322 Questions
What effect does histamine have on small blood vessels in the vascular system?
Dilates small blood vessels
Where is histamine stored in the periphery?
Mast cells and basophils
Which type of cells are responsible for the synthesis and storage of histamine in the periphery?
Mast cells and basophils
What is histamine's role in the bronchi?
Constricts smooth muscle
Where are mast cells predominantly present?
Skin and soft tissues
What is the main clinical use of histamine?
Diagnostic procedures
Where is histamine produced in the central nervous system (CNS)?
Posterior hypothalamus
What stimulates the allergic release of histamine?
Production of antibodies of the immunoglobulin E class
What are the two common pathologic states where histamine is involved?
Allergic disorders and peptic ulcer disease
What are two areas of high histamine content in the body?
Lungs and gastrointestinal tract (GI)
What is the main effect of H1 stimulation?
Vasodilation of the skin, face, and upper body
How does histamine act directly on parietal cells of the stomach?
To promote acid release
Why are antihistamines not effective in treating asthma?
Histamine is not involved in asthma attacks
What is the principal use of H2 blockers?
Treatment of gastric and duodenal ulcers
Which mediator is primarily responsible for mild allergic conditions like hay fever?
Histamine acting at H1 receptors
What triggers allergic release of histamine?
Prior sensitization to allergens
Which agents can trigger histamine release from mast cells without prior sensitization?
Certain drugs, radiocontrast media, plasma expanders
'The intensity of an allergic reaction is determined by which mediator?' - Which of the following best completes this statement?
(H1) receptors
'Other effects of histamine include itching, pain, and secretion of mucous.' - Which receptor plays a significant role in these effects?
(H1) receptors in the central nervous system
Which group of H1 antagonists is known for causing significant sedation?
First-generation H1 antagonists
What is the primary therapeutic effect of H1 antagonists at arterioles and venules?
Inhibit histamine-induced dilation
Which effect is a direct result of blocking histamine at sensory nerves using H1 antagonists?
Reduced itching and pain
What effect do H1 antagonists have on histamine-induced increases in capillary permeability?
Reduce edema
Which symptom is likely to be reduced by blocking H1 receptors in mucous membranes with antihistamines?
Suppressed mucus secretion
What is the primary CNS effect of most second-generation antihistamines?
CNS depression
What is a potential consequence of antihistamine overdose in terms of CNS function?
Seizures
Why are very young children particularly sensitive to CNS stimulation by antihistamines?
They have less developed CNS
Why do most second-generation antihistamines have reduced CNS depression compared to first-generation antihistamines?
Higher receptor selectivity in second-generation antihistamines
What is a common therapeutic use of dimenhydrinate among antihistamines?
Motion sickness
Which generation of antihistamines is associated with the least amount of sedation?
Both second and third generations
What is the primary reason for the reduced sedative effects of second-generation antihistamines?
Low affinity for H1 receptors of the CNS
Which category of first-generation antihistamines causes the most prominent CNS depression?
Ethanolamines
What advice should be given to patients regarding alcohol consumption when taking H1 blockers?
Avoid alcoholic beverages
Why is it recommended to use antihistamines in pregnancy only when clearly necessary?
To avoid any potential risks to the fetus
Which antihistamine group is largely devoid of anticholinergic actions?
Second-generation agents
What characteristic makes alkylamines like chlorpheniramine different from other first-generation antihistamines?
Less prominent CNS depression
Why are second-generation antihistamines less likely to cause sedation than first-generation agents?
Low affinity for H1 receptors of CNS
Which adverse effect is primarily associated with older patients taking antihistamines?
Sedation and fatigue
What should be done if sedation remains excessive with an alkylamine antihistamine?
Switch to a second-generation antihistamine
What is the half-life of fexofenadine?
14.4 hours
Which formulation of fexofenadine should be used for patients with renal impairment?
All are safe
What is the marketed name for the fexofenadine suspension?
Allegra Children's Liquid
Which fruit juice can reduce fexofenadine absorption?
Grapefruit juice
What is the primary symptom of allergic rhinitis?
Pruritus
What is the mechanism behind nasal congestion in allergic rhinitis?
Increased blood vessel permeability
How should patients time fruit juice consumption to avoid affecting fexofenadine absorption?
1 to 2 hours after dosing
Which antihistamine is approved for oral therapy of chronic idiopathic urticaria?
Fexofenadine
What is the primary route of excretion for fexofenadine?
Unchanged in urine
What dosage adjustment is recommended for fexofenadine in patients with renal impairment?
Reduce the dosage
Which inflammatory mediators are released from mast cells upon binding of airborne allergens to IgE antibodies?
Histamine, leukotrienes, and prostaglandins
What is the primary difference between seasonal and perennial allergic rhinitis?
Seasonal rhinitis occurs in the spring and fall due to outdoor allergens, while perennial rhinitis is triggered by indoor allergens.
Which class of drugs is considered the most effective for both prevention and treatment of seasonal and perennial allergic rhinitis?
Glucocorticoids (intranasal)
Which of the following adverse effects is rare but can occur with the use of intranasal glucocorticoids?
Adrenal suppression and slowed growth in children
What makes oral antihistamines most effective for mild to moderate allergic rhinitis?
Taking them prophylactically before symptoms appear
Which route of administration is used for azelastine and olopatadine for the treatment of allergic rhinitis?
Intranasal spray
What common side effect can occur due to systemic absorption when using azelastine or olopatadine for allergic rhinitis?
Somnolence
What is the primary mechanism of action of intranasal cromolyn (Nasalcrom) for treating allergic rhinitis?
Suppressing the release of histamine from mast cells
Why is intranasal cromolyn (Nasalcrom) considered best suited for prophylaxis in allergic rhinitis?
It should be administered before symptoms start
What is a characteristic adverse reaction associated with sympathomimetics when used for allergic rhinitis treatment?
Rebound congestion after prolonged use
How do sympathomimetics reduce nasal congestion in patients with allergic rhinitis?
By activating α1-adrenergic receptors on nasal blood vessels
Which symptom of allergic rhinitis can sympathomimetics help relieve?
Nasal congestion
What is the primary reason for informing patients about the delayed response to intranasal cromolyn (Nasalcrom) therapy?
To set appropriate expectations for symptom relief
Which adverse reaction is most likely associated with oral sympathomimetic drugs used for allergic rhinitis?
Generalized vasoconstriction
What distinguishes the primary therapeutic effect of intranasal glucocorticoids from intranasal cromolyn in treating allergic rhinitis?
Greater benefits in symptom relief
What distinguishes sympathomimetics from intranasal cromolyn in their mechanism of action for treating allergic rhinitis?
Causing shrinkage of swollen membranes via vasoconstriction
What distinguishes topical sympathomimetics from oral agents in terms of onset of action?
Topical agents act faster than oral agents
Which side effect is commonly associated with ipratropium bromide when used for allergic rhinitis?
Nasal drying and irritation
How do systemic effects primarily manifest in relation to oral and topical sympathomimetics?
Systemic effects occur only with oral agents
What differentiates the administration of phenylephrine as a nasal decongestant compared to its use in combination preparations?
Phenylephrine is fast and effective when administered topically
What makes pseudoephedrine preferable to oral phenylephrine according to the text?
Pseudoephedrine is better absorbed and more effective
Which drug is indicated for allergic rhinitis, asthma, and the common cold as an anticholinergic agent?
Ipratropium bromide (Atrovent)
What distinguishes the effect of oral phenylephrine from its topical administration?
Oral phenylephrine has a slower onset of action compared to topical administration
'Even though absorption is poor, why is increasing the dosage of phenylephrine not advisable?'
Higher doses can cause adverse cardiovascular and CNS effects despite poor absorption
'What is a notable difference between the duration of action of topical and oral sympathomimetics?'
'Oral agents act longer than topical preparations'
How does montelukast relieve nasal congestion in allergic rhinitis?
By blocking leukotriene receptors
What is the primary reason for reserving montelukast for patients who do not respond to intranasal glucocorticoids or antihistamines?
Limited beneficial effects
Which of the following is a rare but serious neuropsychiatric effect associated with montelukast?
Depression and insomnia
What type of allergic rhinitis symptom does montelukast have little effect on?
Sneezing
In comparison to intranasal glucocorticoids, how effective is montelukast when used alone or in combination with an antihistamine for allergic rhinitis?
Less effective
What is the primary mechanism of action of omalizumab in treating allergy-mediated asthma?
Inhibiting IgE synthesis
Why is omalizumab approved only for allergy-mediated asthma?
'On-label' use restricted to asthma
Which of the following symptoms are improved by omalizumab according to several studies?
'Allergy-like' symptoms
What distinguishes the approved indications between montelukast and omalizumab in terms of allergic conditions they treat?
Montelukast is approved for seasonal and perennial allergic rhinitis, while omalizumab is approved only for allergy-mediated asthma.
What is the primary reason for the off-label prescription of omalizumab for patients with ragweed-induced seasonal allergic rhinitis?
To manage symptoms when other drugs have been ineffective
Which opioid analgesic is noted for being somewhat more potent than codeine for cough suppression?
Hydrocodone
What is the primary distinguishing factor between codeine and hydrocodone in terms of their classification under the Controlled Substances Act?
Codeine is classified under Schedule II, while hydrocodone is not scheduled.
What sets dextromethorphan apart from traditional opioids like codeine in terms of its side effects?
Dextromethorphan does not produce typical opioid-like euphoria or physical dependence.
Which antitussive acts by decreasing the sensitivity of respiratory tract stretch receptors to suppress cough?
Benzonatate
What is the primary action of an expectorant in relation to cough?
Makes cough more productive by stimulating respiratory tract secretions
Which compound is noted for its mucolytic action by reacting directly with mucus to make it more watery?
Acetylcysteine
What sets guaifenesin apart from other expectorants in terms of its efficacy?
It requires doses higher than normal to be effective.
What adverse effect is specifically noted for benzonatate use in children and adults?
Severe effects
What distinguishes hypertonic saline and acetylcysteine from other expectorants in terms of administration?
They are administered by inhalation.
Which of the following is a characteristic symptom of the common cold?
Headache
Why are antibiotics not justified for treating colds?
Colds are caused by viruses
What is the purpose of including antihistamines in some cold remedies?
To suppress mucus secretion
Why is caffeine added to some combination cold remedies?
To counteract the sedative effects of antihistamines
What is a disadvantage associated with combination cold remedies?
The dosage may lead to excessive or subtherapeutic levels of ingredients
Which group of patients are advised to use single-drug preparations for cold relief?
Patients with just a single symptom (e.g., rhinitis, cough, or headache)
Why are antibiotics not a recommended treatment for the common cold?
They have no effect on viruses.
What is the purpose of including antihistamines in some combination cold remedies?
To suppress mucus secretion
Why is caffeine added to some combination cold remedies?
To offset the sedative effects of antihistamines
What is a disadvantage associated with combination cold remedies?
They may contain unnecessary ingredients.
Why was the use of OTC cold remedies restricted for children below the age of 2 years?
Because they cause life-threatening events
What is the primary reason for informing patients about the delayed response to intranasal cromolyn therapy?
To ensure compliance with the treatment regimen
What distinguishes sympathomimetics from intranasal cromolyn in their mechanism of action for treating allergic rhinitis?
Sympathomimetics stimulate alpha-adrenergic receptors.
What effect does histamine have on small blood vessels in the vascular system?
- It dilates them.
What makes oral antihistamines most effective for mild to moderate allergic rhinitis?
They have longer duration of action.
Which drug is classified under Schedule II of the Controlled Substances Act due to its potential for abuse?
Codeine
What is the main mechanism of action of benzonatate (Tessalon and Zonatuss) in suppressing cough?
Decreasing sensitivity of respiratory tract stretch receptors
Which drug is a derivative of opioids but does not produce typical opioid-like euphoria or physical dependence?
Dextromethorphan
What makes guaifenesin different from other compounds promoted as expectorants?
Questionable efficacy
Which drug acts as a mucolytic by reacting directly with mucus to make it more watery?
Acetylcysteine
What is the primary disadvantage associated with the mucolytic acetylcysteine?
'Rotten egg' smell
What is the main distinguishing factor between codeine and hydrocodone in terms of their action on cough suppression?
'Potency' and 'liability for abuse'
'Which agent acts within the CNS to suppress cough?'
'Dextromethorphan'
Which neurotransmitter is primarily involved in causing nasal congestion in people with allergic rhinitis?
Leukotrienes
What is the primary mechanism of action of montelukast (Singulair) in relieving nasal congestion?
Blocking leukotriene receptors
Which symptom of allergic rhinitis is least affected by the use of montelukast?
Sneezing
What is the primary reason for reserving montelukast for patients who do not respond to intranasal glucocorticoids or antihistamines?
Limited beneficial effects of montelukast
Which drug is a monoclonal antibody directed against IgE, specifically approved for allergy-mediated asthma?
Omalizumab (Xolair)
What is the main role of IgE in allergic reactions?
Stimulating mast cells to release inflammatory mediators
What common neuropsychiatric side effect can occur with the use of montelukast?
Insomnia
How do the benefits of montelukast in allergic rhinitis compare to those of intranasal glucocorticoids?
'Montelukast is less effective than intranasal glucocorticoids'
'What are the main adverse neuropsychiatric effects associated with montelukast?'
'Depression and insomnia'
Why is montelukast generally reserved for patients who do not respond well to intranasal glucocorticoids or antihistamines?
Its benefits are limited, and it can cause rare but serious neuropsychiatric effects.
Which type of COPD is genetically determined and often associated with an alpha one antitrypsin deficiency?
Genetically determined COPD
What environmental factor can cause COPD due to abnormal lung development?
Premature birth
Which type of COPD is associated with exposure to cigarette smoke, pollution, and factory fumes?
Environmental COPD
Which type of COPD is linked with childhood infections such as tuberculosis and HIV?
COPD due to infections
When patients exhibit signs and symptoms of both COPD and asthma, what category of COPD does this fall under?
COPD and asthma combo
In which publication did the lecturer's article on the clinical indicators for diagnosing COPD appear?
The Nurse Practitioner
When should inhaled corticosteroids be used in stable COPD patients?
When a patient has two or more exacerbations per year
What is the main reason for avoiding long-term use of oral glucocorticoids in COPD?
They lead to hearing test impairments
What factors are important when initiating inhaled corticosteroids in patients with COPD?
Blood eosinophils of 100 to 300
In which patients are E for inhibitors used in COPD?
Patients with chronic bronchitis
What effect does treatment with ISIS renascent have on patients?
Increased risk for bacterial resistance
Which pharmacologic treatment shows evidence supporting a reduction in mortality and COPD?
Pulmonary rehab
What is a key goal for treating stable COPD patients?
Enhancing exercise tolerance
Which factor is emphasized in the importance of providing education on inhaler device technique?
Patient preference and ability
What is the key spirometry ratio that needs to be met for a diagnosis of COPD?
0.70
What is a critical component in preventing disease progression in COPD patients?
Avoiding irritant exposures
In the modified Medical Research Council (MRC) Dyspnea Scale, what does Grade 2 indicate?
Breathless when hurrying on a walk
Which category of patients, based on exacerbation history and MRC scores, would fall under Category B for initial COPD treatment?
Zero exacerbations, MRC score 2
What is the recommended GOLD grade classification for a patient with FEV1 between 30% and 50% predicted?
GOLD 3
What is the purpose of using the COPD Assessment Test (CAT) in the assessment of COPD patients?
To assess symptoms and health status
Which of the following conditions is NOT included as a potential cause of chronic cough mentioned in the text?
Pneumonia
What is a recommended therapeutic option for patients with stable COPD demonstrating post bronchodilator FGB1 between 15 to 40 percent and evidence of hyperinflation and lung volume reduction?
Lung volume reduction surgery
Which vaccine is recommended by the CDC to protect against pertussis for patients with COPD who were not vaccinated in adolescence?
Tdap vaccine
What is the main treatment approach for COPD with long-acting muscarinic antagonist and long-acting beta-agonist combinations?
Inhaled corticosteroids
Which of the following medications has been shown to reduce the incidence of community-acquired pneumonia and exacerbations in patients with COPD?
Pneumococcal vaccine
What is recommended for lung cancer screening in patients with COPD due to smoking?
Low dose CT scan
Which medication exerts a small bronchodilator effect in stable COPD and is associated with modest symptomatic benefits?
Theophylline
What is the recommended strategy for choosing an inhalation device for patients?
Use only one device type, minimize the number of different device types, and avoid switching devices without proper information or follow-up.
Why is it essential to assess a patient's ability to perform the correct inhalation maneuver for the inhalation device?
To assess if they can make a forceful and deep inhalation for specific types of inhalation devices.
Which type of inhalers require coordination between device triggering and inhalation?
Soft mist inhalers
Why should physicians only prescribe inhalation devices that they know how to use?
To maintain patient trust in the physician's expertise.
What is the preferred choice when initiating treatment with long-acting bronchodilators?
Combination of a long-acting muscarinic antagonist and long-acting beta-agonist
Which type of bronchodilator treatment should be considered for patients with persistent symptoms on a single long-acting bronchodilator treatment?
Escalation to two single inhalers
What are the indications for non-invasive mechanical ventilation?
Respiratory acidosis with CO2 levels greater than or equal to 6 and arterial pH less than or equal to 7.3
What is a criterion for initiating invasive mechanical ventilation?
Severe hemodynamic instability responsive to fluids and bioactive drugs
Which factor is NOT considered a risk factor for developing lung cancer?
Low BMI below 25 kg/m^2
What is a key point for managing COPD during the COVID-19 pandemic?
Maintain physical activity and ensure an adequate supply of medications
What should be evaluated during the 12 to 16-week follow-up for COPD patients?
Spirometry results and symptom documentation
What is a discharge criteria recommendation for COPD patients?
Ensure early follow-up within 12 weeks
'What is a key intervention to reduce the frequency of exacerbations in COPD patients?' - Which option addresses this best?
'Smoking cessation' as part of interventions
'What patient assessment should be done during the one to four-week follow-up?' - Which choice is most relevant?
'Review the understanding of treatment'
'Which factor should be reassessed during the one to four-week follow-up?' - Which option is most appropriate?
'Capacity to do physical activity'
'What should be maintained in patients with COPD during the COVID-19 pandemic?' - Which choice aligns with this recommendation?
'Continue regular regimens unchanged'
What is the main difference in exacerbation criteria between group A and group B in the twenty twenty to twenty twenty two slide?
Severity of exacerbations
In the management cycle suggested in the text, what step comes after 'assess'?
Review
Which group receives lobal lama based on the twenty twenty to twenty twenty two slide information?
Group E
What distinguishes the new twenty twenty three guidelines from the previous ones mentioned in the text?
Combination therapy requirement
What should be considered for patients whose blood eosinophils are greater than three hundred according to the text?
Including an AC
Which step is crucial at every visit during pharmacologic treatment follow up according to the text?
Check inhaler technique
What is the critical factor determining which group a patient falls into based on exacerbations?
Blood eosinophil count
In the management cycle provided in the text, what is suggested to be considered at every visit regarding treatment?
'Check' inhaler technique
'Group E gets Loblaw and you consider adding an AC if the blood eosinophils are greater than three hundred.' - What does AC stand for in this context?
'Add-on Corticosteroid'
What is the distinguishing factor between group A and group B regarding exacerbation requirements in the twenty twenty to twenty twenty two slide?
Hospital admission rate
What is the primary consideration when prescribing supplemental oxygen in COPD patients?
Maintaining SATs above 90
How can you differentiate a COPD exacerbation related to heart failure from one related to pulmonary issues?
By checking the BNP levels
What is a key contributor to consider when treating patients with COPD, pneumonia, and heart failure?
Technip near tachycardia
What should be monitored when managing severe exacerbations of COPD that are not life-threatening?
Fluid balance
Which pharmacological treatment is indicated for patients with COPD showing evidence of hyperinflation and lung volume reduction?
Bronchodilators
What should be evaluated to determine the cause of an exacerbation in COPD patients?
Pulse ox lab assessment
What is a potential indication for hospitalization in COPD patients?
Worsening or resting hypoxemia
What is a key consideration for patients with COPD that exacerbations do not respond to initial medical management?
Identifying associated conditions
What is the appropriate strategy for choosing an inhalation device for patients with COPD?
'Trial and error' method
What is the maximum recommended daily dose of promotora according to the text?
48 micrograms
How does adding a law to an inhaled corticosteroid regimen affect asthma patients?
Improves symptoms and reduces exacerbations
What is a common side effect of using iciest for asthma control?
Dryness of the mouth
Which leukotriene modifier targets part of the inflammatory pathways in asthma?
Montelukast
What is the main purpose of using muscarinic antagonists or sama's in asthma treatment?
As reliever medication in severe acute asthma
How are controller medications like inhaled corticosteroids supplied?
In multiclass or deep inhalers
What is the recommended duration of short-term treatment with corticosteroids for asthma exacerbations in adults?
5-7 days
For which patients may long-term treatment with corticosteroids be necessary?
Patients with persistent airflow limitation
What are some of the side effects associated with short-term use of corticosteroids?
Mood changes
What is the main reason for confirming evidence documented in medical records before starting controlled therapy in asthma patients?
To prevent making the diagnosis more difficult
What is the primary goal of short-term treatment in asthma management?
Achieve symptom control and minimize risks
Why is a partnership between the asthma patient and healthcare provider crucial for effective asthma management?
To improve health outcomes
What is a common side effect of combining Lopa with volatile zeffirelli medications?
Elevated liver function test
Which statement accurately describes the role of chromoglycate and Hendropriyono sodium as controller medications?
They require meticulous inhaler maintenance
What distinguishes Taiyo tropism among long-acting muscarinic antagonists?
Included in combo medications with inhaled corticosteroids
For which patients is Anomalously Mad suitable as a treatment option?
Patients with controlled severe eosinophilic asthma
What differentiates Eosinophilic Granulomatosis with Polyangiitis treatment with Emam compared to other options?
Subcutaneous injection
In what patient group is New Program (anti interleukin four) most recommended?
Patients requiring maintenance oral corticosteroids
What is the primary purpose of short-acting beta agonists in asthma treatment?
To provide quick relief during asthma symptoms
What is a common side effect associated with regular and excessive use of short-acting beta agonists?
Tremor and tachycardia
When should short-acting beta agonists (SABAs) be used in asthma treatment?
Only as needed at the lowest dose required
What is the primary function of low-dose inhaled corticosteroids in asthma treatment?
To provide maintenance therapy for asthma control
Which medications are referred to as reliever medications for asthma maintenance therapy?
SABAs and MARKT
What distinguishes the use of inhaled corticosteroids like budesonide from oral corticosteroids in asthma management?
Inhaled corticosteroids have reduced risk of systemic side effects
Why is regular Sahba no longer recommended in asthma treatment?
Due to its association with severe adverse effects
What is the risk associated with higher Sobhi use in asthma treatment?
Adverse clinical outcomes
When should step two of the stepwise approach for adults and adolescents be initiated?
If symptoms are twice a month or more, but less than daily
In the stepwise approach for children ages six to 11, what is the alternative dosing for step one?
Low dose inhaled corticosteroid taken whenever Saba is taken
What symptom frequency indicates the need to initiate step four in the stepwise approach for adults and adolescents?
Symptoms on most days or waking with asthma once a week or more
What distinguishes track two from track one in the stepwise approach for adults and adolescents?
Track two involves an as-needed low dose inhaled corticosteroid
What is the recommended treatment for patients with asthma who are experiencing symptoms most days or waking at night more than once a week?
High dose inhaled corticosteroids or add-on Taiyo tropism
When should step-up asthma treatment be considered according to the text?
When symptoms are not controlled after two to three months of sustained treatment
What is the alternative suggested in the text for patients with asthma being treated with Sombat as reliever medication?
Low dose inhaled corticosteroid plus leukotriene receptor antagonists with short-acting beta agonist as reliever medication
What is the initial step recommended by the text to confirm the diagnosis and assess symptom control in children with asthma?
Assess modifiable risk factors
In what scenario should patients with asthma consider moving up to step three in treatment according to the text?
Experiencing symptoms most days or waking at night more than once a week
Which option represents the correct treatment for patients with asthma who do not have symptoms twice a month or more?
Step one treatment
Why is it important to assess inhaler technique, adherence, and other factors before considering stepping up asthma treatment?
To identify comorbidities like allergic rhinitis
Which factor should prompt consideration of step-up asthma treatment according to the text?
Persistent symptoms despite correct inhaler technique
What does the text recommend for patients with asthma who are having symptoms most days or waking at night more than once a week and have poor lung function?
High dose inhaled corticosteroids or add-on Taiyo tropism
What should be done if patients with asthma experience persistent symptoms despite two to three months of sustained control?
Consider evaluating their use of correct inhaler technique and adherence.
What is the recommended stepwise approach for children five and under with asthma?
Double low dose of inhaled corticosteroid plus SABA as needed
What is the primary reason for avoiding Lamai as an add-on treatment before ensuring sufficient inhaled corticosteroid?
To reduce exacerbations
What additional checks are recommended before considering Lamai as an add-on?
Sputum and EKG
What is the main purpose of checking a patient's sputum according to the text?
To evaluate eosinophilic levels
Why are exacerbations often viewed as failures in chronic asthma care?
As they represent opportunities to improve patient care plans
What is the significance of following up with patients until their symptoms and lung function return to normal?
To monitor treatment effectiveness
What distinguishes the stepwise approach for children five and under from older patients with asthma?
Requirement of pediatric nurse practitioners for treatment
What is the main consideration before deciding on Lamai as an add-on treatment?
Ensuring sufficient inhaled corticosteroid
How do exacerbations provide opportunities for improving patient care plans?
By relieving the patient's current plan
Why is it emphasized that only pediatric nurse practitioners should treat children five and under for asthma?
To ensure correct stepwise approach application
What is the recommended approach for stepping down treatment in asthma patients?
Gradually reduce treatment once asthma is under control
How much prednisone should be given to adults for severe asthma exacerbations?
40-50 milligrams for 5-7 days
What is the purpose of documenting the baseline status of lung function in asthma patients?
To track progress and assess response to treatment
What should be considered before stepping down treatment in asthma patients?
Recent E.R. visits
What is the role of corticosteroids during asthma exacerbations?
To reduce the need for oral corticosteroids
What is the typical dose range of prednisone given to adults during severe asthma exacerbations?
40-60 milligrams for 7 days
What is the purpose of providing an asthma action plan to patients?
To provide guidance on managing symptoms and exacerbations
Why is it important not to take asthma patients off corticosteroids during treatment?
To prevent exacerbations and worsening symptoms
What is the significance of assessing risk factors before making treatment decisions in asthma patients?
It assists in identifying potential triggers or exacerbating factors.
How do exacerbations differ from the usual symptoms in asthma patients?
They represent a flare-up or worsening of symptoms beyond the usual.
Which pathogen is most commonly associated with Legionella pneumonia in middle-aged male smokers and alcohol abusers?
Legionella pneumophila
What is a characteristic symptom of mycoplasma pneumonia in patients under thirty-five years old?
Immaculate skin rash
Which bacterial pathogen commonly causes pneumonia in neonates due to exposure to maternal strep?
Streptococcus pneumoniae
In which group of patients is Haemophilus influenza most commonly observed?
Older adults with COPD
What defines severe pneumonia according to the 2007 Infectious Disease Society and American Thoracic Society criteria?
One major criterion or three minor criteria
What is a characteristic feature of pneumococcal pneumonia presentation?
Rust-colored sputum
What is indicated by a degenerative left shift in a blood count?
Depletion of neutrophils and an increase in bands
Which type of patients are hospitalized based on the CURB-65 criteria if they score 4 or greater?
Patients with confusion, high respiratory rate, and age over 65 years
When should a chest X-ray be obtained for patients suspected of pneumonia?
To confirm or establish the diagnosis
Why might a chest X-ray show a false negative in pneumonia patients?
Dehydration
What is recommended for outpatient treatment of healthy adults without comorbidities according to the Infectious Disease Society and American Thoracic Society?
Amoxicillin one gram three times daily
Why should outpatient adults with comorbidities receive combination therapy for pneumonia treatment?
To cover a broader spectrum of pathogens
Which bacterial cause of community-acquired pneumonia is most common in smokers?
Haemophilus influenzae
Which organism is most likely responsible for pneumonia in patients recovering from the flu?
Staphylococcus aureus
Which bacterium is commonly found in college students living in dormitories and is a cause of community-acquired pneumonia?
Mycoplasma pneumoniae
Which bacterium is considered an 'atypical' cause of community-acquired pneumonia but is common in older buildings and air conditioning systems?
Legionella pneumophila
What is the most common bacterial cause of community-acquired pneumonia overall?
Streptococcus pneumoniae
Why is it recommended to avoid using fluoroquinolones for community-acquired pneumonia unless it is the very last option?
To avoid developing resistance to fluoroquinolones
Which bacterium causing community-acquired pneumonia is commonly associated with patients recovering from the flu?
Legionella pneumophila
Which factor would necessitate the use of combination therapy instead of monotherapy in patients with a recent history of antibiotic use?
Repeated courses of therapy with similar antibiotics
What is the main reason corticosteroids are not recommended for outpatient use in pneumonia?
Limited evidence of corticosteroid benefits in outpatient settings
Why should patients with community-acquired pneumonia ideally be febrile and stable for 48 to 72 hours before discontinuing antimicrobial treatment?
To ensure complete eradication of the infection
Why do younger children often acquire RSV from their older siblings?
Higher RSV transmission rates among siblings
What is a key characteristic that limits the immunologic response in RSV-infected individuals?
Limited replicative activity of the virus in the airways
What is a significant risk factor for acquiring RSV in younger children?
Having older siblings in preschool
Which infants are at the greatest risk for severe RSV disease requiring hospitalization?
Infants born at 28 weeks gestation
What is a common symptom of RSV infection in infants over three months of age?
Significant coughing and sneezing
Which condition is NOT a risk factor for severe RSV disease requiring hospitalization?
Attention deficit hyperactivity disorder
What is the purpose of RSV testing according to the text?
To avoid unneeded antibiotic therapy
Why is palivizumab recommended for prophylaxis in high-risk infants?
It reduces RSV hospitalization rate by up to 55%
Which group of patients are recommended for RSV vaccination during pregnancy?
Patients with hemodynamically significant congenital heart disease
What is the purpose of immunizing patients during pregnancy against RSV?
To protect the infant through passive immunity
What is one condition that makes a patient eligible for RSV vaccination according to the text?
Chronic lung disease
For which age group is RSV vaccination during pregnancy especially emphasized?
Second year of life
What factor associated with severe illness in patients 65 and older is mentioned in the text?
Immunosuppressive disease
What is a common misconception about RSV vaccination during pregnancy according to the text?
It protects against bacterial superinfection
Which patient group should be considered for RSV vaccination during pregnancy based on their need for medical intervention?
Patients with chronic heart disease
What is a crucial eligibility criterion for RSV vaccination according to the text?
Less than 24 months of age with heart failure medications
What is a telltale sign of influenza in adults?
Allergies
Which complication can occur as a result of a secondary infection from the flu virus?
Myositis pericarditis syndrome
Which statement about pneumonia caused by a secondary flu infection is true?
It is commonly caused by bacteria (staff)
Which group of patients may experience prolonged recovery from influenza due to preexisting conditions?
Patients with heart disease
Which symptom is highlighted as being uncommon in adults but possible in children with influenza?
Nausea and vomiting
What is the recommended age for giving peramivir to children?
2 and older
When should antiviral therapy be initiated for patients with complications or progressive disease related to influenza?
As soon as possible
Which antiviral medication is given once orally for flu treatment in children 12 and older?
Belloc severe
What is the full name of the virus that causes COVID-19?
SARS-CoV-2
Why are antiviral therapy and booster vaccines important in reducing COVID-19 deaths?
They provide additional protection against existing variants.
What is the primary concern with the timing of COVID-19 immunizations and the emergence of new variants?
Need for updated boosters for new variants
'Why should acetaminophen and ibuprofen be used for chest pain, dyspnea, and wheezing in patients?'
'They manage respiratory symptoms.'
'What is the main reason behind a reduction in masking and social distancing related to COVID-19?'
'Increased vaccination rates'
When is it recommended to start antiviral therapy for flu?
Any time, even up to 10 days after symptoms start
Who should NOT receive live attenuated (nasal spray) flu vaccines according to the text?
Pregnant patients
What is a key factor in determining candidates for antiviral therapy for flu based on the text?
Chronic aspirin therapy
Why might sensitivity testing be done on patients with egg allergies before flu vaccination?
To check if they are suitable for live attenuated vaccines
Based on the text, who are considered candidates for antiviral therapy for flu?
Those with anemia
Why are live attenuated (nasal spray) flu vaccines contraindicated in pregnant patients according to the text?
They can compromise fetal health
What is a significant consideration for starting antiviral therapy for flu as outlined in the text?
The patient's high-risk status
Why should flu immunization be considered even for patients with egg allergies based on the text?
Some patients with anaphylaxis can still be vaccinated
What is the most common chronic health problem that can result in more severe COVID-19?
Obesity
What is the primary antiviral therapy goal for COVID-19 recommended by the CDC?
Reduce hospitalizations
What is the recommended timing to initiate antiviral therapy for most outpatients with COVID-19 symptoms?
Within 5 days of symptom onset
Which drug is known for its inhibition of CYP3A4 metabolism and is often given in combination with another antiviral?
Ritonavir
What drug interaction effect can be anticipated when using a strong CYP3A4 inhibitor with a CYP3A4 substrate?
$5$-fold increase in the substrate
What action is recommended regarding statin medications when initiating antiviral therapy?
Hold for 8 days
What drug should be avoided or doses reduced when using antivirals due to potential interactions?
Calcium channel blockers
$50%$ of all prescription medications are substrates for which enzyme pathway?
$CYP3A4$
What is the recommended management strategy for patients who experience rebound symptoms after taking Paxil?
Continue to use Paxil as recommended
What is the suggested approach for patients who cannot take the preferred antiviral therapies?
Reserve alternative treatments for when preferred options are not feasible
What is the CDC's guidance on patient isolation in the context of rebound symptoms after taking antiviral medications?
Total isolation period of 7 days after symptom onset
What is the anticipated future trend regarding antiviral therapy for COVID-19 based on current research findings?
Shift towards combination therapy due to potential drug resistance
What distinguishes the use of alternative antiviral therapies from the preferred options in the context of severe COVID-19?
Limited evidence in placebo-controlled trials
What does the lecture suggest about the potential development of resistance to antivirals used for COVID-19?
Resistance will be similar to other antivirals in the past
Why is it suggested that future antiviral therapies for COVID-19 may involve combination treatments?
Due to concerns about developing resistance
Test your knowledge on antihistamines, locally acting compounds with various effects on the vascular system, bronchi, stomach, and central nervous system. Learn about the clinical use of antihistamines and their role in managing respiratory disorders.
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