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Asthma, COPD, Smokin

Asthma, COPD, Smoking cessation

QuestionAnswer
What can potentiate oral steroids? Licorice
What decrses theophylline concentrations? St. Johns Wort
What can prevent and treat inflammation? Corticosteroids (inhaled and systemic)
What can prevent inflamm? Leukotriene modifiers
What are the bronchodilator classes for asthma controllers? Long-acting B2-agonist, Theophylline
What are the max effects of different steroid routes? Inhaled = days to wks to months Oral = 6-24 hrs
Inhalers with what are being transitioned out? CFC propellants
How much of the drug from a MDI actually reaches the lungs? 10-30%
Waiting 1 minute bw puffs from an MDI inhaler may what? Second puff man penetrate lungs better
How much of drug from DPI reaches lungs? 10-20%
Using peak flow meter? Do 3x and take highest #
Other acronyms for COPD? COLD, COAD
What are the symptoms of COPD? Cough, sputum, SOB, DOE
Classification of COPD stages? Stage 1:Mild COPD Stage 2:Moderate Stage 3:Severe Stage 4:Very severe
FEV1 for diff't classes of COPD? Stage 1: FEV1>/=80% 2: 50-80% 3: 30-50% 4: <30% or <50% w/chronic resp failure
Pulmonary rehab programs include? -Smoking cessation -Exercise training -Nutrition counseling -Education
O2 therapy has been shown to improve survival and QOL if used? 16-24hrs/day
Specific criteria for O2 use? -PaO2 </=to 55mmHg or SaO2</=88% -PaO2 bw 55&60 or SaO2 @88%, pulm HTN, periph edema sugg CHF, polycythemia (>55%)
Which med is commonly dosed once daily, in the evening for noc dyspnea? Theophylline
Restlessness, insomnia, GER @noc, palpitations, potentiation of diuresis are all AEs of? Theophylline
When are ICS appropriate for COPD pts? -An FEV1<50% predicted and repeat exacerbations (3 in the last 3 yrs)
ICS use in COPD pts increases the chance for? Pneumonia
What is the drug class that selectively inhibits PDE4 = ^cAMP for COPD? Phosphodiesterase 4 inhibitor =Roflumilast
When should the pneumococcal vaccine be given to COPD pts that are <65? When FEV1 <40%
How would you treat Mild COPD? Flu vaccine and SAB-dilator
How to treat Mod COPD? Flu vaccine, SAB-dilator, LAB-dilator, rehab
How to treat Severe COPD? Flu vaccine, SABd, LABd, add ICS if repeated exacerbations (3 in last 3 yrs)
How to treat Very Severe COPD? Flu vaccine, SABd, LABd, rehab, ICS, add O2 if CRF, consider surgical treatment
Smoking cessation effect on CV events? all-cause mortality? -decrs risk ~1yr -decrs risk 10-15 yrs
What is important to note about nicotine patch removal? Nicotine will continue to be delivered into bloodstream for several hrs after removal
What delivers nicotine more rapidly than NRT gum/patch? Nasal spray (peak seen in 10 minutes)
Commit is the NRT trade name for? Nicotine Lozenge
How do you determine NRT gum dosing? -NL=>25cigs/day:4mg 9-12pc/day; max 20pcs -NL=<25cigs/day: 2mg 9-12pcs; max 30pcs/day
How do you determine dosing for NRT lozenges? -1st cig<30min of waking up =4mg -1st cig>30min of waking up =2mg
Dosing taper of NRT lozenges? -1 loz q1-2hrs for 6wks -1 loz q2-4hrs for wks7-9 -1 loz q4-8hrs for wks10-12
Avoid what, w/NRT lozenges? Acidic bev/food (OJ,coffee, soft drinks)for 15min b4, during or after
Bupropion drug interax? Carbamazepine=decrs level of B Cimetidine=^level of B MAOi=^toxicity of B
When should be the target quit date after starting Zyban? 7days (can combine with NRT)
Dosing of Bupropion in those w/ renal or hepatic insuff? Cut dose in half
Besides Bupropion, what is the other first line med for smoking cess? Chantix/Varenicline
How should varenicline be used? As a monotherapy, to prevent additional AEs
What are the second line agents for smoking cessation? Nortriptyline, Clonidine
Created by: 572680793
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