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Clin Pharm > Pulmonary > Flashcards

Pulmonary Flashcards

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1
Q

T/F: Longer rhinosinusitis lasts w/o pt getting ill- more likely its a virus

A

True. Can go 2wks

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2
Q

Purulent sinus drainage is definitive of a ___

A

URI

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3
Q

URI or Allergic Rhinitis Tx: Decongestants

A

URI

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4
Q

URI or Allergic Rhinitis Tx: Pain & Fever reducers

A

URI

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5
Q

URI or Allergic Rhinitis Tx: Cough suppressants

A

URI

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6
Q

URI or Allergic Rhinitis Tx: Cough Expectorants

A

URI

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7
Q

URI or Allergic Rhinitis Tx: Vitamins & Supplements

A

URI

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8
Q

URI or Allergic Rhinitis Tx: Antihistamines

A

Allergic Rhinitis

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9
Q

URI or Allergic Rhinitis Tx: Intranasal Corticosteroids

A

Allergic Rhinitis

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10
Q

URI MOA: Activates alpha & beta adrenergic receptors

A

Decongestants

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11
Q

URI:
MOA: Directly stim α-adrenergic receptor of resp mucosa→ vasoconstriction →
↓ mucosal swelling→ ↑ ventilation

A

Decongestant

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12
Q

URI:
MOA: Directly stim β-adrenergic receptors→ bronchial relaxation

A

Decongestant

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13
Q

Decongestants S/E (which 4 systems?)(monitor which 2 pt groups)

A

*Vasoconstriction & tachycardia
→ angina, HTN, & worsening CV dz
* ↑ glycogenolysis & gluconeogenesis (monitor your diabetics)
*CNS stim (nervous, insomnia, dizzy, drowsy)
* urinary retention (monitor BPH pts)

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14
Q

Decongestants(2) good & bad?duration?

A

*Pseudoephedrine (Sudafed)
Duration: 4-6hrs
100% absorbed
*Phenylephrine (Sudafed PE) GARBAGE
Duration: 2-4hrs
38% absorbed

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15
Q

Decongestants:
avoid in (3)

A

HTN pts,
<6yo,
1st trimester preg

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16
Q

___ is only Decongestant avail for HTN pts

A

*Coricidin

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17
Q

URI:
MOA: dissolve thick mucus, ↑ airway clearing, & promote cough

A

Expectorants (mucolytic)

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18
Q

Expectorants S/E (2)

A

N/V, rash

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19
Q

t/f: Robitussion (expectorant) safe in preg?

A

True

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20
Q

What two rx make up robitussin?

A

dextromethorphan & guaifenesin

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21
Q

t/f: Guaifenesin may exacerbate nephrolithiasis

A

Cough cough kidney stone

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22
Q

Expectorants (mucolytic) avoid:

A

<6yo

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23
Q

MOA: Acts centrally on medullary cough center

A

Cough suppressants/antitussives

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24
Q

URI MOA: Acts locally at site of irritaiton

A

Cough suppressant/antitussives

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25
centrally acting antitussives
Dextromethorphan, opiates, Benzonate (tessalon) "Central BOD"
26
locally acting antitussives
Lozenges, viscous preparations, menthol and camphor
27
Antitussive w/ low abuse potential
Dextromethorphan
28
Dextromethorphan S/E (4) ?
serotonin syndrome (caution w/SSRI), nausea, dizziness, drowsiness
29
Benzonate (Tessalon) Opiate (Codeine) Dextromethorphan Ok in pregnancy?
Dextromethorphan Caution w/others
30
T/F: Dextromethorphan is contraindicated with SSRI & MAOI?
False, caution w/SSRI (ZoProPro's PaCe) contraindicated with MAOI (MarNar)
31
Which vit/supplement does reveal benefit in URI?
Echinacea
32
T/F: zinc does have true benefit in URI
False. Contradictory. WILL cause nausea & mouth irritation
33
Abx for Mild to mod bacterial sinusitis
DOC:Augmentin 875mg PO BID x 7d 2nd line: Doxycycline 100mg BID x7d
34
Abx for severe bacterial sinusitis
Severe = IV. "CAL" the ER Ceftriaxone (Rocephin) 1g IV BID Ampicillin/Sulbactam (Unasyn) 3g IV QID Levofloxacin 500mg IV QD
35
ABX for Risk of resistance bacterial sinusitis
Resistant "AF" think high dose long duration! *Augmentin 2g BID x 10-14d *FQ (Respiratory): Moxifloxacin 400mg QD x10d Levofloxacin 500mg QD x 5d
36
Which 3 drugs are NOT recommended for empiric sinusitis tx b/c of high resistance to Strep pna?
"Make Better Choices" Macrolides Bactrim Cephalosporins
37
T/F: SABA monotherapy is only ok with intermittent (Exercise) Asthma?
True
38
4 Inhalation Devices for Asthma
*Metered-Dose Inhalers (MDI) *Dry Powder Inhalers (DPI) *Nebulizers *HFA - Diskus
39
7 Drug Classifications for Asthma
*Inhaled β-2 Agonist (Short & Long Acting) *Inhaled Corticosteroids *Leukotriene Modifiers *Mast Cell Stabilizers *Anticholinergics *Anti-IgE Antibody *Theophylline
40
Asthma: MOA: B2 agonist
SABA LABA
41
Asthma: MOA: Inhibits inflammatory cytokines via the glucocorticoid receptor
ICS
42
Asthma: MOA: Blocks action of leukotrienes (constrict & mucous production)
Leukotriene modifiers
43
Asthma: MOA: Alters function of delayed Cl- channels and inhibits cell activation
Mast Cell Stabilizers
44
Asthma MOA: inhibits *cough *early response to antigens (mast cells) * late response to antigens (eosinophils)
Mast Cell Stabilizers
45
Asthma Rx: Onset: 5 min; Peak: 30 – 60 min; Duration: 4 – 6 hrs
SABA
46
Asthma Rx: Onset: approx. 30 min; Duration: > 12 hrs
LABA
47
Asthma: SABA S/E (7):
Tachycardia, QTc prolongation, tremor, anxiety, hyperglycemia, hypokalemia & hypomagnesemia (esp if used in high doses)
48
Asthma ICS S/E (4):
Oral candidiasis (thrush), dysphonia, reflex cough (this is ok) & bronchospasm
49
Asthma: LABA S/E (4):
"Labas exacerbate hypo breathing" Paradoxical bronchospasm, asthma exacerbation, laryngospasm, hypokalemia
50
Name 3 electrolyte abnormalities from inhaled SABA use?
hyperglycemia hypokalemia hypomagnesemia
51
5 SABA Rx
Albuterol, Proventil, Proair, Ventolin, Xopenex
52
What is the most effective long-term tx for sx control in asthma?
ICS
53
ICS Rx (3)
Qvar, Pulmicort, Flovent
54
Inhaled LABA rx (2) which is better?
Formoterol> Salmeterol (serevent)
55
T/F: LABAs can be used as monotherapy in asthma?
HELL NO ↑ risk asthma-rel hospitalization, intubation & death!!! the greatest risk was in children 4-11yo
56
Asthma LABA + ICS S/E (4):
Tremors, m. cramps, tachycardia, cardiac effects
57
LABA + ICS Rx (3) which is best?
**FORMOTEROL + BUDESONIDE (Symbicort) Salmeterol/fluticasone (Advair) Formoterol/mometasone (Dulera)
58
T/F: Leukotriene modifiers can be used as monotherapy for asthma?
FALSE. do not use as monotherapy
59
Asthma: Leukotriene modifiers S/E (5):
Abd pain, nausea, jaundice, itching, lethargy
60
Asthma: Mast cell stabilizers S/E (5):
Throat irritation, cough, dry mouth, wheezing, chest tightness
61
Asthma: Leuktriene modifiers Rx
Montleukast (singular)
62
Asthma Mast cell stabilizer Rx
Cromolyn
63
Failure of asthma Rx Tx may be attributed to (5):
* Lack of adherence to Rx * airborne pollutants, allergens or irritants. (tobacco smoke) * Smoking & exposure to 2nd-hand smoke → airway hyperresponsiveness & ↓ ICS effectiveness. * ASA or other NSAIDs → asthma sx * Oral nonselective βB, ie. propranolol, timolol can precipitate bronchospasm in pts w/asthma & ↓ broncho-dilating effect of β- 2 agonists
64
4 Rx class alternatives to propranolol for migraine Prophylaxis
Non-dihydropyridine CCB (Verapamil) B1 selective BB (Metoprolol, Atenolol) Anticonvulsant (Valporic acid, Topamate) TCA (Amitryptiline, Nortriptiline)
65
T/F: Valporic acid and Topirimate can decrease efficacy of OTC's?
TRUE Use condoms yall
66
T/F: ICS causes thrush and can be reduced by using a spacer & rinsing mouth after use
yup!
67
What is the tx for oral candidiasis?
Nystatin 5mL antifungal wash QID x7-14d
68
T/F: You should ALWAYS provide a Rx for albuterol
true
69
follow up for the asthma pt after increasing flovent (fluticasone) or moving to symbicort?
2-4wks
70
T/F; COPD is reversible
False, COPD is not fully reversible
71
T/F: COPD is primarily caused by cigarette smoking?
True
72
T/F: COPD air flow obstruction is usually progressive
True
73
COPD Airflow Obstruction parameters: * FEV1 <__ predicted * FEV1/FVC <__
* FEV1 <80% predicted * FEV1/FVC <0.7
74
4 goals of COPD therapy
* ↓ symptoms * Control dyspnea * Improve exercise tolerance & QOL *↓ complications (ie. acute exacerbations)
75
GOLD 1 (mild) FEV1 >___ predicted Category?
80% A or B
76
GOLD 2 (moderate) __> FEV1 >__ Category?
b/w 50-80% predicted A or B
77
GOLD 3 (severe) __> FEV>__ Category?
30-50% C or D
78
GOLD 4 (Very Severe) FEV1<___ Category?
30% C or D
79
Category A risk & Sx Rx?
Low risk, less Sx SABA- Albuterol
80
Category B risk & Sx Rx?
Low risk, more sx SABA-Albuterol LABA or LAMA
81
Category C risk & Sx Rx?
high risk, Less sx SABA ICS + LABA or LAMA
82
Category D risk & Sx Rx?
High risk, More sx ICS + LABA and LAMA
83
COPD: Who gets a SABA?
EVERYONE! like oprah!
84
Does Combo β2-agonist=SABA (albuterol) w/ muscarinic antagonist=SAMA (ipratropium) cause a (+) effect for COPD
yes! SABA + SAMA = combivent → more effective than either drug alone & is avail in a single inhaler.
85
what is the name of the LAMA we know & love that is used for pts w/evidence of significant airflow obstruction & chronic sx?
Tiotropium (Spiriva)
86
Are ICS 1st line in COPD?
NO! LABA/LAMA are!
87
When do we use ICS in COPD? What are 2 examples?
In pts w/ severe COPD (FEV <50%) who experience freq exacerbations while receiving 1+ long-acting bronchodilators (LABA) The addition of an ICS is recommended to ↓ the # of exacerbations Formoterol/Budesonide (Symibcort) "budesonide better" Salmeterol/Fluticasone (Advair)
88
What are 4 risks of using long term ORAL corticosteroids for COPD?
Wt gain Immunosuppression myopathy glucose intolerance
89
What does long term supplemental O2 therapy do for COPD?
↑ survival and QOL
90
when to consider O2 therapy in COPD (4)?
resting O2 <88%RA evidence of: *pulm HTN *CHF *polycythemia
91
Benefits of pulm rehab for COPD are great! It can (4):
↓ dyspnea improve functional capacity improve QOL ↓ admissions
92
When to f/u on a pt that is gold 2 (Group B)?
4wks
93
DO you know the tic tac toe method for ABG?
yes ma'am
94
What 2 bugs make up 60% of all CAP?
Strep pna & mycoplasma
95
ABX for Strep pna- CAP
"F**k THE Community Mucous" FQ- respiratory (Levo & Moxi) TCN ****DOXY!!!!! 3rd gen Cephs - "TRI TAXING me, you wont get a DIME" Ceftriaxone, Ceftazidime, Cefdinir Macrolides- Azithro & clarithro
96
Abx for Mycoplasma CAP
"LETs go for a walk" Levofloxacin Erythromycin TCN
97
ABX for H. flu CAP
F- respiratory M- Azithro & Clarithro
98
What does IV vs PO depend on for CAP Tx (main reason)?
**IV vs PO depend on bioavailability of Rx drug ie FQ good bioavailability → no diff btw PO & IV
99
What 2 parameters must be met for switching from IV to PO abx?
Pt is stable wit NL VS For 24hrs
100
Define Stable (6) when switching from IV to PO.
Afebrile RR<24 HR <100 O2 >90%RA SBP >90 AND no RESP DISTRESS
101
**Approx __-__% of pts admitted for IV ABX can switch to PO ABX w/in __-__d
40-50% 2-3d
102
t/f: if a pt is hospitalized for PNA, they need IV abx’s
So false
103
When to give IV abx for PNA (3)?
Hypoxia/resp distress Monitoring for improvement Mod-high risk decompensation
104
CURB-65 Grading and results?
Cofusion Urea (BUN >19 or 7mmol/L) RR (>30) BP (<90/60) Age >65 0pts-outpt 2pts-admit 3pts-ICU
105
When to F/u w/PCP for pna?
5-7d post d/c
106
Would you repeat a CXR for a PNA pt post d/c ?
duh! check for resolution
107
Can PNA pts alternate APAP 1g w/ IBU 600mg Q4hrs for fever/body aches?
yes
108
When to go to ER after d/c for pna?
CP trouble breathing Fever >102 leg swelling/calf pain

Clin Pharm (6 decks)

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