pulmonary

Question 1

when is spirometry not recommended

Answer 1

• acute exacerbation
• age < 5 yo

Question 2

treatment for acute asthma exaccerbation

Answer 2

• small volume nebulizer with albuterol (SABA)
  
  • ​alone or in combination with Ipratropium
  • repeat every 20-30 min prn, up to 3 doses
• oral glucocorticoid: prednisone

Question 3

side effects of albuterol

Answer 3

• tachycardia
• tremor
• nervousness
• dizziness

Question 4

side effects of oral glucocorticoid: prednisone in tx of acute asthma exaccerbation

Answer 4

• anxiety
• agitation
• insomnia
• increased appetite

Question 5

classification for intermittent asthma

Answer 5

• symptoms < or = 2 days/week
• 0 nighttime awakenings
• SABA use for symptom control < or = 2 days/week
  
  • *step 1 tx

Question 6

classification for mild persistent asthma

Answer 6

• symptoms > 2 days/week
• 1-2/month nighttime awakenings
• SABA use for symptom control > 2 days/week but not daily
  
  • ​step 2

Question 7

classification for moderate persistent asthma

Answer 7

• symptoms daily
• 3-4 x/month nighttime awakenings
• SABA use for symptom control daily
  
  • ​step 3

Question 8

classification for severe persistent asthma

Answer 8

• symptoms throughout day
• > 1 x/week nighttime awakenings
• SABA use for symptom control several times a day
  
  • ​step 3

Question 9

preferred tx for step 1: intermittent asthma

Answer 9

SABA prn

Question 10

preferred tx for step 2: mild persistent asthma

Answer 10

1. SABA prn
2. low dose inhaled glucocorticoid
   
   • or cromolyn or montelukast

Question 11

step 3 for moderate persistent asthma

Answer 11

1. SABA prn
2. medium dose inhaled glucocorticoid

Question 12

step 4 for moderate-severe asthma treatment

Answer 12

1. SABA prn
2. medium dose inhaled glucocorticoid +
3. LABA or montelukast

Question 13

MOA of Montelukast

Answer 13

• leukotriene receptor antagonist

Question 14

side effects of Montelukast

Answer 14

• URIs
• headache
• abdominal pain
• mood changes

Question 15

tx for acute COPD exaccerbation

Answer 15

• Ipratropium + albuterol (duoneb)
• short course of glucocorticoids
• +/- antibiotics

Question 16

MOA of albuterol

Answer 16

• short acting B2 agonist
  
  • bronchodilator

Question 17

albuterol works within and lasts for

Answer 17

• within 20 min
• lasts 4-6 hours

Question 18

MOA of salmeterol

Answer 18

• long acting beta 2 agonist

Question 19

how long does salmeterol/fluticasone (advair) last for

Answer 19

12 hours

Question 20

side effects of salmeterol/fluticasone (advair)

Answer 20

• nervous or shaky feeling, tachycardia, upset stomach
• thrush, hoarseness

Question 21

MOA of Tiotropium

Answer 21

• anticholinergic
• bronchodilator

Question 22

differentiate between ipratropium bromide and tiotropium bromide

Answer 22

• ipratropium bromide: short acting
• tiotropium bromide: long acting
  
  • not indicated for rescue tx of braonchospasm

Question 23

side effects of tiotropium

Answer 23

• dry mouth
• cough

Question 24

first line abx for acute COPD exaccerbation

Answer 24

• macrolide or
• fluoroquinolone

Question 25

when are abx indicated for acute COPD exaccerbation

Answer 25

• moderate or severe symptoms
  
  • increased dyspnea
  • increased sputum volume
  • increased sputum purulence

Question 26

List the 4 treatment options for chronic COPD for A, B, C, D

Answer 26

• A: SABA or SAMA
• B: LAMA or LABA
• C: ICS + LAMA or LABA
• D: ICS + LAMA and/or LABA