Acute Respiratory Flashcards Preview

Pharm > Acute Respiratory > Flashcards

Flashcards in Acute Respiratory Deck (25):
1

-Antihistamines also known as_______

(First generation) examples:
_______ effects
Cause ________
Active for___-____ hrs

(second generation)
selective for _______ receptors
Dont cross _____
Active for ______

Used for______

-h1 antagonist

(diphenhydramine/benadryl)
-anticholinergic
-sedation
4-6

(claritin/loratidine)
peripheral
bbb
12

sneezing, rhinorrhea, watery eyes, itching

2

Steroid nasal spray
Used specifically for______ does not treat ______
Drugs delivered _____
Potential symptoms (3)

Treat _____ not ______

Example


-allergic rhinitis not common cold
-locally
-nasal irritation, dryness, epistaxis

sight of action not systemic

fluticasone/flonas

3

Viral Upper Respiratory Infections aka ______

Refers to what type of infection?

Most common virus?

Lasts how long?

What are symptoms predictive of viral origin?

Symptoms

common cold

nonbacterial, so viral

rhinovirus

7-9 days

significant runny nose cough on days 1-4

nasal congestion, rhinorrhea, malaise, scratchy sore throat, nasal d/c starts thin thickens to green/yellow, muscle aches, adults NO fever, children LOW-GRADE

4

COUGH AND COLD Decongesgants

_____ _____ receptor _____ aka __________
cause _________ to reduce mucase membrane swelling

Examples: (2) which one is safer and why?

Come in two forms

What is rebound?


Alpha adrenergic receptor antagonists (sympathomomimetics)

vasoconstriction

Phenylephrine, pseuophedrine (bc of cardiac effects)

More congestion than what you started with, do not use longer than 3-5 days

5

Alpha adrenergic receptor antagonists AKA

Systemic:
-
-

Topical
-
-

Sympathomimetics

Pseudoephedrine
Phenylephrine

Phenylephrine (neosyneprhine)
Oxymetazoline (afrin)

6

Oral decongestants (aara cont)

Action:

ADRs:


Vasoconstriction of capillary vessels, decrease congestion

-tachycardia
-hypertension
-anxiety/restlessness/irritability

7

URI TX

Encourage:
Decongestants used in which population?
Antibiotics?

Systemic decongestants in children?



fluids, antipyretics
older children and adults, no young children/infants
No difference in clinical outcomes

No evidence, may be hazardous

8

Cough and cold cont

Antitussive examples
-
-
-

Expectorant
-

May be given together


-dextromethorphan
-codeine
-benzonatate (analgesic)


-guafenesin

9

Cough Suppressants (antitussive)

Dextromethorphan- how does it work?
analog of?
caution with which class of medication and why?

Codeine-how does it work?What does it have little efficacy with and why?

Potential for abuse?


cough center suppressant
morphine molecule
antidepressants- serotonergic syndrome

centrally acting cough suppressant
URI- bc cough is due to irritation

Large quantities hallucinations- no euphoria

10

Expectorant
Guiagenesin (Robitussin)

Action:
-stimulates? - decreases?
No evidence for efficacy in?

Patients need to be?


stimulates respiratory tract secretions
decreases viscosity of secretions

chronic cough, cough d/t URI

hydrated

11

Decongestants

caution with?


children <4 or eldlery or CV disease

12

Acute bacterial rhinosinusitis

common pathogens


s. pneumoniae
h. flu
moraxella catarrhalis
staphylococcus (rare)

13

Sinusitis TX

Duration of abx
Adult uncomplicated
Children

Adjunctive therapy
-
-
What is not recommended?


5-7
10-14

intranasal saline
intranasal corticosteroids (esp hx allergic rhinitis)


Topical and oral decongestants

14

Sinusitis tx continued *clarify this in book*

First line tx? Children? Adults?
Who do you use high dose for?

For PCN allergic patients?

Drugs not recommended for empiric therapy?


Amoxicillin/clavulanate (augmentin)
-severe infx >39 degrees
-daycare
-<2
-recent hospitalization or abx use in last month

Doxycycline (adults) or respiratory fluoroquinolone

resp fluroquinolone, macrolides, bactrim (trimethoprim/sulfamethoxazole)

15

Non responsive
If symptoms worsen in __ to ___ days
or no improvement in ___to ___ days

consider that it may be?

if fail tx 1 and 2 then...


2-3
3-5

resistant pathogen, noninfectious, structures

seek consult, imaging, culture

16

Influenza
Antivirals? tx what types?

Pharmacodynamics/kinetics

ADRs


Oseltamivir (tamiflu)
Zanamivir (relenza)

dynamics- tx A or B
kinetics-
tamiflu- well absorbed after oral
relenza- inhaled 4-17% absorbed



minimal ADRs

17

Pneumonia

How does it develop?

Bacterial pneumonia results when?

Common pathogens?

Organism invades lung parenchyma and host defenses are depressed

Lungs PRIMARY defenses are altered (viral, immunological)

S. pneumoniae
Patients with underlying lung disease
Nontypeable Haemophilus influenza and Moraxella catarrhalis
Staph aureus: co-pathogen with influenza
Mycoplasma pneumoniae
Viral pneumonia (usually bacterial)

18

Outcomes for pneumonia treatment

Return to baseline ____
Fever resolve in___ to ___ days
Leukocytosis resolves by
Chest-xray may take ____ to return to normal
Clinical improvement in __ to ___days


respiratory status
2-4
day 4
4 weeks
2-3 days

19

Community Acquired Pneumonia (CAP)

Review different recommendations

What is curb65?




Confusion Uremia Respiratory low Blood pressure 65+

20

Adult treatment CAP NO RISK FACTORS

First line? Examples?

If allergy?

Treat for a minimum of ___ days or afebrile for __ to ___days


Macrolides
*azithromycin or clarythromyin, erythromycin
*lowest SE and interactions

Doxycycline

5, afebrile 2-3 days

21

Adult treatment CAP with COMORBIDITIES or HX drug resistant S.pneumo (drsp)

Tx: Oral?

Parenteral?

Oral:
respiratory fluoroquinolone
beta lactam and a macrolide
if allergic to macrolide give doxycycline

IV Ceftriaxone (Rocephin) or fluoroquinolones
IM Ceftriaxone (Rocephin)

22

fluoroquinolone drugs

beta lactam+ macrolide

*moxifloxacin, *levofloxacin, gemifloxacin

amoxicillin + amoxicillin/clavulanate OR cefpodoxime/cefuroxime

OR
Parenteral ceftriaxone then oral cefpodoxime

23

Tx CAP pregnant women

Main pathogens?

Which class?
Category B example
Category C example

If co-morbid condition or recent abx use treat with what?

S. pneumoniae, H. influenzae, M. pneumoniae

Macrolides
*arythromycin, erythromycin
clarythromycin (category c)

Beta lactam + macrolide

24

Pediatric pneumonia CAP

Most common pathogen

Infants 4-16 weeks consider_____

age 5- adolescense consider____

S. pneumoaie

chlamydia

mycoplasma

25

pediatric continued

Preschool aged tx:

Children > 5 years:
if allergy?

if atypical pathogens treatment of choice is?

abx not usually required, viral

amoxicillin or amoxicillin/clavulanate
if pcn allergy: clindamycin or macrolide

macrolide