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Block 2 > Pharm Pulm Review > Flashcards

Pharm Pulm Review Flashcards

1
Q

HFA

A

hydrofluroalkane

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2
Q

LT

A

leukotriene

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3
Q

MDI

A

metered-dose inhaler

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4
Q

PDE

A

phosphodiesterase

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5
Q

PG

A

prostaglandin

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6
Q

Obstructive lung diseases:

A
  • asthma
  • COPD
  • bronchiectasis
  • bronchiolitis
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7
Q

Restrictive patho- parenchymal diseases:

A
  • idiopathic PF
  • Asbestosis
  • Desquamative interstitial pneumonitis (DIP)
  • Sarcoidosis
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8
Q

Restrictive patho - neuromuscular weakness diseases

A
  • ALS
  • Guillain-Barre syndrome
  • Myasthenia gravis
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9
Q

Restrictive patho - chest wall/pleural disease

A
  • kyphoscoliosis
  • ankylosing spondylitis
  • chronic pleural effusions
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10
Q

Pulmonary vascular diseases

A
  • PE
  • PAH
  • Pulmonary vennocclusive disease
  • vasculitis
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11
Q

Malignancy pulm diseases

A
  • bronchogenic carcinoma (NSC & SC)
  • metastatic dz
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12
Q

Infectious lung diseases

A
  • pneumonia
  • bronchitis
  • tracheitis
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13
Q

How much of medication is inhaled?

A

10-20%

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14
Q

How much of medication is swallowed?

A

80-90%

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15
Q

Describe pressurized Metered-Dose Inhalers

A

drug propelled from cannister w/ help of propellant.
50-200 doses of drug

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16
Q

Why are space chambers used?

A
  • reduce speed of particles entering airways & size of particles
  • increased proportion of drug inhaled into lower airways
  • good for small children >3yo
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17
Q

What is the age limit for DPI?

A

< 7yo

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18
Q

When do we used nebulizer therapy?

A

acutely ill & those who can’t use inhalers

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19
Q

Define hypoxia

A

low tissue oxygenation

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20
Q

Define hypoxemia

A
  • low oxygen in blood
  • a decrease in the partial pressure of O2 in the blood
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21
Q

What does hypoxemia generally imply?

A
  • Low FIO2
  • Hypoventilation
  • V/Q mismatch
  • Shunt or venous admixture
  • ^ diffusion barrier
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22
Q

Causes of poor O2 deliever can be narrow to 3 categories

A

Low CO, Low Hgb, Low SaO2

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23
Q

Accepted indication for acute O2 therapy

A
  • doc. hyoxemia
  • acute care situation, resp distress
  • trauma
  • acute MI w/ hypoxemia
  • Low CO w/ metabolic acidosis
  • Hypotension
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24
Q

How is doc. hypoxemia defined

A

PaO2 < 60mmHg
SaO2 < 90%

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25
Q

Questionable indication for acute O2 therapy

A
  • acute MI w/o hypoxemia
  • dyspnea w/o hypoxemia
  • sickle cell pain crisis
  • pneumothorax
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26
Q

Too much O2 therapy causes

A

decr ventilation

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27
Q

what happens when 100% O2 is breathed?

A

HR & CO are slightly decr

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28
Q

High flows of dry O2 can…

A

dry out & irritate mucosal surfaces & eyes.

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29
Q

What should be done if O2 is used for prolonged therapy (>1hr)

A

it should be humidified

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30
Q

List the O2 therapy methods in order from least to greatest based on FiO2 per flow rate O2.

A

Nasal cannula–>O2 mask–>Mask w/ reservoir bag–> nonbreathing mask–> Venturi mask

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31
Q

Which method of O2 therapy delivers the highest FiO2 per flow rate O2?

A

Venturi mask

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32
Q

Which method of O2 therapy delivers the lowest FiO2 per flow rate O2?

A

nasal cannula

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33
Q

O2 indication summary: Acute

A
  • measured hypoxemia
  • potential hypoxia (trauma/low CO)
  • Indications for hyperbaric O2
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34
Q

O2 indication summary: Chronic

A
  • measured hypoxemia @ rest or w/ exertion
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35
Q

Patient has PaO2 < 55mmHg, SaO2 <88%, do they qualify for long-term O2 therapy?

A

absolutely, no qualifiers needed

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36
Q

Patient has PaO2 55 - 59mmHg, SaO2 <88-90%, do they qualify for long-term O2 therapy?

A

Relative w/ qualifier
- signs of Cor pulmonale (hx of edema, polycythemia, EKG)

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37
Q

Patient has PaO2 >/= 60mmHg, SaO2 >/=90%, do they qualify for long-term O2 therapy?

A

None unless qualifier
- exercise desaturation
- sleep desaturation (no help from CPAP)
- lung dz w/ dyspnea

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38
Q

Main to systems that are targeted by O2 toxicity?

A
  1. resp tract–> w/n 8-12 hours of exposure
  2. nervous system–> seizures & visual changes (babies can get retinopathy
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39
Q

O2 toxicity is usually reserved for

A

tracheobronchial & alveolar damage

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40
Q

A FiO2 value ____ is not likely to induce O2 toxicity

A

< 60%

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41
Q

Uses for O2 (resp oxygen)

A
  • correct hypoxemia
  • would healing (hyper baric O2)
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42
Q

What can cause hypoxemia that requires O2?

A
  • Low FiO2
  • hypoventilation
  • V/Q mismatch
  • shunt or venous admixture
  • incr diffusion barrier
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43
Q

How much of room air is O2?

A

21%

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44
Q

Safety warning for O2?

A
  • Pulm damage
    [levels 0.5 [0.6] atm are safe
  • retinopathy of prematurity (eye dz in premature infants
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45
Q

ECMO is used to….

A

support pts w/ cardiac failure or cardiac + resp failure

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46
Q

What does ECMO do?

A

removes blood from venous system, oxygenates it, & returns it to venous or arterial system.

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47
Q

VV ECMO is used to support what type of patient?

A

resp failure

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48
Q

VA ECMO is used to support what type of patient?

A
  • cardiac failure
  • or cardiac + resp failure
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49
Q

ECMO requires____ and is usually ____.

A

anticoagulation; heparin

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50
Q

What is the most common risk for ECMO

A

bleeding

51
Q

What are thromboemboli?

A

small clots that can develop in the ECMO machine & become dislodged & enter circulation & possible do damage to organs

52
Q

Define expectorants

A

reduces thickness of secretions which incr mucus coming out during coughing

53
Q

Define mucolytics

A

break down the chemical structure of mucus molecules, which makes it thinner and removed during coughing

54
Q

How does Acetylcysteine affect mucus?

A

uses its free sulfhydryl group, which opens the disulfide bonds & lowers mucus viscosity

55
Q

Acetylcysteine can be used to decr mucus in what dz?

A
  • COPD
  • CF
  • pneumonia
56
Q

How does Acetylcysteine relate to acetaminophen OD?

A

it can be used to prevent or lessen liver injury of the acetaminophen OD

57
Q

What should be given along w/ acetylcysteine?

A

a bronchodilator

58
Q

Does acetylcysteine have an odor?

A

YES

59
Q

Tx for bronchoconstriction of airways

A
  • bronchodilator
  • Methylxanthine drugs
  • Muscarinic antagonist aka anticholinergics
60
Q

Tx for inflammation/thickening of airways

A
  • Corticosteroids
  • Cromolyn & Nedocromil
  • Leukotriene pathway inhibitors
61
Q

Name bronchodilators

A
  • Beta-adrenergic agonist (SABAs & LABAs)
  • Anticholinergics [antimuscarinic agents] SAMAs & LAMAS
  • Phosphodiesterase inhibitors
62
Q

Name immunomodulators

A
  • corticosteroids (inhaled & systemic)
  • Mast cell inhibitors
  • Leukotriene modifiers
  • Targeted monoclonal antibodies
  • Vax
63
Q

Beta 2 agonist target what tissue?

A
  • resp
  • uterine
  • vascular smooth muscle
64
Q

Beta 2 agonists promote what action?

A

smooth muscle relaxation

65
Q

Beta 2 agonist SEs

A
  • muscle tremor
  • tachycardia
  • hypokalemia
  • restlessness
  • hypoxemia
  • metabolic effects
66
Q

What is the only OTC medication for asthma?

A

OTC epinephrine (Primatene Mist)

67
Q

What is the most effective therapy for prompt relief of asthmatic symptoms?

A

SABAs

68
Q

Name SABAs

A
  • albuterol
  • levalbuterol
  • pirbuterol
69
Q

How long does it take SABAs to kick in, peak, & lasting time?

A

onset: 5 mins
peak: 30-60 mins
last: 4-6 hours

70
Q

NOTE

A

B-blockers can lessen effectiveness of SABA, but not contraindicated

71
Q

Delivery mechanism of choice for all SABAs

A

MDI + spacer

72
Q

What is an alternative delivery mechanism for SABAs for those who can’t uses MDIs?

A

nebulizer

73
Q

How many puff of an MDI equals one nebulizer tx?

A

10 puffs

74
Q

What can be added to a SABA if pt. has severe asthma attacks or b/c of B-blockers in urgent care setting?

A

anticholinergic bronchodilators

75
Q

Uses: Albuterol [Proventil] & Levalbuterol [Xopenex]

A
  • bronchospasm
  • exercise-induced bronchospasm
76
Q

Interaction characteristics: Albuterol [Proventil] & Levalbuterol [Xopenex]

A
  • HTN
  • Hypokalemia
77
Q

Age limits for Albuterol [Proventil]

A
  • Neb form <2yo
  • MDI form, 4 or >
78
Q

Serious Rxns for both SABAs?

A
  • hypersensitivity rxn
  • angioedema
  • hypotension
  • anaphylaxis
  • hypokalemia
  • arrhythmia
  • hypertension
  • angina
  • bronchospasm, paradoxical
  • cardiac arrest
  • hyperglycemia
79
Q

Which drug can get confused w/ Levalbuterol {Xopenex]

A

Xanax

80
Q

How many hours does do LABAs provide bronchodilation after a single dose?

A

12 hrs

81
Q

List LABAs

A
  • Salmeterol
  • Formoterol
82
Q

What other medication are LABAs usually added with and used as controller medication?

A

ICS

83
Q

Can LABAs be used as monotherapy in asthma?

A

NO

84
Q

Uses for both LABAs

A
  • asthma, maintenance tx
  • exercise-induced bronchospasm
  • COPD, maintenance tx
85
Q

BB warnings for both LABAs

A
  • asthma-related death: when used as monotherapy
  • can incr asthma-related hospitalization in peds & adolsc pts
86
Q

Common Rxns for LABAs

A
  • Headache
  • throat issues
  • Nasal issues
  • Urticaria/rash
  • Palpitations/Tachycardia
  • Tremors
  • Nervousness
87
Q

Direct-acting cholinoceptor stimulants’ do what to the lungs?

A
  • bronchial muscle (contraction-bronchoconstriction)
  • bronchial glands (secretion)
88
Q

Muscarinic antagonist is given by which deliver mechanism?

A

inhaler

89
Q

Muscarinic antagonist bind to what and do what?

A
  • bind to muscarinic receptors
  • block acetylcholine to lessen smooth muscle contraction
90
Q

Name a SAMA?

A

Ipratropium bromide

91
Q

How long does Ipratropium last?

A

4-6 hours

92
Q

Name a LAMA?

A

Tiotropium

93
Q

How long does Tiotropium last?

A

24 hours

94
Q

How do muscarinic antagonist compare to B2-agonist?

A
  • less effective for asthma
  • more effective for COPD
95
Q

Uses for Ipratropium [Atrovent]

A
  • COPD, maintenance tx
  • mod-severe asthma exacerbation
96
Q

What is the drug of choice for patients w/ intolerance to SABA or bronchospasm due to B-block meds?

A

Ipratropium [Atrovent]

97
Q

SEs: SAMAs & LAMAs

A
  • glaucoma, angle-closure
  • prostatic hypertrophy
  • bladder neck obstruction
98
Q

Uses: Tiotropium [Spiriva]

A

COPD, maintenance tx

99
Q

Study Slide 114 & 115 10 mins

A

DONE

100
Q

Name DOACs

A
  • Dabigatran
    -Rivaroxaban
  • Apixaban
  • Edoxaban
101
Q

Which two DOAC can be used as monotherapy?

A

Rivaroxaban & Apixaban

102
Q

patients treated w/ dabigatran or edoxaban must first receive ___.

A
  • 5 - 10days or parenteral anticoag
  • DOAC is started when the parenteral agent is stopped
    (no overlap is req)
103
Q

List the DOAC?

A
  • Apixaban [Eliquis]
  • Rivaroxaban [Xarelto]
104
Q

Apixaban [Eliquis] Serious Rxns

A
  • bleeding
  • thrombocytopenia
  • thrombosis
  • hypersensitivity
  • syncope
105
Q

Apixaban [Eliquis] Common Rxns

A
  • bleeding
  • anemia
  • nausea
106
Q

Apixaban [Eliquis] & Rivaroxaban [Xarelto] Uses

A

Prophylaxis
- Thrombus/stroke
- DVT/VTE
- DVT/VTE tx

107
Q

How long must you wait to remove an epidural catheter after last dose of rivaroxaban dose?

A

> 18hr

108
Q

How long must you wait to give a dose of rivaroxaban after an epidural catheter?

A

> 6hr

109
Q

What are the BB warnings for both direct oral anticoagulants?

A

Tx discont: incr thrombotic event & stroke risk

Epidural/Spinal Hematoma Risk

110
Q

What can be given for life-threatening or intracranial hemorrhage due to heparin or LMWH?

A

protamine sulfate

111
Q

Major bleeding from warfarin is best managed w/

A

prothrombin complex conc

112
Q

With less serious bleeding what can be given instead of coag?

A

fresh-frozen plasma or intravenous Vit K

113
Q

Describe the length & intensity of anticoag

A

a balance b/t risk of reoccurrence of VTE & risk of bleeding

114
Q

Risk of VTE usually goes ___ over time

A

down

115
Q

Risk of bleeding goes ___ w/ length of anticoag

A

up

116
Q

Duration of tx of VTE: underlying significant thrombophilia

A

indefinite

117
Q

Duration of tx of VTE: cancer-related

A

> /= 3-6 mos
or
as long as cancer is active

118
Q

Duration of tx of VTE: recurrent unprovoked

A

indefinite

119
Q

Duration of tx of VTE: unprovoked

A

at least 3mos

120
Q

Duration of tx of VTE: provoked by major transient risk factor

A

3mos

121
Q

What is the recommended anticoagulant of choice in pts. w/ cancer & venous thromboembolism

A

LMWH

122
Q

After completing anticoagulation therapy, what should be recommended for pt. to take?

A

Aspirin

123
Q

What should be used for the prevention of stroke in pts w/ Afib w/ mod-server mitral stenosis

A

Vitamin K

124
Q

3rd most common CV cause of death in the US

A

VTE/PE

Block 2 (13 decks)

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