Respiratory Flashcards
Rank the following in order of adverse effects occurring when used over long periods for asthma.
#1 for most serious ADR and #5 for least serious ADR.
a. Albuterol, a short acting beta agonist, used 3/5 days, sometimes used 2-3 x/day
b. Beclomethasone, glucocorticosteroid inhaler, used daily for months
c. Cromolyn, mast cell stabilizer, used daily during allergy season (3-4 months/year)
d. Prednisone, a glucocorticoid, as a burst (1-2 weeks of an oral dose for an exacerbation).
e. Theophyline, a phosphodiesterase inhibitor, oral administration for several weeks/months
e. Theophyline, a phosphodiesterase inhibitor, oral administration for several weeks/months
d. Prednisone, a glucocorticoid, as a burst (1-2 weeks of an oral dose for an exacerbation).
a. Albuterol, a short acting beta agonist, used 3/5 days, sometimes used 2-3 x/day
b. Beclomethasone, glucocorticosteroid inhaler, used daily for months
c. Cromolyn, mast cell stabilizer, used daily during allergy season (3-4 months/year)
Levalbuterol (Xopenex) stimulation of beta 2 receptors is greater than albuterol stimulation of beta-2 receptors.
a. Yes
b. No
a. Yes
Most diuretics work by changing the osmolarity of serum.
a. True
b. False
b. False
Renal function has an effect on the efficacy of loop and thiazide diuretics
a. True
b. False
a. True
What is the difference between medications that act on Histamine-1 receptors and Histamine-2 receptors?
?
What should you tell patients about usinga probiotic to treat acute gastroenteristis?
a. It is safe for newborns
b. It is unlikely to reduce the severity or duration of symptoms
c. Immunocompromised patients would benefit the most
d. It should be used for at least 5 days for effectiveness
b. It is unlikely to reduce the severity or duration of symptoms
Weak data suggests it may shorten diarrhea in kids (not newborns!) by about a day according to guidelines, but new 2019 data has strong evidence that treating infants, young children, and adults with lactobaccillis does not reduce the duration or severity of symptoms.
Instead, recommend hydration and electrolytes.
Generally, probiotics are not harmful except to patients with immunosuppression.
There is no sure way to know that a probiotic contains what the label says - no USP verified probiotics.
Some probiotics do have evidence around preventing diarrhea caused by antibiotics.
By the time a patient has developed clinical sinusitis, which of the following is likely to be true?
a. The infection is bacterial and the patient would likely benefit from an antibiotic like amoxicillin
b. The infection is bacterial and no specific treatment is needed
c. The infection is likely to be viral and the patient will benefit from an antiviral like acyclovir
d. The infection is likely to be viral and no specific treatment is indicated
d. The infection is likely to be viral and no specific treatment is indicated
About 98% of rhinosinusitis cases are caused by a virus, and the natural history of this condition is spontaneous resolution within 2 weeks. Nevertheless, antibiotics are prescribed for symptomatic patients in 82% of office visits.
If a patient is prescribed 5 different drugs, the chance for drug interactions because of polypharmacy is approximately:
a. 25%
b. 100%
c. 10%
d. 50%
d. 50%
Risk for 2 drugs = 6%
Risk for 8 drugs = 100%
Participate in drug reconciliation effeorts and to carefully consider current prescriptions when adding a new drug.
Mr. Cruz is a 60 yo man with a dx of COPD x 2 years. Despite adherence to his long-acting LAMA/LABA inhaler maintenance therapy, his has experienced 2 exacerbations (moderate severity) in the past year. His CAT score is 24; 4 points higher than his previous assessment. His eosinophil count is 300 cells/microliter. According to GOLD recommendations, how should his maintenance therapy be modified?
a. Add roflumilast (inhibition of the PDE4 isoenzyme with a consequent increase of cyclic adenosine monophosphate) to current LABA/LAMA therapy
b. Switch to inhaled corticosteroid (ICS)/LABA therapy
c. Escalate to ICS/LANA/LABA combination therapy
d. Add azithromycin to current inhaled LAMA/LABA therapy
c. Escalate to ICS/LANA/LABA combination therapy
This pt does not have an exacerbation right now. Worsening dyspnea. Consider switching inhalation devices or molecules. Investigate the causes of dyspnea, including ensuring patients use risk reduction strategies that decelerate the downward cycle of breathing difficulties, activity avoidance, and physical decline that characterizes COPD progression. Use a COPD ACTION PLAN.
Mild exacerbation - treat with short-acting bronchodilators (SABD). Use MDI, delievered 1-2 puffs every 2-3 hours, then every 4 hours, dependent on the patient response for 1-2 days.
Moderate exacerbations - treat with SABD plus antibiotics and/or oral glucocorticoids. The recommended dose is prednisone 40 mg for 5 days
Consider fluid, oxygen, nutrition, and prophylaxis for VTE, especially if severe.
Severe - hospitalized. Consider roflumilast if in exacervation, FEV1 < 50% and chronic bronchitis (only). The 5 year mortality for AE-COPD is upward of 50%. Have that difficult conversation about end of life choices.
Drugs that cause an increased risk of osteoporosis include: Select all that apply.
a. Biphosphonates
b. Oral corticosteroids
c. Fluoroquinolones
d. Beta-blockers
e. Inhaled corticosteroids
b. Oral corticosteroids
e. Inhaled corticosteroids
Any amount of corticosteroids administered in any route has some association with osteoporosis. Some sources cite a dose of 2.5 mg/day as the threshold for increased risk, but patients often have conditions or disease that contribute to risk, so any dose is concerning.
Fluoroquinolones can cause joint damage.
Bisphosphonates improve osteoporosis.
Other drugs associated with osteoporosis are anticonvulsants, excessive thryoid hormones, some chemotherapy agents such as methotrexate (also used for autoimmune conditions), antacids with aluminum, cyclosporine (transplant RX), and heparin.
Nasal glucocorticoids are indicated for respiratory symptoms related to allergy.
a. True
b. False
a. True
Although they may take a while to work, steroids can reduce symptoms of rhinitis
Why is inhalation a preferred administration method in treating respiratory diseases like asthma or COPD?
a. Inhalation delivers medication direction to target tissues and white blood cells
b. Inhalation provides effective dosing with reduced/few systemic effects
c. Inhalation avoids tolerance and tachyphylaxis in airway tissues
d. The lipophilic side chains in respiratory meds mean better penetration in lung tissue.
b. Inhalation provides effective dosing with reduced/few systemic effects
Availability of an insurance company formulary is useful in selecting agents to manage asthma agents.
a. True
b. False
a. True
Formularies - whether they originate from the BON, an institution or a third party payor - will guide your choices. The patient may not be able to afford off-formulary drugs and so may not take the drug or the whole prescription.
Mild COPD (GOLD Stage I) is typically treated with long-acting bronchodilators.
a. True
b. False
b. False
Gold stages 2-4 (moderate-severe) is treated with long-acting bronchodilators
Patient-related drug-drug interactions, such as NSAIDs with respiratory agents used to treat asthma, include decreased renal function.
a. True
b. False
a. True
NSAIDs can exacerbate renal insufficiency, leading to altered exretion of some drugs. They can also alter hepatic function.
Other patient related risks for drug-drug interaction include acute medical condition (dehydration, infection, HF), age extremes, female gender, metabolic or endocrine condition (esp hypothyroid), multiple med use, genetics
Some drug-related risks: narrow therapeutic index, multiple meds (4 seems to be the critical number of high alert for probable risk), drug formulation, diet, protein binding, inhibition, or induction of CYP450 enzymes and more.
Misc. risks around drug related errors include work flow and work load (more errors/interactions when clinician is busy), too many computer alerts (no one pays attention when too many) and large numbers of clinicians or pharmacists involved with dispensing meds.
