NR565 / NR 565 Final Exam Question Bank
(Latest ): Advanced Pharmacology
Fundamentals - Chamberlain
SABA use= daily.
Effect on activity= some activity limitation.
Risk for exacerbations requiring systemic glucocorticoids= increased frequency & intensity of
exacerbations or wheezing.
Asthma Step 4: Severe Persistent
Symptoms= several times daily
Nighttime awakenings= more than once/week (often nightly for 5 y.o. & up).
SABA use= several times a day
Effect on activity= severe activity limitation.
Risk for exacerbations requiring systemic glucocorticoids= even greater increased frequency &
intensity
of exacerbations or wheezing.
0-4 y.o (STEP 3), 5-11 y.o. (STEP 3 OR 4), 12 y.o. & up (STEP 4 OR 5)
Asthma & COPD
o Symptoms associated with each classification of asthma (mild-persistent, moderate-
persistent, etc.).
- Nighttime wakening from ages 0-4 years old is normal and cannot be used in the data due to
asthma nighttime wakening
,Steps 3-5 are more aggressive as our patients get older
Pg. 575 in the book for classifications of asthma severity and recommendation for initial
treatment
Intermittent: symptoms 2 days a week or less
No nighttime wakening
SABA use is 2 days a week or less
Mild-persistent: symptoms more than 2 days a week but less than daily
Nighttime wakening 1-2 times a month
SABA use is more than 2 days a week but less than daily
Moderate-persistent: Symptoms daily
Nighttime wakening 3-4 times a month
SABA use is daily
Severe-persistent: Symptoms several times a day
Nighttime wakening more than once a week
SABA use is several times a day 7
Recommended step is step 3-4 for ages 5-11 and step 4-5 for those above 12 years old (Steps on
pg. 576-577 in book)
Asthma & COPD
o Know examples of drug classes (SABA, LABA, ICS, etc.)
SABA, LABA, Anticholinergics (ipratropium & aclindinium), inhaled corticosteroids, leukotriene
receptor agonists (montelukast & zafirlukast), and oral corticosteroids (prednisone)
Asthma & COPD
o SABA
Know examples
Examples:
Albuterol, isoproterenol, levalbuterol, terbutaline sulphate
Asthma & COPD
o SABA
Benefits of use
Patient instructions
Benefits of use:
,Rescue inhaler, all asthma patients should have a SABA, they are for prophylaxis of exercise-
induced bronchospasms and to relieve ongoing asthma attacks and COPD exacerbations
Patient instructions:
How to use the inhaler (have patients demonstrate), use a
spacer for those with difficulty with hand-breath coordination, patients with asthma should
assess peak expiratory flow daily and compare with personal best
and keep record, patients using meter dose inhalers or dry powder inhalers should have at least
1-minute intervals between inhalers if using more than one, report chest pain associated with
changes in HR or rhythm, do not exceed
recommended dosages (Provider should be notified if symptoms require more frequent use of
SABA)
Asthma & COPD
o SABA
Why is it important to know the frequency a patient is using their SABA?
If patients are using it more frequently due to symptoms, the provider should be notified so
medication changes can take place and the NP can provide adequate asthma relief
Asthma & COPD
o LABA
Know examples
Examples:
Salmeterol, formoterol, oldaterol
Asthma & COPD
o LABA
Benefits of use
Use in COPD
Benefits of use:
LABAs are for patients who experience frequent attacks and
, dosing is done on a fixed, NOT PRN, schedule. For asthma, they must be combined with a
glucocorticoid because they are not a first line therapy in asthma (FDA recommends a LABA and
glucocorticoid are both contained in the same inhaler to prevent a LABA asthma-associated
death - LABA monotherapy in asthma is contraindicated)
Use in COPD:
LABAs are preferred over SABAs for patients with stable COPD.
LABA can increase the risk for severe asthma attacks and asthma related death; however, this is
not a concern for those with COPD
Asthma & COPD
o Inhaled Corticosteroid (ICS)
Know examples
Examples:
Budesonide, ciclesonide, beclomethasone
Asthma & COPD
o Inhaled Corticosteroid (ICS)
Benefits of use
Benefits of use:
Most effective drugs available for long-term control of airway inflammation.
By reducing inflammation, they reduce bronchial hyper-reactivity and decrease airway mucus
production in both asthma and COPD. They do not alter the course of the conditions, but they
provide significant long-term control and management of symptoms
Cromolyn
Used as prophylaxis for mild to moderate asthma
Monoclonal Antibodies
Used for allergy-related asthma and Eosinophilic asthma
Leukotriene Receptor antagonists
Second-line therapy to reduce inflammation and bronchoconstriction
B2RA (Beta 2 Receptor Agonists)
(Latest ): Advanced Pharmacology
Fundamentals - Chamberlain
SABA use= daily.
Effect on activity= some activity limitation.
Risk for exacerbations requiring systemic glucocorticoids= increased frequency & intensity of
exacerbations or wheezing.
Asthma Step 4: Severe Persistent
Symptoms= several times daily
Nighttime awakenings= more than once/week (often nightly for 5 y.o. & up).
SABA use= several times a day
Effect on activity= severe activity limitation.
Risk for exacerbations requiring systemic glucocorticoids= even greater increased frequency &
intensity
of exacerbations or wheezing.
0-4 y.o (STEP 3), 5-11 y.o. (STEP 3 OR 4), 12 y.o. & up (STEP 4 OR 5)
Asthma & COPD
o Symptoms associated with each classification of asthma (mild-persistent, moderate-
persistent, etc.).
- Nighttime wakening from ages 0-4 years old is normal and cannot be used in the data due to
asthma nighttime wakening
,Steps 3-5 are more aggressive as our patients get older
Pg. 575 in the book for classifications of asthma severity and recommendation for initial
treatment
Intermittent: symptoms 2 days a week or less
No nighttime wakening
SABA use is 2 days a week or less
Mild-persistent: symptoms more than 2 days a week but less than daily
Nighttime wakening 1-2 times a month
SABA use is more than 2 days a week but less than daily
Moderate-persistent: Symptoms daily
Nighttime wakening 3-4 times a month
SABA use is daily
Severe-persistent: Symptoms several times a day
Nighttime wakening more than once a week
SABA use is several times a day 7
Recommended step is step 3-4 for ages 5-11 and step 4-5 for those above 12 years old (Steps on
pg. 576-577 in book)
Asthma & COPD
o Know examples of drug classes (SABA, LABA, ICS, etc.)
SABA, LABA, Anticholinergics (ipratropium & aclindinium), inhaled corticosteroids, leukotriene
receptor agonists (montelukast & zafirlukast), and oral corticosteroids (prednisone)
Asthma & COPD
o SABA
Know examples
Examples:
Albuterol, isoproterenol, levalbuterol, terbutaline sulphate
Asthma & COPD
o SABA
Benefits of use
Patient instructions
Benefits of use:
,Rescue inhaler, all asthma patients should have a SABA, they are for prophylaxis of exercise-
induced bronchospasms and to relieve ongoing asthma attacks and COPD exacerbations
Patient instructions:
How to use the inhaler (have patients demonstrate), use a
spacer for those with difficulty with hand-breath coordination, patients with asthma should
assess peak expiratory flow daily and compare with personal best
and keep record, patients using meter dose inhalers or dry powder inhalers should have at least
1-minute intervals between inhalers if using more than one, report chest pain associated with
changes in HR or rhythm, do not exceed
recommended dosages (Provider should be notified if symptoms require more frequent use of
SABA)
Asthma & COPD
o SABA
Why is it important to know the frequency a patient is using their SABA?
If patients are using it more frequently due to symptoms, the provider should be notified so
medication changes can take place and the NP can provide adequate asthma relief
Asthma & COPD
o LABA
Know examples
Examples:
Salmeterol, formoterol, oldaterol
Asthma & COPD
o LABA
Benefits of use
Use in COPD
Benefits of use:
LABAs are for patients who experience frequent attacks and
, dosing is done on a fixed, NOT PRN, schedule. For asthma, they must be combined with a
glucocorticoid because they are not a first line therapy in asthma (FDA recommends a LABA and
glucocorticoid are both contained in the same inhaler to prevent a LABA asthma-associated
death - LABA monotherapy in asthma is contraindicated)
Use in COPD:
LABAs are preferred over SABAs for patients with stable COPD.
LABA can increase the risk for severe asthma attacks and asthma related death; however, this is
not a concern for those with COPD
Asthma & COPD
o Inhaled Corticosteroid (ICS)
Know examples
Examples:
Budesonide, ciclesonide, beclomethasone
Asthma & COPD
o Inhaled Corticosteroid (ICS)
Benefits of use
Benefits of use:
Most effective drugs available for long-term control of airway inflammation.
By reducing inflammation, they reduce bronchial hyper-reactivity and decrease airway mucus
production in both asthma and COPD. They do not alter the course of the conditions, but they
provide significant long-term control and management of symptoms
Cromolyn
Used as prophylaxis for mild to moderate asthma
Monoclonal Antibodies
Used for allergy-related asthma and Eosinophilic asthma
Leukotriene Receptor antagonists
Second-line therapy to reduce inflammation and bronchoconstriction
B2RA (Beta 2 Receptor Agonists)
