Module 9 Questions Flashcards
The following are precipitating factors/triggers for which respiratory disease?
- Exercise
- Respiratory infections
- Environmental/occupational allergens
- Smoking
- Irritants
- Emotions
- Stress
- Food additives or preservatives
- Endocrine factors
- Changes in weather
- Exposure to cold air
- Comorbid conditions
1) COPD
2) Asthma
3) Allergic Rhinitis
2) Asthma
Pathophysiology
- Airflow obstruction
- Bronchospasm
- Edema
- Hypersecretion
- Bronchial hyperresponsiveness
- IgE immune response to aeroallergens strongest identifiable predisposing factor for developing this
- Partly due to and correlates with extent of airway inflammation
- Airway inflammation
- Acute
- Chronic
- Airway remodeling (in some)
Which disease is this?
1) Allergic Rhinitis
2) Asthma
3) COPD
2) Asthma
These drugs are relative (not absolute) contraindications for which disease?
- Aspirin
- NSAIDs
- Beta Blockers
1) Asthma
2) COPD
3) Allergic Rhinitis
Asthma
There are situations when the benefits outweigh the risk of using some of these classes of medications for asthma. One example is the use of certain _______ in patients with heart failure as they have demonstrated significant improvement in patient mortality and outcomes.
Which drug class is this?
1) Statins
2) Beta-Blockers
3) PPIs
4) Quinolones
2) Beta Blockers
Regarding asthma:
For patients with reactive airway disease, use cardio-selective _______ when possible.
1) Statins
2) H2RAs
3) TCAs
4) Beta Blockers
4) Beta Blockers
Also known as “Aspirin Exacerbated Respiratory Disease,” ____________________ is a condition in which an individual has asthma, sinus inflammation with recurring nasal polyps, and sensitivity to aspirin and some other NSAIDs. When aspirin or a similar drug is taken, people with this have a severe reaction with both upper and lower respiratory symptoms.
1) Asthma
2) Samter’s Triad
3) COPD
4) Allergic Rhinitis
2) Samter’s Triad
_____________ is a chronic medical condition that consists of three clinical features:
- Asthma
- Sinus disease with nasal polyps
- Sensitivity to aspirin and other NSAIDs
Which disease is this?
1) Samter’s Triad/AERD
2) COPD
3) Asthma
4) Allergic Rhinitis
1) Samter’s Triad/AERD
Doctors may perform an aspirin challenge to confirm a ___________ diagnosis.
1) COPD
2) AERD
3) PNA
4) Allergic rhinitis
5) Asthma
2) AERD (Aspirin-Exacerbated Respiratory Disease)
Diagnostic for asthma if obstruction reversed following an inhaled short-acting bronchodilator (SABA) ≥12% improvement in FEV1.
What is this?
1) Stress test
2) Blood culture
3) Spirometry
4) Pulse oximetry
3) Spirometry
Taken on a daily basis to maintain control of persistent asthma and should not be used for rescue therapy (With the possible exception of a SMART regimen as defined by GINA).
1) Medium-term control (maintenance) medications
2) Short-term control (maintenance) medications
3) Long-term control (maintenance) medications
4) Antibiotics
3) Long-term control (maintenance) medications
ICSs (Inhaled Corticosteroids) are the most effective medications for long-term control of persistent asthma.
True or False?
True
ICSs (Inhaled Corticosteroids) are not the most effective medications for long-term control of persistent asthma.
True or False?
False
All adults and adolescents with asthma should receive ICS-containing controller treatment to reduce their risk of serious exacerbations and to control symptoms.
True or False?
True
All adults and adolescents with asthma should not receive ICS-containing controller treatment to reduce their risk of serious exacerbations and to control symptoms.
True or False?
False
ICS-containing controller can be delivered either with regular daily treatment or, in mild asthma, with as-needed ICS-formoterol taken whenever needed for symptom relief.
True or False?
True
ICS-containing controller can not be delivered either with regular daily treatment, nor can it be used in mild asthma, with as-needed ICS-formoterol taken whenever needed for symptom relief.
True or False?
False
ICSs (Inhaled Corticosteroids)
improve asthma control more effectively in both children and adults than leukotriene receptor antagonists (LTRAs) or any other single, long-term control medication do.
True or False?
True
Leukotriene receptor antagonists (LTRAs) improve asthma control more effectively in both children and adults than ICSs (Inhaled Corticosteroids) or any other single, long-term control medication do.
True or False?
False
The potential risks of ICSs are well balanced by their benefits.
True or False?
True
The potential risks of ICSs are not well balanced by their benefits.
True or False?
False
Spacer/holding chamber devices recommended.
True or False?
True
Spacer/holding chamber devices are not recommended.
True or False?
False
Rinse mouth and spit after use of inhaled corticosteroids.
True or False?
True
There’s no need to rinse mouth and spit after use of inhaled corticosteroids.
True or False?
False
Inhalation preparations are NOT interchangeable on a mcg/puff basis.
True or False?
True
Inhalation preparations are interchangeable on a mcg/puff basis.
True or False?
False
Which drug is this?
- Limited usefulness for asthma.
- Therapeutic response usually occurs within 2 weeks, but 4-6 weeks of use may be necessary to see full effect.
- Primary advantage is safety (children, pregnancy)
- SEE AR
1) Leukotriene modifiers
2) Inhaled Corticosteroids
3) LABAs (Long-Acting Beta Agonists)
4) Cromolyn
5) LAMAs (Long-Acting Muscarinic Antagonists)
6) Methylxanthines
4) Cromolyn
Which drug is this?
- Alternative therapy to low doses of inhaled corticosteroids or cromolyn for patients with mild-moderate persistent asthma
- May be given in combination with inhaled corticosteroids in moderate persistent asthma
- Not for acute asthma. (NO INDICATION IN COPD)
- Used for exercise-induced bronchoconstriction and aspirin-induced asthma
- Also indicated in AR
- Allow 4-6 week trial to determine efficacy
1) Leukotriene modifiers
2) Inhaled Corticosteroids
3) LABAs (Long-Acting Beta Agonists)
4) Cromolyn
5) LAMAs (Long-Acting Muscarinic Antagonists)
6) Methylxanthines
1) Leukotriene Modifiers
Which drug is this?
- Used for long-term prevention of asthma symptoms
- β2 agonist (Bronchodilation by smooth muscle relaxation)
- Does not eliminate need for an ICS
- Should not be used to relieve symptoms or treat exacerbation (With the possible exception of a SMART regimen containing formoterol)
- Adjunct to anti-inflammatory therapy
- In patients (≥ 12yo) with moderate persistent asthma or asthma inadequately controlled on low-dose ICS [Step 2], the option to increase the ICS dose should be given equal weight to the option of adding this med.
- Used only if patients have not responded to other controller medications
- This med should not be used as monotherapy for long-term control, but in combination with ICS
- Associated with increase in asthma related deaths when used as monotherapy.
- The addition of this med to ICS provides greater control than increasing the ICS alone and reduces the frequency of exacerbations (Ducharme F, et al. Cochrane Database Syst Rev 2010;(5):CD005535)
- (Note this will not be the case with COPD).
- Prevention of EIB, but decreased duration of protection with regular use
1) Leukotriene modifiers
2) Inhaled Corticosteroids
3) LABAs (Long-Acting Beta Agonists)
4) Cromolyn
5) LAMAs (Long-Acting Muscarinic Antagonists)
6) Methylxanthines
3) LABAs (Long-Acting Beta Agonists)
Which drug class is this? (Tiotropium)
- Add-on therapy (to ICS) for patients aged ≥12 years with a history of exacerbations (GINA).
- Step 4/5
1) Leukotriene modifiers
2) Inhaled Corticosteroids
3) LABAs (Long-Acting Beta Agonists)
4) Cromolyn
5) LAMAs (Long-Acting Muscarinic Antagonists)
6) Methylxanthines
5) LAMAs (Long-Acting Muscarinic
Which drug class is this? (Theophylline)
- Current place in therapy : Adjunct/Alternative in mild-moderate or persistent asthma.
- Second line overall
- Narrow therapeutic index
- Increases in theophylline concentrations have disproportional bronchodilatory effects
- Serious toxicity can occur without preceding signs of less serious toxicity
- Many drug-drug, drug-disease interactions, including smoking. (See COPD for greater discussion)
1) Leukotriene modifiers
2) Inhaled Corticosteroids
3) LABAs (Long-Acting Beta Agonists)
4) Cromolyn
5) LAMAs (Long-Acting Muscarinic Antagonists)
6) Methylxanthines
6) Methylxanthines
Has many drug-drug, drug-disease interactions, including smoking.
1) Leukotriene modifiers
2) Inhaled Corticosteroids
3) LABAs (Long-Acting Beta Agonists)
4) Cromolyn
5) LAMAs (Long-Acting Muscarinic Antagonists)
6) Methylxanthines
6) Methylxanthines (Theophylline)
Regarding this drug class, serious toxicity can occur without preceding signs of less serious toxicity.
1) Leukotriene modifiers
2) Inhaled Corticosteroids
3) LABAs (Long-Acting Beta Agonists)
4) Cromolyn
5) LAMAs (Long-Acting Muscarinic Antagonists)
6) Methylxanthines
6) Methylxanthines (Theophylline)
Regarding this drug class, increases in theophylline concentrations have disproportional bronchodilating effects.
1) Leukotriene modifiers
2) Inhaled Corticosteroids
3) LABAs (Long-Acting Beta Agonists)
4) Cromolyn
5) LAMAs (Long-Acting Muscarinic Antagonists)
6) Methylxanthines
6) Methylxanthines
Add-on therapy (to ICS) for patients aged ≥12 years with a history of exacerbations .
1) Leukotriene modifiers
X) Inhaled Corticosteroids
3) LABAs (Long-Acting Beta Agonists)
4) Cromolyn
5) LAMAs (Long-Acting Muscarinic Antagonists)
6) Methylxanthines
5) LAMAs (Long-Acting Muscarinic
Should not be used as monotherapy for long-term control, but in combination with ICSs.
1) Leukotriene modifiers
X) Inhaled Corticosteroids
3) LABAs (Long-Acting Beta Agonists)
4) Cromolyn
5) LAMAs (Long-Acting Muscarinic Antagonists)
6) Methylxanthines
3) LABAs (Long-Acting Beta Agonists)
-
-
Not for acute asthma. (NO INDICATION IN COPD.)
1) Leukotriene modifiers
2) Inhaled Corticosteroids
3) LABAs (Long-Acting Beta Agonists)
4) Cromolyn
5) LAMAs (Long-Acting Muscarinic Antagonists)
6) Methylxanthines
1) Leukotriene modifiers
-
-
Allow 4-6 week trial to determine efficacy.
1) Leukotriene modifiers
2) Inhaled Corticosteroids
3) LABA (Long-Acting Beta Agonists)
4) Cromolyn
5) LAMAs (Long-Acting Muscarinic Antagonists)
6) Methylxanthines
1) Leukotriene modifiers
Therapeutic response usually occurs within 2 weeks, but 4-6 weeks of use may be necessary to see full effect.
1) Leukotriene modifiers
2) Inhaled Corticosteroids
3) LABAs (Long-Acting Beta Agonists)
4) Cromolyn
5) LAMAs (Long-Acting Muscarinic Antagonists)
6) Methylxanthines
4) Cromolyn
All adults and adolescents with asthma should receive _______________-containing controller treatment to reduce their risk of serious exacerbations and to control symptoms.
1) Leukotriene modifiers
2) Inhaled Corticosteroids
3) LABAs (Long-Acting Beta Agonists)
4) Cromolyn
5) LAMAs (Long-Acting Muscarinic Antagonists)
6) Methylxanthines
2) Inhaled Corticosteroids
These are the most effective medications for long-term control of persistent asthma.
1) Leukotriene modifiers
2) Inhaled Corticosteroids
3) LABAs (Long-Acting Beta Agonists)
4) Cromolyn
5) LAMAs (Long-Acting Muscarinic Antagonists)
6) Methylxanthines
2) Inhaled Corticosteroids
Primary advantage is safety (children, pregnancy).
1) Leukotriene modifiers
2) Inhaled Corticosteroids
3) LABAs (Long-Acting Beta Agonists)
4) Cromolyn
5) LAMAs (Long-Acting Muscarinic Antagonists)
6) Methylxanthines
4) Cromolyn
These provide prompt relief of bronchoconstriction and its accompanying symptoms:
1) Long-term control (maintenance) medications
2) Quick relief (rescue) medications
3) Immunoglobulin E (IgE) Inhibitors
2) Quick relief (rescue) medications
ALL patients should have a SABA (Short-Acting Beta Agonist) available for PRN use [STEP 1]
- Or if prescribed budesonide/formoterol or beclemathosone/formoterol as maintenance therapy, they can also be used as the “rescue.”
[SMART regimen outlined in GINA]
True or False?
True
ALL patients should not have a SABA (Short-Acting Beta Agonist) available for PRN use [STEP 1]
- Or if prescribed budesonide/formoterol or beclemathosone/formoterol as maintenance therapy, they can also be used as the “rescue.”
[SMART regimen outlined in GINA]
True or False?
False
Which drug class?
- Bursts given to establish control when initiating therapy or during periods of deterioration
- Deaths caused by adrenal insufficiency have occurred in asthmatic patients during and after transfer from these to inhaled corticosteroids
- In order to prevent this situation for years we were taught to taper corticosteroid treatment after short term “burst” course treatments. The key to avoiding adrenal suppression after a short course of corticosteroids is not tapering, but to keeping the course of therapy as short as possible (Eg. 6o mg of prednisone daily for up to 7 days is really safer than taking 10-21 days to taper off the high dose)
- If treated with a course of prednisone, even in moderate or low doses, for more that about 3 weeks you are likely to need a prednisone taper. Many experts would use the 3 week time frame for this, although some would use as little as 2 weeks.
- Some indications for steroids benefit from a taper in dosage to avoid a flare in the disease process being treated
1) Systemic Corticosteroids
2) SABAs (Short-Acting Beta Agonists)
3) SAMAs (Short-Acting Muscarinic Antagonists)
1) Systemic Corticosteroids
Which drug class?
- Relief of acute asthma symptoms
- Preventive for exercise-induced bronchoconstriction
- β2 agonist (Bronchodilation by smooth muscle relaxation)(p 254)
- In addition to asthma monitoring (eg. FEV1 , FVC, etc.), monitoring should include BP, HR and IOP
- Given prior to exercise and as needed (exercise induced bronchospasm, formerly exercise induced asthma)
- When administered in equipotent doses, beta agonists produce same intensity of response
- Increasing use or lack of expected effect indicates inadequate asthma control
- Greater than 1 canister/month may indicate over-reliance on drug
- Greater than 2 canisters/month creates additional adverse risk
- ≥3 canisters dispensed in a year is associated with an increased risk of severe exacerbations
- ≥12 canisters in a year is associated with increased risk of asthma-related death.
- Use of this > twice a week is an indication of poor control. Controller medication should be readdressed
- Note the components of severity and components of control charts below
1) Systemic Corticosteroids
2) SABAs (Short-Acting Beta Agonists)
3) SAMAs (Short-Acting Muscarinic Antagonists)
2) SABAs (Short-Acting Beta Agonists)
Which drug class is this?
- Alternative for patients who do not tolerate SABA, due to less cardiac effects or as add on therapy.
- Use for asthma is indicated in ED setting with albuterol
- (Greater role in COPD)
1) Systemic Corticosteroids
2) SABAs (Short-Acting Beta Agonists)
3) SAMAs (Short-Acting Muscarinic Antagonists)
3) SAMAs (Short-Acting Muscarinic Antagonists)
GINA (Global Initiate for Asthma) determines severity based on therapeutics necessary to maintain control (ie. retrospectively from medications needed to maintain control).
True or False?
True
GINA (Global Initiate for Asthma) does not determine severity based on therapeutics necessary to maintain control (ie. retrospectively from medications needed to maintain control).
True or False?
False
Mild asthma is treated with which steps?
GINA (Global Initiate for Asthma) determines severity based on therapeutics necessary to maintain control (ie. retrospectively from medications needed to maintain control).
1) Steps 1 or 2 (as-needed SABA or low dose ICS).
2) Step 3 (low-dose ICS/LABA).
3) Step 4/5 (moderate or high dose ICS/LABA ± add-on), or remains uncontrolled despite this treatment.
1) Steps 1 or 2 (as-needed SABA or low dose ICS).
Moderate asthma is treated with which steps?
GINA (Global Initiate for Asthma) determines severity based on therapeutics necessary to maintain control (ie. retrospectively from medications needed to maintain control).
1) Steps 1 or 2 (as-needed SABA or low dose ICS).
2) Step 3 (low-dose ICS/LABA).
3) Step 4/5 (moderate or high dose ICS/LABA ± add-on), or remains uncontrolled despite this treatment.
2) Step 3 (low-dose ICS/LABA).
3) Step 4/5 (moderate or high dose ICS/LABA
Severe asthma is treated with which steps?
GINA (Global Initiate for Asthma) determines severity based on therapeutics necessary to maintain control (ie. retrospectively from medications needed to maintain control).
1) Steps 1 or 2 (as-needed SABA or low dose ICS).
2) Step 3 (low-dose ICS/LABA).
3) Step 4/5 (moderate or high dose ICS/LABA ± add-on), or remains uncontrolled despite this treatment.
3) Step 4/5 (moderate or high dose ICS/LABA ± add-on), or remains uncontrolled despite this treatment.
Mild asthma is asthma that can be controlled with Step 1 or 2 treatment.
True or False?
True
Moderate asthma is asthma that can be controlled with step 3 or 4.
True or False?
True