Pharm Test Ii

Front 1

underlying mechanism for asthma

Back 1

inflammation

Front 2

parthological changes in asthma

Back 2

submucosa swelling
increased mucous
narrowing of passageway

Front 3

delivery devises for inhaled meds

Back 3

MDI, PDI, spacer/chamber
spacer/holder/face mask
nppb

Front 4

daily: long-term control geared at

Back 4

prevention

Front 5

daily: long term-term control meds

Back 5

corticosteroids (inhaled/sys)
cromolyn/nedocromil
long-acting beta2-agonists
methylxanthines (bronchodilators)
leukotriene modifiers

Front 6

prn: quick relief meds

Back 6

short acting beta2-agonists
anticholinergics
systemic corticosteroids

Front 7

The most effective long-term-control therapy for persistent asthma

Back 7

Inhaled corticosteroids

Front 8

risk is ____ at _____ dose

Back 8

small; recommended

Front 9

ways to reduce potential adverse events by

Back 9

use spacer; rinse mouth; use lowest dose possible; combo with long-acting beta2-agonists
monitor growth in children

Front 10

benefits of daily use of inhaled corticosteroid

Back 10

fewer sx; fewer exacerbations; reduced use of rescue meds; improved lung fxn; decreased airway inflammation

Front 11

studies of inhaled corticosteroids effect on linear growth in children shows _____ effect with low to medium doses

Back 11

no

Front 12

potential risk appears to be ______ dependent

Back 12

dose

Front 13

high doses have a ______ potential for growth _____ or _______

Back 13

greater; delay; suppression

Front 14

for severe peristent asthma, _____ doses of inhaled CS have _____ risk than oral CS

Back 14

high; less

Front 15

while administering an inhaled CS in a child you should monitor ______

Back 15

growth

Front 16

use ____ dose necessary to maintain control
____ therapy when possible

Back 16

lowest; step down

Front 17

administer with ______ chambers

Back 17

spacer/holding

Front 18

advise pt to _____ & _____ following inhalation
inorder to decrease _____ absorption

Back 18

rinse; spit; systemic

Front 19

consider adding a ____-_____ beta2 _____ to a ____to____ dose inhaled CS
vs using a ____ dose of CS

Back 19

long-acting; agonist; low to medium; higher

Front 20

most important determinant of dosing is _____ judgement

Back 20

clinical

Front 21

monitor pts clinical _____ to therapy

Back 21

response

Front 22

adjust ____ accordingly

Back 22

dose

Front 23

if seeing an improvment in PFT ____ with one med, don't _____ back and forth, ____ dose if necessary

Back 23

stay; switch; increase

Front 24

SE of B2 agonists

Back 24

tachycardia, tremors, anxiety

Front 25

LA B2-agonists are not a _____ for anti-inflammatory therapy

Back 25

sustitute

Front 26

are not appropriate for ______

Back 26

monotherapy

Front 27

beneficial when added to _____ ______

Back 27

inhaled CS

Front 28

not for ___ sx or exacerbations

Back 28

acute

Front 29

examples of LA Beta2-agonists are

Back 29

salmeterol (Servevent)
formoterol (Foradil)

Front 30

examples of SA B2-agonists are

Back 30

albuterol (proventil)
Pirbuterol (Maxair)
metaproterenol (Alupent)
Levabluterol (Xopenex)

Front 31

Metaproterenol is a _____ beta agonists

Back 31

non selective

Front 32

Levalbuterol is now available in what forms

Back 32

nppb and MDI

Front 33

Every asthma pt should have a _____-_____ Beta2-agonist as part of their therapy

Back 33

short-acting; used for rescue

Front 34

most effective med for relief of acute bronchospasm

Back 34

SA Beta2 agonists

Front 35

more than ____ cannister per ____ indicates inadequate asthma control

Back 35

one; month

Front 36

_____ scheduled use is not generally recommended

Back 36

regularly

Front 37

regularly scheduled use of SAB2A can result in _____ effectiveness and may increase ____

Back 37

lower; hyperresponsiveness

Front 38

Caffine, theophylline are examples of _______

Back 38

Xanthine derivatives

Front 39

theophylline is a ______ inhibitor and stimulates endogenous ________, which bind to ____ receptors

Back 39

phosphodiesterase; catecholamines; B2

Front 40

which is used IV, theophylline or aminophylline?

Back 40

theophylline; aminophylline doesn't dissovle in water

Front 41

What is the therapeutic level of theophylline?

Back 41

10-20mcg/ml

Front 42

adverse effects of theophylline

Back 42

n/v, anorexia; tachycardia; arrhythmia; CNS (cerebral vasoconstriction); anxiety

Front 43

factors that decrease theophylline concentrations

Back 43

antiepiletic drugs (phentoyin (dilatin)(clears faster)
carbamazapine (tegretol)
smoking
high protein diet

Front 44

factos that increase theophylline concentration

Back 44

abtx, OC, systemic viral illness, cimetidine (tagamet)
decrease matabolism

Front 45

anticholinergics are useful only in cholinergic-mediated ________ and work well in acute severe asthma in combo with __________

Back 45

bronchoconstriction; B2 agonists

Front 46

examples of anticholinergics

Back 46

ipratropium bromide (Atrovent) (MDI, nppb)
glycopyrate (Robinul)
triotropium (Spiriva)
Combos with B2-agonisits(Combivent)

Front 47

SE of anticholinergics are _____ than with systemic administration

Back 47

less; tachycardia; dry mouth; decreased tracheal secretion

Front 48

mast cell stabilizers _______ the release of _______

Back 48

inhibit; histamines

Front 49

Examples of mast cell stabilizers are

Back 49

Cromolyn (Intal) (DPI); Nedocromil sodium (Tilade)

Front 50

mast cell stabilizers are indicated for

Back 50

prophylaxis of mild to moderate asthma regardless of etiology

Front 51

Leukotriene modifiers are released from _____ ______

Back 51

mast cells

Front 52

mechanisms of leukotriene modifiers are

Back 52

5-LO (lipoxydenase) inhibitors
cysteiny leukotriene receptor antagonist

Front 53

example of 5-LO is
example of CLRAs are

Back 53

Zyleuton (Zyflo)
Zafirlukast (Accolate), Montelukast (Singulair)(commonly used in peds and rhinnitis)

Front 54

leukotriene modifiers are indiciated for

Back 54

long-term control therapy in mild persistant asthma

Front 55

LM ______ lung fxn; decrease need for ______; _______exacerbations

Back 55

improve; SAB2 agonists; prevent

Front 56

stepwise approach to control of asthma
start _____ and step _____ or start at initial level of ______ and gradually step ___

Back 56

high; down; severity; up

Front 57

step wise approach for adults and children >5 is
step 1________, step 2________, step 3_______, step 4_________

Back 57

quick relief, prn; 1 long-term control med: antiinflammatory;
>= 1 Long-term control med
multiple long term control med: inlcuding oral CS

Front 58

indicators of poor asthma control
awakens at ______ with sx
has _____ _____ visit
has _____ need for SAB2A
uses more than ______ cansiter of SAB2A in ____ month

Back 58

night; urgent care; increased; one; one;

Front 59

what you do next

Back 59

step up therapy

Front 60

before increasing medications you should check

Back 60

inhaler technique; adherence of prescribed regimen; environmental changes; alternative dx

Front 61

step one tx for adults and children >5
mild intermediate

Back 61

daily long-term control: not needed
quick relief: inhaled SAB2A prn

Front 62

step two for adults and children >5
mild persistent

Back 62

Daily LT control: anti-inflammatory (inhaled CS low dose or Cromooyn or nedocromil)
OR
sustained-release theop (not prefered); leuk modi. may be considered
quick relief: SAB2A prn

Front 63

step 3 for adults and children >5
moderate persistant

Back 63

Daily LT control: inhaled CS (med dose) or
inhaled CS (low to med dose and LA bronchodilator (LAB2A or sustained relase theoph)
if needed increase to:
inhaled CS (med to high dose) and LA bronchodil
consider refferal

Front 64

step 4 tx for adults and children >5
severe persistent

Back 64

daily LT control: inhaled CS (high dose) and LA bronchodil: inh LAB2A or sustained release theoph OR
LAB2A tabs and
oral CS, long term
quick relief
rerferral

Front 65

step 1 tx for children <5 yrs
mild intermittent

Back 65

Daily LT control: not needed
Quick relief: bronchodilator
prn OR oral B2A; SAB2A; consider systemic CS if current exacerbation is severe

Front 66

Step 2 tx for infants and young children <5
mild persistent

Back 66

DLTC: anti-inflam: Cromolyn (nppb) or nedocromil OR
low-dose inhaled CS
quick relief: SAB2A (nppb or oral)

Front 67

step 3 tx infants and young children <5
persistent

Back 67

DLTC: anti-inflamm: med inh CS OR lower med-dose inh CS & nedocromil or theoph
QR: SAB2A (nppb/oral)

Front 68

step 4 tx infants and young children <5
severe persistent

Back 68

DLTC: high-dose inhaled CS
QR: inh SAB2A or nppd

Front 69

School-age children special considerations:

consider use of _____ or ______ first for step 2 care

encourage active participation in _____ activity

Back 69

cromolyn or nedocromil; physical

Front 70

Special considerations for older adults
high prevelance of coexisting ____ lung disease
essential to review pt ____ in using medicaiton and devices
meds have increased ____ ____
_____ clearance is reduced; causing _____ blood levels

Back 70

obstructive; technique; adverse effects; theoph; increased

Front 71

systemic corticosteroids can provoke _______, agitation and changes in _____ metabl.

inhaled CS may be associated with dose-dependent reduction in ____ mineral content

Back 71

confusion; glucose; bone

Front 72

meds that may exacerbate asthma

Back 72

NSAIDS; non-selective B-blockers; B-blockers found in some eye drops (Timolol)

Front 73

Mangagement of EIB

_____ used shortly a exercise

______ may prevent EIB for 1--12 hours

_____ and nedcromil are also acceptable

Back 73

SAB2A (inh); salmeterol; cromolyn

Front 74

managing seasonal asthma sx

just a allergy season start daily ___-____ therapy

Back 74

anti-inflammatory

Front 75

during allergy season

______ anti-inflammatory therapy
use _____ approach to control sx

Back 75

continue; stepwise