Pulm Therapeutics Flashcards by Julia B

What is treatment for healthy patients with community acquired pneumonia?

macrolides (azithrymycin, clarithromycin, erythromycin) or doxy

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What is treatment for patients with co-morbidity and community acquired pneumonia?

β-lactam (amoxicillin or augmentin) plus macrolide

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What is inpatient treatment for community acquired pneumonia?

floroquinolones (moxifloxacin, gemifloxacin or levofloxacin)

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What is outpatient tx for S. pneumonia?

Macrolide (azithromycin, clarithromycin)

Add β-lactam if likely resistance

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What is inpatient tx for S. pneumonia?

respiratory fluoroquinolone (moxifolxacin, gemifloxacin, levofloxacin plus β-lactam)

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What is treatment for H. influenzae pneumonia?

Hospitalize

Azithromycin & respiratory fluroquinolone

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What is tx for mycoplasma pneumonia?

macrolide

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What is tx for viral pneumonia?

Supportive

Antiviral agents in sicker pts ( neuraminidase inhibitors or inhaled ribavirin)

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What is tx for aspiration pneumonia?

β-lactam & clindamycin

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What is tx for Coccidioidomycosis fungal pneumonia?

Itraconazole

Fluconazole

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What is tx for Histoplasmosis fungal pneumonia?

Amphotericin then switch to itraconazole

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What is tx for Blastomycosis fungal pneumonia?

Itraconazole

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What is tx for acute bronchitis?

Symptomatic (fluids, cough, suppressants)

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Tx for influenza

Supportive
Rest, hydration, NSAIDs
Stay home & stay away from others

Neuramindase inhibitors only useful in 1st 48 hrs for pts at risk

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What are the neuramindase inhibitors?

oseltamivir
zanamivir
peramivir

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Tx for latent TB

Isoniazid and Rifampin or rifapentine for 9 mo

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Tx for active TB

Isoniazid, pyrazinamide Rifampin (or rifapentine) for 9 mo 
plus ethambutol (or streptomycin)

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Tx for Obstructive Sleep Apnea

Weight loss
CPAP
Uvulopalatopharyngoplasty
Tracheostomy

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Tx for central sleep apnea

Treat underlying disease

CPAP

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Tx for Pickwickian Syndrome

Weight loss
CPAP
BIPAP
Tracheostomy

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How do you treat hypoxemia?

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How do you treat hypercapnia?

ventilation

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Tx of ARDS

Postive pressure mechanical ventilation
Use low volumes, mode of ventilation doesn’t matter, use PEEP
Prone the pt

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What are indications for ECMO in severe ARDS?

Postive pressure mechanical ventilation (CPAP)
Use ↓ tidal volumes (<60), use ↑ PEEP (>55)
Conservative fluid management
Prone the pt
If nothing working try ECMO

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Tx for PE

anticoags for 3 mo, TPA, if large then TPA or embolectomy

PE pphx

Ambulation, pneumatic compression devices | Smoking cessation, discontinue OCP or anticoagulant (Heparin, enoxalarin or fondaparinox) if at risk

Tx for pulmonary HTN

Secondary: treat underlying cond Primary: 1st lline calcium channel blockers (nifefipine or diltiazem) if vasoreactive If not: endothelian receptor antagonist, phosphodiesterase inhibitors, prostainoids

Endothelin receptor antagonists to treat pulm HTN

bosentan or ambrisentan

Phosphodiesterase inhibitors to treat pulm HTN

sildenafil or tadalafil

Prostanoids to treat pulm HTN

epoprostanol, iloprost, treprostinil

Tx for Cor Pulmonale

Acute: fluids to maintain CO, correct underlying cause Chronic: O2, diuretics (furosemide), vasodilators, digoxin

What vasodilators can be used to treat cor pulmonale?

nifedipine, diltiazem or long acting nitrates

What anticoags can be used to treat PE?

heparin, enoxaparin, warfarin, fondaparinux, rivoxaban, apixaban, edoxaban, dabigatran

Tx for coal workers pneumonia

None Avoid further exposure Stop smoking

Tx for silicosis

Prevent by ↓ exposure Treat complications w/ bronchodilators, O2, steroids and vaccinations Lung lavage if acute

Tx for abestosis

None→respiratory failure

Tx for BAPE

follow up and cleared once gone 3 yrs

Tx for pleural plaque

No tx just follow -rarely becomes malignant

Tx for hypersensitivity pneumonitis

Avoid exposure | Steroid if subacute or chronic

Tx for BO and BOOP

Systemic steroid

Tx for Reactive Airway Dysfunction Syndrome (RADS)

Bronchodilator may help

Tx for round atelectasis

Surgery

Tx for mesothelioma

Surgery not so beneficial Chemo is better Survival 8-12 mo

What mucolytics are used to treat CF?

Inhaled N-acetylcysteine, dornase alpha or hypertonic saline

What anti-inflammatories are used to treat CF?

prednisone or ibuprofen

What antibiotics are used to treat acute CF infections?

keflex, azithromycin, if MRSA use vanco or linezolid if pseudomonas use IV tobra and piperacillin

What is Ivacaftor?

helps correct function of G551D mutation in CFTR gene but does not work on delta F508

What is tx for CF?

refer to CF specialist, chest physiotherapy, mucolytics, bronchodilators (sometimes) and ant-inflam, if G551D then ivacaftor

What is the MC tx for CF acute exacerbations?

tobramycin (inhaled) and ceftazidime

Tx for bronchiectasis

``` treat underlying cond control infection (fluoroquinolone) reduce inflammation improve bronchial hygiene surgical resection ```

What fluoroquinolones are used to treat bronchiectasis infection?

levofloxacin, moxifloxicin, gemifloxacin | tobra and aztreonam if CF pt

What is used to treat inflammation in bronchiectasis?

SABA, LABA, ipratropium, fluticasone

Tx for bronchiolitis

symptom relief-hydration and oxygenation | hospitalize if severe

What is best tx for asthma pt with nighttime awakenings?

SABA

What is tx for asthma acute exacerbation

SABA: albuterol Anticholinergic: ipratropium Corticosteroids: prednison or methylprednisone

What is tx for asthma long term maintenance?

ICS: beclomethasone or triamcinoline LABA: Salmeterol Mast cell stabilizers: cromolyn or necromil Leukotriene modifiers: montelukast or theophylline

What is the drug of choice for long term persistent chronic asthma maintenance?

ICS: Beclomethasome or fluinsolide or triamcinolone

Tx for COPD exacerbation

Mild: change bronchodilator & Abx Mod: prednisone Severe: hospital admission

What drugs can be used to help smoking cessation?

nicotine replacement or varenicline

Tx for COPD management

bronchodilators, B2 agonists, anticholinergics, theophylline | systemic steroid for exacerbation

What are the B2 agonists used to treat COPD?

SABA: albuterol, levoalbuterol LABA: salmeterol, formoterol

What are the anticholinergics used to treat COPD?

SAMA: ipratropium LAMA: tiotropium

What are the ICS used to treat COPD?

fluticasone, mometasone, budesonide

What is first line tx for COPD?

SAMA (ipratropium) or | LAMA (tiotropium)

What is tx to reduce exacerbations?

macrolides 3 x weekly

Tx for IPF

lung transplant

Tx for NSIP

steroids

Tx for RB-ILD

smoking cessation

Tx of DIP

systemic steroids

Cancer immunotherapy tx

PDL1-PD1 to inhibit interaction and restore anti-tumor T cell activity

Pulm Therapeutics Flashcards

(70 cards)