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91 Cards in this Set
- Front
- Back
Are also known as cromolyn-like agents used as prophylactic to treat the inflammatory response in asthma? |
Mast cell stabilizers |
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Alternatives to low-dose corticosteroids in Step 2 asthma include? |
cromolyn-like drugs and antileukotrienes |
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Systemic corticosteroids are controllers or relievers? |
Relievers |
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Leukotriene Modifers are controllers or relievers? |
Controller |
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Cromolyn sodium and Nedocromil sodium are controllers or relievers? |
Controllers |
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SABA is controllers or relievers? |
Relievers |
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LABA is a controller or reliever? |
Controller |
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TMP-SMZ (Bacterim) (1st line) is considered as 1st line therapy to treat Pneumocystis carinii pneumonia (PCP) or (Pneumocystis jiroveci)? True or False |
True |
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What is 2nd line prophylactic therapy in HIV or AIDS patients to prevent Pneumocystis carinii pneumonia (PCP) or (Pneumocystis jiroveci)? |
Pentamidine (NebuPent); given through inhalation and IV; give with SABA like Albuterol |
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Which drugs are Antileukotrienes (anti-LTs)? Know which agents is appropriate per specific |
a. Zileuton (Zyflo, Zyflo (R): Zyflo 600 mg QID and Zyflo ER 1200 mg BID b. Zafirlukast (Accolate): 10 mg bid children 5-11 years old. 20 mg bid 12 years old and older. c. Montelukast (singulair): 10 mg tabs, 4 mg- 5mg chewable tabs, 4 mg granules QD for >6 months of age |
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Ribavirin is FDA approved for use in infants? True or False |
True |
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Ribavirin treats TB? |
False |
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When giving an aersolized antibiotic, can you mix them with other drugs or use the same nebulizer? |
No |
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Know which steroids are available for inhalation and the purpose of their use with asthmatic and COPD patients? |
1. QVAR; Beclomethasone dipropionate 2. Pulmicort; Budesonide 3. Alvesco; ciclesonide 4. Aerospan; Flunisolide 5. Flovent; Fluticasone propionate 6. Asmanex; mometasone furoate 7. Advair; Fluticasone propionate + Salmeterol 8. Symbicort; Budesonide + Formoterol 9. Dulera; mometasone furoate + Formoterol 10. Breo Ellipta; Fluticasone furoate + vilanterol |
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Know the time frame for early phase and late phase of an asthmatic reaction? |
Early phase: 50 min to an hour Late phase: can be up to12 hours. 8 to 10 hours |
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All of the following represent modes of action of cromolyn sodium except? |
Remember is NOT a bronchial smooth muscle relaxer |
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Name the antileukotriene modifier that is approved for children less than 5 years of age is? |
Singulair |
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Per NAEPP guidelines which drugs should be the first line maintenance therapy in asthma patients? |
Inhaled corticosteroid agents |
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What is the difference between endogenous and exogenous? |
Endogenous is our body produces it and external (outside) ( produced outside of patients body) |
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Body cannot distinguish between endogenous and exogenous? True or False |
True |
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Corticotropin, or adrenocorticotropic (ACTH), produced in the hypothalamus, stimulates the adrenal cortex to secrete glucocorticoids, such as cortisol. True or False |
True |
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Which antibiotic is commonly used in CF population to treat Pseudomonas aeruginosa? |
Tobi or Tobromyosin |
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Body can distinguish between endogenous and exogenous? True or False |
True |
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Side effects with inhaled steroids can be minimized by use of reservoir device, rinsing of mouth after treatments, and use of minimal doses. True or False |
True; rinse after treatments so don’t get fungal infection in the mouth (oral thrush) |
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Side effects associated with systemically administered steroids. |
Fluid retention, osteoporosis, hyperglycemia |
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Patients with adrenal or HPA suppression can be abruptly withdrawn from oral steroids and placed on an aerosol dosage. True or False |
False |
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Know side effects associated with aerosol corticosteroids. |
Oral thrush (fugal infection - oropharyngeal candidiasis), dysphonia (difficulty in speaking), minimal HPA suppression, voice alteration |
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Symbicort is combination of what two drugs? |
Budesonide and Formoterol |
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Symbicort is combination of what two drugs? |
Budesonide and Formoterol |
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Omalizumab (xoliar) is monoclonal antibody against human IgE, it inhibits the binding of IgE to receptors on mast cells and basophils. Given subcutaneous 150/1.2 mL every 2 to 4 weeks. True or False |
True |
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Nonsteroidal antiasthmatic drugs are Relievers and can be used in acute asthma exacerbation. True or False |
False |
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What is the most common aerosol generator used to aerosolize Ribavirin? |
SPAG (Small Particle Aerosol Generator) |
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What is the most common aerosol generator used to aerosolize Ribavirin? |
SPAG (Small Particle Aerosol Generator) |
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Oral candidiasis is a common side effect of inhaled corticosteroids. True or False |
True |
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Before choosing an antimicrobial agent, it is important to identify the organism responsible for the infection. True or False |
True |
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It is acceptable to treat an unknown microorganisms with a broad-spectrum antibiotic? |
Yes |
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Name two groups of nonsteroidal anti asthma agents |
Cromolyn-like drugs and leukotrienes inhibitors (antileukotrienes) |
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Name two groups of nonsteroidal anti asthma agents |
Cromolyn-like drugs and leukotrienes inhibitors (antileukotrienes) |
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Name two cromolyn-like drugs? |
1. Cromolyn sodium, intal (brand name, generic still available). For cromolyn sodium: SVN 20 mg/amp 2. Nedocromil sodium, Tilade (off market) |
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Why to use cromolyn- like drugs ? |
-Used to prevent degranulation of the mast cell and subsequent release of Histamine, PGs, LTs, proteases, cytokines - NOT USED AS A BRONCHODILATOR - thought to help prevent or reduce LATE-PHASE response in asthma - Used as ACE inhibitor cough pts., a reduction in Sickling in sickle cell pts.. |
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List the leukotriene inhibitors? |
1. Zafirlukast - Accolate 2. Montelukast- Singulair 3. Zileuton-Zyflo |
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What is the dosage for Zafirlukast-Accolate? |
Tablet: 10 mg, age 5-11 y/o Tablet: 20 mg, age> 11y/o |
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Dosage for Zileuton-Zyflo? |
Tablets: 600 mg & Zyflo ER 1200 mg (complications include liver decreasing effective use of the drug, Also may interact with Theophylline and Warfarin |
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What is the dosage for Montelukast- Singulair ? |
Tablets: 10 mg, 4 mg and 5 mg chewable. 4 mg packet of granules can be given children over 6 months |
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What is the roles of antileukotriene drugs in asthma management? |
1. Exercise induced asthma 2. Aspirin induced asthma 3. Allergen induced asthma 4. Used to block or stop formation of leukotrienes at receptor site 5. Can cause Churg- Strauss Syndrome, which is a vasculitis of unknown etiology, usually occurs in adults between 20 and 40 y/o Note: corticosteroid are still better anti-inflammatory agent for treatment of asthma 6. In clinical use for asthma it is ONLY to be used prophylactically for the control of mild persistent step 2 asthma |
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In acute and moderate ER asthmatic attacks what SABA would be a good choice? |
Albuterol would be a good choice. Salmeterol would not be good cause it’s slow acting. |
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What is the first line drug for PCP-PJP, PCP means Pneumocystis carinii pneumonia and PJP means Pneumocystis jiroveci pneumonia? |
Bactrim (TMP- SMX) |
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What are inhaled corticosteroids used for? |
1. Maintenance control therapy of chronic asthma 2. COPD 3. Intranasal aerosol agents |
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What are inhaled corticosteroids used for? |
1. Maintenance control therapy of chronic asthma 2. COPD 3. Intranasal aerosol agents |
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Another name for Beclomethasone dipropionate ? |
QVAR (40 mcg, 80 mcg) |
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What are inhaled corticosteroids used for? |
1. Maintenance control therapy of chronic asthma 2. COPD 3. Intranasal aerosol agents |
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Another name for Beclomethasone dipropionate ? |
QVAR (40 mcg, 80 mcg) |
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Another name for Flunisolide hemihydrate ? |
Aerospan (80 mcg) |
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Other names for Fluticasone propionate? |
Flovent( 44, 110, 220 mcg) Flovent Diskus ( 50, 100, 250 mcg) |
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Another name for Fluticasone furoate? |
Arnuity Ellipta ( 100 & 200 mcg dosages) |
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Another name for Budesonide? |
Pulmicort Flexhaler, Pulmicort Respules |
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Another name for Budesonide? |
Pulmicort Flexhaler, Pulmicort Respules |
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Other names for mometasone furoate? |
Asmanex Twisthaler, Asmanex |
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Another name for Budesonide? |
Pulmicort Flexhaler, Pulmicort Respules |
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Other names for mometasone furoate? |
Asmanex Twisthaler, Asmanex |
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Another name for Alvesco? |
Ciclesonide |
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What two drugs do Symbicort have? |
Budesonide and Formoterol |
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What two drugs does Dulera have? |
Mometasone furoate, Formoterol |
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What two drugs does Advair have? |
Salmeterol, Fluticasone propionate |
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What two drugs are in Breo Ellipta ? |
Fluticasone furoate, vilanterol |
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What two drugs are in Advair? |
Fluticasone propionate, Salmeterol |
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What do glucocorticoids do? |
Regulate the metabolism of carbohydrates, fats, and protein to increase levels of glucose for body energy |
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What do mineralocorticoids do? |
Regulate water, e.g.. aldosterone |
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What do mineralocorticoids do? |
Regulate water, e.g.. aldosterone |
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What do sex hormones do? |
Androgens and estrogens |
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Name 3 adrenal cortical hormones? |
Glucocorticoids, mineralocorticoids, sex hormones |
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What is the (HPA) Axis or the Hypothalamic-Pituitary- Adrenal- Axis? |
Pathway for release and control of endogenous (made in the body) corticosteroids. Stimulation of the hypothalamus causes impulses to be sent to median eminence, where corticotropin- releasing factor (CRF) is released. |
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What does the HPA suppression do? |
Inhibits hypothalamus and pituitary glands. Ex: Thermostat regulates production of heat by monitoring temperature levels. |
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What is Diurnal steroid cycle? |
Production of body’s own glucocorticoids follows rhythmic cycle; termed diurnal or circadian rhythm. |
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What is Diurnal steroid cycle? |
Production of body’s own glucocorticoids follows rhythmic cycle; termed diurnal or circadian rhythm. |
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When are cortisol levels the highest? |
At 8:00 am in the morning |
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Give examples of interference with the diurnal or circadian rhythm? |
Jet lag, and Night shift work |
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What is one of the primary reasons for aerosolized steroids ? |
To minimize adrenal or HPA suppression by minimizing dosage and localizing the site of treatment |
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What is the triple response for inflammation? |
Redness( local dilation of blood vessels, occurring in seconds), Flare ( Reddish color several centimeters from the site, occurring 15 to 30 seconds after injury), Wheal ( local swelling, occurring in minutes) |
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Name four categories for the inflammatory response? |
1. Increased vascular permeability- an exudate is formed in surrounding tissues 2. Leukocytic infiltration- white blood cells emigrate 3. Phagocytosis- white cells and macrophages ingest bacteria 4. Mediator cascade: histamine release |
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Name the two most common inflammatory diseases? |
Chronic bronchitis, and asthma |
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What is the number 1 cause of chronic bronchitis? |
Smoking tobacco |
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Name the major effector cells of inflammatory response? |
Mast cells and esinophils |
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The early asthmatic response is caused by what? |
Immunoglobulin E (IgE) - Activates mast cells that releases histamines (bronchospasm) - Response peaks at 15 min - Declines over 1 hour |
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Mast cell mediators and release of cytokines recruit other inflammatory cells to cause what? |
Late-phase reaction - Recruit esinophils, basophils, monocytes/macrophages and lymphocytes - response occurs after 6 to 8 hours - can last up to 24 hours |
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What happens in the airway inflammatory response? |
- smooth muscle spasm, mucus secretions, shedding of airway, goblet cell hyperplasia |
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What do steroids do? |
Reduce number of mast cells within the airway and help restore responsiveness to beta- adrenergic stimulation |
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Side effects of oral corticosteroids? |
Suppression of the HPA axis, immunosuppression, slowing of growth in children, osteoporosis, peptic ulcer, fluid retention, hypertension, increased WBC count, hyperglycemia |
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Name the most common side effects with aerosol administration? |
Fungal infection - Oropharyngeal candidiasis (oral thrush), Dysphonia (difficultly in speaking), voice alteration, cough, incorrect use of MDI |
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What to do cause of the side effects with the aerosol administration? |
Use minimal dose, use reservoir, rinse mouth after use |
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Inhaled corticosteroids are considered to be the most effective long-term therapy for ? |
Mild, moderate or severe persistent asthma. In addition to beta agonist therapy |