Respiratory

Question 1

Decongestant contraindications

Answer 1

narrow angle glaucoma
severe uncontrolled HTN
CAD
Tx with MAOI in past 14 days

Question 2

Decongestants with MAOI medication

Answer 2

HTN crisis

Question 3

Antitussive contraindication

Answer 3

MAOI in past 14 days

Question 4

Acute and chronic rhinosinusitis

Answer 4

Acute lasts for less than 4 wks

Chronic lasts for more than 12 wks

Question 5

Abt prescribing for rhinosinusitis

Answer 5

Most cases are viral but abt is still prescribed in most cases

Question 6

Abts for tx on ARS

Answer 6

Amoxicillin/Augmentin
doxycycline
levofloxacin/moxifloxacin
clindamycin
cefpodoxime/cefixime

Question 7

contraindications to amoxicillin/augmentin

Answer 7

hepatic dysfunction/jaundice

ER contraindicated with CrCl <30mL/min

Question 8

Amoxicillin/Augmentin interactons

Answer 8

may increase methotrexate and warfarin
may be increased by probenecid
taking allopurinol can cause increased risk of allergy to amoxicillin

Question 9

1st line therapy for ABRS

Answer 9

Augmentin unless PCN allergic then use:
doxycycline, levofloxacin, or moxifloxacin
Levofloxacin in children with PCN allergy

Question 10

2 or less symptoms/wk
2 or less night awakening/mo
use of emergency SABA 2x or less/wk
exacerbations requiring corticosteroids 0-1/yr

Answer 10

intermittent asthma age 12 and older

Question 11

symptoms more than 2 days/wk but not daily
3-4 night awakenings/mo
SABA use >2 days/wk but not more than once daily
2+ exacerbations requiring corticosteroids/yr

Answer 11

mild persistent asthma 12 yrs and older

Question 12

symptoms daily
more than 1 night awakening per week but not nightly
SABA daily
2+ exacerbations/yr

Answer 12

moderate persistent asthma age 12 and older

Question 13

symptoms throughout the day
often 7 night awakening/wk
SABA several times/day
2+ exacerbation/yr

Answer 13

severe persistent asthma in 12 and older

Question 14

what should all persons with asthma have

Answer 14

SABA for quick relief of symptoms

Question 15

preferred tx for intermittent asthma

Answer 15

SABA prn

Question 16

preferred tx for mild persistent asthma

Answer 16

Low dose ICS

Alternative: Cromolyn, LTRA, theophylline

Question 17

Preferred tx for moderate persistent asthma (step 3)

Answer 17

Low dose ICS + LABA
OR
medium-dose ICS

Question 18

preferred tx for moderate persistent asthma (step 4)

Answer 18

Med dose ICS + LABA

Question 19

preferred tx for severe persistent asthma (step 5)

Answer 19

High dose ICS + LABA
AND
consider omalizumab for those with allergies

Question 20

preferred tx for severe persistent asthma (step 5)

Answer 20

High dose ICS + LABA + oral CS
AND
consider omalizumab for those with allergies

Question 21

SABA drugs

Answer 21

albuterol (Proventil HFA, Ventolin HFA, ProAir HFA)
Albuterol neb (Accuneb)

Question 22

ICS drugs

Answer 22

beclomethasone (QVAR)
budesonide (Pulmicort)
ciclesonide (Alvesco)
fluticasone (Flovent)
mometasone (Asmanex)

Question 23

combo ICS/LABA drugs

Answer 23

formoterol/budesonide (Symbicort)
formoterol/mometasone (Dulera)
samlmeterol/fluticasone (Advair HFA/Advair diskus)
vilanterol/fluticasone (Breo Ellipta)

Question 24

Leukotriene-modifying drugs

Answer 24

montelukast (Singular)
zafirlukast (Accolate)
zileuton (Zyflo)

Question 25

LABA drugs

Answer 25

Salmeterol (Serevent diskus) | formoterol (Perforomist or Foradil)

Question 26

contraindications to SABA/LABA drugs

Answer 26

use with caution with known cardio disease, DM, glaucoma, hyperthyroidism, and seizure disorders

Question 27

when would you use leukotriene modifier drugs

Answer 27

alternate medications for long term control of mild persistent asthma or with an ICS for long term control of moderate persistent asthma

Question 28

mast cell stabilizer drugs

Answer 28

cromolyn (neb)

Question 29

methylxanthine drugs

Answer 29

theophylline | aminophylline

Question 30

omalizumab high risk for anaphylaxis

Answer 30

Observe for 2 hours after 1st 3 doses and 30min after each dose thereafter

Question 31

How long does it take to achieve max benefit with most asthma control medications

Answer 31

3-4 months

Question 32

exercise induced bronchospasm

Answer 32

SABA 15 minutes prior to exercise if anticipated, otherwise they can try warming up, breathing through a mask

Question 33

SAMA (short-acting anticholinergics) drugs

Answer 33

Ipratropium bromide (Atrovent)

Question 34

LAMA (long term anticholinergic) drugs

Answer 34

``` tiotropium bromide (Spiriva) aclidinium bromide (Tudorza) umeclidinium bromide (Incruse ellipta) ```

Question 35

combo SABA/SAMA drugs

Answer 35

ipratropium bromide/albuterol (DuoNeb) - nebulizer | ipratropium bromide/albuterol (Combivent Respimat) - inhaler

Question 36

combo LAMA/LABA drugs

Answer 36

tiotropium/olodaterol (Stiolto Respimat)

Question 37

Tx for Group A COPD

Answer 37

prn: SABA or SAMA (SABA if on LAMA) maint: LAMA or LABA or SABA/SAMA

Question 38

Tx for group B COPD

Answer 38

prn: SABA or SAMA or SABA/SAMA (SABA if on LAMA) 1st choice maint: LAMA or LABA 2nd choice maint: LAMA/LABA

Question 39

Tx group C COPD

Answer 39

prn: SABA or SAMA or SABA/SAMA (SABA if on LAMA) 1st choice maint: LAMA/ICS or LABA/ICS 2nd choice maint: LABA/LAMA or LAMA/PDE4I or LABA/PDE4I

Question 40

PDE4I drugs for COPD

Answer 40

roflumilast (Daliresp)

Question 41

Tx for group D COPD

Answer 41

prn: SAMA or SABA or SAMA/SABA (SABA if on LAMA) 1st choice maint: ICS/LAMA or ICS/LABA 2nd choice maint: ICS/LAMA/LABA or ICS/LABA/PDE4I or LABA/LAMA or LAMA/PDE4I

Question 42

ultra long-acting beta-adrenergic agonists (ULABAs)

Answer 42

Vilanterol indacaterol (Arcapta) olodaterol (Striverdi) aformoterol (Brovana)

Question 43

SAMA and LAMA contraindications

Answer 43

use with caution in narrow-angle glaucoma, myasthenia gravis, prostatic hyperplasia, and bladder neck obstruction

Question 44

methylxanthines (theophylline) and smoking

Answer 44

smoking induces theophylline metabolism lowering drug concentration

Question 45

PDE4I adverse events

Answer 45

increases suicide risk | weight loss

Question 46

when are abts indicated in acute bronchitis

Answer 46

concomitant COPD high fevers purulent sputum respiratory symptoms >4-6 days

Question 47

why are those with chronic bronchitis predisposed to respiratory infections

Answer 47

overproduction and hypersecretion of mucus from goblet cells | impaired mucociliary clearance due to chronic inhalation of irritating substances

Question 48

tx of simple chronic bronchitis

Answer 48

amoxicillin or doxycycline

Question 49

tx for complicated chronic bronchitis

Answer 49

augmentin 2nd or 3rd generation cephalosporin macrolide fluoroquinolone

Question 50

when should fluoroquinolones be used for bronchitis

Answer 50

when patients fail alternative abt treatment, those with allergies to alternative abts, those with resistant pathogens

Question 51

preferred tx for pna in previously healthy adults with no recent abt usage and no risk factors for DRSP

Answer 51

macrolide (azithromycin or clarithromycin) OR doxycycline

Question 52

preferred tx for pna in those with comorbidities, abt usage in past 3 months, or risk factors for DRSP

Answer 52

B lactam (high dose amoxicillin) or Augmentin