Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

RRCCPA Pharmacotherapeutics > Pulm Case Wrap-Up (Jaynstein) (Midterm) > Flashcards

Pulm Case Wrap-Up (Jaynstein) (Midterm) Flashcards

(122 cards)

Start Studying
1
Q

Medications used for symptom control in a URI?

A
  • Decongestants
  • Pain and fever relievers
  • Cough suppressants
  • Cough expectorants
  • Vitamins and supplements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Medications used for allergic rhinitis

A
  • Antihistamines
  • Intranasal corticosteroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

MOA for decongestants

A
  • Directly stimulate alpha-adrenergic receptors of the respiratory mucosa causing vasoconstriction which reduces mucosal swelling and improves ventilation
  • Directly stimulate beta-adrenergic receptors causing bronchial relaxation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

S/E of decongestants

A
  • Vasoconstriction and tachycardia can result in angina
  • HTN
  • Worsening of CV disease
  • Increase in glycogenolysis and gluconeogenesis
  • CNS stimulation
    • Nervousness
    • Insomnia
    • Dizziness
    • Drowsiness
  • Urinary retention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Who should avoid taking decongestants

A
  • Pts with HTN
  • <6 YO
  • During first trimester of pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Examples of decongestant medications and their duration of action

A
  • Pseudoephedrine (Sudafed)
    • Duration 4-6 hours
    • 100% absorbed
  • Phenylephrine (Sudafed PE)
    • Duration 2-4 hours
    • 30% absorbed
    • Garbage medication that does not help most people
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

MOA cough suppressants/Antitussives

A
  • Act at one of two sites
    • Centrally on the medullary cough center
    • Locally at the site of irritation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

WHich cough suppressants act Centrally on the medullary cough center

A
  • Dextromethorphan
  • Opiates
  • Benzonate (Tessalon)
    • Does not cause drowsiness
    • Many Pts report these do not help
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which cough suppressants act locally at the sight of irritation?

A
  • Lozenges
  • Viscous preparations
    • Such as viscous lidocaine
  • Menthol
  • Camphor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is dextromethorphan?

A
  • A centrally acting D-isomer of codeine
    • Lower addiction profile
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

S/E of dextromethorphan

A
  • Serotonin syndrome
  • Nausea
  • Dizziness
  • Drowsiness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Is dextromethorphan safe in pregnancy?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Who should avoid taking dextromethorphan?

A
  • Pts on MAOIs
  • Caution in Pts taking SSRIs but not contraindicated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe codeine

A
  • Centrally acting
  • High abuse potential
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

S/E of codeine

A
  • CNS depression
  • Respiratory depression
  • Common allergen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Is codeine safe in pregnancy?

A
  • Use with caution in pregnancy
    • Category C
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Benzonate (Tessalon) is?

A
  • Centrally acting
  • No addictive properties
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

S/E of Benzonate (Tessalon)

A
  • Headache
  • Dizziness
  • Rarely causes drowsiness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Is Benzonate (Tessalon) safe in pregnancy?

A

Caution advised no data on safety profile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

MOA of expectorants (mucolytics)

A
  • Dissolve thick mucus
  • Enhance airway clearing
  • Promote cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

S/E of expectorants (mucolytics)

A
  • Nausea
  • Vomiting
  • Rash
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Are expectorants (mucolytics) safe in pregnancy?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Common expectorants (mucolytics)

A
  • Mucinex
  • Guaifenesin (Robitussin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Who should avoid taking expectorants (mucolytics)?

A
  • Children < 6 YO
  • Guaifenesin may exacerbate nephrolithiasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Robitussin DM is a mix of which two medications?
Dextromethorphan and guaifenesin
26
Common vitamins and supplements used in the treatment of URIs. Do they work?
* Vitamin C * Anecdotal evidence only * Echinacea * EBM reveals benefit * Appears most effective in Pts with compromised immune systems * Zinc * EBM shows contradictory evidence * S/E are common but not life-threatening * Nausea * Mouth irritation
27
Abx options for Mild to moderate bacterial sinusitis
* Amoxicillin/clavulanate 875mg PO BID X 7 days * Doxycycline 100mg BID X 7 days
28
In cases of bacterial sinusitis where there is a concern for resistance of prior Abx failure which Abx may be used?
* Amoxicillin/clavulanate 2000mg BID X 10-14 days * Levofloxacin 500mg QD X 5 days * Moxifloxacin 400mg QD X 10 days
29
In cases of severe bacterial sinusitis where the Pt is hospitalized which Abx may be used?
* Ampicillin/Sulbactam 3gm IV QID * Levofloxacin 500mg IV QD * Ceftriaxone (Rocephin) 1gm IV BID
30
Why are macrolides (clarithromycin or azithromycin), trimethoprim-sulfamethoxazole, and second or third-generation cephalosporins **_NOT_** recommended for empiric therapy of bacterial sinusitis?
High rates of resistance of *S. pneumoniae*
31
Define well-controlled asthma
* Symptoms: \< / = 2 days/week * Nighttime awakenings: = 2x/month * Interference with normal activity: None * Short-acting beta2-agonist use for symptom control: = 2 days/week * FEV1 or peak flow: \> 80% predicted/personal best * Exacerbations requiring oral systemic corticosteroids: 0-1/year
32
Recommended action for the treatment of well-controlled asthma?
* Maintain current step * Regular follow-up at every 1-6 months to maintain control * Consider step down if well controlled for at least 3 months
33
Define not well-controlled asthma
* Symptoms: \> 2 days/week * Nighttime awakenings: 1-3x/week * Interference with normal activity: Some limitation * Short-acting beta2-agonist use for symptom control: \> 2 days/week * FEV1 or peak flow: 60-80% predicted/personal best * Exacerbations requiring oral systemic corticosteroids: \>/= 2/year
34
Define very poorly controlled asthma
* Symptoms: Throughout the day * Nighttime awakenings: \>/= 4x/week * Interference with normal activity: Extremely limited * Short-acting beta2-agonist use for symptom control: Several times per day * FEV1 or peak flow: \> 60% predicted/personal best * Exacerbations requiring oral systemic corticosteroids: \>/= 2/year
35
Recommended action for the treatment of well-controlled asthma
* Maintain current step * Regular follow-up every 1-6 months to maintain control * Consider step down if well controlled for at least 3 months
36
Recommended action for the treatment of not well controlled asthma
* Step up 1 step * Reevaluate in 2-6 weeks * For side effects consider alternative treatment options
37
Recommended action for the treatment of very poorly controlled asthma
* Consider short course of oral systemic corticosteroids * Step up 1-2 steps * Reevaluate in 2 weeks * For side effects, consider alternative treatment options
38
In the stepwise approach to the treatment of asthma, how many steps are there?
6
39
What does step 1 in the treatment of asthma consist of?
* Recommended for intermittent asthma * SABA PRN
40
What does step 2 in the treatment of asthma consist of?
* Recommended starting point for persistent asthma * SABA PRN * Low-dose ICS For all of these step questions I omitted the alternative treatment options
41
What does step 3 in the treatment of asthma consist of?
* SABA PRN * Low-dose ICS + LABA * OR medium-dose ICS
42
What does step 4 in the treatment of asthma consist of?
* SABA PRN * Medium-dose ICS + LABA
43
What does step 5 in the treatment of asthma consist of?
* SABA PRN * High-dose ICS + LABA * And consider omalizumab for Pts with allergies
44
What does step 6 in the treatment of asthma consist of?
* SABA PRN * High-dose ICS + LABA + oral corticosteroid * Consider omalizumab for Pts with allergies
45
Before stepping up the treatment of asthma what should you first check?
* Adherence * Environmental control * Comorbid conditions
46
At what step in the treatment of asthma should you consult an asthma specialist?
When Pts require step 4 or higher
47
Typed of inhalation devices used in the treatment of asthma
* Metered-Dose Inhalers (MDI) * Dry Powder Inhalers (DPI) * Nebulizers * HFA - Diskus
48
Classes of drugs used in the treatment of asthma
* Inhaled Beta-2-Agonists * Short and long-actingLeuko * Inhaled Corticosteroids (ICS) * Leukotriene Modifiers * Mast Cell Stabilizers * Anticholinergics * Anti-IgE Antibodies * Theophylline
49
Describe the MOA, Onset, Peak, and Duration for inhaled Short-Acting Beta-2-agonists (SABA)
* MOA: Beta-2 agonist * Onset: 5 minutes * Peak: 30-60 minutes * Duration: 4-6 hours
50
S/E of inhaled Short-Acting Beta-2-agonists (SABA)
* Tachycardia * QTc prolongation * Tremor * Anxiety * Hyperglycemia * Hypokalemia * Hypomagnesemia The higher the does the more likely the S/E
51
Are Long-Acting Beta-2-agonists (LABA) recommended as monotherapy for the treatment of asthma?
* NO!! * Black box warning * LABA use was associated with an increased risk of asthma-related hospitalizations, intubation, and death. * The greatest risk was in children 4-11 YO
52
If a LABA is required for the treatment of asthma what should it be used in combination with?
* An ICS * Preferably in the same inhaler
53
MOA for inhaled corticosteroids (ICS)
* Inhibits inflammatory cytokines via the glucocorticoid receptor
54
S/E of ICS
* Oral candidiasis (Thrush) * Dysphonia * Reflex cough * Reflex bronchospasm
55
Of all the medications used in the treatment of asthma which is the most effective for long-term control of symptoms?
ICS
56
Common ICS medications
* Qvar * Pulmicort * Flovent
57
Updated asthma guidelines now recommend what?
PRN ICS at initial asthma Dx
58
S/E of LABA+ICS combos
* Tremor * Muscle cramps * Tachycardia * Other cardiac effects These S/E are more likely if the LABA+ICS combo is used in higher-than-recommended doses
59
Common LABA+ICS medications
* Salmeterol/fluticasone (Advair) * Formoterol/budesonide (Symbicort) * Formoterol/mometasone (Dulera)
60
Are leukotriene modifiers ever used as first-line treatment of asthma?
No
61
MOA of leukotriene modifiers
* Inhibits physiologic actions of LTD4 at the CysLTI receptor without any agonist activity * AKA block the actions of leukotrienes * Leukotrienes cause constriction and mucus production
62
S/E of leukotriene modifiers
* Abdominal pain * Nausea * JAundice * Itching * Lethargy
63
When are leukotriene modifiers used?
* Alternative to low-dose ICS when Pts are unable or unwilling to use an ICS * Less effective than ICS * Used as an alternative therapy instead of LABA for Pts not well controlled on an ICS alone * Less effective than LABA
64
What medication is a leukotriene modifier?
Singular
65
MOA of Mast Cell Stabilizers
* Alters function of delayed Cl- channels and inhibits cell activation * Inhibition of cough * Inhibition of early response to antigens (mast cells) * Inhibition of late response to antigens (eosinophils)
66
S/E of Mast Cell Stabilizers
* Throat irritation * Cough * Dry mouth * Wheezing * Chest tightness
67
Common Mast Cell Stabilizer medication
Cromolyn
68
Failure of pharmacologic treatment in asthma can usually be attributed to?
* Lack of adherence to prescribed medications * Most common cause of treatment failure * Continued exposure to tobacco smoke and other airborne pollutants, allergens, or irritants * Smoking and exposure to second-hand smoke can cause airway hyperresponsiveness and decrease the effectiveness of ICS * Some Pts with asthma may be concurrently be taking aspirin or other NSAIDs, or other medications that can cause asthma symptoms * Samter's triad * Oral nonselective beta-adrenergic blockers, such as propranolol, timolol, etc, can precipitate bronchospasm in Pts with asthma and decrease the broncho-dilating effect of Beta-2agonists
69
Oh shit, your Pt with asthma also suffers from migraines, what are some migraine prophylaxis options that will not interfere with their asthma medications?
* Non-dihydropyridine CCB * Verapamil * Beta-1-selective Beta-blocker * Metoprolol * Atenolol * Anticonvulsant * Valproic acid * Topiramate * If Pt is on an OCP anticonvulsants can decrease their efficacy * TCA * Amitriptyline * Nortriptyline
70
How can Pts who use ICS reduce the risk of developing thrush?
* Rinse mouth after using ICS * Use a spacer
71
Will thrush related to ICS use go away without treatment?
No, it must be treated
72
Recommended treatment for oral thrush associated with ICS use
Nystatin 5 mL whish and swallow QID X 7-14 days
73
# Define COPD
A preventable and treatable disease state characterized by airflow obstruction that is **_not fully reversible_**
74
Primary cause of COPD
Cigarette smoking
75
The airflow obstruction in COPD is defined as?
* FEV1 \< 80% predicted and FEV1/FVC \< 0.7
76
Using the GOLD criteria define mild COPD
* In Pts with FEV1/FVC \< 0.70 * GOLD1 * FEV1 \> 80% predicted
77
Using the GOLD criteria define moderate COPD
* In Pts with FEV1/FVC \< 0.70 * GOLD2 * 50% \< FEV1 \< 80% predicted
78
Using the GOLD criteria define severe COPD
* In Pts with FEV1/FVC \< 0.70 * GOLD3 * 30% \< FEV1 \< 50% predicted
79
Using the GOLD criteria define very severe COPD
* In Pts with FEV1/FVC \< 0.70 * GOLD4 * FEV1 \< 30% predicted
80
There are 4 stages of COPD for all stages what is the recommended treatment?
* Avoidance of risk factors * Influenza/Pneumococcal vaccination
81
There are 4 stages of COPD for stage I what are the characteristics and the recommended treatment?
* Characteristics * FEV1/FVC \< 70% * FEV1 \> 80% predicted * With or without symptoms * Recommended treatment * Short-acting bronchodilator PRN
82
There are 4 stages of COPD for stage II what are the characteristics and the recommended treatment?
* Characteristics * FEV1/FVC \< 70% * 50% \< FEV1 \< 80% predicted * DOE * With or without cough and sputum production * Recommended treatment * Short-acting bronchodilator PRN * Regular treatment with one or more long-acting bronchodilators * Rehabilitation
83
There are 4 stages of COPD for stage III what are the characteristics and the recommended treatment?
* Characteristics * FEV1/FVC \< 70% * 30% \< FEV1 \< 50% predicted * Increased dyspnea * Reduced exercise capacity * Fatigue * Repeated exacerbations * Recommended treatment * Short-acting bronchodilator PRN * Regular treatment with one or more long-acting bronchodilators * Rehabilitation * Inhaled glucocorticoids if significant symptoms, lung function response, or if repeated exacerbations
84
There are 4 stages of COPD for stage IV what are the characteristics and the recommended treatment?
* Characteristics * FEV1/FVC \< 70% * FEV1 \< 30% predicted OR \< 50% plus respiratory failure * Recommended treatment * Short-acting bronchodilator PRN * Regular treatment with one or more long-acting bronchodilators * Rehabilitation * Inhaled glucocorticoids if significant symptoms, lung function response, or if repeated exacerbations * Treatment of complications * Long-term O2 therapy if chronic failure * Consider surgical treatment
85
Using the ABCD classification of COPD what does A indicate and what are the recommended treatments?
* A * Low risk * Less symptoms * Treatment * SABA or SAMA For these I'm omitting the alternative treatments, they can be found in the power point.
86
Using the ABCD classification of COPD what does B indicate and what are the recommended treatments?
* B * Low risk * More symptoms * Treatment * LABA or LAMA
87
Using the ABCD classification of COPD what does C indicate and what are the recommended treatments?
* C * High risk * Less symptoms * Treatment * ICS + LABA or LAMA
88
Using the ABCD classification of COPD what does D indicate and what are the recommended treatments?
* D * High risk * More symptoms * Treatment * ICS + LABA plus/or LAMA
89
Goals of treatment for COPD
* Reduce symptoms * Control dyspnea * Improve exercise tolerance and quality of life * Decrease complications of the disease such as acute exacerbations
90
Which COPD Pts get a SABA?
* All of them
91
A SABA can be combined with what to have an additive effect?
* Ipratropium * The combination of ipratropium/albuterol has been found to be more effective than either drug alone and is available in a single inhaler; Combivent
92
For Pts with evidence of significant airflow obstruction and chronic symptoms of COPD, regular treatment with what is recommended?
* A long-acting inhaled bronchodilator * Either * Long-acting Beta-2-agonist (LABA) * Or a Long-acting muscarinic antagonist (LAMA)
93
Commonly used LABAs
* Formoterol (Foradil) * Salmeterol (Serevent)
94
Commonly used LAMA
* Tiotropium (Spiriva) * Jaynsein's reccomendation
95
Which COPD Pts are ICS recommended for?
* Pts with severe COPD (FEV \< 50%) who experience frequent exacerbations while receiving one or more long-acting bronchodilators * Addition of an ICS is recommended to reduce the number of exacerbations
96
Name some LABA/ICS combo medications
* Formoterol/Budesonide (Symbicort) * Salmeterol/Fluticasone (Advair) * Vilanterol/Fluticasone (Breo Ellipta) * Memetasone/Formoterol (Dulera)
97
Name some LAMA/ICS combo medications
* Vilanterol/Umeclidinium (Anoro Ellipta) * Olodaterol/Tiotropium (Stiolto Respimat)
98
Is long-term treatment with **_oral_** corticosteroids recommended for COPD Pts?
* No the treatment can lead to: * Myopathy * Glucose intolerance * Weight gain * Immunosuppression
99
When should oral corticosteroids be used in COPD Pts?
During severe exacerbations
100
For COPD Pts with severe hypoxemia what medication has been shown to both increase survival and quality of life?
Long-term supplemental O2
101
In COPD Pts with mild or moderate hypoxemia what might O2 therapy help with?
* Increase exercise capacity * Effects of long-term benefits in this population are unclear
102
Which COPD Pts should you consider home O2 therapy for?
* Resting O2 \< 88% on RA * Evidence of pulmonary HTN, CHF or polycythemia
103
What is the hardest thing you will ever do has a PA?
Get a Pt approved for home O2
104
The benefits of pulmonary rehab for COPD Pts are well established, what are the benefits?
* Reduce dyspnea * Improve functional capacity * Improve the quality of life * Reduce number of hospitalizations
105
* An ABG comes back with the following: * pH: 7.38 * PaCO2: 29 * HCO3: 15 mEq/L This indicates?
Something probably, but for the exam it's unimportant. Won't be any ABG questions.
106
Which organisms make up 60% of community acquired pneumonia (CAP)?
*Streptococcus pneumoniae* and *Mycoplasma pneumoniae*
107
Which Abx are **_no_** longer considered first line in the treatment of S. pneumoniae PNA due to high levels of resistance?
* Penicillins * Pen VK * Amox * Augmentin * First and second-generation cephalosporins
108
Which ABx are good choices for the treatment of CAP caused by *S. pneumoniae*
* Third-generation cephalosporins * Ceftriaxone * Ceftazidime * Macrolides * Azithromycin * Clarithromycin * Fluoroquinolones * Levofloxacin * Moxifloxacin * Tetracycline * Doxycycline * Jaynstein's go-to for CAP monotherapy
109
ABx options for treatment of CAP caused by *Mycoplasma*
* Tetracyclines * Doxycycline * Macrolides * Erythromycin * Fluoroquinolones * Levofloxacin
110
ABx options for CAP caused by *H. flu*
* Macrolides * Clarithromycin * Azithromycin * Fluoroquinolones * Levofloxacin * Moxifloxacin
111
ABx options for CAP caused by *Chlamydohilia pneumonia*
* Macrolides * Clarithromycin * Azithromycin * Fluoroquinolones * Levofloxacin
112
ABx options for CAP caused by *Legionella*
* Macrolides * Clarithromycin * Azithromycin * Fluoroquinolones * Levofloxacin * Tetracyclines * Doxycycline
113
When determining whether to give an Abx IV or PO what should you consider?
* Bioavailability of the drug * Fluoroquinolones have good bioavailability so there is no difference in their efficacy between IV and PO * ICU Pts are usually on antimicrobials that only come in IV form
114
When should you switch a Pt from IV Abx to PO?
As soon as it is safe to do so
115
Which criteria determine whether a Pt is stable enough to switch from IV ABx to PO?
* Normal VS for 24 hours * Afebrile * RR \< / = 24 breaths/minute * HR \< / = 100 bpm * Systolic BP \>/= 90 mmHg * O2 sat \> 90% on RA * No respiratory distress
116
Early transition from IV Abx to PO decreases what?
* Length of hospital stay * Cost
117
40-50% of Pts admitted for IV ABx can be switched to PO within what time frame?
2-3 days
118
Just because a Pt is hospitalized for CAP does not mean they need IV ABx, what other reasons might they be hospitalized for?
* Hypoxia/respiratory distress * Monitoring for improvment * Moderate to high risk of decompensating
119
What are the criteria of the CURB-65 score?
* Each is worth 1 point (max 5 points) * **_C_**onfusion * **_U_**rea (\>7 mmol/L) * **_R_**espiratory rate (\>/=30/min) * **_B_**P (SBP \<90 mmHg or DBP \<60 mmHg) * Age (=**_65_** years)
120
Which CURB-65 scores indicate outpatient treatment of CAP may be appropriate?
* 0-1 * Score of 0 indicates a 0.7% mortality rate * Score of 1 indicates a 2.1% mortality rate
121
A CURB-65 score of 2 indicates?
* A short hospital stay or supervised outpatient treatment * Score of 2 indicates a 9.2% mortality rate
122
Which CURB-65 scores indicate the need for hospital admission and possible admission to the ICU?
* CURB-65 scores of 3-5 * Score of 3 indicates a 14.5% mortality * Score of 4 indicates a 40% mortality * Score of 5 indicates a 57% mortality

RRCCPA Pharmacotherapeutics (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions