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From Flashcardlet > pharm unit 2 > Flashcards

pharm unit 2 Flashcards

1
Q

Levalbuterol

A

Short acting b2-agonist

MDI or neb

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2
Q

Salbutamol (albuterol)

A

Short acting b2-agonist

MDI or neb

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3
Q

Indacaterol

A

Long acting b2-agonist MDI

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4
Q

Salmeterol

A

Long acting b2-agonist

Most commonly used

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5
Q

Ipatropium bromide

A

Short acting anticholinergic
MDI or neb that lasts 6-8 hrs.
If pt is on this scheduled, there is no reason to also have tiotropium scheduled.

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6
Q

Tiotropium

A

Long acting anticholinergic 1/day. MDI or neb.

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7
Q

Salbutamol/Ipatropium

A

Combined short acting b2-agonist and anticholinergic.

Q4-6 hours “combivent” or “duoneb”

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8
Q

Theophylline (SR)

A

Methylxanthine that cannot be used with caffiene, needs to be monitored with blood levels and should not be used in the elderly

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9
Q

Budesonide

A

Inhaled corticosteroid

MDI and DPI

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10
Q

Fluticasone

A

50-500 MDI or DPI inhaled corticosteroid

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11
Q

Formoterol/Budesonide “Symbicort”

A

Combo long acting b2-agonist and corticosteroid in one DPI.

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12
Q

Salmeterol/Fluticasone “Advair”

A

Combo long acting b2-agonist and corticosteroid in one inhaler.
50/100, 250, 500 DPI
25/50, 125, 250 MDI
Use up to 500mg in a COPD pt.

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13
Q

Roflumilast

A

Phosphodiesterase-4-inhibitor

Last line tx when everything else has been tried for COPD.

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14
Q

Group A/ Stage 1 & 2 COPD with minimal sx

A

Stage 1: ratio <70%, FEV1 80% with or w/o sx

1: short acting anticholinergic PRN - or - short acting b2-agonist PRN
2: long acting anticholinergic -or- ling acting b2-agonist -or- combo of both

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15
Q

Group B/Stage 2-3 COPD

A

Stage 2: ratio 50% with or w/o sx

Long acting anticholinergic -or- long acting b2-agonist.

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16
Q

Group C/Stage 3 COPD

A

Stage 3: ratio 30% with or w/o sx

Inhaled corticosteroid plus a long acting b2-agonist -or- long actin anticholinergic.

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17
Q

Group D/Stage 4 COPD

A

Ratio <50% with presence of chronic respiratory failure or right sided heart failure)

Inhaled corticosteroid plus long acting b2-agonist -or- long acting anticholinergic

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18
Q

Airway hyper-reactivity

A

Antihistamine and/or anticholinergic

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19
Q

Singulair (montelukast) and Accolate (zafirlukast)

A

Leukotriene inhibitor

Food decreases zafirlukast absorption

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20
Q

Asthma triggers

A

RSV, rhinovirus, parainfluenza, influenza, M. Pneumonia, allergens, cold air, fog, ozone, sulfur dioxide, NO2, smoke of any kind, emotions, exercise, ASA, NSAIDs, sulfites, occupational stimuli

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21
Q

Asthma tx

A

Assess severity
Initial: SABA neb every 3-4 hours for 24-48 hrs.
If poor response and PEP 50-79%: add systemic corticosteroid to reduce inflammation, continue SABA.
If poor response and PEP <50%: add systemic corticosteroid, repeat SABA immediately and send to ER if no improvement.

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22
Q

SABA (albuterol, xopenex, piralbuterol) side effects/interactions

A

Tachycardia, skeletal muscle tremor, headache

Interactions with beta blockers

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23
Q

Anticholinergic (ipatropium, tiotropium) side effects

A

Headache, dry mouth, dyspepsia

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24
Q

Inhaled corticosteroid side effects

A

Hyperglycemia, mood swings, high BP, thrush.

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25
Q

Intermittent asthma

A

SABA PRN plus antihistamine

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26
Q

Mild asthma

A

Low dose ICE plus SABA PRN for exacerbations

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27
Q

Moderate to severe asthma

A

Increase dose of ICS and/or add LABA or oral steroid plus SABA for acute exacerbations.

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28
Q

LABA for asthma

A

Do not use for long term control alone bc it increases risk of death, use with an ICS.
Max daily dose is 100mcg of salmeterol or 24mcg of formoterol.

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29
Q

Cromolyn and Nedocromil

A

Rarely used asthma tx that can cause bad taste in mouth, sire throat, rash and cough.

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30
Q

Omalizumab

A

An immunomodulator that is an anti-IgE monoclonal antibody that prevents binding of IgE to the high affinity receptors on basophils and mast cells.
Used as adjunct therapy for patients >12 with specific allergies but there is a high risk of anaphylaxis.

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31
Q

Mild (type 1) COPD exacerbation

A

One cardinal sx plus at least one of the following
URTI w/in last 5 days
Fever w/o other explanation
Increased wheezing
Increased cough
Increased resp rate and HR >20% above baseline

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32
Q

Moderate (type 2) COPD exacerbation

A

Two cardinal sx

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33
Q

Severe (type 3) COPD exacerbation

A

Three cardinal sx

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34
Q

Acute exacerbation tx

A

Abx for PNA until infection is ruled out.
Nebulized bronchodilators - albuterol may not be effective enough bc of decreased receptor availability.
PO steroids is DOC for chronic management.
Controlled O2 therapy.
Non invasive ventilation if necessary.

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35
Q

Factors to hospitalize COPD exacerbation

A 
Presence of high risk comorbidity
Suboptimal response to outpt management
Worsening dyspnea
Inability to eat or sleep dt sx
Worsening hypoxemia or hypercapnia
Mental status changes
Lack of home support for care
Uncertain diagnosis
36
Q

Initiate O2 therapy if…

A

Resting PaO2 <55mmHg

Evidence of R. Sided heart failure, polycythemia, impaired neuropsychiatric function with a PaO2 of less than 60mmHg.

37
Q

Cirteria for Pulm HTN

A

Mean pulm arterial pressure (mPAP) >25mmHg

Left ventricular end diastolic pressure (LVEDP) >15mmHg

38
Q

Classification of PHTN

A

Pulm arterial HTN (genetic or idiopathic)
Pulm HTN owing to left heart disease
Pulm HTN owing to lung disease and/or hypoxia
Chronic romboembolic pulm HTN (CTEPH)
Pulm HTN with unclear multifactorial mechanisms

39
Q

Class 1 PHTN

A

No limitatns on physical activity

40
Q

Class 2 PHTN

A

Dyspnea, fatigue, chest pain or syncope with ordinary activity

41
Q

Class 3 PHTN

A

Dyspnea and or fatigue with minimal activity. They are comfortable at rest.

42
Q

Class 4 PHTN

A

Dyspnea and or fatigue at rest

43
Q

Molecular features of PHTN

A

PGI2 is reduced in PHTN
Endothelian 1 which enhances vasoconstriction is enhanced in PHTN
Nitric oxide is reduced in PHTN

Therefore vasoconstriction is uninhibited. Tx aims to block endothelian A and B while promoting NO and PGI2

44
Q

For those with PHTN that respond to acute vasoreactivity test

A

For classes 1-4 tx with Amlodipine, ditiazem, nifedipine (Ca++ channel blockers) if response is maintained then continue, otherwise try traditional tx for non acute responders

45
Q

Tx of PHTN with non acute sponders or those who did not respond to Ca++ channel blockers class A recommendation

A 
For class 2: Ambrisentan, Bosentan, Sildefail
For class 3: Ambrisentan, Bosentan, Eproprostenol IV, Iloprost inhaled, Sildefail
For class 4: Eproprostenol IV

If response is inadequate try steps B-E
Sequential combo therapy if still ineffective which consits of a protanoid plus a PDE 5 inhibitor or protanoid plus an ERA
If still ineffective then atrial septostomy and/or lung transplant

46
Q

Epoprostenol (Flolan)

A

Synthetic analog of prostacycline and has a short half life of 3-5 minutes. Admin via continuous IV infusion - rate based on sx but the rate is limited by side effects of flushing, headache, diarrhea, jaw pain, backache, abd cramping, foot/leg pain and rarely hypotension.

Infection, catheter obstruction and sepsis are potential complications.

This is the only tx proven to improve mortality but has a short half life

47
Q

Treprostinil (Remodulin)

A

Stable analog of prostacycline given subcutaneous or IV infusion for classes 2-4. Has been shown to improve 6 minute walk test results and hemodynamic outcomes are similar to those of epoprostenol.

Benefits over use of epoprostenol are ease of use, increased safety because of longer half life, and lowered risk of rebound effects.

48
Q

Iloprost (Ilomedin, Ventavis)

A

A prostacycline analog that is given by inhalation using a dosing system provided by the manufacturer with the intial inhaled dose being 2.5 mcg 6 to 9 times per day up to every 2 hours during waking hours

49
Q

Bosentan (Tracleer)

A

An oral active dual endothelian (ET) a and b receptor antagonist.

Side effects: increases in hepatic aminotransferases occured in 11% of patients and were dose dependent.

Liver function tests should be monitored at baseline and monthly thereafter with monthly pregnancy testing in females.

Interacts with Sidenafil causing Sidenafil levels to fall and Bosentan levels to raise. Also reduces simvastatin levels by 50% so cholesterol should be monitored. Finally, hormone levels drop so oral contraception is unreliable.

50
Q

Ambrisentan (Letairis)

A

Once daily selective ETa receptr antagonist that improves exercise capacity and hemodynamics while delaying clinical worsening of PAH. There is a decreased rate of hepatitis when compared to bosentan.

51
Q

Phosphodiesterse inhibitors

A

Increase intracellular concentration of cyclic guanosine monophosphate leading to vasorelaxation via NO production and antiproliferative effects on vascular smooth muscle cells.

I.e. Sildenafil (Revatio) and Tadalafil (Adcirca)

Side effects:headaches, flushing, epistaxis, dyspnea and diarrhea

Interactions: concurrent nitrate therapy may lead to excessive blood pressure reduction and the combination should be avoided (whether for sexual function or for heart).

52
Q

Nifedipine and Amlodipine

A

dihydropyridines that are direct vasodilators of arterioles.

53
Q

Verapamil and Diltiazem

A

non-dihydropyridines that work on the heart to decrease HR and BP.

Verapimil has not been shown to be as effective as Diltiazem, Nifedipine and Amlodipine.

54
Q

Sidenafil

A

Interacts with Bosentan - Sidenafil levels drop and Bosentan levels increase.
May increase simvastatin/atorvastatin levels through competition for metabolism and Sildenafil levels may increased. Increased risk of rhabdomyolysis.
Profound systemic hypotension if given with nitrates.

55
Q

Tadalfil

A

levels decreased by 42% if given with Bosentan but no changes in Bosentan levels.
Systemic hypotension with nitrates.

56
Q

Drug induced apnea

A

opioids and benzodiazepines

57
Q

Pulmonary Eosinophilia tx

A

daptomycin, nitrofurantoin, etc.

58
Q

Pulmonary Fibrosis tx

A

cancer drugs (i.e. Bleomycin) Amiodarone, etc.

59
Q

Cystic fibrosis tx

A

nutrition: 500-2500 lipase units/kg of body weight per meal; or 10,000units/kg/day; or 4000 units/g of dietary fat per day.
Caution: >6000 units/kg/meal can cause fibrosing colonopathy or distal intestinal obstruction.
Creon, Zenpep and Pancreaz are approved for pancreatic sx.
Bronchodilator, hypertonic saline to facilitate mucociliary function a mucolytic agent like Dornase Alpha and an inhaled antibiotic to prevent the acquisition of an infection.

60
Q

Creon, Zenpep, Pancreaz

A

encapsulated lipase enzymes that allow the patient to process fat soluble vitamins. Should be given prior to meals and snacks if taken PO.

Don’t crush but may be opened and mixed with non-alkaline foods (i.e. applesauce) if eaten very soon.

61
Q

fibrosing colonopathy

A

may develop if dosed >66000 lipase units/kg/meal so reduce the dose and give the patient a laxative.

62
Q

Dornase Alpha (Pulmozyme)

A

enzyme that cleaves extracellular DNA which results in decreased mucus viscosity.

63
Q

Tobramycin (TOBI)

A

an aerolized aminoglycoside given to prevent the acquisition of an infection with a pathogen in CF patients. Usually combined with one of the Penicillins used to treat pseudomonal infections.

64
Q

Ivacraftor

A

potentiates CFTR protein to increase chloride transport in patients with G551D-CFTR mutation (not effective for any other mutation).
Many interactions - watch closely

65
Q

CF patient with pulm infection

A

start IV Tobramycin empirlcally, then switch to trimethoprim-sulfamethoxazole or doxycycline if the organism is resistant to TOBI.
Common organisms: P. aeruginosa, Alcaligenes, Stenotrophomonas, Mycobacteria, Aspergillus, and Burkholderia.

66
Q

Aztreonam

A

monobactam that elicits activity in vitro against gram - aerobes like P. aeruginosa

67
Q

Trimethoprim and Sulfamethoxazole

A

Bactrim covers most organisms found in patients with CF and can be used for more mild infections outpatient with oral administration.

68
Q

Macrocytic Megaloblastic Anemias

A

caused by vit. B12 and or folic acid deficiency

69
Q

Macrocytic Non-megaloblastic Anemias

A

caused by liver disease, hypothyroidism, hemolytic processes and alcholism.

70
Q

Iron deficiency Anemia tx

A

replenish iron stores which is best absorbed from meat, fish and poultry. Ascorbic acid rich foods and drink help to absorb iron.
Ferrous sulfate 60-65mg absorbed in a 324-325 mg tablet. (OTC)
18mg iron/5mL syrup in a prenatal vitamin

71
Q

Sodium Ferric Gluconate

A

Most common and very safe. 62.5mg iron/5mL. Normal dose is 125 mg diluted in 100mL normal saline infused over an hour or admin as a slow IV injection.

72
Q

Iron Dextran

A

DO NOT GIVE D/T HIGH RISK OF ANAPHYLAXIS

73
Q

Iron Sucrose

A

20mg iron/mL IV. Common if soduim ferric gluconate is not covered. Normal dose is 100mg into the dialysis line at a rate of 1mL per minute.

74
Q

Megaloblastic Anemia (drug induced) tx

A

initial parenternal vitamin B12 regimine of daily injections of 1000mcg of cyanocobalamin daily for 1 week, then 1mg of Vit B12 is encouraged daily. IM is best to ensure fast absorption.

75
Q

Methotrexate

A

the most toxic folate antagonist

76
Q

Folate dosing in pregnancy

A

.4mg to prevent spina bifida, but if a family hx of spina bifida exists, then as much as 1mg daily for 3 months prior to pregnancy.

77
Q

Folate dosing

A

1mg daily is sufficient to replace stores except in cases of deficiency d/t malabsorption.

78
Q

Recombinant epoetin alfa and recombinant darbepoetin alpha

A

erythropoiesis stimulating agents used to treat patient with anemia of chronic disease with a hb level below 11-12g/dl. Target hemoglobin level for patient on ESA is 11-12g/dl.

79
Q

Sickle cell anemia

A

mutation that substitutes a lysine for glutamic acid in the beta chain which makes it susceptible to sickle under low O2 conditions.

80
Q

Sickle Cell anemia tx

A 
hydration and analgesia 
pneumococcal immunization
Penicillin prophylaxis until at least 5 years of age to reduce risk of pneumococcal infection.
Folic acid 1mg/day
Hydroxyurea to increase HbF levels
Desferrioxiamine-Iron Chelator
81
Q

Butyrate

A

a fatty acid that increases HbF by altering gene expression leading to increased globin chain production. Does not appear to be as cytotoxic as hydroxyurea.

82
Q

Intermittent asthma

A

Symptoms less than 2 days per week and use of short term beta agonist less than 2 days per week. Use step 1 (SABA PRN)

83
Q

Mild asthma

A

symptoms more than 2 days per week but not daily and use of short term beta agonist more than 2 times per week but not daily. Use step 2 (Low dose ICS and SABA PRN)

84
Q

Moderate asthma

A

Daily symptoms and use of short acting beta agonist. Use step 3 (Low or medium dose ICS and LABA)

85
Q

Severe asthma

A

Symptoms throughout the day and use of short acting beta agonist several times per day. Use step 3 or 4 (medium to high dose ICS and LABA plus short course oral steroid)

86
Q

methylprednisolone,prednisolone, prednisone

A

oral systemic corticosteroid

87
Q

Symbicort and QVAR

A

Budesonide/Formoterol combination MDI

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