PNN Key Concepts Practice Test Questions With Complete Solution

PNN Key Concepts Practice Test Questions With Complete Solution Diuril - chlorothiazide (thiazide diuretic; proximal DCT; contains sulfa) (tabs, suspension, IV) Lozol - indapamide (thiazide-like diuretic; proximal DCT) Zaroxlyn - metolazone (thiazide-like diuretic; proximal DCT) (metolazone and furosemide are the only diuretics OK in 30ml/min) Dyrenium - triamterene (potassium-sparing diuretic; caps only) Inspra - eplerenone (potassium sparing diuretic; reduces morbidity & mortality in CHF; tabs only; CYP 3A4 substrate) Sectral - acebutolol (BB; can cause Lupus; positive ANA) Kerlone - betaxolol (BB) Lopressor - metoprolol tartrate (BB; with food; "tart food") (IV form available) Toprol XL - metoprolol succinate (BB; scored tabs are OK to cut in half) Corgard - nadalol (BB) Levatol - penbutolol (BB) Hemangeol - propranolol (BB; oral soln; indicated for infantile hemangioma) Inderal, Inderal LA/XL - propranolol (IR on empty stomach; ER caps with or w/o food) (Do NOT sub ER for IR on mg for mg basis) Betapace - sotalol (BB for ventricular arrhythmias) (Do not sub Betapace for Betapace AF) Sular - nisoldipine (CCB; doesnt say but comes in XR only; empty stomach) BB's with more orthostatic hypoTN - 1. Nebivolol (Bystolic), 2. Carvedilol (Coreg; with food), 3. Labetalol (Trandate; IV form available) verapamil - Calan, Calan SR, Isoptin SR, Verelan, VerelanPM (Calan SR, Isoptin SR: with food) (Verelan, VerelanPM: caps may be sprinkled; IV form available for SVT) As mentioned during the Asthma lecture, board exams emphasize: - Ages of use for each asthma inhaler, which ones are MDI, which are DPI and which ones come in both forms Asthma disease classification, Asthma attack Zones (green, yellow & red) and how to manage each and Stepwise approach (both preferred and alternative!!!). Asthma Exacerbation Zones - PEF = Peak Expiratory Flow Green Zone: PEF 80% personal best Yellow Zone: PEF 50-80% personal best Red Zone: PEF 50% personal best, requires that patient go to emergency department Obtaining the correct peak flow reading depends on the technique (stand up straight, hold meter horizontally, seal lips, blast out air as quickly as possible, record results, repeat 2x more, choose the highest reading). NSAIDs and ASA in some Asthma patients - NSAIDs and Aspirin can induce asthma in some patients. Patient Case Explanation for Question #20 - With some patients, asthma can flare up by aspirin /NSAIDs. B-Blockers at higher doses especially non-selective ones like propranolol can also worsen asthma symptoms. Asthma is commonly worsened by: Non controlled GERD: because of loose or non functioning lower esophageal sphincter, the acid in the stomach refluxes into esophagus and this refluxed acid can drain into trachea and cause cough and consequently irritate and inflame the airways. Allergic rhinitis: The same offending agent/chemical that is causing the patient's nasal allergies can cause the same inflammatory changes in the deeper airways, bronchus or bronchioles. Beta blockers: If a B-Blocker is required (post M.I.) recommend Selective B1 blockers like metoprolol. NSAIDS: Recommend Tylenol OTC instead of Aleve; this change might improve both GERD and Asthma. Inhaled Corticosteroids - - 1st line therapy for persistent asthma - BID dosing for asthma - SE: oral candidiasis, dysphonia (difficulty speaking), cough, pharyngitis - DPI's don't need spacers beclomethasone - QVAR MDI - ICS - MDI, but doesn't need spacer - QVAR is a solution so don't need to shake it. Nasal preparations for allergic rhinitis: - 1. Beconase AQ: aqueous, 1-2 inh each nostril BID - 2. Qnasal: dry spray, prime 4x, 2 sprays each nostril once daily budesonide - Pulmicort Flexhaler - DPI - The Flexhaler is the only ICS that's a DPI - Fast & Deep - DPI's don't need a spacer - 6 years old!! Pulmicort Respules - nebulization - can be used for as young as 1 year old (12 months old!!!) Nasal preparation for allergic rhinitis: - Rhinocort NASAL Other forms of budesonide: - 1. Entocort EC: Crohn's. Avoid GFJ, - 2. Uceris: ER rectal foam for ulcerative coliti. Avoid GFJ. Flunisolide - Aerospan MDI - ICS - comes with a built-in spacer, so don't recommend a spacer on the exam.!!! - /= 6 years of age!!! mometasone - Asmanex Twisthaler DPI - DPI, don't need no spacer - twist-haler, means it's active once you twist it open. - Fast & Deep - QD or BID - discard 45 days after removal from foil pouch Nasonex for allergic rhinitis - 2 spray each nostril daily Elocon: topical mometasone - use sparingly daily fluticasone - Flovent MDI - 4-11 yo: 44mcg 2 puff BID - 12yo: adult dose Flovent Rotadisk DPI - expires 6 weeks after removal from pouch - available with salmeterol: Advair Arnuity Ellipta DPI - QD dosing - 12 yo!!! Flonase: allergic rhinitis Veramyst: similar to Flonase but contains furoate instead of propionate. Dymista: fluticasone/azelastine for allergic rhinitis Cromolyn - Cromolyn - Mast Cell Stabilizer - asthma maintenance - Px of exercise-induced bronchospasm - nebulized soln QID Nasalcrom OTC - OTC nasal solution Opticrom, Alocril - for allergic conjunctivitis Alvesco MDI - ciclesonide - antiasthmatic - ICS - indicated for 12yo, - solution, so don't shake - prodrug until reaches lungs, so less risk of thrush