with a short acting beta agonist

• albuterol alone or in combination with Ipratropium
• different concentrations of albuterol are available

Question 3

How long does albuterol last?

Answer 3

4 hours

Question 4

You are treating a 12 year old boy for an acute asthma exacerbation. You treated him with an SVN. On re-exam, patient is having persistent expiratory wheezing in the bases and CXR is negative. What should you do?

Answer 4

Repeat SVN with albuterol

Question 5

What should you discharge a patient with after they have had an acute asthma exacerbation?

Answer 5

• SABA: albuterol, either nebulized or inhalation aerosol with MDI
• Oral glucocorticoid: Prednisolone or prednisone

Question 6

What are the side effects of albuterol?

Answer 6

Tachycardia, tremor, nervousness, dizziness

Question 7

What is the dosage of oral glucocorticoids fo acute asthma exacerbation?

Answer 7

• Dosed 1-2mg/kg.day QD or divided BID for 3-5 days
• Prednisolone 15mg/5ml
• Prednisone oral salutation 5mg/5ml

Question 8

What are the side effects of oral glucocorticoids?

Answer 8

Anxiety, agitation, insomnia, and increased appetite

Question 9

You are treating a 12 year old for asthma with Albuterol MDI. Patient is still coughing and has been using the inhaler 3-4 times per week and occasional nighttime symptoms. What should you consider next?

Answer 9

Low dose inhaled glucocorticoids or Cromolyn or montelukast

Question 10

What kind of drug is Montelukast?

Answer 10

LTRA

Question 11

What are the indications for LTRAs?

Answer 11

Asthma, allergic rhinitis, exercise induced bronchospasm, and urticaria

Question 12

What are the side effects of LTRAs?

Answer 12

URIs, headache, abdominal pain, mood changes

Question 13

What is the dosing for Montelukast?

Answer 13

1-6yo: 4mg QD
6-15 yo: 5mg QD
>15yo: 10mg QD

Question 14

You are treating a 12 year old patient with Montelukast and albuterol for asthma. He has been using his albuterol inhaler 3 days per week and had nighttime symptoms twice this month. What should you do next?

Answer 14

-Discontinue montelukast and begin low dose ICS

Question 15

What kind of drug is Fluticasone?

Answer 15

ICS

Question 16

What kind of drug is tiotropium?

Answer 16

Long acting anticholinergic

Question 17

What are the side effects of Tiotropium?

Answer 17

Headache, dry mouth, cough, nausea, blurred vision, and dizziness

Question 18

What kind of drug is Ipratropium bromide?

Answer 18

Short acting anticholinergic dose 4x daily

Question 19

Are anticholinergics use for acute rescue treatment of asthma?

Answer 19

No

Question 20

What kind of drug is advair (Salmeterol/fluticasone)?

Answer 20

Long acting beta2 agonist and ICS

Question 21

What are the side effects of Advair?

Answer 21

-Same for short acting B2 agonist plus thrush and hoarseness due to ICS

Question 22

What is the treatment for acute COPD exacerbation?

Answer 22

SVN with albuterol and ipratropium (duoneb), then recheck vitals

• Short course of glucocorticoids
• Antibiotics (macrolide or fluoroquinolone 1st degree)

Question 23

How often should someone having a COPD exacerbation use their albuterol inhaler?

Answer 23

-2 pulls every 6 hours for 48 hours, then return to PRN use

Question 24

What are the 4 first line treatment options for stable COPD?

Answer 24

• Short acting bronchodilator (SABA, SAMA, or combo)
• Long acting bronchodilator (LABA or LAMA)
• Long acting anticholinergic (LAMA)
• Combination of LABA and LAMA