Pulm cases Flashcards
(141 cards)
1
Q
What is a good indicator of whether or not a URI is bacterial or viral
A
Is the patient getting worse or better after certian amount of time
2
Q
What classes of medications are appropriate to recommend or provide for URI
A
Decongestants
Pain and fever relievers
Cough suppressants
Cough expectorants
Vitamins and Supplements
3
Q
What medication classes are appropriate to recommend or RX for allergic rhinitis
A
Antihistamines
Intranasal Corticosteroids
4
Q
What is the MOA for oral decongestants
A
Activate alpha and beta adrenergic receptors
5
Q
What is the effect of PO decongestants binding alpha adrenergic receptors
A
When bound to alpha receptors of resp mucosa it causes vasoconstriction which reduces mucosal swelling and improves ventilation
6
Q
What effect do PO decongestants have when binding the beta receptors
A
Bronchial relaxation
7
Q
What are the s/e of PO decongestants
A
Vasoconstriction/tachycardia leading to angina
HTN
Worsening of CVD
Increase BG
Nervousness
Insomnia
Dizziness
Drowsiness
Urinary retention
8
Q
What population should you avoid PO decongestants
A
- In pts with HTN
- Pts less than 6 y/o
- Pts in the first trimester of pregnancy
9
Q
What should you look out for in pts taking PO decongestants
A
Urinary retention
10
Q
what is the only decongestant for pt with HTN?
A
HBP
11
Q
What are the two decongestants meds?
A
Pseudoephedrine
Phenylephrine
12
Q
Which decongestant did jaynstein say “never use this”
A
Phenylephrine
13
Q
What is the duration of action for pseudoephedrine
A
4-6h
14
Q
What is the duration of action for Phenylephrine
A
2-4 hours
15
Q
How much of the pseudoephedrine is absorbed vs phenylephrine
A
100% vs 38%
16
Q
What are the MOA of cough suppressants/antitussives (2)
A
- Centrally act on the medullary cough center
OR
- Locally at the site of irritation
17
Q
What antitussives act centrally on the medullary cough center
A
Dextromethorphan
Opiates
Benzonate
18
Q
What antitussives act locally at the site of irritation
A
Lozenges
Viscous preps
Menthol
Camphor
19
Q
Dextromethorphan is actually the D-isomer of what drug?
A
Codeine
20
Q
What are the s/e of dextromethorphan
A
Nausea
Dizziness
Drowsiness
21
Q
What is a DDI to watch out for with dextromethorphan
A
Serotonin Syndrome if Rxs with SSRIs and MOAIs.
Esp MOAIs
22
Q
T/F
Dextromethorphan is contraindicated in pregnancy
A
False, it is safe
23
Q
What medication is completely contraindicated with dextromethorphan
A
MAOIs bc greater risk for serotonin syndrome
24
Q
Why is codeine not used often as an antitussive
A
High abuse potential
25
What are the s/e of Codeine
CNS depression
Resp depression
Common allergen
26
What category is codeine considered in pregnancy? Why?
Cat C- leads to resp depression and addiction risk
27
T/F
Benzonate has mildly addictive properties
False, they have no addictive properties
28
What are the s/e associated with Benzonate
HA
Dizziness
Drowsiness
29
T/F
Benzonate is safe to use in pregnancy
False- it is cautioned in pregnancy
30
Why does Jaynstein say you shouldn't prescribe benzonate to pts with no insurance
They are expensive and there is only a 50:50 chance it will actually work for the pt
31
What is the MOA of expectorants?
Dissolves thick mucus
Enhances airway clearing
Promotes coughing
32
What are the s/e of expectorants
N/V
Rash
33
What meds are expectorants
Mucinex
Guaifenesin (robitussin)
34
What pt population should you avoid expectortants in?
Pts <6
35
T/F
Expectorants are safe in pregnancy
True
36
Guaifenesin may exacerbate ?
Nephrolithiasis
37
What is robitussin DM a combination of
Dextromethorphan/guaifenesin
38
What vitamins and supplements MAY be beneficial based on EBM
Echinacea
39
What vitamins/supplements have ANECDOTAL evidence of benefi
Vitamin C
40
What vitamins and supplements have contradictory EBM results
Zinc
41
Whats the s/e of zinc
Nausea
Mouth irritation
42
What are the recommended abx to tx mild to moderate bacterial sinusitis
- Amoxicillin/Clavulanate 875mg PO BID 7 days
- Doxycycline 100mg BID 7 days
43
What are the recommended abx to tx sinusitis that is risk for resistance of abx failure
Amoxicillin/clavulanate 2000mg BID, 10-14 days
Levofloxacin 500mg QD, 5 days
Moxifloxacin 400mg, 10 days
44
What are the abx recommended for severe cases of abx (inpatient)
Amp/sulbactam 3gm IV QID
Levofloxacin 500mg IV QD
Ceftriaxone 1gm IV BID
45
What abx are NOT recommended for sinusitis and why?
- Macrolides
- TMP/SMX
- 2nd or 3rd gen cephalosporins
They all do not tx S. pneumo
46
What is the tx for intermittent asthma (step 1)
PRN SABA
47
What is the step 2 tx of mgmt of presistent asthma
- low dose ICS
or
- low dose LABA PRN
48
What is the step 3 tx of mgmt of presistent asthma
- Low dose ICS + LABA
49
What is the step 4 tx of mgmt of presistent asthma
- Medium dose ICS + LABA
50
What is the step 5 tx of mgmt of presistent asthma
- High dose ICS + LABA
51
What are the add ons for asthma?
Leukotriene modifiers
Mast Cell Stabilizers
Anticolinergics
52
What are example of leukotriene modifiers?
Montelukast (Singular)
53
What are example of mast cell stabilizers?
Cromolyn Sodium
Nedocromil
54
What are examples of anticholinergics?
- Ipratropium Bromide (Atrovent) (SAMA)
- Tiotropium (Spiriva) (LAMA)
55
What are different inhaled devices?
Metered-Dose Inhalers (MDI)
Dry Powder Inhalers (DPI)
Nebulizers
HFA - Diskus
56
What are the different asthma drug class
- Inhaled Beta-2 Agonist (Short and Long Acting)
- Inhaled Corticosteroids
- Leukotriene Modifiers
- Mast Cell Stabilizers
- Anticholinergics
- Anti-IgE Antibody
- Theophylline
57
Whats the MOA for inhaled short acting?
Beta-2-agonist
58
Whats the onset, peak and duration for short acting?
Onset: 5 min
Peak: 30-60min
Duration: 4-6hrs
59
What is the s/e for short acting?
Tachycardia, QTc prolongation, tremor, anxiety, hyperglycemia, hypokalemia and hypomagnesemia, especially if used in high doses
60
What are example of short acting?
Albuterol, Proventil, ProAir, Ventolin
Xopenex
61
Whats the MOA for ICS?
Inhibits multiple inflammatory cytokines via the glucocorticoid receptor (Bring down inflammation)
62
What are the s/e for ICS?
- Oral candidiasis (thrush), dysphonia, and reflex cough and bronchospasm
- Might cough, but don’t worry it’s a good thing meaning meds going to the right place
63
What is the most effective long-term treatment to control asthma symptoms?
ICS
64
What are names of common ICS?
Qvar, Pulmicort, Flovent
65
Per updated asthma guidelines whats now the standard of care
PRN ICS at initial asthma dx
66
What is the MOA of long acting?
Beta-2-agnoist
67
Whats the onset and duration of inhaled long acting beta-2 agonist?
Onset: 30min
Duration >12hrs
68
Whats the S/E of LABA
Paradoxical bronchospasm, asthma exacerbation, laryngospasm, hypokalemia
69
What are the LABA names?
Salmeterol (Serevent)
Formoterol
70
What med is monotherapy NOT recommended?
LABA
LABA was associated with an increased risk of asthma-related hospitalization, intubation and death; the greatest risk was in children 4-11 years old
71
If a LABA is needed then what should you added?
ICS
72
What are examples of LABA+ICS combos?
- Salmeterol/fluticasone (Advair)
- Formoterol/budesonide (Symbicort)
- Formoterol/mometasone (Dulera)
73
What are the s/e of LABA/ICS?
Especially if used in higher- than-recommended doses, can cause tremor, muscle cramps, tachycardia and other cardiac effects
74
Whats the MOA for leukotriene modifiers?
- Inhibits physiologic actions without any agonist activity.
- Block the action of leukotrienes
75
What does Leukotrienes cause?
constriction and mucus production
76
T/F leukotrienes modifiers are more effective than low-dose ICS
False, less effective than ICS
77
When are leukotriene modifiers used?
When pts are unable or unwilling to use ICS
78
What is the s/e of leukotriene modifiers?
Abdominal pain, nausea, jaundice, itching or lethargy
79
Common name of leukotriene modifiers?
Singular
80
What is MOA of mast cell stabilizers?
Alters function of delayed Cl- channels and inhibits cell activation
81
How does mast cell stabilizers work?
- Inhibition of cough
- Inhibition of early response to antigens (mast cells)
- Inhibition of late response to antigens (eosinophils)
82
What is the S/E of mast cell stabilizers?
Throat irritation, cough, dry mouth, wheezing, chest tightness
83
What are the common mast cell stabilizers?
Cromolyn
84
What can cause asthma treatment failure?
- Lack of adherence to prescribed meds
- Continued exposure to tobacco smoke and other pollutants
- Smoking/exposure to second-hand smoke
- Some pt taking aspirin/other NSAIDs
- Oral non-selective beta-adrenergic blockers (propranolol, timolol) can cause bronchospasm in pt with asthma and cause decrease bronchodilating effects!
85
What medications can lead to asthma exacerbations in some pts
NSAIDs
ASA
86
What medications MAY be shown to ppt bronchospasm in pts with asthma when they are taking beta-2-agonists
Beta blockers
87
What are some alternatives to beta blockers as a migraine prophylaxis medication
- Non-dihydropyridine CCB (Diltiazem and verapamil)
- Beta 1 selective Beta blocker
- Anticonvulsants
- TCAs
88
What medications can decrease the efficacy of OCP
Anticonvulsants
89
Whats the tx for oral thrush?
Nystatin 5mL swish and swallow QID for 7-14d
90
T/F always provide refill for albuterol
TRUE
91
When should you follow up after adjusting a pts asthma meds
Guideline = 2-6 weeks
Jaynstein = 2-4 weeks
92
T/F Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease
True
93
is COPD restrictive or obstructive?
Obstructive
94
T/F
COPD is not fully reversible
True
95
In COPD the FEV1 is < _____ and FEV1/FVC is < ________
80%
0.7
96
What is the GOLD 1
Mild COPD
FEV >80% predicted
97
What is the GOLD 2
Moderate COPD
FEV 50-80% predicted
98
What is the GOLD 3
Severe COPD
FEV 30-50% predicted
99
What is GOLD 4
Very Severe COPD
FEV <30% predicted
100
What is the tx for all GOLD categories
Avoidance of risk factors
Influenza/Pneumococcal
101
What is the tx for GOLD 1?
SABA PRN
102
What is the tx for GOLD 2?
SABA PRN
LABA??
Pulm rehab
103
What is the GOLD III tx
SABA PRN
LABA or LAMA
Rehab
ICS if significant sxs
104
What is the GOLD IV tx
SABA PRN
LABA or LAMA
Rehab
ICS if significant sxs
Long term O2 therapy
105
What is the mMRC/CAT scale
Ways to stratify a pt based on risk in COPD, to decide how to medicate
106
Group A COPD treatment
Bronchodilator (SABA or SAMA)
107
Group B COPD treatment
LABA or LAMA
108
Group C COPD treatment
ICS + LABA or LAMA
109
Group D COPD treatment
ICS +LABA +/or LAMA
110
What are the tx goals for treating COPD
Reduce sxs
Control dyspnea
Improve exercise tolerance and QOL
Decrease complications and exacerbations
111
What is the LAMA of choice for COPD
Spiriva (tiotropium)
112
What are ICS most useful in treating, asthma or COPD
Asthma
113
Whats the combination of ipratropium/albuterol?
combivent
114
T/F Inhaled corticosteroid is recommended to reduce the number of exacerbations
True
115
Review combo meds
slide 37
116
T/F Oral steroids is recommended in COPD
False, NOT recommended in COPD.
The risks of such treatment include myopathy, glucose intolerance, weight gain and immunosuppression
117
What are the things that can improve M+M in COPD
O2 therapy
Smoking cessation
118
T/F Oxygen therapy may also increase exercise capacity in patients
True, but its long-term benefits in such patients are unclear
119
When do you consider O2 therapy
O2 <88% on RA
Evidence of pulm HTN
CHF
Polycythemia
120
What are the benefits of pulm rehab?
Reducing dyspnea
improving fxn capacity and quality of life
Reduce hospitalization
121
ICS is reserve for which group A, B, C, D
C & D
122
What orgs make up 60% of CAP
Strep and mycoplasma
123
What are the PCN that MAY work for STrep CAP
Pen VK
Amox
Augmentin
Don't RX these tho bc high resistance
124
What gen of cephalosporin may be used to tx Strep CAP
3rd- cefdinir, ceftriaxone, ceftazadime
125
What macrolide may be used to tx Strep CAP
Azithromycin and Clarithromycin
126
What FQ may be used to tx Strep CAP
Levofloxacin and Moxifloxacin
127
What med does Jaynstein love for Strep
Doxy (tetracycline)
128
Tx for mycoplasma pna
Doxy
Erythromycin
Levofloxacin
129
Tx for H. flu pna
Macrolides (clarithromycin/azithromycin)
FQs (levo and moxifloxacin)
130
Tx for chlamydia PNA
Macrolides (clarithromycin/azithromycin)
FQs (levo)
131
Tx of legionella pna
Macrolides
FQs (levo)
Second gen tetracycline (Doxy)
132
IV vs PO should be decided based on what (for abx)
Bioavailability, point is you can RX PO abx for an inpatient tx
133
When can you switch a pt who was on IV abx to PO abx
If they are stable with nl VS for 24 hours:
(Afebrile, RR <24, HR <100, SBP >90, O2 sat >90% RA AND NO RESP DISTRESS)
134
What is the benefit of transferring a pt from IV to PO abx
Early transition decreases length of hospital stay and cost
135
T/F just because they are in the hospital, they need IV abx
false, just bc a pt is hospitalized for PNA does not mean they need IV abx’s
136
What scoring system is good for determining whether or not a pt should be admitted for the PNA
CURB-65
137
What does CURB-65 stand for?
C = confusion
U = Urea (>7mmol/L)
R = RR >30
B = BP <90/30
65 = >65 y.o
138
Score of what in a CURB-65 indicates need for admission
>2
139
When you discharge a pt for outpt tx of PNA when should they be seen again
After finishing course of Abx have them in ASAP
140
When should you do CXR after d/c pt with PNA
just prior to D/C and again when they return after completion of PO Abx
141
What is a good recommendation for body aches associated with PNA
APAP 1gm with IBU 600mg q4h
