Pharm 17

Question 1

List names of controller medications

Answer 1

• ICS
• LABA
• Leukotriene-modifiers
• Cromolyn
• Oral theophylline
• Omalizumab
• Ipratropium, tiotropium

Question 2

Step up when

Answer 2

therapy when asthma is uncontrolled

Question 3

step down when

Answer 3

asthma has been well controlled for at least 3 months

Question 4

Preferred therapy in step 2

Answer 4

Low-dose inhaled glucocorticoids

Question 5

Alt therapy in step 2

Answer 5

Cromolyn, LTRA, or theophylline

Question 6

Preferred therapy in step 3

Answer 6

Low-dose inhaled Glucocorticoids + LABA or medium-dose inhaled glucocorticoids

Question 7

Preferred therapy in step 4

Answer 7

Medium-dose inhaled glucocorticoids + LABA

Question 8

Preferred therapy in step 5

Answer 8

High-dose inhaled glucocorticoids + LABA

Question 9

Preferred therapy in step 6

Answer 9

High-dose inhaled glucocorticoids + LABA + oral systemic glucocorticoids

Question 10

Guidance on appropriately managing days in yellow zone

Answer 10

Mild-moderate asthma symptoms are present.
- Add quick relief/rescue medicine
with a spacer to attempt to get asthma symptoms under control.
- Use of low dose ICS or cromolyn, montelukast, or theophylline
- Contact provider

Question 11

Guidance on appropriately managing days in red zone

Answer 11

• Severe asthma symptoms are present.

- Use of quick relief/rescue medicine if still in red zone after 15 minutes then call 911.

Question 12

GOLD COPD group A

Answer 12

• Low risk and less symptomatic

- SAMA or SABA

Question 13

GOLD COPD group B

Answer 13

• Low risk, but highly symptomatic

- LAMA or LABA + PRN use of SABA

Question 14

GOLD COPD group C

Answer 14

• High risk, but less symptomatic

- LAMA

Question 15

GOLD COPD group D

Answer 15

• High risk and highly symptomatic

- LABA + LAMA and/or ICS

Question 16

COPD exacerbation tx if having 1 additional symptom

Answer 16

SABA and/or SAMA

Question 17

COPD exacerbation tx if having 2 or 3 additional symptom

Answer 17

• Antibiotics
• <65 years, FEV1 >50% or fewer annual exacerbations, no cardiac disease = macrolide, 2nd generation cephalosporin, doxycycline, or SMZ-TMP
• > 65 years or more exacerbations = FQ or amoxicillin/clav

Question 18

COPD exacerbation MC tx

Answer 18

Prednisone 40 mg daily x 5 days

Question 19

Reversibility in asthma

Answer 19

• Confirmed by demonstrating the reversibility of airflow obstruction FEV1 to short-acting bronchodilator

Question 20

Reversibility in COPD

Answer 20

• Depends on the bronchodilator type

- 34.6% reversability if using ipratropium and albuterol together.

Question 21

What is the role of systemic corticosteroids in asthma and COPD.

Answer 21

• No role for inhaled steroids for the ACUTE treatment of either asthma or COPD
• Acute exacerbation or moderate/severe asthma may need to use a short course of systemic steroids
• ICS is first choice controller in chronic asthma
• Used as maintenance therapy in some COPD pts

Question 22

Describe the typical txs used to treat CAP

Answer 22

• Macrolide (azithromycin or clarithromycin)
• Macrolide + cephalosporin
• Doxycycline
• Fluoroquinolone
• in hospital settings Beta-lactam IV plus macrolide or doxycycline

Question 23

Atypical pathogens are more common in

Answer 23

• Smokers and patients with COPD
• Those hospitalized or in long term care
• Cystic fibrosis
• Aspiration, recent antibiotic use

Question 24

Describe the typical txs used to treat HAP

Answer 24

• Receive antibiotics prior to onset of pneumonia
• Ceftizoxime (Antispeudomonal cephalosporin)
• piperacillin/tazobactam or carbapenem + Cipro (antipseudomonal fluroquinolone) or aminoglycoside

Question 25

What should be avoided in immunosuppressed patients with pneumonia

Answer 25

Any antimicrobial agent used for prophylaxis should be avoided in empiric therapy for bacterial pneumonia as resistance may emerge

Question 26

List the four first line drugs to treat tuberculosis

Answer 26

``` Rifampin Isoniazid Pyrazinamide Ethambutol (use for 2 months) ```

Question 27

List the two first line drugs to treat tuberculosis continuously

Answer 27

Isoniazid + rifampin for a minimum of an additional 4 months

Question 28

Impacts of drug resistance on drug selection and time course of therapy for TB

Answer 28

Multi-drug resistance or severe, active infection, courses of therapy may go much longer than 6 months and up to 7 different medications may need to be used

Question 29

ASE of Isoniazid

Answer 29

- Liver injury- monitor liver enzymes - Neruopathy- symmetric paresthesia - limit tyramine intake

Question 30

ASE of Rifampin

Answer 30

- Hepatotoxic - discoloration of body fluids (red color) - Enzyme inducer

Question 31

ASE of Pyrazinamide

Answer 31

Polyarthralgias

Question 32

ASE of Ethambutol

Answer 32

Optic neuritis

Question 33

What is "DOT"

Answer 33

- Direct observation of therapy | - allows dosing to be 5 days per weeks instead of 7

Question 34

The primary metabolic pathway of isoniazid

Answer 34

Primarily metabolized by the liver acetylation into acetylhydrazine

Question 35

How does the phenotypic expression effect isoniazid plasma concentrations

Answer 35

- Two forms the enzyme are responsible for acetylation either rapid or slow acetylators - can inhibit the metabolism of other drugs

Question 36

The drug interaction of rifampin and warfarin or BC therapy

Answer 36

- Enzyme inducer (P450) - Decreases the efficacy of anticoags and BC - ex: if a decrease of efficacy occurs with thewarfarin that then cause the body to form clots because warfarin is not able to think the blood as well d/t rifampin