RESPIRATORY

Question 1

GOAL OF FEV1

Answer 1

> / 90%

Question 2

goal of using reliever therapy

Answer 2

<2/wk

Question 3

when should LABA be used in asthma

Answer 3

only if patient is already taking ICS

Question 4

List the ICS inhaler

Answer 4

beclomethasone 
budesonide,
 ciclesonide, 
fluticasone furoate, fluticasone propionate 
and mometasone

Question 5

which drug are LABA

which has slow and rapid acting

Answer 5

salmeterol, formoterol, indacaterol, vilanterol

**formoterol is rapid acting, the rest is short acting

Question 6

can budesonide/formoterol be used as rescue? what about salmeterol/ICS?

Answer 6

formoterol/ budesonide can be used as rescue as it is rapid acting,
salmeterol/ ICS is not

** note budesonide/formoterol can be use as rescue and controller therapy

Question 7

what is in triple therapy

Answer 7

LAMA+LABA+ICS ( trelegy and enerzair)

Question 8

list LAMA agent

Answer 8

tiotropium,

Aclidinium, glycopyrronium and umeclidinium

Question 9

LAMA approved for asthma

Answer 9

tiotropium

Question 10

list SAMA?

Answer 10

Ipratropium

Question 11

which delivery methods of inhaler is best for children <5 years old

Answer 11

MDI with spacer

Question 12

role of montelukast

Answer 12

2nd line, steroid sparing and may be add on to low dose ICS in patient with concomitant rhinitis

Question 13

Differences in the management of asthma in young children versus adults include:

Answer 13

LTRAs and anti-allergic agents may play a greater role in children versus adults.
LABAs are not first-line adjunctive therapy in children under 5 years of age.

Question 14

what should we monitor for when using ICS

Answer 14

patient with history of glaucoma should have Intraocular pressure check periodically

Question 15

exercise induced bronchospasm ( EIB)

Answer 15

It is defined as a reduction in FEV1 of 15-20% after exercise

Question 16

is there ICS/LAMA combo

Answer 16

no, there is ICS/LABA

Question 17

which agent is safe in pregnancy

Answer 17

Short-acting inhaled beta2-adrenergic agonists, theophylline and inhaled corticosteroids (particularly budesonide) have been used extensively and are considered safe for use in pregnancy;​ however, theophylline may worsen gastroesophageal reflux, can cause nausea, and has a narrow therapeutic index, so avoid if possible. Accumulating evidence indicates montelukast may be used safely during pregnancY

Question 18

diagnosis of COPD

Answer 18

FEV1: FVC <0.7

Question 19

GOLD spirometry severity criteria

Answer 19

mild FEV1 > 80%
moderate: FEV1 50-80%
severe: 30-50%
very severe <30%

Question 20

for COPD, which only intervention can slow down FEV1 decline

Answer 20

SMOOKING CESSATION

Question 21

what does it mean when asthma is control

Answer 21

SEE pic

Question 21

what does it mean when asthma is control

Answer 21

SEE pic

Question 22

which LAMA is approved for asthma

Answer 22

tiotripium

Question 23

when is mepolizumab indicated

Answer 23

add-on therapy in adult patients with severe eosinophilic asthma who are poorly controlled on ICS plus an additional agent and who have a blood eosinophil count >150 cells/mcL

Question 24

adverse effects of montelukast

Answer 24

Headache (common), abdominal pain, flulike symptoms. Neuropsychiatric effects (e.g., depression, agitation/aggression, hallucinations, suicidal ideation)

Question 25

asthma affects which inflammatory cells and COPD?

Answer 25

Asthma: eosinophilic vs COPD=

Question 26

How to manage AECOPD

Answer 26

1: scheduled SABA+/ LAMA
2: pred 30-50mg x 5-10 days
3: add antibiotic if change in sputum purulence AND increased sputum volume or increased dyspnea

Question 27

which antibiotic for AECOPD?

Answer 27

low risk: amox, doxy, TMP/SMX, Clarithromycin, azithromycin, cefuroxime, cefprozil

HIGH risk ( >4 exacebation, chronic steroid use): amox/clav, levo or moxi

Question 28

role of Roflumilast

Answer 28

Roflumilast may be considered for add-on therapy to existing triple therapy (ICS/LAMA/LABA or LAMA + ICS/LABA) for people with COPD who have had at least 1 exacerbation in the past year

Question 29

treatment of asthma exacerbation

Answer 29

SAMA+ SABA concurrent

add steroid