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Exam 2: NU641/ NU 641 (Latest 2025/ 2026 Update) Guide| Qs & As| 100% Correct- Regis
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Leukotrienel modifiers Answer: Leukotrienel receptorl antagoinistsl (LTRAs)l andl 5 l lipoxygenasael pathwayl inhibitorsl developedl basedl onl thel theoryl thatl cysteinyll leukotrienesl playl al significantl rolel inl thel chronicl inflammationl associatedl withl asthmal andl allergy
l Thisl causesl airwayl ededmal smoothl musclel constriction,l andl cellularl changesl associatedl withl thel inflammatoryl process
Originallyl al lotl ofl excitementl whenl thesel camel tol thel marketl butl nowl actuallyl onlyl typicallyl usedl asl secondl line
Canl bel orall whichl mightl helpl withl compliance
Leukotrienel modifiersl PK Answer:
Leukotrienel modifersl precautions Answer:
LTRA'sl clinicall usel andl ptl education Answer:
Inhaledl corticosteroidsl (ICS) Answer:
l reductionl inl thel severityl ofl asthmal symptoms,l increasedl peakl flowl readings,l andl decreasedl airwayl hyperl responsiveness
Dryl vsl meteredl dose Answer: Dryl powderl inhaler=l onlyl appropriatel ifl thel patientl canl makel al forcefull andl deepl inhalation Meteredl dosel inhaler=l (andl tol al lesserl extentl softl mistl inhalers)l requirel coordinationl betweenl devicel triggeringl andl inhalationl andl patientl canl inhalel slowlyl andl deeplyl froml thel device-l ifl therel isl doubtl considerl addingl al spacer
reviewl inhalerl thingl inl moodle Answer:
Asthmal pathophysiology Answer:
Asthma-l howl tol determinel treatment?l Andl goals Answer:
l needl forl medicationl tol relievel symptomsl (howl muchl rescuel medication)
l nightimel symptoms
l lungl function
exacerbation Goals Improvel impairmentl (preventl chronicl symptoms,l reducel thel usel ofl inhaledl shortl actingl betal agonists,l maintainl normall orl nearl normall pulmonaryl function,l maintainl normall activityl levels,l meetl patient/l familyl expectationsl ofl asthmal care) Reducel riskl (preventl recurrentl exacerbationsl andl minimizel EDl visitsl andl hospitalizations,l preventl lossl ofl lungl function,l providel optimall therapyl withl minimall sidel effects)
Asthmal classification Answer:
l asl neededl lowl dosel ICS-formoteroll (preferred)l orl lowl dosel ICSl takenl wheneverl SABAl isl taken
lowl dosel ICSl (-formoterol)l orl lowl dosel ICSl arel thel mainstayl forl alll ages
leukotrienel modifier/theophyllinel arel alternatives
l ptsl atl riskl ofl asthmal attacksl include:l previousl severel exacerbationsl requiringl intubationl orl ICUl admission,l 2 l orl morel hospitalizationsl orl 3 l EDl visitsl inl thel pastl year,l usel ofl 2 l orel morel shortl actingl betal agonistl inhalersl inl thel pastl month,l worseningl asthma
Asthmal inl preg Answer:
Pediatricl asthma Answer:
Pedl asthmal considerations Answer:
Asthmal inl olderl adults Answer:
Asthmal outcomes Answer:
difficultiesl achievingl orl maintingl control
l immunosuppressivel therapyl isl beingl considered
l anyl adultl thatl requiresl stepl 4 l therapyl orl al childl whol requiresl stepl 3 l therapy
Asthmal variants Answer: Seasonall allergies
Patho:l conditionl ofl chronicl airflowl limitationl thatl isl notl fullyl reversible Includes:l chronicl bronchitis,l emphysemal (pinkl puffers),l asthmaticl bronchitisl (bluel bloaters) Diseasel progression:l respiratoryl musclel fatigue,l ventilatoryl disorders,l cardiovascularl compromisel andl poorl qualityl ofl life
COPDl clinicall indicators Answer:
GOTl withl COPD Answer:
GOLDl guidelines Answer:
mmrcl gradel 0 l orl 1 l [dyspneal scale=l SOBl withl strenuousl exercise,l SOBl walkingl upl hilll orl walkingl fast],l Catl scorel <
l LAMAl e.l gl tiotropium(Spiriva)l +l SABAl e.l g.l albuteroll (proair)
zerol tol onel exascerbationl perl yearl withoutl hospitalization
mmrcl gradel >2l [l 2=l walkl slowerl thanl ppll bcl I'ml SOBl orl havel tol stopl becausel SOB,l 3=l Il havel tol stopl forl breathl afterl walingl 100 l metersl orl more,l 4=l Il aml tool SOBl tol leavel thel house,l dressingl makesl mel SOB]l orl CATl scorel >
zerol tol onel exacerbationl perl yearl withoutl hospitalization
LAMA+l LABA******l e.l g.l tiotropium+olodateroll (stiolto)l +l SABAl egl albuterol
l >2l exacerationsl perl yearl orl >1l hospitalizationl forl exacerbations
l Groupl E:l - >LAMA+l LABA******l e.l g.l tiotropium+olodateroll (stiolto)l +l SABAl egl albuteroll [WHENl NOl HOSPITALIZATIONSl ORl EOSINOPHILSl >300]
l ICS+l LAMA+l LABAl E.l G.l Fluticasone-umeclidinium-vilanteroll (Trelegy)l +l SABA
LOOKl ATl MEDl LISTl EXAMPLES Answer:
COPDl exacerbationsl OPl management Answer:
l predl 40mg/dayl forl 5 - 14 l days
indicatedl forl outpatientsl whol havel moderatel tol severel COPDl exacerbationl (iel increasel inl >2l ofl 3 l cardinall symptoms:l dypsnea,l sputuml volume/l viscosityl orl sputuml purulence)
l nol riskl factorsl forl poorl outcomes:l macrolidel (azithromycin)l orl secondl orl thirdl genl cephealosporinl (cefdinirl orl cefpodoxime)
l riskl factorsl forl poorl outcomes:l amoxicillin/l clavulanatel orl respiratoryl fluoroquinolonel (levofloxacin,l moxiflocaxin)
l riskl factorsl forl poorl outcomel andl riskl forl pseudomonasl infection:l ciprofloxacin
5 l A'sl ofl quitting Answer: Ask:l forl everyl patientl atl everyl clinicl visit,l askl tobaccol usel statusl andl documentl it Advise:l stronglyl urgel alll tobaccol usersl tol quitl inl al clear,l strong,l personalizedl manner Assess:l determinel willingnessl andl rationalel ofl patient'sl desirel tol quit Assist:l providel aidl forl ptsl tol quit Arrange:l schedulel followl upl contact,l eitherl inl personl orl byl telephone
Smokingl cessationl treatment Answer:
pharmacotherapyl isl startedl eitherl beforel orl onl thel quitl datel dependingl onl thel medl selected
Nicotinel receptorl partiall agonists Answer: Vareniclinel (chantix) PD:l partiall agonistl ofl nicotinicl acetylcholinel (naCh)l receptorsl (manyl many.l .l .l .l )l tol dimmishl nicotinel cravingsl andl withdrawll symptoms,l reducesl thel pharmacologicl rewardl ofl nicotinel inl casesl wherel al patientl relapsesl andl usesl tobacco,l alsol bindsl withl serotoninl receptors Precautions:l patientsl withl psychiatricl illness DDI:l alc ADR:l nausea,l insomnia,l abnormall dreamsl (vivid,l unsual,l strange),l headache,l skinl rash
Startl 1 - 2 l weeksl beforel quite,l upl tol 5 l weeksl before Advantages:l duall action-relievesl nicotinel withdrawll andl blocksl rewardl froml smoking,l orall pill Disadvantages:l reducedl dosel inl severel renall insufficiency,l avoidl inl ptsl withl unstablel psycl orl historyl ofl suicidall ideationl orl PTSD,l monitorl forl neuropsycl issues
Nicotinel replacementl therapy Answer: OTCl drugs Patch-nicotrol,l nicoderm,l habitrol
smokingl cessation:l monitoringl andl patientl education Answer: monitoring:l withdrawll symptoms-l cravings,l nervousness,l irritability,l impatientence,l hostility,l labilel mood,l difficutlyl concentrating,l restlesness,l anxiety patientl ed:l properl dosing,l removel patchl atl appropriatel times,l properl dosingl ofl guml andl inhaler
Vareniclinel (Chantix)l mayl bel prescribedl forl tobaccol cessation.l Instructionsl tol al patientl whol isl startingl vareniclinel include: A.l Thel maximuml timel vareniclinel canl bel usedl isl 12 l weeks B.l Nauseal isl al signl ofl vareniclinel toxicityl andl shouldl bel reportedl tol thel provider C.l Itl canl bel usedl safelyl withl alcohol D.l Neuropsychiatricl symptomsl mayl occur Answer: d
Transdermall nicotinel replacementl (thel patch)l isl anl effectivel choicel inl tobaccol cessationl because: A.l Thel patchl providesl al steadyl levell ofl nicotinel withoutl reinforcingl orall aspectsl ofl smoking.l B.l Therel isl thel abilityl tol "finel tune"l thel amountl ofl nicotinel thatl isl deliveredl tol thel patientl atl anyl onel time.l C.l Therel isl lessl ofl al probleml withl nicotinel toxicityl thanl withl otherl formsl ofl nicotinel replacement.l Transdermall nicotinel isl saferl inl pregnancy.l Answer: a
tuberculosis Answer:
TBl goalsl ofl treatment Answer:
TBl rationall drugl therapy Answer: riskl stratification highl risk:l childrenl <4l yo,l HIV/AIDs,l transplantl patients,l foreignl bornl patients drugl therapyl principles:l
whatl dol partsl ofl thel endocrinel systeml do? Answer: hypothalamus=l controll center thyroid=l metabolism parathyroid=l bloodl calcium adrenal=l steroids,l catacolamine gonad=l estrogen thyropropinl releasel hormone->l TSH GnRH->l FSH,l LH growthl hormonel releasingl hormone->l GHl (somatropin) prolactinl releasingl hormone->l prolactin pancrease exocrine:l trypsinogen,l chymotropysin,l amylase,l lipasel endocrine:l insulin,l glucagon adrenal:l cortisol,l aldosterone,l estrogens,l androgens
pancreaticl enzymes Answer: uses:l cysticl fibrosisl andl pancreatitisl (helpl withl digestion)l withl al goall ofl minimizingl steatorrheal andl keepl goodl nutritionall status,l bonel statesl havel obstrucionl ofl pancrease PD:l inactivatedl byl pHl valuesl <4,l dol notl crushl orl chewl (effectsl inl jejunum/l duodenum)l onlyl Viokasel notl entericl coatedl (mustl bel onl PPI)
panrealipsase Answer: agel andl weightl based eachl drugl isl specifiedl inl lipase,l protease,l andl amlyasel unites,l drugsl arel prescribedl inl unitsl ofl kgl basedl onl lipasel
admin:l don'tl chew,l crush,l drinkl withl water,l avoidl leavingl inl mouth,l entericl coatedl formulationl shouldl notl bel mixedl withl alkalinel foodsl priorl tol ingestion thisl populationl typicallyl toleratesl smallerl meals
Patientsl withl cysticl fibrosisl arel oftenl prescribedl enzymel replacementl forl pancreaticl secretions.l Eachl replacementl drugl hasl lipase,l protease,l andl amylasel components,l butl thel drugl isl prescribedl inl unitsl of: A.l Lipase B.l Protease C.l Amylase D.l Pancreatin Answer: a
Differentl brandsl ofl pancreaticl enzymel replacementl drugsl are: A.l Bioequivalent B.l Aboutl thel samel inl costl perl unitl ofl lipasel acrossl brands C.l Ablel tol bel interchangedl betweenl genericl andl brand-namel productsl tol reducel cost D.l Nonel ofl thel above Answer: b
insulinl clinicall pearls Answer: