Pulmonary Flashcards by Maya Birchler

immediate hypersensitivity

exposed to allergen/trigger –> IgE, T helpers, mast cells, histamine

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asthma: in the past 4 weeks has the patient had:

day time symptoms >2x/week
any night waking due to asthma
reliever needed >2x/week
any activity limitation due to asthma

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3 types of asthma treatments

1) relievers/bronchodilators
2) bronchidilators (anticholinergic)
3) anti-inflammatories – ICS

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albuterol sulfate

SABA = proair HFA, ventolin hfa, proventil hfa, nebulized
levalbuterol = xopenez

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binds to beta2 receptors to cause fast=acting bronchodilation
onset <5 minutes, duration 4-6 hours, 2 puffs every 4-6 hours

SABA

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ADRs of SABA

tachycardia, tremor, hypokalemia

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salmeterol, formoterol, vianterol

LABA

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long term bronchodilation that opens airway

LABA

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can LABA be used alone

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ABA is either __ or __

BID or QD

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LABA is more

costly

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inhaled versions of sympathomimetics are more ___

effective

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ADRs of sympathomimetics

nausea, tachycardia, muscle tremors, cardiac and respiratory compromise

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selective direct-acting stimulant of beta-2 receptors, causing smooth muscle to relax

terbutaline

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terbutaline can also be used

to stop contractions in OB

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toxicity of terbutaline

acidosis, rhabdo, ARF, SVT, a fib

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IV terbutaline can cause

hypokalemia

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ipatropium bromide

SAAC - atrovent, combivent, duoneb

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blocks acetylcholine, relaxes + opens airway

SAAC/SAMA
PRN or QID

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onset 15-20 min, duration 4-6 hours
ADR = dry mouth, nausea, metallic taste

SAAC/SAMA

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tiotropium, glycopyrrolate, umeclidinium

LAMA/LAAC

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blocks acetycholine longer

LAMA/LAAC

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ADRS = dry mouth, constipation, urinary retention, tachycardia, blurred vision

LAMA/LAAC

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fluticasone propionate, budesonide, beclometahsone, mometasone

ICS

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rinse month after -- to reduce thrush risk

ICS

ADRs = hoarseness, sore throat, thrush treat with lowest dose possible

ICS

montelukast/singulair

leukotriene receptor antagonist QHs, ages 12mo +, few DDIs

block action of leukotrines (antiinflam) mild-severe asthma, goal for control + exacerbation reduction almost equal to ICS ADR= headache, N/V/D/ abdominal pain, flu-like

leukotriene receptor antagonists

sublingual immunotherapy

grass = grazax, odactra ragweed = ragwitek build up tolerance!

antibody for IgE

omalizumab (reduces response)

antibody for IL-5

mepolizumab (death of eosinophils)

antibody for IL-4

dupilumab (reduces inflammation)

moderate to severe asthma, SC ADRS = injection site reaction, black box warning anaphylaxis, expensive

monoclonal antibodies

rarely used, mostly in hospital for severe refractory asthma - bronchodilator, inibits phosphodiesterase, release of epi, relaxes, stimulates narrow therapeautic index, seizures/arrhythmias LOTS of DDIs, CYP1A2, 2E1, 3A4 (smoking increases elimination, prolonged w/ CHF and hepatic disease)

theophylline/methylxanthine

children may need

delivery devices, leukotrine modifiers, pulmicort nebs

tx of asthma exacerbations

home -- increased dosing of inhaler, may require oral steroids er -- controlled oxygen for >90%, nebulized SABA w/ SAMA oral or IV steroids

-- not used for exacerbations, rescue, or monotherapy in asthma

salmeterol

risk for anaphylaxis with

omalizumab

COPD treatments

SABA PRN LABA for moderate-severe B-D w/ persistent symptoms ICS for severe to very severe ICS/LABA improves but increaed pneumonia risk

SAMA first line for

periodic COPD symptoms, PRN, maybe with SABA

LAMA/LAAC first line for

moderate-severe COPD w/ persistent symptoms

phosphodiesterase IV inhibitors

roflumilast (COPD only) severe or very severe COPD uncontrolled adjunct therapy ADRs = weight loss, neuropsychiatric effects, bad in underweight, 3A4, 1A2

tiotropium vs LABA

tiotropium increased time to 1st exacerbation -- dries up secretions

first line for COPD

smoking cessation, vaccines, O2 <88%

3 cardinal symptoms of COPD

increased dyspnea increased sputum purulence increased sputum volume all 3 = severe

Risk for p aeruginosa in COPD exacerbation

- recent hospitalization - chronic steroid use - resident of nursing home - >4 courses of abx - known pseudomonas infection in past

COPD exacerbation treatments --

SABA, steroids, O2

Abx recommended for COPD exacerbation treatment if

2/3 cardinal symtpoms + one includes increased sputum purulence or 3/3 like bactrim, augmentin, doxy, clarithro, azithro

if at risk for p aeruginosa COPD abx

levofloxicin, zosyn, cefepime

if complicated COPD abx

augmentin, levo, moxi

if uncomplicated COPD abx

doxy, azithro, cefdinir, bactrim

cortisone hydrocortisone prednisone methylprednisolone dexamethasone

glucocorticoids

fludricortisone

mineralocorticoids

intermediate acting steroids

prednisone 5 methylprednisolone 4

long acting steroids

dexamethasone .75

corticosteroid dosing

equal to amount secreted by adrenal cortex (physiologic) or pharmacologic (supraphysiologic)

short term, high dose steroid ADRs

hyperglycemia leukocytosis GI bleeding (PUD) insomnia sodium and water retention psychaitric status changes increased appetite

long-term steroid ADRs

amenorrhea cataracts diabetes osteoporosis immunosuppression HPA axis suppresion HTN myopathy hypokalemia acne Cushing's

main one to start young

leukotriene receptor antagonists

cushings syndrome is

hyperadrenocorticosism from - primary defect or excessive secretion of ACTH (pituitary adenoma), ectopic ACTH secreting tumor or use of steroids with high dose + long term use Dx w/ dexamethasone challenge (cushings = high levels of ACTH in morning blood draw)

moon face central fat obesity striae buffalo hump bruising psychiatric changes HTN osteoporosis glucose intolerance amenorrhea hirsutism

cushing's

primary adrenal insufficiency

addison's disease

adrenal gland not producing hormones from soemthing suppressing it (long-term exogenous steroid administration >14 days)

secondary adrenal insufficiency

hypotenison hypoglycemia N/V/D chronic fatigue loss of appetite

Addison's

most common cause of --- is chronic use of exogenous glucocorticoids + abrupt withdrawal w/ weakness weight loss GI symptoms craving salt HA memory loss depression psotural dizziness vomiting fever HOTN shock

Addisonian crisis hydrocortisone is TOC

tapering in addisons

cortisol 10-30mg - measure ACTH or AM serum cortisol if normal/>20, daily steroid is unnecessary if cortisol <3, continue therapy

courses of steroids >-- weeks pose risk for HPA-axis suppression

2 weeks

Use shorter acting forumlations to prevent steroid withdrawal like

short - hydrocortisone intermediate - prednisone/methylprednisone long - dexamethasone give in morning limut duration TAPER

anorexia n/v weight loss lethargy headache fever joint/muscle pain postural HOTN

rapid reduction in corticosteroid levels

burst therapy

asthma/copd exacerbations short term therapy x 5-7 days no taper if <14 days

short term taper

taper over 2 weeks 60 x 3, 40 x 3, 20 x 3 off

long term taper

tapered over months 60 mg x 1-2wk 50 mg x 1-2 weeks etc

long term ADR steroids

HTN hypokalemia hyperglycemia osteoporosis hidden infections

short term ADR steroids

GI, insomnia, excitability

ADR steroids

EKG changes Edema cushings

monitor with steroids --

glucose, WBC, short term side effects take with food don't stop suddenly drug side effects timing missed

use steroids cautiously with

PUD HD, HTN, HF infectious psychoses DM osteoporosis glaucoma

with trauma/surgery

10x dosage increase 48-72 hours

minor stress

2x dosage increase 24-48hrs

pregnant women can use

albuterol and budesonide

How do you calculate the percentage of pulm volume?

x/y = percentage 50-70 = yellow <50 = red

green

> 80%

yellow

50-80% SABA

red

<50% SABA go to ED

Pulmonary Flashcards

(84 cards)