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Questions and Answers
What medication is considered a Short-Acting Beta Agonist (SABA) commonly used for asthma relief?
What medication is considered a Short-Acting Beta Agonist (SABA) commonly used for asthma relief?
Which statement accurately describes the use of Inhaled Corticosteroids (ICS)?
Which statement accurately describes the use of Inhaled Corticosteroids (ICS)?
When prescribing a long-acting medication for persistent asthma, which combination is appropriate?
When prescribing a long-acting medication for persistent asthma, which combination is appropriate?
What is the primary purpose of Long-Acting Beta Agonists (LABAs) in asthma management?
What is the primary purpose of Long-Acting Beta Agonists (LABAs) in asthma management?
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Which of the following statements about SABA usage is false?
Which of the following statements about SABA usage is false?
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What is a common recommendation after using an inhaled corticosteroid?
What is a common recommendation after using an inhaled corticosteroid?
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In the case of acute exacerbations of asthma, which treatment is recommended?
In the case of acute exacerbations of asthma, which treatment is recommended?
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Which of the following is not a role of Long-Acting medications in asthma?
Which of the following is not a role of Long-Acting medications in asthma?
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Which of the following conditions can result in a PaO₂ between 56-59 mmHg?
Which of the following conditions can result in a PaO₂ between 56-59 mmHg?
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What is a primary safety consideration when using Theophylline?
What is a primary safety consideration when using Theophylline?
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What are the potential severe reactions from high levels of Theophylline toxicity?
What are the potential severe reactions from high levels of Theophylline toxicity?
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Which devices are typically used for oxygen therapy at home?
Which devices are typically used for oxygen therapy at home?
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What is a common side effect of Theophylline?
What is a common side effect of Theophylline?
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What is the effective blood level range for Theophylline?
What is the effective blood level range for Theophylline?
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Which drug interaction can increase Theophylline levels?
Which drug interaction can increase Theophylline levels?
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What is the mechanism of action for acetylcholinesterase inhibitors?
What is the mechanism of action for acetylcholinesterase inhibitors?
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What is the primary indication for using Roflumilast?
What is the primary indication for using Roflumilast?
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Which medication is commonly used as a non-nicotine aid for smoking cessation?
Which medication is commonly used as a non-nicotine aid for smoking cessation?
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What is the recommended initial dosing for Varenicline?
What is the recommended initial dosing for Varenicline?
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Which statement correctly describes the use of oxygen therapy?
Which statement correctly describes the use of oxygen therapy?
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What is a common form of Nicotine Replacement Therapy (NRT) that helps manage nicotine withdrawal symptoms?
What is a common form of Nicotine Replacement Therapy (NRT) that helps manage nicotine withdrawal symptoms?
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For smoking cessation, how is the Nicotine Patch typically dosed for heavy smokers?
For smoking cessation, how is the Nicotine Patch typically dosed for heavy smokers?
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What are the target oxygen saturation levels that indicate the need for oxygen therapy?
What are the target oxygen saturation levels that indicate the need for oxygen therapy?
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Cromolyn is typically indicated for which of the following conditions?
Cromolyn is typically indicated for which of the following conditions?
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What is a common gastrointestinal side effect of AChE inhibitors?
What is a common gastrointestinal side effect of AChE inhibitors?
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Which of the following side effects is associated with bradycardia from AChE inhibitors?
Which of the following side effects is associated with bradycardia from AChE inhibitors?
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What could excessive sweating due to AChE inhibitors indicate?
What could excessive sweating due to AChE inhibitors indicate?
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In which condition might AChE inhibitors help improve muscle strength?
In which condition might AChE inhibitors help improve muscle strength?
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What is a suggested duration of seizure-free period before tapering off anti-seizure medication?
What is a suggested duration of seizure-free period before tapering off anti-seizure medication?
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Which type of epilepsy might allow for earlier discontinuation of anti-seizure medications?
Which type of epilepsy might allow for earlier discontinuation of anti-seizure medications?
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What neurological finding is most supportive of stopping anti-seizure medication?
What neurological finding is most supportive of stopping anti-seizure medication?
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What EEG finding could suggest a lower risk of seizure recurrence?
What EEG finding could suggest a lower risk of seizure recurrence?
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What is the primary mechanism of action of Dilantin?
What is the primary mechanism of action of Dilantin?
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Which of the following is a potential side effect of phenytoin?
Which of the following is a potential side effect of phenytoin?
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Which of the following drugs is indicated for partial seizures?
Which of the following drugs is indicated for partial seizures?
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What is one of the mechanisms by which many anticonvulsants function?
What is one of the mechanisms by which many anticonvulsants function?
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What condition is associated with teratogenicity when using Dilantin during pregnancy?
What condition is associated with teratogenicity when using Dilantin during pregnancy?
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Which of the following anticonvulsants increases GABA activity?
Which of the following anticonvulsants increases GABA activity?
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What type of seizures can Lacosamide treat?
What type of seizures can Lacosamide treat?
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Which condition is NOT a side effect associated with phenytoin?
Which condition is NOT a side effect associated with phenytoin?
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Study Notes
Asthma Management
-
Mild Intermittent Asthma:
- Short-Acting: SABA (like albuterol) as needed.
- Long-Acting: None.
-
Mild Persistent Asthma:
- Short-Acting: SABA as needed.
- Long-Acting: Low-dose ICS (like budesonide); LTRAs (like montelukast) as an alternative.
-
Moderate Persistent Asthma:
- Short-Acting: SABA as needed.
- Long-Acting: Medium-dose ICS or Low-dose ICS + LABA (like formoterol).
-
Severe Persistent Asthma:
- Short-Acting: SABA as needed.
- Long-Acting: High-dose ICS + LABA; add biologics (like omalizumab) if needed.
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Acute Asthma Exacerbation:
- Short-Acting Focus: High-dose SABA (often nebulized) + ipratropium; add oral steroids (like prednisone) for severe cases.
Patient Education for Asthma Medications
-
Inhaled Corticosteroids (ICS):
- Daily use is important even without symptoms, preventing inflammation.
- Not for immediate relief, use SABAs for acute attacks.
- Rinse mouth with water after use to prevent oral thrush.
-
Short-Acting Beta-Agonists (SABAs):
- "Rescue" inhalers for rapid relief during asthma attacks.
- Use only when needed, overuse can lead to decreased effectiveness.
- Can cause tremors and palpitations.
-
Long-Acting Beta-Agonists (LABAs):
- Maintenance medications, not for immediate relief.
- Typically prescribed alongside ICS to enhance control.
- Example: Formoterol or Salmeterol.
Smoking Cessation Medication Options and Dosing
-
Nicotine Replacement Therapy (NRT):
- Patches, gum/lozenges, nasal spray, inhalers, all deliver controlled doses of nicotine.
- Dosing varies based on smoking habits.
-
Bupropion SR (Zyban):
- Non-nicotine aid for smoking cessation.
- Typical dosage: 150 mg once daily for 3 days, then 150 mg twice daily.
- Treatment lasts 7-12 weeks.
-
Varenicline (Chantix):
- Partial agonist for nicotine receptors, reducing cravings and withdrawal.
- Gradual dosing increase over several days.
- Treatment lasts 12 weeks, add-on 12 weeks available.
Smoking Cessation Education: The 5 As
- Ask: Assess if the patient is a smoker.
- Advise: Counsel the patient to quit.
- Assess: Determine the patient's willingness to quit.
- Assist: Provide counseling and pharmacotherapy.
- Arrange: Plan follow-up appointments.
Oxygen Therapy
- Primarily used for chronic lung diseases with low oxygen saturation.
- May prolong survival when used for over 15 hours per day in severe cases.
- Recommended for patients with:
- PaO₂ ≤ 55 mmHg or SaO₂ ≤ 88% at rest.
- PaO₂ between 56-59 mmHg with complications like pulmonary hypertension, right-sided heart failure, or elevated hematocrit.
- Oxygen concentrators for home use, portable cylinders for transport (D-cylinder: small, E-cylinder: larger).
Safety Considerations with Theophylline
- Narrow therapeutic window, regular monitoring is crucial.
- Side effects include nausea, vomiting, insomnia, tremors, headaches, restlessness.
- Toxicity can cause arrhythmias, seizures.
- Metabolism affected by liver enzymes and interactions with various drugs.
- Conditions like smoking, heart failure, and liver disease can alter levels.
Acetylcholinesterase Inhibitors
- Block the enzyme acetylcholinesterase, increasing acetylcholine levels.
- Used in Alzheimer's disease and myasthenia gravis.
- Side effects:
- Gastrointestinal distress: Nausea, vomiting, diarrhea, abdominal cramps.
- Bradycardia and heart block.
- Increased salivation and sweating.
- Muscle cramps and weakness.
- CNS effects: Dizziness, headache, confusion.
Anti-Seizure Medications
- Discontinuation guidelines:
- Seizure-free period of 2-5 years.
- Consider seizure type, control stability, and risks.
- Normal neurological exam and neuroimaging.
- Normal EEG findings.
Dilantin (phenytoin)
- Mechanism of action: Blocks sodium channels, increasing membrane stability.
- Side effects:
- Gingival hyperplasia.
- Hirsutism.
- Facial coarsening.
- Hyperglycemia.
- Hematologic effects (anemia).
- Osteoporosis.
- Rash including DRESS.
- Megaloblastic anemia.
- Teratogenicity.
- Side effects:
Indications for Anticonvulsant Medications
- Keppra: Partial seizures.
- Lacosamide: Large, whole-body seizures (tonic-clonic).
- Lacosamide: Myoclonic seizures (muscle-jerk seizures).
- Lacosamide (off-label): Continuous seizure emergencies.
- Gabapentin: Nerve-related pain.
Mechanisms of Action for Seizure Medications
-
Inhibiting Sodium Channels:
- Phenytoin, Carbamazepine, Lamotrigine.
-
Increasing GABA Activity:
- Benzodiazepines (diazepam), Valproic Acid.
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Description
This quiz covers key concepts in asthma management, focusing on the treatment strategies for mild, moderate, and severe persistent asthma. It will also address the role of inhaled corticosteroids and the management of acute asthma exacerbations. Test your knowledge on the medications and their appropriate use.
