Nurs 502 Exam 1 study guide > Untitled Deck > Flashcards

Untitled Deck Flashcards

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1
Q

Respiratory (GINA Asthma / GOLD COPD / Allergic Rhinitis)

A
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2
Q

GINA big safety shift (adults/adolescents)

A

SABA-only treatment is not recommended (↑ severe exacerbations + asthma-related death); everyone should get ICS-containing therapy (daily or symptom-driven).

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3
Q

Track 1 reliever (preferred)

A

Low-dose ICS–formoterol (anti-inflammatory reliever).

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4
Q

Track 2 reliever (alternative)

A

Reliever = SABA (or ICS-SABA); if SABA used, patient must be on maintenance ICS (adherence risk).

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5
Q

Track 1 Step 1–2 (preferred)

A

Low-dose ICS–formoterol PRN (AIR-only).

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6
Q

Track 1 Step 3–5 key idea

A

MART = daily maintenance ICS–formoterol + extra doses PRN; lowers severe exacerbations vs SABA-reliever regimens.

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7
Q

MART can only use which LABA?

A

Only formoterol-containing ICS/LABA inhalers can be MART.

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8
Q

Track 1 benefit (Step 1–2)

A

Cuts ED visits/hospitalizations ~2/3 vs SABA alone.

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9
Q

When asthma not controlled—before step up

A

Check adherence, inhaler technique, risk factors, comorbidities first.

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10
Q

After exacerbation follow-up

A

Follow-up until sx/lung fx normal; consider switch to Track 1 ICS–formoterol reliever to reduce recurrence.

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11
Q

SABA “red flag”

A

Frequent/regular SABA → tolerance + ↑ inflammation; excess use/poor response = poor control + ↑ risk.

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12
Q

Allergic rhinitis (in asthma)

A

Treat rhinitis with intranasal corticosteroids (common comorbidity).

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13
Q

Obesity + asthma

A

Weight reduction helps; 5–10% loss can improve control.

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14
Q

LTRA effectiveness

A

LTRAs less effective than daily ICS for preventing exacerbations; montelukast linked to serious mental health effects.

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15
Q

Add-on LAMA (asthma)

A

Small ↑ lung function, small ↓ exacerbations; increase ICS to ≥ medium or switch to MART first.

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16
Q

Step 5 biologic options—name the classes

A

Anti-IgE, Anti–IL-5/IL-5R, Anti–IL-4Rα, Anti-TSLP.

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17
Q

Anti-IgE example + big rare AE

A

Omalizumab; rare anaphylaxis.

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18
Q

Anti–IL-5/IL-5R examples

A

Mepolizumab, benralizumab, reslizumab.

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19
Q

Dupilumab caution

A

Not advised if current/past eosinophils ≥1500/µL; rare EGPA after steroid reduction.

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20
Q

Tezepelumab note

A

Add-on for severe asthma uncontrolled on high-dose ICS-LABA; rare anaphylaxis.

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21
Q

Systemic steroids for asthma exacerbation (adult duration)

A

Usually 5–7 days.

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22
Q

Long-term oral steroids

A

Last resort only (serious adverse effects).

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23
Q

GOLD assessment tool name

A

ABE tool (Groups A, B, E).

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24
Q

GOLD Group A initial tx

A

A bronchodilator (short or long acting).

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25
GOLD Group B initial tx
LABA + LAMA (dual bronchodilation best for dyspnea).
26
GOLD Group E initial tx
LABA + LAMA; consider adding ICS if eosinophils ≥300.
27
Allergic rhinitis 1st line
Intranasal corticosteroids (fluticasone, mometasone): best monotherapy for mod–severe AR.
28
Why INCS > oral antihistamines for AR?
INCS treat all symptoms including congestion; oral antihistamines don’t treat congestion well.
29
Intranasal antihistamine pearl
Fast onset (~15 min) → good “on-demand” add-on.
30
Oral antihistamine preference
Prefer 2nd gen (cetirizine, fexofenadine) over 1st gen.
31
High-intensity statins (LDL ↓ ≥50%)
Atorvastatin 40–80 mg; Rosuvastatin 20–40 mg.
32
Moderate-intensity statins (LDL ↓ 30–50%)
Atorvastatin 10–20 mg; Rosuvastatin 5–10 mg; Simvastatin 20–40; Pravastatin 40–80, etc.
33
Statin big risks to remember
Myopathy/rhabdo risk ↑ in elderly w kidney issues + dehydration; hepatotoxicity risk ↑ with combos.
34
Statin CYP interaction red flag
Simvastatin + atorvastatin are CYP3A4-metabolized → interaction risk.
35
Warfarin + statin monitoring
Monitor INR if on warfarin (interaction noted).
36
When to recheck lipids after statin start/change
~6 weeks (per chart).
37
Ezetimibe MOA
Blocks intestinal cholesterol absorption; low systemic absorption; minimal GI effects.
38
Ezetimibe interaction pearl
No significant CYP450 interaction.
39
Thiazide first-line HTN (examples/dose)
HCTZ 25 mg/day; chlorthalidone 12.5–25 mg/day.
40
Thiazide key AEs
↓Na/↓K/↓Mg; ↑ uric acid (gout); ↑ BG/TG at high doses.
41
Thiazide contraindication (renal)
Avoid if CrCl <30 mL/min.
42
Dihydropyridine CCB examples
Amlodipine 2.5–10; nifedipine ER 30–60; felodipine 2.5–20.
43
DHP CCB AEs
Edema, headache, dizziness, reflex tachycardia.
44
Non-DHP CCB (rate control) caution
Verapamil/diltiazem contraindicated in HF (negative inotropy).
45
ACEI examples (HF mortality benefit)
Lisinopril 20–40 daily; enalapril 10–20 BID; captopril 50 TID.
46
ACEI AEs to know
Cough, angioedema, ↑K, worsening renal function, hypotension (first dose).
47
ACEI absolute “NO”
Pregnancy; bilateral renal artery stenosis; hx angioedema with ACEI.
48
Hold ACEI when?
If K > 5.5.
49
ARB example + key contraindications
Losartan 25–100 BID; pregnancy; bilateral RAS; hx angioedema with ACEI; volume depletion caution.
50
ARNI = Entresto (what + when)
Sacubitril/valsartan; first-line for HFrEF Class II–IV Stage C; replaces ACEI/ARB.
51
Entresto “do not combine”
Do not combine with ACEI or ARB.
52
Entresto washout
Wait 36 hours when switching from ACEI → Entresto (angioedema risk).
53
Entresto monitoring
Monitor K, creatinine, BP.
54
3 evidence-based beta blockers for HFrEF
Bisoprolol, carvedilol, metoprolol ER (succinate).
55
Beta blocker “avoid in asthma”
Avoid nonselective beta blockers (e.g., propranolol) in asthma.
56
NOAC classes
Direct Xa inhibitors (rivaroxaban, apixaban, edoxaban) + direct thrombin inhibitor (dabigatran).
57
NOAC common indication (per chart)
Non-valvular AF; also DVT treatment/long-term management.
58
CHA2DS2-VASc threshold (per chart)
Anticoag when >2 (men) or >3 (women).
59
When choose warfarin over NOAC (per chart)
Mechanical heart valve; severe renal insufficiency.
60
Warfarin INR goal for DVT
2–3.
61
Warfarin INR goal mechanical mitral valve
2.5–3.5.
62
Warfarin “bridge” concept
Needs bridge at initiation; delayed efficacy.
63
Warfarin ↑INR interactions (examples)
Amiodarone, metronidazole, TMP-SMX, acetaminophen.
64
Warfarin ↓INR interactions (examples)
Vitamin K, rifampin, barbiturates.
65
UFH MOA (per chart)
Binds antithrombin III → inhibits Factor Xa + thrombin.
66
P2Y12 inhibitors = what drugs?
Clopidogrel, prasugrel, ticagrelor.
67
P2Y12 MOA
Blocks ADP (P2Y12) receptor → prevents platelet activation.
68
#1 risk of P2Y12s
Bleeding.
69
Prasugrel contraindication
Hx stroke/TIA → do not give prasugrel.
70
Ticagrelor dose
180 mg LD then 90 mg BID.
71
Ticagrelor contraindications (per chart)
Recent thrombolytic; moderate/severe liver dysfunction.
72
Ticagrelor interactions
Avoid CYP3A4 inhibitors.
73
Thrombolytics: STEMI only (per chart)
Given for confirmed STEMI when PCI not available quickly; big risk = bleeding.
74
Thrombolytic + P2Y12 rule
If STEMI treated with thrombolytic → only P2Y12 allowed is clopidogrel.
75
What are the case questions I should be ready to answer?
Rhea A: step + start tx + concerns + nonpharm; Rhea B: new step + tx + what if not responding; Case 2: needed info + GOLD step + tx + nonpharm.
76
Absorption = what?
Movement of drug from site of admin → bloodstream.
77
Bioavailability (F) = what?
Fraction of dose reaching systemic circulation unchanged.
78
First-pass effect = what?
Gut/liver metabolism before systemic circulation → ↓F (oral).
79
Distribution depends on?
Blood flow, protein binding, lipophilicity, Vd.
80
Volume of distribution (Vd) meaning
“Where the drug lives” (high Vd = more in tissues).
81
Protein binding high → what?
Less free drug now; interactions if displaced; dialysis less effective.
82
Metabolism Phase I
CYP oxidation/reduction/hydrolysis → can activate/inactivate; adds polarity.
83
Metabolism Phase II
Conjugation → more water-soluble → excretion.
84
Clearance (Cl) definition
Volume of plasma cleared of drug per unit time.
85
Half-life (t½) depends on
t½ = 0.693 × (Vd/Cl).
86
Time to steady state
~4–5 half-lives.
87
Loading dose when?
Need rapid effect with long t½ (LD = target Cp × Vd / F).
88
Maintenance dose relates to
MD rate = Cl × target Cp / F.
89
Agonist vs antagonist
Agonist activates receptor; antagonist blocks activation.
90
Partial agonist
Activates but less than full agonist; can antagonize full agonist.
91
Competitive antagonist
Right shift dose-response; ↑ agonist can overcome.
92
Noncompetitive antagonist
↓Emax; cannot overcome with more agonist.
93
CYP inhibitor effect
↑ substrate drug levels (toxicity risk).
94
CYP inducer effect
↓ substrate drug levels (failure risk).
95
Renal dosing trigger
Check CrCl/eGFR; adjust for renally cleared drugs; watch nephrotoxins.
Nurs 502 Exam 1 study guide
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