Pharm Pulmonary Exam 2 Flashcards
(152 cards)
1
Q
COPD order of therapy
A
LAMA
Then
LABA
Then
ICS
2
Q
Stable COPD
Quick relief of symptoms
for patients already on a LAMA
A
SABA
Short acting beta agonist
3
Q
Stable COPD
Group B
GOLD ABCD
A
Group B is usually hospitalized with steroids
moderate to severe symptoms
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
5
Q
Symbicort Name
A
Budesonide - formoterol MDI
6
Q
Advair HFA Name
A
Fluticasone propionate - salmeterol MDI
7
Q
Advair Diskus Name
A
Fluticasone propionate - salmeterol DPI
8
Q
Breo Ellipta Name
A
Fluticasone furoate - vilanterol DPI
9
Q
Dulera Name
A
Mometasone - formoterol MDI
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
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)
12
Q
COPD exacerbation definition
A
Acute increase in symptoms beyond normal day to day variation that leads to a change in medication
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
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
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
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
17
Q
Obstructive sleep apnea Treatment
A
Weight loss exercise Changing sleep position Avoid alcohol Avoid certain meds CPAP
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
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
20
Q
DXM MOA
A
Reduces the need to cough
inhibits the cough reflex
(dextromethorphan)
21
Q
Low dose codeine MOA
A
Reduces the need to cough
inhibits the cough reflex
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
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
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
25
Influenza tx
Anti-virals within 48 hours of onset of symptoms
Oseltamivir (neuraminidase inhibitor)
26
Oseltamivir
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
27
Empyema treatment
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)
28
Cor Pulmonale
Treat underlying cause of Pulmonary disease
29
Prostanoids
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
30
Endothelin receptor antagonist
For pulmonary HTN
Reverses the effects of endothelin
Endothelin causes blood vessel narrowing
this allows the blood vessels to open allowing more blood flow
31
PDE-5 inhibitors
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
32
Soluble guanylate cyclase stimulator
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
33
Anti-coagulants
For pulmonary HTN
Helps prevent blood clots from forming
can increase risk of bleeding and can interact with other drugs, herbals, and foods.
34
Diuretics
For pulmonary HTN
Eliminates excess H2O this helps Pulmonary HTN by reducing the water and the amount of work the heart has to do
35
Epoprostenol
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
36
ambrisentan
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
37
riociguat
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
38
PE treatment
Low risk of bleeding
High clinical suspicion
Low risk of bleeding
High clinical suspicion
Empiric anticoagulation until definitive tests are complete
39
PE treatment
hemodynamically unstable
with definitive diagnosis
Systemic thrombolytic therapy
rather than empiric anti coagulation
40
Which of the below meds is a short-acting anticholinergic med for COPD?
albuterol (Ventolin)
tiotropium (Spriva)
ipratropium (Atrovent)
salmeterol (Serevent)
ipratropium (Atrovent)
41
Which medication is considered a long-acting muscarinic antagonist?
albuterol (Ventolin)
tiotropium (Spriva)
ipratropium (Atrovent)
salmeterol (Serevent)
tiotropium (Spriva)
42
Which medication is considered a long-acting beta agonist?
albuterol (Ventolin)
tiotropium (Spriva)
ipratropium (Atrovent)
salmeterol (Serevent)
salmeterol (Serevent)
43
Which medication is considered a short-acting beta agonist?
albuterol (Ventolin)
tiotropium (Spriva)
ipratropium (Atrovent)
salmeterol (Serevent)
albuterol (Ventolin)
44
What category of cough medicines is best for the drug, dextromethorphan?
Analgesics
Antitussive
Antihistamine
Expectorant
Antitussive
45
Idiopathic Pulmonary Fibrosis Treatment
Supportive care
Select meds (pirfenidone, nintedanib)
participation in clinical trials
Referral for lung transplant
Treatment of Comorbidities
46
Idiopathic Pulmonary Fibrosis Treatment
Mild to moderate
pirfenidone, nintedanib
if available in the area
47
nintedanib
Ofev (kinase inhibitor)
Idiopathic Pulmonary Fibrosis
Adverse
NVD, abdominal pain, Liver enzyme elevation, decreased appetite
48
nintedanib active ingredient
Tyrosine Kinase inhibitor
inhibits growth factor
49
pirfenidone
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
50
Pneumoconiosis Treatment
Supplemental O2 (liquid or compressed)
Bronchodilators - to open lung passages
Not smoking - can exacerbate symptoms
Avoid harmful dust and particles
51
Sarcoidosis Definition
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.
52
Sarcoidosis Treatment
Glucocorticoids
Attenuate the granulomatous inflammatory process
53
Sarcoidosis Treatment
| Refractory to steroids
methotrexate (MTX) or azathioprine,
Prior to initiating therapy with methotrexate (MTX), azathioprine, or leflunomide,
baseline complete blood counts and serum aminotransferases, albumin, and creatinine are obtained
54
Methotrexate
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
55
Why use methotrexate for sarcoidosis
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.
56
Folic acid and methotrexate
Check CBC Liver and kidney labs ever 1-3 months
Folic acid supplements may be used to reduce toxicity
57
azathioprine
Imuran (immunosuppressant) (antimetabolite)
Contra
RA, Pregnancy, prior use of alkylating agents
Warning
Malignancy
Increased risk of lymphoma
Skin cancer
Adverse
Leukopenia, thrombocytopenia, anemia
58
azathioprine (Imuran)
| Most common side effects
```
Diarrhea
abdominal cramping
hair loss
Liver enzyme elevation
Bone marrow suppression
```
59
Silicosis Treatment
```
Supportive
Smoking cessation
Bronchodilators
Flu and Pneumo vaccine
Supplemental O2
```
Systemic glucocorticoids have been used to interrupt the inflammation that leads to progressive silicosis
60
Preferred Antibiotic
| Strep pneumo
Pen G
| Amoxicillin
61
Preferred Antibiotic
| Resistant strep pneumo
Ceftriaxone
Cefotaxime
Fluoroquinolones
62
Preferred Antibiotic
| H FLu
Amoxicillin
Secondary 3rd gen Cef
or Augmentin
63
Preferred Antibiotic
| Mycoplasma pneumonia
Macrolides
| or tetracycline
64
Preferred Antibiotic
| Chlamydophila pneumoniae
Macrolides
| or tetracycline
65
Preferred Antibiotic
| Legionella
Fluoroquinolones
or
Azithromycin
66
Preferred Antibiotic
| Chlamydophila psittaci
Tetracycline
67
Preferred Antibiotic
| Francisella tulaensis
Doxycycline
68
Preferred Antibiotic
| Yesinia pestis
Streptomycin
or
gentamycin
69
Preferred Antibiotic
| Coxiella burnetii
Tetracycline
70
Preferred Antibiotic
| Bacillus anthracis
Cipro
Levo
Doxy
71
Preferred Antibiotic
| Enterobacteriaceae
3rd gen Cef
| Carbapenem
72
Preferred Antibiotic
| Pseudomonas aeruginosa
antipseudomonal beta-lactam
Plus
Cipro or levo or aminoglycoside
73
Preferred Antibiotic
| Burkholderia pseudomallei
Carbapenem
or
ceftazidime
74
Preferred Antibiotic
| Acinetobacter
Carbapenem
75
Preferred Antibiotic
| Staph aureus
Anti-staph penicillin
76
Preferred Antibiotic
| MRSA
Vanc or linezolid
77
Preferred Antibiotic
| Bordatella pertussis
Macrolide
78
Preferred Antibiotic
| Anaerobes
Beta lactam inhibitor
| or clindamycin
79
Preferred Antibiotic
| Mycobacterium tuberculosis
RIPE (All 4)
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
80
Preferred Antibiotic
| coccidioides
No therapy if uncomplicated
if complicated
itraconazole
or
fluconazole
81
Preferred Antibiotic
| Histoplasmosis
itraconazole
82
Preferred Antibiotic
| Blastomycosis
itraconazole
83
Most common pulmonary disease in HIV patients
Pneumonia
Consequence of altered B cell function and/or defects in neutrophil function secondary to HIV
84
Most common bacteria in pneumoina of AIDS patients
Strep pneumo
and
H Flu
85
Pneumonias that occur with increased frequency in HIV patietns
Staph aureus
| Pseudomonas aeruginosa
86
```
Pneumocystis Pneumonia (PCP)
Treatment
```
Bactrim x 21 days
100% mortality if not treated
87
Bactrim prophylaxis in HIV patients
Bactrim prophylaxis for all HIV patients with a CD4 count of 200
Pneumocystis Pneumonia (PCP)
88
Medications for viral pneumonia
Anti virals
Fever reducers
Cough medicine
89
Asthma
intermittent
Step 1
SABA
90
Asthma
Mild persistent
Step 2
Low dose ICS
91
Asthma
Moderate persistent
Step 3
Low dose ICS
and
LABA
or Medium dose ICS
92
Asthma
Severe persistent
Step 4
Medium dose ICS
and
LABA
93
Asthma
Severe persistent
Step 5
High dose ICS
and
LABA
94
Asthma
Severe persistent
Step 6
High dose ICS
and
LABA
oral
corticosteroid
95
Short acting bronchodilators
Quick acting, rescue
lasts 2-4 hours
15-20 mins before exercise
96
Long acting bronchodilators
used to provide control
not quick relief
lasts for 12 hours
take 45 minutes to begin working
97
SABA
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
Terbutaline
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
ICS Drugs
```
Beclamethasone
Budesonide
ciclesonide
flunisolide
fluticasone propionate DPI
fluticasone furoate DPI
Mometasone DPI
Mometasone HFA
```
100
LABA Side effects
```
HA
Pain
Elevated BP
Dizziness
Nasal irritation
Throat irritation
```
101
LABA Contraindications
Acute asthma attack
102
LABA precautions
```
CVD
DM
COPD
Hyperthyroid
Glaucoma
Seizures
Hypokalemia
Pregnancy, lactation
```
Must be used with ICS
103
Pure LABAs
Salmeterol
| Formeterol
104
Salmeterol
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
LABA and ICS
| FDA Approved
Advair
Fluticasone + Salmeterol
Airduo
Fluticasone + Salmeterol
Breo Ellipta
Fluticasone + vilanterol
Dulera
Mometasone + formoterol
Symbicort
Budesonide + Formoterol
106
Leukotriene receptor antagonist
Montelukast
zafirlukast
zileuton
107
LTRA
Leukotriene receptor antagonist
MOA
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
LTRA
Leukotriene receptor antagonist
Anti-leukotriene agents inhibit the action of leukotrienes by blocking the CysLT1 receptor
What meds?
Montelukast
Zafirlukast
Pranlukast
MZP
Generally well tolerated
Be aware of possible psych , behavior, neurogenic issues
109
LTRA
Leukotriene receptor antagonist
by interrupting production by 5-lipoxygenase
Zileutron
Generally has more adverse effects than the others
110
montelukast
Singulair (leukotriene receptor antagonist)
Warning:
Serious neuropsychiatric events
Adverse:
URI, Fever, HA, Pharyngitis, cough, abdominal pain, diarrhea, otitis media, influenza, rhinorrhea, sinusitis
111
LTRA
Leukotriene receptor antagonist
MOA
Arachidonic acid
↓
↓ (5 -lipoxygenase) ≠ Zileuton (5-LO inhibitor)
↓
Leukotrienes
↓
↓ ≠ CysLT1 receptor antagonists
↓ ≠ Montelukast, pranlukast, zafirlukast
↓
Leukotrienes receptor
112
Zileuton
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
Mast Cell stabilizer
Cromolyn
114
Cromolyn
Intal (mast cell stabilizer)
Asthma prophylaxis
prevention of bronchoconstriction before exposure
Not for acute attack
Interactions
Pregnancy
115
Cromolyn MOA
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
Methylxanthines
Theophylline
117
Theophylline
Theo-24 (Xanthine)
Asthma, Chronic bronchitis, Emphysema
Not for Acute attack
Adverse
GI upset, HA, CNS stimulations, Diuresis, arrhythmias, seizures
118
Theophylline MOA
Inhibits phosphodiesterase
anti-inflammatory and bronchodilator activity
through decreased mast cell mediator release
119
Immunomoduators
For patients whose asthma is inadequately controlled on high-dose inhaled glucocorticoids and LABAs, the anti-IgE therapy omalizumab (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
omalizumab
Xolair Anti-asthmatic (IgE blocker).
Moderate-to-severe persistent asthma in patients ≥6yrs of age with a (+) skin test or in vitro reactivity 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
omalizumab
Neutralizes IgE in circulation
inhibits activation of IgE bound Mast cells
Down regulates IgE receptors on mast cells
122
The four important components of effective asthma therapy during pregnancy are:
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
Acute asthma in pregnant patients
SABA (same as non preg)
124
Long term control for asthma in pregnant patients
Budesonide
beclomethasone
fluticasone
These are the preferred ICS's
125
Elderly Asthma patients
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
Exercise induced asthma
Avoid triggers
SABA or
Combo (budesonide-formoterol) 160mcg/4.5mcg
1 puff, 5-20 mins prior to exercise
Alternatives include LTRA or ipratropium
127
Aspirin induced asthma
Cyclooxygenase pathway inhibition by ASA
results in shunting to second pathway of arachidonic acid metabolism
results in the production of leukotrienes
128
Status asthmaticus
ABX - (more needed with COPD)
Oxygen is a must
Mag sulfate
129
Mag sulfate
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
TB
First Line
RIPE
Give all
Rifampin
Isoniazid
pyrazinamide
ethambutol
131
Rifampin MOA
| and adverse
Blocks the beta subunit of bacterial RNA polymerase stopping bacterial RNA synthesis
Adverse
red/orange sweat/urine, induces p450, hepatitis
132
Isoniazid MOA
| and adverse
Inhibits mycolic acid synthesis in cell wall
Adverse
Peripheral neuropathies, hepatitis, hepatotoxicity
133
pyrazinamide MOA
| and adverse
Nicotinamide analog with unknown MOA
Adverse
hepatitis, hyperuricemia, gouty arthritis
(never used alone due to resistance)
134
ethambutol MOA
| and adverse
Inhibits mycolic acid synthesis in cell wall
Adverse
reversible retrobulbar neuritis
loss of central vision
135
INH Interaction
Alcohol increases hepatitis
136
pyrazinamide contra
Sever hepatic damage
| acute gout
137
Ethambutol Contra
Optic neuritis
138
Alpha 1 antitrypsin deficiency
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
Alpha 1 antitrypsin deficiency
| Lung transplant
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
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
Intravenous augmentation with pooled human AAT.
141
MOA of Augmentation therapy
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
Alpha 1 proteinase inhibitor
Prolastin C
Adverse
URI, UTI, Nausea, pain, chills, cough, dizziness, dyspnea, HA, Hot flush, oral candidiasis
143
ARDS treatment
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
Omalizumab
Not for relief of acute bronchospasm or status asthmaticus. Not indicated for treatment of other allergic conditions.
Boxed Warning:
Anaphylaxis.
Antiasthmatic (IgE blocker).
145
Immunomodulators
For patients whose asthma is inadequately controlled on high-dose inhaled glucocorticoids and LABAs, the anti-IgE therapy omalizumab (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
What is the most common pneumonia associated with patients having HIV-related illnesses?
Pneumocystis
Streptococcal
Legionella
Mycoplasma
Streptococcal
147
What is the most common therapy for patients with Pneumocystis pneumonia?
azithromycin
clarithromycin
TMP-SMX
vancomycin
TMP-SMX
148
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
Mild persistent
149
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
Step 3
150
Which of the following medication is considered a mast cell stabilizer?
Cromolyn (Intal)
Zileuton (Zyflo)
Theophylline (Theo-24)
Omalizumab (Xolair)
Cromolyn (Intal)
151
What Vitamin B should be given with INH?
Vitamin B1
Vitamin B3
Vitamin B6
Vitamin B12
Vitamin B6
152
Which antiarrhythmic is known to cause drug-induced pulmonary fibrosis?
Quinidine
Amiodarone
Propafenone
Adenosine
Amiodarone
