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Therapeutics > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

which class of asthma meds are used for RESCUE ONLY

A

SABA

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2
Q

which 2 agents are SABAs

A

albuterol levalbuterol

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3
Q

which med is a ICS/SABA? how is it used?

A

budesonide/albuterol
reliever only

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4
Q

AEs of SABAs

A

tremor, shaky, lightheaded, palpitations

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5
Q

what are the 5 ICS

A

ciclesonide
fluticasone (propionate, furoate)
beclomethasone
mometasone
budesonide

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6
Q

2 major AE of ICS

A

oropharyngeal candidiasis, dysphonia

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7
Q

counsel for ICS to

A

rinse and spit with each us

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8
Q

which inhaler type should be shaken? not?

A

shake MDI
do not shake DPI

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9
Q

avoid DPI in

A

children <4 and milk protein allergy

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10
Q

3 LABAs? should they be used alone for asthma?

A

salmeterol, formoterol, vilanterol
DO NOT USE ALONE IN ASTHMA- BBW

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11
Q

BBW for LABA

A

asthma related death when used alone

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12
Q

4 ICS/LABA combos

A

budesonide/formoterol
fluticasone propionate/salmeterol
fluticasone furoate/vilanterol
mometasone/formoterol

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13
Q

which agent is a LAMA? when is it used

A

tiotropium
usually add on later

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14
Q

3 leukotriene modifiers

A

montelukast, zafirlukast, zileuton

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15
Q

AE for leukotriene modifiers

A

headache, psych changes
montelukast suicide BBW

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16
Q

asthma PO med dosed based on serum concentrations

A

theophylline

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17
Q

should OTC epinephrine be used for asthma

A

limit to short term use for unexpected situations, facilitate follow up

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18
Q

which 2 conditions are part of atopy and may contribute to asthma

A

eczema, allergic rhinitis

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19
Q

which meds can trigger asthma

A

ASA, NSAIDs, nonselective BB

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20
Q

4 main symptoms of asthma

A

wheezing, SOB, chest tightness, cough

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21
Q

signs of asthma

A

wheezing, dry cough, atopy signs, low O2 sat

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22
Q

how & when is asthma severity assessed

A

retrospective, after controlled for several months

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23
Q

mild, moderate, and severe asthma are controlled with which steps of therapy….

A

mild- step 1 or 2
mod- step 3 or 4
sev- step 5

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24
Q

how is asthma symptom control assessed? what do you ask?

A

daytime asthma sx >2x week?
nighttime waking?
reliever for sx >2x week?
activity limitations?

0= well controlled
1-2= partly controlled
3-4= uncontrolled

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25
Q

when assessing asthma symptom control do you always consider frequency of reliever use for symptoms? when would you not?

A

Do not as if use ICS/formoterol for reliever, do not include reliever for exercise

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26
Q

if asthma symptoms <3-5 days a week with normal/mild reduced lung function, start on which step of therapy?

A

step 1 or 2

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27
Q

is asthma symptoms most days, waking at night once a week or more, and low lung function, start on which step of therapy?

A

step 3

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28
Q

if daily asthma symptoms, waking at night once a week or more, low lung function, or a recent exacerbation, start on which step of therapy

A

step 4

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29
Q

what is started on step1-2 of asthma therapy

A

PRN only low dose ICS-formoterol

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30
Q

what is started on step 3 of asthma therapy

A

low dose maintenance ICS/formoterol

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31
Q

what is started on step 4 of asthma therapy

A

medium dose maintenance ICS/formoterol

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32
Q

what is preferred to use as the reliever for all steps of asthma therapy? alternate?

A

ICS/formoterol preferred
SABA alternate

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33
Q

2 main options if moving to step 5 of asthma therapy

A

high dose ICS/formoterol
add on a LAMA

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34
Q

after asthma therapy have been well controlled for 3 months, you can

A

maintain or step down therapy then reassess

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35
Q

if after a few months asthma is partly controlled or uncontrolled what do you do

A

check adherence and technique
step up 1 step

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36
Q

how to treat exercise induced bronchospasm in asthma

A

PRN SABA used once before exercise

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37
Q

patients managing an acute asthma exacerbation at home should

A

follow asthma action plan
increase reliever or controller

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38
Q

presentations of mild and moderate asthma exacerbation

A

pulse 100-120 bpm
O2 sat 90-95%
talk in phrases
prefers to sit
not agitated
no accessory muscle use

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39
Q

what should be assessed for asthma exacerbations

A

severity of sx (dyspnea), vitals, ability to complete sentences, consciousness, O2 sat, no response to initial therapy

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40
Q

(primary care) treatment for mild asthma exacerbation include

A

SABA 4-10 puffs Q20 min for 1 hour
prednisone
oxygen

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41
Q

O2 sat target for asthma exacerbation

A

93-95%

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42
Q

what is done for mild/mod asthma exacerbation discharge

A

reliever continue PRN
start or step up controller/ICS
steroid continue x5-7 days

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43
Q

(ED) treatment for moderate asthma exacerbation include

A

SABA
controlled O2
prednisone 50 mg

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44
Q

presentations of severe asthma exacerbation

A

RR>30
accessory muscle use
pulse >120 bpm
O2 sat <90

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45
Q

what is initiated for severe asthma exacerbation

A

SABA
ipratropium bromide
controlled O2
prednisone

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46
Q

which 2 agents may be considered for use in severe asthma exacerbation

A

IV magnesium
high dose ICS

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47
Q

main 2 environmental causes of COPD

A

smoking, occupational exposure

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48
Q

3 risk factors for COPD

A

smoker/exsmoker, >age 40, men

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49
Q

COPD is diagnosed with spirometry showing an FEV1/FVC of

A

<0.7

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50
Q

symptoms of COPD

A

dyspnea, chest tightness, wheezing, fatigue, activity limitation cause, +/- sputum production

51
Q

which 3 classes are bronchodilators used for COPD

A

beta 2 agonists
muscarinic antagonists
theophylline

52
Q

2 SABAs used for COPD

A

albuterol, levalbuterol

53
Q

4 LABAs used for COPD

A

salmeterol, formoterol, arformoterol, olodaterol

54
Q

which 2 LABAs for COPD are nebulizer only

A

formoterol, arformoterol

55
Q

AEs of beta 2 agonists

A

tachycardia, tremor, tachyphylaxis

56
Q

SAMA used for COPD

A

ipratropium bromide

57
Q

LAMAs used for COPD (4)

A

tiotropium, aclidinium, umeclidinium, revefenacin

58
Q

AEs of LAMAs for COPD

A

dry mouth, cough, blurred vision, metallic taste (tio)

59
Q

what is a SABA/SAMA combo medication? how is it available

A

albuterol ipratropium
combivent respimat – SMI
DuoNeb – nebulizer

60
Q

DuoNeb is contraindicated in

A

soybean and peanut allergy

61
Q

4 LAMA/LABA combo agents

A

tiotropium/olodaterol (stiolto)
umeclidinium/vilanterol (anoro)
glycopyrrolate/formoterol (bevespi)
aclidinium/formoterol (duaklir pressair)

62
Q

4 ICS/LABA combos that may be used in COPD

A

fluticasone furoate/vilanterol (breo)
budesonide/formoterol (symbicort)
mometasone/formoterol (dulera)
fluticasone propionate/salmeterol (advair, wixela, airduo)

63
Q

which 2 agents are triple therapy (ICS/LAMA/LABA) used for COPD

A

fluticasone furoate/umeclidinium/vilanterol (trelegy)
budesonide/glycopyrrolate/formoterol (breztri)

64
Q

what is a PDE4 inhibitor that may be used PO in COPD

A

roflumilast (daliresp)

65
Q

AEs of roflumilast

A

nausea, diarrhea, weight loss, sleep disturbances, HA, worsen depression

66
Q

COPD gold 1 mild FEV1 is

A

≥80

67
Q

COPD gold 2 (moderate) FEV1 is

A

50-79

68
Q

COPD gold 3 (severe) FEV1

A

30-49

69
Q

COPD gold 4 (very severe) FEV1 is

A

<30

70
Q

regardless of COPD symptom scores, having ≥2 mod exacerbations OR ≥1 leading to hospitalization puts you in COPD class ___

A

E

71
Q

in COPD, if has 0 or 1 mod exacerbation (no hospitalization), and a mMRC of 0-1 OR CAT<10, they are class __

A

A

72
Q

in COPD, if has 0 or 1 mod exacerbation (no hospitalization), and a mMRC ≥2 OR CAT ≥10, they are class ___

A

B

73
Q

initial therapy for COPD in class A is

A

a bronchodilator
LAMA or LABA preferred over SAMA or SABA

74
Q

initial therapy in COPD for class B is

A

LABA + LAMA combo better than mono

75
Q

initial therapy in COPD for class E is

A

LABA + LAMA
AND ICS IF BLOOD EOS >300

76
Q

when are ICS favored in COPD

A

blood eos >300
concomitant asthma
history of hospitalization for exacerbation
3 or more mod exacer/yr

77
Q

in addition to maintenance therapy, ALL COPD PATIENTS should be prescribed

A

SAMA, SABA, or a combo (preferred)

78
Q

if at COPD follow-up a patient is still having PREDOMINANT DYSPNEA and is on a LABA or LAMA, what do you do next?

A

switch to LABA/LAMA combo

79
Q

if at COPD follow-up a patient is still having PREDOMINANT DYSPNEA and is on a LABA/LAMA combo, what do you do next?

A

switch inhaler device or molecules
implement nonpharm
check for other dyspnea causes

80
Q

if at COPD follow-up a patient is still having PREDOMINANT EXACERBATIONS and is on a LABA or LAMA, what do you do next if blood eos <300 or >300?

A

<300 –> switch to LAMA/LABA combo
>300 –> switch to LAMA/LABA/ICS combo

81
Q

if at COPD follow-up a patient is still having PREDOMINANT EXACERBATIONS and is on a LABA/LAMA combo with blood eos >100 what do you do?

A

switch to LAMA/LABA/ICS combo

82
Q

if at COPD follow-up a patient is still having PREDOMINANT EXACERBATIONS and is on a LABA/LAMA combo with blood eos <100 OR is on a LAMA/LABA/ICS, what do you do?
-if FEV1<50 or chronic bronchitis?
-if former smoker?

A

FEV1<50 or chronic bronchitis- roflumilast
former smoker- azithromycin

83
Q

if at COPD follow up patients are having both dyspnea and exacerbation symptoms, which treatment pathway do you follow

A

exacerbation pathway

84
Q

what do you do at COPD follow up with a patient on a ICS/LABA if they have coexisting asthma

A

continue therapy

85
Q

what do you do at COPD follow up with a patient on a ICS/LABA if they do not have asthma but are controlled

A

continue

86
Q

what do you do at COPD follow up with a patient on a ICS/LABA if they do not have asthma but have major symptoms

A

switch to LAMA/LABA

87
Q

what do you do at COPD follow up with a patient on a ICS/LABA if they do not have asthma and are having exacerbations with blood eos >100 or <100

A

> 100 – switch to LAMA/LABA/ICS
<100 – switch to LAMA/LABA

88
Q

5 main nonpharm treatments for COPD

A

smoking cessation
vaccines
pulm rehab (group B & E)
oxygen therapy
noninvasive ventilation

89
Q

3 triggers for COPD exacerbation ? what do they cause?

A

bacteria, viruses, pollutants – inflammation of airways

90
Q

characteristics of mild COPD exacerbation include

A

no resp failure, mild tachypnea
HR <95, RR<25, O2 >92

91
Q

characteristics of moderate COPD exacerbation include

A

acute non life threatening resp failure
significant tachypnea
use of accessory muscles
PaCO2 50-60
HR >95, RR>24, O2 sat <92

92
Q

characteristics of severe COPD exacerbation

A

acute life threatening resp failure
significant tachycardia
use of accessory muscles
acute mental status change
PaCO2 >60
acidosis

93
Q

what are the 4 main therapies initiated for an acute COPD exacerbation

A

oxygen
SABA/SAMA
LAMA/LABA
steroids

94
Q

what is target O2 sat with oxygen therapy for COPD exacerbation

A

88-92%

95
Q

what short acting bronchodilators can be used for acute COPD exacerbation

A

albuterol
levalbuterol
ipratropium
ipratropium/albuterol combo

96
Q

when are long acting bronchodilators used for acute COPD exacerbation

A

when stable and can tolerate inhalers

97
Q

how long are steroids used for COPD exacerbation?
what is used for mild/mod? severe?

A

5 DAYS TOTAL
mild/mod- prednisone 40 mg
sev- methylprednisolone 60 mg IV Q8-12H

98
Q

when are antibiotics used for COPD exacerbation

A

> sputum purulence + >dyspnea or >sputum volume

99
Q

which abx should NOT be used for COPD exacerbation

A

erythromycin, Bactrim, amoxicillin, 1st gen ceph

100
Q

which abx are used and how long for COPD exacerbation if uncomplicated, <4 exac/yr, & no comorbidities

A

macrolide, 2nd/3rd gen cep, doxycyline
x5 days

101
Q

which abx are used and how long for COPD exacerbation if complicated, >65 y/o, >4 exac/yr, or comorbidities

A

amox/clav, fluoroquinolone x 5 days

102
Q

which abx are used and how long for COPD exacerbation if high risk for MDR pathogens

A

levofloxacin, cefepime, ceftazidime x5-7 days

103
Q

classification of allergies if symptoms <4 days per week or <4 weeks per year that do not interfere with life

A

mild intermittent

104
Q

classification of allergies if symptoms <4 days per week or <4 weeks per year that DO interfere with life

A

mod to sev intermittent

105
Q

classification of allergies if symptoms >4 days per week or >4 weeks per year that do not interfere with life

A

mild persistent

106
Q

classification of allergies if symptoms >4 days per week or >4 weeks per year that DO interfere with life

A

mod to sev persistent

107
Q

2 nonpharm options for allergies

A

nasal saline
adhesive nasal strips

108
Q

IN steroids work for which allergic symptoms

A

ALL

109
Q

AEs of IN steroids

A

HA, dryness, burning, stinging, blood tinged secretions

110
Q

oral antihistamines work for which allergy symptoms

A

all except congestion

111
Q

IN antihistamines work which allergy symptoms

A

all except ocular

112
Q

AEs of IN antihistamines

A

bitter taste, epistaxis, HA

113
Q

topical decongestants should be used how long

A

3 days or less

114
Q

ocular antihistamines work for which symptoms of allergies

A

ocular only

115
Q

IN cromolyn works for which allergy symptoms

A

all except ocular

116
Q

IN ipratropium helps which allergy symptoms

A

rhinorrhea

117
Q

allergy choice if primarily nasal congestion

A

INS or PO decongest

118
Q

allergy choice if primarily sneezing, nasal itch, rhinorrhea

A

OAH, IN antihistamine

119
Q

allergy choice if primarily mild sx

A

OAH

120
Q

allergy choice if primarily mod/sev symptoms

A

INS, IN antihistamine, combo

121
Q

if INS not helping enough what can you add

A

IN antihistamine or oxymetazoline

122
Q

if OAH not helping enough what can you add

A

PO decongestant

123
Q

if IN antihistamine not working enough what can you add

A

IN steroid

Therapeutics (27 decks)

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