Extra

Question 1

Asthma Treatment

Answer 1

• all patients need a SABA (quick relief, prevention w/ triggers)
• ICS is most effective monotherapy and first line
• ICS + LABA is the preferred treatment for age 5+ with moderate persistent asthma
• LTRAs - second best add on or monotherapy for pts that do not want to be on ICS

Question 2

Asthma Monitoring

Answer 2

• 2-6 wks after initiatign medication

- 1-6 months if asthma is controlled; consider step down if controlled for over 3 months

Question 3

COPD Treatment

Answer 3

• SABAs for all
• Step 1: monotherapy bronchodilator - LABA or long-acting anticholinergic
• Step 2: if needed, LABA + long-acting anticholinergic OR LABA + ICS
• Step 3: if needed LABA + long-acting anticholinergic + ICS

Question 4

Acute Asthma Exacerbation

Answer 4

Help patient get O2 first! (until 90+) - give albuterol (SABA) via nebulizer (maybe inhaler with a valved chamber)

If more severe - give ipratropium via nebulizer

Calm the airways to prevent future issues - give systemic oral corticosteroids; if resp distress, IV

After emergency - get patient on correct therapy: add/increase ICS and maybe add LABAs; continue systemic oral corticosteroids for short burst (3-10 days); counsel on inhaler technique

Question 5

COPD Exacerbations

Answer 5

Help patient get O2 first! (until 88-92%) - give albuterol (SABA) via nebulizer (maybe inhaler with a valved chamber); discontinue long acting anticholinergics

If more severe - give ipratropium via nebulizer

Calm the airways to prevent future issues - give systemic oral corticosteroids (40 mg preddnisone for 5 days); if resp distress, IV

Address possible infection - treat according to pathogen

After exacerbation - long acting anticholinergic or ICS + LABA; counsel on inhaler technique

Question 6

What is the Conventional Disease Modifying Antirheumatic drug of choice for pregnancy?

Answer 6

Sulfasalazine

Question 7

NSIAD use for high GI risk

Answer 7

add gastroprotection to nonselective NSAID

use lower GI risk NSAID: selective COX2 NSAID-celecoxib

Question 8

NSIAD use for high CV risk

Answer 8

use nonselective NSAID naproxin (lowest CV risk)

low dose aspirin - should already be on

Question 9

NSIAD use for if high CV and GI risk

Answer 9

add gastroprotection

use naproxen

Question 10

NSIAD use for low CV and GI risk

Answer 10

use nonselective NSAID

Question 11

Which Conventional Disease Modifying Antirheumatic Drug is used for patients with renal, hepatic, or bone marrow suppression?

Answer 11

Hydroxychloroquine

Question 12

RA Treatment

Answer 12

• initiate 1+ DMARDs in all patients within first 3 mo of diagnosis to reduce joint erosion
• start with 1 conventional DMARD (methotrexate is drug of choice); unless poor prognosis/severe disease, then start 2 conventional DMARDs
• add a 2nd conventional DMARD if needed
• consider triple conventional DMARD therapy OR add or switch to biologic DMARD

DMARDs may take months to help
- bridge therapy for symptomatic relief with NSAIDs or glucocorticosteroids

Question 13

What is the initial drug of choice for RA and what must be prescribed with it?

Answer 13

Methotrexate

FOLIC ACID must also be prescribed!

Question 14

Nonpharmacologic treatment of RA

Answer 14

• OT/PT- preserve joint function, extend ROM, strengthens joints/muscles
• mobility or assistive devices - minimize disability, allow activities of daily living
• stress management (CBT, yoga, etc.)
• joint replacement or reconstruction in severe cases

Question 15

Treating Juvenile RA

Answer 15

• NSAIDs - monotherapy for initial treatment for 1 month
• Glucocorticosteroids: initial treatment affecting 4 or less joints (intra-articular injections)
• Methotrexate: for more than 4 active joints

Question 16

Treating Osteoarthritis

Answer 16

• lifestyle modifications
• try acetaminophen - 4g daily for 4-6 wks before determining ineffective
• try topical NSAID (Diclofenac)
• try oral NSAID - if CI, try intraarticular glucocorticoid injection
• last resort: tramadol or opiods
• try experimental meds or surgery

Question 17

OA Nonpharmacologic Treatment

Answer 17

cornerstone of treatment

• education - focused on health behaviors
• exercise - low impact, aerobic, strength training
• can reduce pain, disability, analgesic use
• weight loss - even 5kg loss helps
• cognitive behavioral intervention

Question 18

Meds that can precipitate Gout

Answer 18

Thiazides
Loop Diuretics
Niacin
Pyrazinamide
Calcineurin inhibitors
Aspirin at higher doses

Question 19

Treating Gout

Answer 19

• topical ice
• first line drug options for acute relief (use ASAP, witin 24 hrs): NSAIDS (naproxen, indomethacin, sulindac), colchicine, corticosteroids, combo if severe attack
• long term prophylaxis - urate lowering therapy

Question 20

If you prescribe methotrexate, think…

Answer 20

birth control