CMN 568 -UNIT 3 COMBO WITH 100% CORRECT ANSWERS.

For moderate persistant asthma, symptoms occur Daily For moderate persistant asthma, SABA use is Daily For moderate persistant asthma, nighttime awakenings ages 0-4 3-4 times/month For moderate persistant asthma, nighttime awakenings for 5 once a week, not nightly For moderate persistant asthma, interference with normal activity Some For moderate persistant asthma, Lung function FEV1 or PEF (personal best), 12 60-80& For moderate persistant asthma, FEV1/FVC, ages 5-11 75-80% For moderate persistant asthma, FEV1/FVC ages over 12 less than 5% For moderate persistant asthma, exacerbations requiring oral corticosteroids, ages 0-4 =2times/6 months or = 4 wheezing episodes in a year that last longer than a day AND risk factors for persistent asthma. For moderate persistant asthma, exacerbations requiring oral corticosteroids, = 5 years = 2 times/year of exacerbations For moderate persistant asthma, exacerbations, recommended step for starting treatment Step 3 and reevaluate in 2-6 weeks After starting treatment for asthma, you should reevaluate the patient in 2-6 weeks When is treatment not appropriate when using SABAs PRN? When more than 1 canister/month is used Can LABAs be used as mono therapy? No, administer with ICS What is the action of Theophylline? relaxes and opens airways, rarely used because it requires careful monitoring How and why is Omalizumab given? Sub-q every 2-4 weeks; given to patients over 12 with mod to persistent asthma with positive skin test. What is the action of ICS? prevent inflammation of the airways What is the hallmark on CXR for miliary TB? Snowstorm Treatment of TB in pregnancy: 2 mos: INH, RIF, EMB 7 mos: INH, RIF What drug cannot be used in pregnancy when treating TB? PZA Side effect of RIF? Orange secretions SIde effect of PZA? Hyperuricemia; hepatotoxicity - (reason not given in LTBI) Side effect of EMB: optic neuritis Side effect of INH: Peripheral neuropathy What drug is added to INH therapy? Vit B6 A false negative TB test can result in: malnourished, overwhelming disease, 10% of kids Does a negative TST exclude TB? No You should consider COPD, and perform spirometry if any of these indicators are present in an individual over age 40: Dyspnea (progressive, worse with exercise, persistent daily, described as air hunger, gasping, etc), Chronic cough, chronic sputum production, and history of exposure (tobacco smoke, occupational dusts and chemicals, smoke from home cooking and heating fuel) Diagnosis of COPD should be confirmed by Spirometry and clinical symptoms and signs Why is a low peak flow inconsistent with diagnosing COPD? poor specificity; low peak flow can be caused by other diseases and by poor performance What drug is contraindicated in COPD and asthma? Beta blockers Stage III - Severe COPD has a FEV1 of FEV150% predicted Stage 1 - Mild COPD has a FEV1 of FEV1 80% predicted Stage 4 - Very severe COPD has a FEV1 of FEV130% predicted Stage 2 - Mod COPD has a FEV1 of FEV180% predicted All COPD patients have a FEV1/FEV of 70% or 0.70 When are bronchodilators prescribed in COPD? As needed to relieve intermittent or worsening symptoms, and on a regular basis to prevent or reduce persistent symptoms When are inhaled glucocorticoids prescribed in COPD? symptomatic patients with an FEV150% predicted and repeated exacerbations. Mild COPD treatment Flu vaccine,SABA Mod COPD treatment Flu vaccine, SABA, LABA, Rehab Severe COPD treatment Flu vaccine, SABA, LABA, Rehab, ICS Very severe COPD treatment Flu vaccine, SABA, LABA, Rehab, ICS, O2 (worn 15 hrs/daily) SABAs: Levalbuterol, Albuterol, Terbutaline, Fenoterol LABAs: Formoterol, Salmeterol, Indacaterol, Arformoterol Anticholinergics: Ipratropium bromide ICS: Budenoside, Fluticasone, Beclomethasone Systemic Glucocorticoids: Prednisone, Methylprednisolone Characteristics of Emphysema: Usually over 50 y/o, insidious progressive dyspnea, no cough, scant, clear sputum, hyperressonance, decreased breath sounds Characteristics of chronic bronchitis Usually over 35 y/o, recurrent cough, PFT normal or decreased lung capacity with residual volume, sputum is copious mucopurulent Asthma 12 yrs: Step 4 is treated with _____. Medium dose ICS and LABA Asthma 12 yrs: Step 1 is treated with ____. SABA PRN Asthma 12 yrs: Step 3 is treated with ____. Low dose ICS and LABA or Med ICS Asthma 12 yrs: Step 2 is treated with _____. Low dose ICS Asthma 12 yrs: Step 5 is treated with ____. High dose ICS and LABA and consider omalizumab Asthma 12 yrs: Step 6 is treated with____. High dose ICS and LABA and oral corticosteroid and consider omalizumab. What is the isoniazid chemoprophylaxis treatment if exposed to TB? 10mg/kg/d x 2 months after last contact, then Mantoux test, continue therapy for 7 months if positive. Symptoms of active disease in TB: chronic cough, anorexia, wt loss or poor wt gain, fever, night sweats (most children are asymptomatic) Transmission of TB: Airborne precautions...transmitted by respiratory droplets. For moderate persistant asthma, symptoms occur Daily For moderate persistant asthma, SABA use is Daily For moderate persistant asthma, nighttime awakenings ages 0-4 3-4 times/month For moderate persistant asthma, nighttime awakenings for 5 once a week, not nightly