Asthma
Unlike albuterol, which is limited to 3 canisters per year under GINA guidelines, this combination inhaler can be prescribed at least 4 times a year as it expires 90 days after opening.
What is Symbicort?
>/=3 canisters per year associated with increased risk of exacerbations, increased mortality particularly if >/=1 canister per month.
References:
1) Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. 2026 update. Fontana (WI): Global Initiative for Asthma; 2026 May.
This drug is used to treat GERD in pregnancy and can cause bezoar formation.
What is sucralfate?
Bezoar: tightly packed collection of partially digested or undigested material
References:
1) Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol. 2022 Jan 1;117(1):27-56. doi: 10.14309/ajg.0000000000001538. PMID: 34807007; PMCID: PMC8754510.
This is the drug class of choice for chronic rhinitis.
What are intranasal corticosteroids?
References:
1) Scadding GK, Kariyawasam HH, Scadding G, et al. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy. 2017; 47: 856-889. https://doi.org/10.1111/cea.12953
A protein bar is 100 calories, in order for it to be a good protein bar, it should contain this many grams of protein.
What is 10 grams?
10% of the calories should come from protein.
References:
1) Wolfe RR, Miller SL. The Recommended Dietary Allowance of Protein: A Misunderstood Concept. JAMA. 2008;299(24):2891–2893. doi:10.1001/jama.299.24.2891
In the Anti-Inflammatory Reliever (AIR) therapy approach, Symbicort should be prescribed as needed at this strength and dose.
What is 160/4.5 mcg, 1 inhalation as needed?
Low-dose ICS-formoterol is called an anti-inflammatory reliever (AIR) because it relieves symptoms and reduces inflammation. AIR significantly reduces the risk of severe exacerbations across treatment steps compared with using a SABA reliever, with similar symptom control, lung function and adverse effects.
References:
1) 1) Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. 2026 update. Fontana (WI): Global Initiative for Asthma; 2026 May.
This component of Breztri requires a higher dose when used for asthma.
What is glycopyrrolate?
9 mcg for COPD vs. 18 mcg for asthma. Label does not state a mechanistic reason. Doses reflect findings from COPD trials vs. asthma trials.
References:
1) AstraZeneca Pharmaceuticals LP. Breztri Aerosphere (budesonide, glycopyrrolate, and formoterol fumarate) inhalation aerosol: prescribing information [Internet]. Wilmington (DE): AstraZeneca Pharmaceuticals LP; 2026 Apr 27 [cited 2026 Sep 21]. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=715433dc-cb2b-43ea-b6df-c5b4177adc6c.
For patients with uncontrolled GERD symptoms on a once-daily PPI, this dosing strategy is preferred.
What is twice-daily dosing?
Mismatch between half-life of PPIs and continuous regeneration of proton pumps. Twice-daily dosing extends the duration of acid suppression by inhibiting new pumps. Also, dose-response plateau limits effect.
References:
1) Yadlapati R, Gyawali CP, Pandolfino JE; CGIT GERD Consensus Conference Participants. AGA Clinical Practice Update on the Personalized Approach to the Evaluation and Management of GERD: Expert Review. Clin Gastroenterol Hepatol. 2022 May;20(5):984-994.e1. doi: 10.1016/j.cgh.2022.01.025. Epub 2022 Feb 2. Erratum in: Clin Gastroenterol Hepatol. 2022 Sep;20(9):2156. doi: 10.1016/j.cgh.2022.05.005. PMID: 35123084; PMCID: PMC9838103.
This medication can be prescribed for patients with rhinitis that fail Dymista or Flonase. It contains the same active ingredient as Flonase, but at a higher dose and is delivered via an exhalation device.
What is XHANCE?
References:
1) OptiNose US, Inc. XHANCE (fluticasone propionate) nasal spray, metered: prescribing information [Internet]. 2026 Jan 12 [cited 2026 Sep 21]. Available from: https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=c79bbb9f-e483-4093-8c92-ea978e7bf278
For patients at low/borderline to intermediate cardiovascular risk, this is the target LDL-C level for primary prevention.
What is LDL <100 mg/dL?
References:
1) Blumenthal RS, Morris PB, Gaudino M, Johnson HM, Anderson TS, Bittner VA, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of dyslipidemia: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2026;87(19):2624-2757. doi:10.1016/j.jacc.2025.11.016.
This rescue inhaler can be used with any maintenance inhaler except Symbicort.
What is AIRSUPRA?
References:
1) Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. 2026 update. Fontana (WI): Global Initiative for Asthma; 2026 May.
This problem can occur when a patient uses Pepcid every night.
What is tolerance?
Loss of pH control after one month of bedtime H2RA therapy.
References:
1) Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol. 2022 Jan 1;117(1):27-56. doi: 10.14309/ajg.0000000000001538. PMID: 34807007; PMCID: PMC8754510.
A 30-year-old with an acute episode of allergic rhinitis should use this agent for rapid symptomatic relief.
What is an intranasal antihistamine?
References:
1) Scadding GK, Kariyawasam HH, Scadding G, et al. BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clin Exp Allergy. 2017; 47: 856-889. https://doi.org/10.1111/cea.12953
This new drug can be used in people aged 12 years and older to prevent getting sick after exposure to COVID‑19.
What is Xocova (ensitrelvir)?
References:
1) Shionogi Inc. XOCOVA (ensitrelvir) tablets, for oral use: prescribing information [Internet]. 2026 Jun 3 [cited 2026 Sep 21]. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=526acf60-abc3-2cc2-e063-6294a90affa6
According to GINA, as-needed ICS-formoterol reduces the risk of what by approximately 65% compared with SABA alone?
What are emergency department visits and hospitalizations?
References:
1) Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. 2026 update. Fontana (WI): Global Initiative for Asthma; 2026 May.
This PPI indicated for GERD cannot be given twice a day.
What is dexlansoprazole?
Dual delayed-release formulation: two separate drug peaks to cover the day.
References:
1) TWI Pharmaceuticals, Inc. Dexlansoprazole delayed-release capsules: prescribing information [Internet]. 2023 Aug 3 [cited 2026 Sep 21]. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=9abcfb1e-c894-44bb-807a-e4bdd755f28f
2) Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol. 2022 Jan 1;117(1):27-56. doi: 10.14309/ajg.0000000000001538. PMID: 34807007; PMCID: PMC8754510.
While Dymista delivers 137 mcg of azelastine per spray, this azelastine strength can be used for a patient who has uncontrolled rhinits.
What is 205.5 mcg per spray?
Azelastine 0.15%: delivers 205.5 mcg azelastine hydrochloride/spray
Azelastine 0.1% solution: delivers 137 mcg azelastine hydrochloride/spray
Dymista: Delivers 137mcg azelastine / spray
**Astepro (0.15%) does not require any approval**
References:
1) Seidman, M.D., Gurgel, R.K., Lin, S.Y., Schwartz, S.R., Baroody, F.M., Bonner, J.R., Dawson, D.E., Dykewicz, M.S., Hackell, J.M., Han, J.K., Ishman, S.L., Krouse, H.J., Malekzadeh, S., Mims, J.W., Omole, F.S., Reddy, W.D., Wallace, D.V., Walsh, S.A., Warren, B.E., Wilson, M.N. and Nnacheta, L.C. (2015), Clinical Practice Guideline. Otolaryngology–Head and Neck Surgery, 152: S1-S43. https://doi.org/10.1177/0194599814561600
Patients taking GLP-1 medications should aim for at least this much protein per kg per day to help preserve muscle during weight loss.
What is 1.2-1.6 g/kg/day?
References:
1) Mozaffarian D, Agarwal M, Aggarwal M, Alexander L, Apovian CM, Bindlish S, et al. Nutritional priorities to support GLP-1 therapy for obesity: a joint advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society. Am J Clin Nutr. 2025 Jul;122(1):344-367. doi:10.1016/j.ajcnut.2025.04.023.