BCACP EXAM QUESTIONS WITH ALL CORRECT ANSWERS

In asthma, FeNo 20 is associated with a better or worse response to corticosteroids? - CORRECT ANSWER- better: recommended to increase ICS or add on other therapy Difference in pattern of symptoms between asthma and COPD - CORRECT ANSWERasthma has variation; COPD is persistent despite treatment Intermittent Asthma (symptom freq, nightime, SABA use, FEV1) - CORRECT ANSWER- less then/= 2 days/wk, less than/= 2 times per month, /= 2 days/wk, 80% Mild persistent Asthma (symptom freq, nightime, SABA use, FEV1) - CORRECT ANSWER- 2 days/wk, 3-4 times/mo, 2 days/wk, 80% Mod Persistent Asthma (symptom freq, nightime, SABA use, FEV1) - CORRECT ANSWER- daily, 1x weekly, daily, 60-80% Sev Persistent Asthma (symptom freq, nightime, SABA use, FEV1) - CORRECT ANSWER- throughout day, 7x/wk, several times/day, 60% Goal for frequency of needing a SABA in asthma - CORRECT ANSWER- /= 2x per week in asthma, we should not use ____ alone - CORRECT ANSWER- LABA therapy LABA with fastest onset - CORRECT ANSWER- formoterol In COPD we should not use ___ alone - CORRECT ANSWER- ICS the only ICS available nebulized - CORRECT ANSWER- budesonide LAMA that cannot be used with severe milk allergy - CORRECT ANSWERumeclidinium Theophylline goal trough - CORRECT ANSWER- 5-15; clearance decreases with age When do we consider stepping down asthma treatment? - CORRECT ANSWER- well controlled for 3 months What MDI inhalers do not need to be shaken? - CORRECT ANSWER- alvesvo, QVAR, atrovent respimat education: when to prime - CORRECT ANSWER- spray 1 puff if not used in 3 days; spray 3x if not used for 21 days GOLD grades 1-4 according to FEV1 - CORRECT ANSWER- 1: /= 80% 2: 50-79% 3: 30-49% 4: 30% COPD treatment according to pt groups A-D - CORRECT ANSWER- A: SAMA/SABA/LAMA/LABA B: LABA or LAMA C: LAMA D: LAMA or LABA+LAMA or ICS+LABA When to use steroids based on eosinophil count - CORRECT ANSWER- 100: little effect 300: likely effect COPD exacerbation steroid dose - CORRECT ANSWER- 40 mg x 5 days 3 cardinal copd symptoms - CORRECT ANSWER- 1. Increased dyspnea 2. Increased sputum 3. Increased sputum purulence When to give antibiotics in COPD - CORRECT ANSWER- If all 3 cardinal symptoms present OR Increased sputum purulence + 1 other Antibiotics choice and duration in COPD - CORRECT ANSWER- 5-10 days Uncomplicated: azith, clarith, doxy, amox Complicated: augmentin, levo, moxi Pseudomonas: high dose levo (750 mg) or cipro 5 A's of smoking cessation: ask at every visit - CORRECT ANSWER- Ask Advice Assess Assist Arrange Set a quit date within ______days/weeks - CORRECT ANSWER- 2 weeks Quit plan "STAR" - CORRECT ANSWER- Set a quit date Tell family/friends Anticipate challenges Remove tobacco Which smoking cessation agent has BBW of SI/mood changes - CORRECT ANSWERvarenicline Bupropion, varenicline, and NRT all _____ weight gain - CORRECT ANSWER- delay but do not prevent weight gain Dosing schedule for nicotine replacement patches and when to use 21 mg vs 14 mg - CORRECT ANSWER- 21 mg x6 wks, 14 mgx2 wks, 7 mg x 2 wks 21 mg = 10 cigs/day 14 mg = 10 cigs Which smoking cessation agent has contrainidication for hx of seizure, eating disorder, MAOI use? - CORRECT ANSWER- Bupropion Diagnosis for diabetes is made by: - CORRECT ANSWER- 2 abnormal results of the SAME sample (FPG and A1c) or in 2 separate samples *if pt is symptomatic, diagnosis can be made without a 2nd diagnostic test FPG cutoffs for prediab and diabetes - CORRECT ANSWER- pre-diabetes: 100-125 mg/dL Diabetes: /= 126 mg/dL OGTT cutoff for prediab and diabetes - CORRECT ANSWER- pre-diabetes: 140-199 mg/dL Diabetes: /= 200 mg/dL A1c cutoff for prediab and diab - CORRECT ANSWER- pre: 5.7% - 6.4% diabetes: /= 6.5% 2 hour OGTT level cutoffs for gestational diabetes - CORRECT ANSWER- fasting: 92 1 hr: 180 2 hr: 153 When is A1c goal less stringent (7.5-8%)? - CORRECT ANSWER- severe hypoglycemia Limited life expectancy Extensive comorbid conditions Uncontrolled DM despite appropriate management When is A1c goal more stringent (6-6.5%)? - CORRECT ANSWER- short disease duration Long life expectancy No significant CVD Managed with lifestyle changes w or w/o metformin Weight loss __% is necessary to improve glycemic control - CORRECT ANSWER- 5% At what BMI is metabolic surgery considered recommended? - CORRECT ANSWERconsidered at 30 kg/m2 Recommended at 40 kg/m2 What A1c do you use dual therapy? When should you make it an injectable dual therapy? - CORRECT ANSWER- dual therapy when A1c is 9% dual injectable when A1c is 10% or BG 300 mg/dL when do you step up therapy for diabetes treatment? - CORRECT ANSWER- if A1c targets are not met within 3 months of dual therapy What 2nd line agent (in addition to metformin) is best for: Heart failure CKD - CORRECT ANSWER- Heart failure: canagliflozin, dapagliflozin, empagliflozin CKD: canagliflozin and dapagliflozin Med classes used in T1DM - CORRECT ANSWER- insulin, metformin, pramlintide Med classes used in gestational diabetes - CORRECT ANSWER- insulin (usually NPH and regular) glyburide metformin Metformin (MOA, A1c reduction, fasting or post prandial, clinical pearls, weight) - CORRECT ANSWER- inhibits hepatic glucose production A1c reduction 1-2% fasting plasma reduction dont use in CrCl 30 weight loss or neutral Sulfonylureas (MOA, A1c reduction, fasting or post prandial, clinical pearls, weight) - CORRECT ANSWER- stimulates insulin secretion from beta receptors A1c: 1-2% postprandial primarily works quickly, hypoglycemia risk weight GAIN glipizide, glimepiride, glyburide Meglitinide (MOA, A1c reduction, fasting or post prandial, clinical pearls, weight) - CORRECT ANSWER- stimulates insulin secretion from pancreas A1c: 0.5-1% postprandial faster onset than sulfonylureas and less hypoglycemia TID dosing :( weight GAIN repaglinide (prandin), nateglinide (starlix) Thiazolidinediones (MOA, A1c reduction, fasting or post prandial, clinical pearls, weight) - CORRECT ANSWER- increases insulin dependent glucose disposal 0.8-1.5% fasting primarily (some postprandial) delayed onset (8-12 wks), positive metaboilc impact, BBW: heart failure, can cause bone fracture or bladder cancer weight GAIN pioglitazone (actos), rosiglitazone (avandia) SGLT-2 (MOA, A1c reduction, fasting or post prandial, clinical pearls, weight) - CORRECT ANSWER- reabsorption of filtered glucose from lumen 0.8-1.2% both FPG and post prandial risk of lower limb amputations, bone fractures, euglycemic DKA, risk of UTI oral and once daily weight LOSS canagliflozin (invokana), dapagliflozin (farxiga), empagliflozin (jardiance), ertugliflozin (steglatro) What SGLT-2's have ASCVD benefits - CORRECT ANSWER- canagliflozin empagaliflozin What SGLT2s have renal benefits? - CORRECT ANSWER- canagliflozin dapagiflozin what SGLT-2s have CHF benefits? - CORRECT ANSWER- cana dapa empa DPP-4 (MOA, A1c reduction, fasting or post prandial, clinical pearls, weight) - CORRECT ANSWER- inhibits DPP-4 from breaking down GLP-1 0.6-0.8% postprandial oral and once daily caution of pancreatitis, can use in renal insufficiency weight neutral sitagliptin, saxagliptin, linagliptin, alogliptin GLP-1 (MOA, A1c reduction, fasting or post prandial, clinical pearls, weight) - CORRECT ANSWER- increased insulin secretion, inhibits glucagon secretion, increased satiety, reduced gastric emptying 0.5-1.8% Short acting: postprandial long acting: FPG and postprandial all injections weight LOSS exenatide (byetta), liraglutide (victoza), lixisenatide (adlyxin), exanatide LAR (bydureon), dulaglutide (trulicity), semaglutide (ozempic) What GLP-1 are dosed once weekly? - CORRECT ANSWER- exanatide LAR (bydureon) dulaglutide (trulicity) semaglutide (ozempic)