Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PAM Semester 3 > Pharm Pulmonary Exam 2 > Flashcards

Pharm Pulmonary Exam 2 Flashcards

1
Q

COPD order of therapy

A

LAMA

Then

LABA

Then

ICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Stable COPD
Quick relief of symptoms
for patients already on a LAMA

A

SABA

Short acting beta agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Stable COPD

Group B
GOLD ABCD

A

Group B is usually hospitalized with steroids

moderate to severe symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Tiotropium

A

Spiriva (long acting anticholinergic)

For long term maintenance of bronchospasm due to COPD. Includes chronic bronchitis and emphysema.
Reduces exacerbations of COPD

Dose: 2 puffs of one capsule (18mcg) QD

Contra
Allergy to ipratropium

Interactions:
Other anticholinergics

Adverse:
Anti-cholinergic effects, Glaucoma, dysuria, blurred vision, constipation, urinary retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Symbicort Name

A

Budesonide - formoterol MDI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Advair HFA Name

A

Fluticasone propionate - salmeterol MDI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Advair Diskus Name

A

Fluticasone propionate - salmeterol DPI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Breo Ellipta Name

A

Fluticasone furoate - vilanterol DPI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Dulera Name

A

Mometasone - formoterol MDI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Fluticasone propionate - salmeterol MDI

250 mcg / 50mcg

A

Advair Diskus
(corticosteroid + LABA)

Dose: Asthma:
>12 y/o = 1 puff of 100/50 or 250/50 or 500/50 BID

Children: rinse mouth after use

Contra:
Primary treatment of status asthmaticus or other acute asthma or COPD

Interactions:
Caution during 2 weeks of discontinuing MAOI’s or tricyclics

Adverse:
URI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

2 Combo LAMA/LABA’s

A

Tiotropium 2.5mcg
olodaterol 5.5mcg
(Stiolto Respimat)

Fluticasone furoate 100mcg
umeclidnium 62.5mcg
vilanterol 25mcg
(Trelegy Ellipta)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

COPD exacerbation definition

A

Acute increase in symptoms beyond normal day to day variation that leads to a change in medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

COPD exacerbation treatment

A

SABA is mainstay of treatment
Short acting beta-adrenergic agonist
(albuterol, Levalbuterol)

All patients with COPD exacerbation should get steroids
ICU dose = prednisone 40-60 PO QD 5-14 days

ABX may be indicated for many patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

COPD exacerbation ABX treatment

No pseudomonas risk factors:

A

Used for majority of COPD exacerbations
(use pseudomonas risk factors, sputum cultures and patterns of resistance)

No pseudomonas risk factors:

1-2 g Cef IV,

or

levo 500 IV

or

moxi 400 IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

COPD exacerbation ABX treatment

Yes pseudomonas risk factors:

A

Used for majority of COPD exacerbations
(use pseudomonas risk factors, sputum cultures and patterns of resistance)

Yes pseudomonas risk factors:

Levo 750 IV,

or

Piper-Taz 4.5g IV

or

2g Cefepime/ceftazidime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Obstructive sleep apnea definition

A

a common disorder that is characterized by obstructive apneas and hypopneas due to repetitive collapse of the upper airway during sleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Obstructive sleep apnea Treatment

A 
Weight loss
exercise
Changing sleep position
Avoid alcohol
Avoid certain meds
CPAP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Acute Bronchitis Causes

A

Majority are caused by virus:

Rhinovirus
Coronavirus
Influenza virus
RSV

Bacterial cases are rare <10%

Most common are:
Chlamydia pneumoniae
Mycoplasma pneumoniae
Bordetella pertussis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Acute Bronchitis Tx

A

OTC
Dextromethorphan
Guaifenesin

Inhaled beta agonists are used for patients with wheezing and
underlying pulmonary disease

ABX are not recommended empirically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

DXM MOA

A

Reduces the need to cough
inhibits the cough reflex

(dextromethorphan)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Low dose codeine MOA

A

Reduces the need to cough

inhibits the cough reflex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Guaifenesin MOA

A

Thins mucus making it easier to cough up

Expectorant

Reflex stimulation
Stimulates the respiratory tract secretions, allowing ciliary movement to carry the loosened secretions upward

Direct stimulation
The secretory glands are stimulated directly to increase their production of respiratory tract fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

dextromethorphan

A

Delsym (OTC) (antitussive)

inhibits the cough reflex

Contra:
Don’t use under 4 years old
within 14 days of MAOI’s

Interactions:
Hyperpyretic crisis with MAOI’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Guaifenesin

A

Mucinex (expectorant)

Thins mucus making it easier to cough up

Dose: Swallow whole, take with full glass of water, Q 12, max of 2 tabs per day

Adverse:
GI Upset, Drowsiness, HA, rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Influenza tx

A

Anti-virals within 48 hours of onset of symptoms

Oseltamivir (neuraminidase inhibitor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Oseltamivir

A

Tamiflu (neuraminidase inhibitor)

Acute uncomplicated illness within 48hours
>2 weeks of age
Prophylaxis of influenza >1 yr old

(not a substitute for Vaccine)

> 13 y/o 75mg BID x5 days

Interactions:
Not for use with live vaccine with 2 weeks prior or 48 hours after treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Empyema treatment

A

Infections in the pleural space that are community acquired
3rd gen Cef + metronidazole
or ampicillin-sulbactam (monotherapy)

Hospital acquired infections or post pneumonia
Vanc + metronidazole and anti-pseudomonal cef (cefepime, ceftazidime)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Cor Pulmonale

A

Treat underlying cause of Pulmonary disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Prostanoids

A

For pulmonary HTN

relax and open arteries in the lungs by

targeting the prostacyclin pathway

These meds increase the prostacycin in the body

Oral, IV or inhaler

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Endothelin receptor antagonist

A

For pulmonary HTN

Reverses the effects of endothelin

Endothelin causes blood vessel narrowing

this allows the blood vessels to open allowing more blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

PDE-5 inhibitors

A

For pulmonary HTN

Blocks the action of PDE-5

PDE-5 causes the smooth muscles in the lungs to constrict.

PDE-5 stops this allowing the vessels to open and more blood flow to the lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Soluble guanylate cyclase stimulator

A

For pulmonary HTN

A chemical in the body that interacts with Nitric Oxide

This drug stimulates sGC which then interacts with NO and increases blood flow through the vessels of the lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Anti-coagulants

A

For pulmonary HTN

Helps prevent blood clots from forming

can increase risk of bleeding and can interact with other drugs, herbals, and foods.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Diuretics

A

For pulmonary HTN

Eliminates excess H2O this helps Pulmonary HTN by reducing the water and the amount of work the heart has to do

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Epoprostenol

A

Flovan (prostacyclin analogue)

Pulmonary arterial HTN (WHO group 1)

Contra
HF due to reduced left ventricle ejection fraction

Interactions
Hypotensive effects may be potentiated by diuretics, anti-hypertensives, vasodilators
increased risk of bleeding with anti-coagulants, anti-platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

ambrisentan

A

Letairis (Endothelin receptor antagonist)

Pulmonary arterial HTN (WHO group 1)

Contra
Pregnancy, idiopathic pulmonary fibrosis including those with pulmonary HTN (WHO group 3)

Box warning
Fetal toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

riociguat

A

Adempas (Soluble guanylate cyclase stimulator)

Pulmonary arterial HTN (WHO group 1)
To improve exercise capacity

Contra
Pregnancy, Nitrates or NO, PDE-5 inhibitors, Pulmonary HTN associated with idiopathic interstitial pneumonia

Box warning
Fetal toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

PE treatment

Low risk of bleeding
High clinical suspicion

A

Low risk of bleeding
High clinical suspicion

Empiric anticoagulation until definitive tests are complete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

PE treatment

hemodynamically unstable
with definitive diagnosis

A

Systemic thrombolytic therapy

rather than empiric anti coagulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Which of the below meds is a short-acting anticholinergic med for COPD?

albuterol (Ventolin)
tiotropium (Spriva)
ipratropium (Atrovent)
salmeterol (Serevent)

A

ipratropium (Atrovent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Which medication is considered a long-acting muscarinic antagonist?

albuterol (Ventolin)
tiotropium (Spriva)
ipratropium (Atrovent)
salmeterol (Serevent)

A

tiotropium (Spriva)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Which medication is considered a long-acting beta agonist?

albuterol (Ventolin)
tiotropium (Spriva)
ipratropium (Atrovent)
salmeterol (Serevent)

A

salmeterol (Serevent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Which medication is considered a short-acting beta agonist?

albuterol (Ventolin)
tiotropium (Spriva)
ipratropium (Atrovent)
salmeterol (Serevent)

A

albuterol (Ventolin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What category of cough medicines is best for the drug, dextromethorphan?

Analgesics
Antitussive
Antihistamine
Expectorant

A

Antitussive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Idiopathic Pulmonary Fibrosis Treatment

A

Supportive care

Select meds (pirfenidone, nintedanib)

participation in clinical trials

Referral for lung transplant

Treatment of Comorbidities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Idiopathic Pulmonary Fibrosis Treatment

Mild to moderate

A

pirfenidone, nintedanib

if available in the area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

nintedanib

A

Ofev (kinase inhibitor)

Idiopathic Pulmonary Fibrosis

Adverse
NVD, abdominal pain, Liver enzyme elevation, decreased appetite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

nintedanib active ingredient

A

Tyrosine Kinase inhibitor

inhibits growth factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

pirfenidone

A

Esbriet (pyridone)

Idiopathic Pulmonary Fibrosis

Antifibrotic, anti-inflammatory, anti-oxidant
Suppression of Tumor necrosis factor & interleukin

Warnings
Perform liver function tests prior to initiating treatment, monthly for the first 6 months, and every 3 months thereafter.

Permanently discontinue if ALT/AST >3 – ≤5XULN with symptoms or hyperbilirubinemia,

or if ALT/AST >5XULN occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Pneumoconiosis Treatment

A

Supplemental O2 (liquid or compressed)

Bronchodilators - to open lung passages

Not smoking - can exacerbate symptoms

Avoid harmful dust and particles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Sarcoidosis Definition

A

Sarcoidosis is a multisystem disease of unknown etiology characterized by tissue infiltration with noncaseating granulomas.

The granulomas may occur in any organ, but the most frequently affected sites are the lungs, lymph nodes, skin, eyes, and liver.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Sarcoidosis Treatment

A

Glucocorticoids

Attenuate the granulomatous inflammatory process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Sarcoidosis Treatment

Refractory to steroids

A

methotrexate(MTX) or azathioprine,

Prior to initiating therapy withmethotrexate(MTX),azathioprine, orleflunomide,

baseline complete blood counts and serum aminotransferases, albumin, and creatinine are obtained

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Methotrexate

A

Rheumatrex (DMARD)

Folic acid antagonist

Contra
Alcoholism, Chronic liver disease, immnuodeficiency, blood dyscrasias, Preg Cat X, Nursing mothers

Warning
Severe toxic reactions, Deaths have been reported
Only used by experienced MD’s
Inform patients of risks

Adverse
Elevated liver enzymes, NV, Rash, Thrombocytopenia, stomatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Why use methotrexate for sarcoidosis

A

Methotrexate is one of the most commonly used corticosteroid-sparing therapies for sarcoidosis,

due to its effectiveness, low cost and, at the dosages used to treat sarcoidosis, relatively low risk of side effects compared to other cytotoxic agents.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Folic acid and methotrexate

A

Check CBC Liver and kidney labs ever 1-3 months

Folic acid supplements may be used to reduce toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

azathioprine

A

Imuran (immunosuppressant) (antimetabolite)

Contra
RA, Pregnancy, prior use of alkylating agents

Warning
Malignancy
Increased risk of lymphoma
Skin cancer

Adverse
Leukopenia, thrombocytopenia, anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

azathioprine (Imuran)

Most common side effects

A 
Diarrhea
abdominal cramping
hair loss
Liver enzyme elevation
Bone marrow suppression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Silicosis Treatment

A 
Supportive
Smoking cessation
Bronchodilators
Flu and Pneumo vaccine
Supplemental O2

Systemic glucocorticoids have been used to interrupt the inflammation that leads to progressive silicosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Preferred Antibiotic

Strep pneumo

A

Pen G

Amoxicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Preferred Antibiotic

Resistant strep pneumo

A

Ceftriaxone
Cefotaxime
Fluoroquinolones

62
Q

Preferred Antibiotic

H FLu

A

Amoxicillin

Secondary 3rd gen Cef
or Augmentin

63
Q

Preferred Antibiotic

Mycoplasma pneumonia

A

Macrolides

or tetracycline

64
Q

Preferred Antibiotic

Chlamydophila pneumoniae

A

Macrolides

or tetracycline

65
Q

Preferred Antibiotic

Legionella

A

Fluoroquinolones
or
Azithromycin

66
Q

Preferred Antibiotic

Chlamydophila psittaci

A

Tetracycline

67
Q

Preferred Antibiotic

Francisella tulaensis

A

Doxycycline

68
Q

Preferred Antibiotic

Yesinia pestis

A

Streptomycin
or
gentamycin

69
Q

Preferred Antibiotic

Coxiella burnetii

A

Tetracycline

70
Q

Preferred Antibiotic

Bacillus anthracis

A

Cipro
Levo
Doxy

71
Q

Preferred Antibiotic

Enterobacteriaceae

A

3rd gen Cef

Carbapenem

72
Q

Preferred Antibiotic

Pseudomonas aeruginosa

A

antipseudomonal beta-lactam
Plus
Cipro or levo or aminoglycoside

73
Q

Preferred Antibiotic

Burkholderia pseudomallei

A

Carbapenem
or
ceftazidime

74
Q

Preferred Antibiotic

Acinetobacter

A

Carbapenem

75
Q

Preferred Antibiotic

Staph aureus

A

Anti-staph penicillin

76
Q

Preferred Antibiotic

MRSA

A

Vanc or linezolid

77
Q

Preferred Antibiotic

Bordatella pertussis

A

Macrolide

78
Q

Preferred Antibiotic

Anaerobes

A

Beta lactam inhibitor

or clindamycin

79
Q

Preferred Antibiotic

Mycobacterium tuberculosis

A

RIPE (All 4)

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

80
Q

Preferred Antibiotic

coccidioides

A

No therapy if uncomplicated

if complicated
itraconazole
or
fluconazole

81
Q

Preferred Antibiotic

Histoplasmosis

A

itraconazole

82
Q

Preferred Antibiotic

Blastomycosis

A

itraconazole

83
Q

Most common pulmonary disease in HIV patients

A

Pneumonia

Consequence of altered B cell function and/or defects in neutrophil function secondary to HIV

84
Q

Most common bacteria in pneumoina of AIDS patients

A

Strep pneumo
and
H Flu

85
Q

Pneumonias that occur with increased frequency in HIV patietns

A

Staph aureus

Pseudomonas aeruginosa

86
Q 
Pneumocystis Pneumonia (PCP)
Treatment
A

Bactrim x 21 days

100% mortality if not treated

87
Q

Bactrim prophylaxis in HIV patients

A

Bactrim prophylaxis for all HIV patients with a CD4 count of 200

Pneumocystis Pneumonia (PCP)

88
Q

Medications for viral pneumonia

A

Anti virals
Fever reducers
Cough medicine

89
Q

Asthma
intermittent
Step 1

A

SABA

90
Q

Asthma
Mild persistent
Step 2

A

Low dose ICS

91
Q

Asthma
Moderate persistent
Step 3

A

Low dose ICS
and
LABA

or Medium dose ICS

92
Q

Asthma
Severe persistent
Step 4

A

Medium dose ICS
and
LABA

93
Q

Asthma
Severe persistent
Step 5

A

High dose ICS
and
LABA

94
Q

Asthma
Severe persistent
Step 6

A

High dose ICS
and
LABA

oral
corticosteroid

95
Q

Short acting bronchodilators

A

Quick acting, rescue

lasts 2-4 hours

15-20 mins before exercise

96
Q

Long acting bronchodilators

A

used to provide control
not quick relief

lasts for 12 hours

take 45 minutes to begin working

97
Q

SABA

A

Most effective for quick relief

more than one canister a month is inadequate control

not for regular use

mat lower effectiveness

may increase airway hyperresponsiveness

Albuterol, levalbuterol

98
Q

Terbutaline

A

Brethine (Beta 2 agonist)

Chronic Bronchitis, Asthma, Emphysema

Not for children

Warnings
not for preterm labor, avoid excess use, DM, Cardiac disease, Hypertension, hyperthyroidism, seizures, monitor potassium,
Preg Cat B

Adverse
Tachycardia, palpitaions, nervousness, tremors, HA, drowsiness, nausea

99
Q

ICS Drugs

A 
Beclamethasone
Budesonide
ciclesonide
flunisolide
fluticasone propionate DPI
fluticasone furoate DPI
Mometasone DPI
Mometasone  HFA
100
Q

LABA Side effects

A 
HA
Pain
Elevated BP
Dizziness
Nasal irritation
Throat irritation
101
Q

LABA Contraindications

A

Acute asthma attack

102
Q

LABA precautions

A 
CVD
DM
COPD
Hyperthyroid
Glaucoma
Seizures
Hypokalemia
Pregnancy, lactation

Must be used with ICS

103
Q

Pure LABAs

A

Salmeterol

Formeterol

104
Q

Salmeterol

A

Serevent (LABA)

prevention and treatment of asthma
only used with ICS

Not for acute bronchospasm

Contra
Use without ICS, status asthmaticus, acute asthma, acute COPD

Warning
Asthma related death

105
Q

LABA and ICS

FDA Approved

A

Advair
Fluticasone + Salmeterol

Airduo
Fluticasone + Salmeterol

Breo Ellipta
Fluticasone + vilanterol

Dulera
Mometasone + formoterol

Symbicort
Budesonide + Formoterol

106
Q

Leukotriene receptor antagonist

A

Montelukast
zafirlukast
zileuton

107
Q

LTRA
Leukotriene receptor antagonist
MOA

A

Montelukast
Zileuton

Anti-leukotriene agents inhibit the action of leukotrienes by blocking the CysLT1 receptor
Montelukast
Zafirlukast
Pranlukast

or

by interrupting production by 5-lipoxygenase
zileuton

108
Q

LTRA
Leukotriene receptor antagonist
Anti-leukotriene agents inhibit the action of leukotrienes by blocking the CysLT1 receptor
What meds?

A

Montelukast
Zafirlukast
Pranlukast

MZP

Generally well tolerated

Be aware of possible psych , behavior, neurogenic issues

109
Q

LTRA
Leukotriene receptor antagonist
by interrupting production by 5-lipoxygenase

A

Zileutron

Generally has more adverse effects than the others

110
Q

montelukast

A

Singulair (leukotriene receptor antagonist)

Warning:
Serious neuropsychiatric events

Adverse:
URI, Fever, HA, Pharyngitis, cough, abdominal pain, diarrhea, otitis media, influenza, rhinorrhea, sinusitis

111
Q

LTRA
Leukotriene receptor antagonist
MOA

A

Arachidonic acid
↓
↓ (5 -lipoxygenase) ≠ Zileuton (5-LO inhibitor)
↓
Leukotrienes
↓
↓ ≠ CysLT1 receptor antagonists
↓ ≠ Montelukast, pranlukast, zafirlukast
↓
Leukotrienes receptor

112
Q

Zileuton

A

Zyflo (5-lipooxygenase inhibitor)

Prophylaxis and chronic treatment of asthma

Not recommended for Children

Contra:
Active liver disease, ALT elevated 3x normal limit

Warnings:
Not for primary treatment of acute attacks
Monitor liver function

History of liver disease, Monitor liver function 1st 3 months, every 2-3 months for remainder of the year
Alcohol consumption, neuropsych events

Interactions
Potentiates theophylline (reduce dose of theophylline)
113
Q

Mast Cell stabilizer

A

Cromolyn

114
Q

Cromolyn

A

Intal (mast cell stabilizer)

Asthma prophylaxis
prevention of bronchoconstriction before exposure

Not for acute attack

Interactions
Pregnancy

115
Q

Cromolyn MOA

A

Alters delayed chloride channels in cell membrane
inhibits cough
inhibits response to antigens (mast cells)
inhibits inflammation (eosinophils)

No smooth muscle effect

Only for prophylaxis of asthma

116
Q

Methylxanthines

A

Theophylline

117
Q

Theophylline

A

Theo-24 (Xanthine)

Asthma, Chronic bronchitis, Emphysema

Not for Acute attack

Adverse
GI upset, HA, CNS stimulations, Diuresis, arrhythmias, seizures

118
Q

Theophylline MOA

A

Inhibits phosphodiesterase

anti-inflammatory and bronchodilator activity
through decreased mast cell mediator release

119
Q

Immunomoduators

A

For patients whose asthma is inadequately controlled on high-dose inhaled glucocorticoids and LABAs, the anti-IgE therapyomalizumab(Xolair)may be considered if there is objective evidence of sensitivity to a perennial allergen (by allergy skin tests or in vitro measurements of allergen-specific IgE) and if the serum IgE level is within the established target range.

120
Q

omalizumab

A

Xolair Anti-asthmatic (IgE blocker).

Moderate-to-severe persistent asthma in patients ≥6yrs of age with a (+) skin test orin vitroreactivity to a perennial aeroallergen and whose symptoms are inadequately controlled by inhaled corticosteroids.

Not for relief of acute bronchospasm or status asthmaticus. Not indicated for treatment of other allergic conditions.

Boxed Warning:
Anaphylaxis.

121
Q

omalizumab

A

Neutralizes IgE in circulation

inhibits activation of IgE bound Mast cells

Down regulates IgE receptors on mast cells

122
Q

The four important components of effective asthma therapy during pregnancy are:

A

Objective monitoring of maternal lung function and fetal well-being as a guide to therapy

Proper control of environmental and other triggers for asthma (eg, cigarette smoking, animal allergen exposure)

Patient education

Pharmacologic therapy

123
Q

Acute asthma in pregnant patients

A

SABA (same as non preg)

124
Q

Long term control for asthma in pregnant patients

A

Budesonide
beclomethasone
fluticasone

These are the preferred ICS’s

125
Q

Elderly Asthma patients

A

Asthma is common over 65

Similar treatment to adults

No theophylline

mild persistent or more severe, we recommend using a controller regimen that includes inhaled glucocorticoids. Selection of the initial dose is based on symptom frequency and severity and degree of airflow obstruction.

126
Q

Exercise induced asthma

A

Avoid triggers

SABA or
Combo (budesonide-formoterol) 160mcg/4.5mcg
1 puff, 5-20 mins prior to exercise

Alternatives include LTRA or ipratropium

127
Q

Aspirin induced asthma

A

Cyclooxygenase pathway inhibition by ASA

results in shunting to second pathway of arachidonic acid metabolism

results in the production of leukotrienes

128
Q

Status asthmaticus

A

ABX - (more needed with COPD)

Oxygen is a must

Mag sulfate

129
Q

Mag sulfate

A

Single dose IV 2g over 20 minutes
(for severe exacerbation who are not responding to initial therapy)

IV mag has bronchodilator activity in acute asthma possibly due to inhibition of calcium influx into airway smooth muscle cells

130
Q

TB

A

First Line

RIPE
Give all

Rifampin
Isoniazid
pyrazinamide
ethambutol

131
Q

Rifampin MOA

and adverse

A

Blocks the beta subunit of bacterial RNA polymerase stopping bacterial RNA synthesis

Adverse
red/orange sweat/urine, induces p450, hepatitis

132
Q

Isoniazid MOA

and adverse

A

Inhibits mycolic acid synthesis in cell wall

Adverse
Peripheral neuropathies, hepatitis, hepatotoxicity

133
Q

pyrazinamide MOA

and adverse

A

Nicotinamide analog with unknown MOA

Adverse
hepatitis, hyperuricemia, gouty arthritis

(never used alone due to resistance)

134
Q

ethambutol MOA

and adverse

A

Inhibits mycolic acid synthesis in cell wall

Adverse
reversible retrobulbar neuritis
loss of central vision

135
Q

INH Interaction

A

Alcohol increases hepatitis

136
Q

pyrazinamide contra

A

Sever hepatic damage

acute gout

137
Q

Ethambutol Contra

A

Optic neuritis

138
Q

Alpha 1 antitrypsin deficiency

A

Severe deficiency of alpha-1 antitrypsin (AAT)

due to certain genetic variants is associated with both early onset pulmonary emphysema

and several forms of liver disease, including cirrhosis, neonatal hepatitis, and hepatocellular carcinoma.

139
Q

Alpha 1 antitrypsin deficiency

Lung transplant

A

Lung transplantation is reserved for patients with advanced emphysema due to severe AAT deficiency.

Similarly, liver transplantation is reserved for patients with end-stage hepatic disease.

After liver transplantation, the AAT deficiency is corrected, because the normal phenotype donor liver produces and secretes AAT.

140
Q

Alpha 1 antitrypsin deficiency

For AAT deficient patients who are never or ex-smokers, age 18 or older with an AAT genetic variant consistent with severe AAT deficiency, and evidence of airflow limitation (forced expiratory volume in one second [FEV1] 30 to 65 percent predicted)…

Treatment

A

Intravenous augmentation with pooled human AAT.

141
Q

MOA of Augmentation therapy

A

Augmentation therapy is intended to augment (add to) the amount of alpha-1 antitrypsin protein (AAT) floating in the blood and bathing the tissues of the body in people with lung disease related to Alpha-1.

142
Q

Alpha 1 proteinase inhibitor

A

Prolastin C

Adverse
URI, UTI, Nausea, pain, chills, cough, dizziness, dyspnea, HA, Hot flush, oral candidiasis

143
Q

ARDS treatment

A

Key components of supportive care include appropriate use of sedatives, careful hemodynamic management (Oxygen supplementation via prone positioning and fluid management), nutritional support, control of blood glucose, expeditious evaluation and treatment of nosocomial pneumonia, and prophylaxis against deep vein thrombosis (DVT) and gastrointestinal (GI) bleeding.

144
Q

Omalizumab

A

Not for relief of acute bronchospasm or status asthmaticus. Not indicated for treatment of other allergic conditions.

Boxed Warning:
Anaphylaxis.

Antiasthmatic (IgE blocker).

145
Q

Immunomodulators

A

For patients whose asthma is inadequately controlled on high-dose inhaled glucocorticoids and LABAs, the anti-IgE therapyomalizumab(Xolair)may be considered if there is objective evidence of sensitivity to a perennial allergen (by allergy skin tests or in vitro measurements of allergen-specific IgE) and if the serum IgE level is within the established target range.

146
Q

What is the most common pneumonia associated with patients having HIV-related illnesses?

Pneumocystis
Streptococcal
Legionella
Mycoplasma

A

Streptococcal

147
Q

What is the most common therapy for patients with Pneumocystis pneumonia?

azithromycin
clarithromycin
TMP-SMX
vancomycin

A

TMP-SMX

148
Q

Which of the below is the most accurate asthma classification for patients that have to use a SABA more than twice a week but not daily?

Intermittent
Mild persistent
Moderate persistent
Severe persistent

A

Mild persistent

149
Q

Which of the following is the correct Step therapy for a patient with moderate persistent asthma classification?

Step 2
Step 3
Step 4
Step 5

A

Step 3

150
Q

Which of the following medication is considered a mast cell stabilizer?

Cromolyn (Intal)
Zileuton (Zyflo)
Theophylline (Theo-24)
Omalizumab (Xolair)

A

Cromolyn (Intal)

151
Q

What Vitamin B should be given with INH?

Vitamin B1
Vitamin B3
Vitamin B6
Vitamin B12

A

Vitamin B6

152
Q

Which antiarrhythmic is known to cause drug-induced pulmonary fibrosis?

Quinidine
Amiodarone
Propafenone
Adenosine

A

Amiodarone

PAM Semester 3 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions