Asthma
COPD
Smoking Cessation
Avoid this
100
What is the most correct counseling point for patients using an HFA inhaler?
A. Holding Chamber is not necessary unless patient's technique is inadequate
B. HFA inhalers to not have counters
C. HFA inhaler cases do not need to be cleaned
D. HFA inhalers need to be primed before each use
A. Holding Chamber is not necessary unless patient's technique is inadequate
100
Recommend antibiotics during an exacerbation when a patient presents with these symptoms
Increased dyspnea, increased sputum volume, AND increased sputum purulence; or 2 of the above including sputum purulence
100
Name 5 pharmacologic options used in smoking cessation
Varenicline, bupropion, nicotine patch, gum, lozenge, inhaler, nasal spray
100
Use of this long term medication alone is contraindicated in asthma patients
LABA monotherapy
200
Patients should use this to determine treatment if they have symptoms of an asthma exacerbation at home
Asthma Action Plan
200
This medication can be used in patients who have frequent exacerbations and have quit smoking
Azithromycin
- Increases time between exacerbations, decreases rate of exacerbations, improves QoL.
200
A 40-year-old man presents to the clinic wanting to quit smoking. He rates how much he wants to quit as 10/10 and believes he can quit with help. Together, you decide to use varenicline to help him quit smoking.
Which is most accurate regarding medication use and counseling for this patient?
A. A combination of behavioral counseling and drugs is more effective than either behavioral counseling or medication alone.
B. Varenicline is contraindicated in patients with renal impairment.
C. Varenicline should be taken on an empty stomach.
D. Use of varenicline longer than 3 months is not recommended.
A. A combination of behavioral counseling and drugs is more effective than either behavioral counseling or medication alone.
200
48 year old male with history of depression, anxiety, seizures, interested in quitting smoking
bupropion
300
Consider step-down therapy after this point
Consider step down therapy if well controlled for 3 + months
300
Describe the differences in the letter groups used to guide initial therapy
300
Outcome of the EAGLES study
•Varenicline more effective than placebo, nicotine patch, and bupropion
•Bupropion and nicotine patch more effective than placebo
•No significant increase in neuropsychiatric adverse events related to varenicline or bupropion relative to nicotine patch or placebo
•Dec 2016: Neurophyschiatric event box warnings removed
300
When quitting smoking, patients become more sensitive to this substance
Caffeine
400
A 23 year old with asthma in your clinic needs this/these vaccine(s) today
PPSV23, Flu vaccine
400
This class of medications helps decrease exacerbations
ICS
--
ICS decrease exacerbation rates, time to first exacerbation.
Bronchodilators help improve FEV1, symptoms, and exercise capacity
400
How long should patients be on a smoking cessation medication for?
•>12 weeks of therapy is recommended over standard 6-12 weeks of therapy
• Increased abstinence and decreased relapse rates
• Does not change the adverse event risk
400
Patient wants to maximize delaying weight gain in smoking cessation
Varenicline
500
Pretreat 2 hrs before exercising using this in patients with exercise induced bronchospasm
Leukotriene receptor antagonist
500
52-year-old woman with COPD has experienced a gradual worsening in shortness of breath during the past few years. Spirometry shows FEV1/FVC 55% and FEV1 63% of predicted. Her COPD assessment test score is 10. She has not had a COPD exacerbation or received systemic corticosteroids in the past 2 years. Her current COPD medications are tiotropium inhaler once daily and albuterol HFA as needed. According to the GOLD guidelines, which is the most appropriate course of action?
A. Discontinue tiotropium, and start tiotropium/olodaterol 2.5 mcg/2.5 mcg 2 inhalations daily.
B. Add long-term azithromycin 250 mg once daily.
C. Add fluticasone 110 mcg 2 puffs twice daily.
D. Discontinue tiotropium, and start salmeterol/fluticasone 250/50 one puff twice daily
A. This patient is in GOLD grade 2 group B, and is already on the first-choice therapy. Because she is experiencing dyspnea, an LABA should be added to her LAMA. Azithromycin is recommended to prevent exacerbations for patients already on LAMA and LABA or ICS/LABA/LAMA. Inhaled corticosteroids are only recommended for exacerbations and increased eosinophils.
500
When to start varenicline in patients who are not ready to set a quit date?
Right away!
•Start varenicline even it patients are not ready to set a quit date
•Initiation in those not ready to quit still showed increased effect on abstinence
• Small increase in adverse events
• Clinical benefit outweighs the potentially increased cost and patient preference
500
44 year old male
Symptoms started when 18 years old, worsened in the last 2 years
Symptoms are worse in the morning and with climbing upstairs, but has symptoms daily. Albuterol provides limited relief
Mother has asthma
FEV1/FVC 66%, CXR shows some hyperinflation
Smokes 1ppd
Avoid ICS monotherapy