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Pharmacology > Q3 Pulm > Flashcards

Q3 Pulm Flashcards

1
Q

First line for asthma tx

A

ICS - Beclomethasone, budesonide, fluticasone, mometasone
- with rescue SABA/LABA - albuterol, levalbuterol/salmeterol, formoterol.

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2
Q

What therapy is useful for nocturnal symptoms of asthma?

A

LABAs - salmeterol and formoterol.

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3
Q

How do SABAs/LABAs work?

A

Beta2 agonists that relax the airway smooth muscle by stimulating beta 2 receptors in the airway.

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4
Q

Since SABAs are not 100% selective, what other things do they affect?

A

Can affect cardiac and skeletal muscle B1 receptors. = tachycardia, muscle tremors.

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5
Q

What medications can be used Off Label for asthma? MOA?

A

Anti Cholinergic - although mostly used in COPD.
Ipatropium (SAMA) and Tiotropium (LAMA)

MOA - inhibit Muscarinic acetylcholine receptors in the lungs to inhibit bronchoconstriction.

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6
Q

What LTRA is used in asthma and what is its MOA?

A

Leukotrienes receptor antagonist (LTRA) - anti inflammatory
Monteleukast.

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7
Q

What is theophylline and is it used in asthma?

A

Methylxantine - anti-inflammatory properties and bronchodilator by relaxing smooth muscle in lungs

Not typically used in asthma - ICS are better.

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8
Q

What meds are reserved for treatment resistant asthma?

A

Immunomodulators (monoclonal antibodies)

Omalizumab and Mepolizumab and reslizumab.

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9
Q

SABA/LABA onset and duration

A

SABA - 30min/ 3-5hrs
LABA - 30-60min/>12hrs

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10
Q

LABAs are best combined with _____

A

ICS

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11
Q

What is the agent of choice for long term asthma therapy? Clinical considerations?

A

ICS.
Educate patient to rinse mouth out with water after use (to prevent oral thrush)

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12
Q

Oral steroids should be used ______

A

Short term - <2weeks

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13
Q

Step 1 reliever and controller
Step 2
Step 3
Step 4
Step 5

A

Step 1 = PRN ICS - formoterol and PRN SABA
Step 2 = Daily low dose ICS or PRN low dose ICS - formoterol OR daily LTRA and low dose ICS whenever SABA is taken + PRN SABA
Step 3 = daily low dose ICS-LABA or medium dose ICS + PRN SABA
Step 4 = Daily Medium dose ICS-LABA or high dose ICS and add-on tiotropium or LTRA + PRN SABA
Step 5 = daily high dose ICS-LABA, refer for phenotypic assessment, and add on therapies, Low dose OCS but consider SEs + PRN SABA

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14
Q

Class A, B, C, D for COPD

A

A = low symptom burden (mMRC 0-1, CAT <10) and low airflow limitation (grade 1-2 GOLD)
B = high symptom burden (mMRC >=2, CAT >=10) and low airflow limitation (grade 1-2 GOLD)
C = low symptoms burden, high airflow limitation (3-4GOLD)
D = high symptom burden, high airflow limitation

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15
Q

Class C COPD tx?
Class A?
B?
D?

A

C = LAMA
A = ??
B = ??
D = LAMA or LAMA+LABA (if highly symptomatic CAT>20) or ICS+LABA (eosinophils>=300).

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16
Q

When should corticosteroids be added in COPD therapy?

A

In FEV1<60%

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17
Q

Therapy for COPD:

A

Bronchodilators: B2 agonists (S+L), Anticholinergics (S+L), Methylxanthines.
Corticosteroids

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18
Q

Other clinical considerations for COPDers?

A

Flu vaccine yearly, PPSV23 vaccine x1 to all COPD patients. If over 65, then repeat if it’s been >5 years
PCV13 EVERYONE over 65

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19
Q

Hh

A
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20
Q

Free form drawings

A
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21
Q

A LABA should be added when?

A

When a patient is not maintained with ICS

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22
Q

SABAs should not be overused because?

A

decrease efficiency over time.

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23
Q

MOA of Leukotrienes receptors?

A

Leukotrienes are chemicals released when exposed to an allergen. If they receptors are blocked, then they can’t mount as intense an immune response.

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24
Q

T/F: bronchodilator’s should not be used to treat COPD because COPDers do not have an “adequate response” to them (<80%)

A

False. The can still improve symptoms and improve activity tolerance.

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25
Q

Meds used in tx of COPD

A

Bronchodilators
- beta 2 agonists (SABA and LABA)
- Anticholinergics (LAMA/SAMA)
- corticosteroids.

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26
Q

Duration of therapy for pneumonias:

T/F: if a CAP patient is a febrile for 48-72hours and stable, treatment may be discontinued before the 5 days.

A

CAP at least 5 days.
HAP and VAP 7 days

True

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27
Q

What is the duration of Azithromycin PO 500mg for CAP?

A

3 days - it has a long half life and can remain in the body past those 3 days.

28
Q

What is the new flu medication?MOA?

A

Baloxavir Marboxil (Xofluza)

Endonuclease inhibitor.

29
Q

When you have aspiration PNA, there is concern for ______ bacteria. Treat with ______

A

Anaerobic
Metronidazole + PCN or amoxicillin or ampicillin/sulbactam.

30
Q

What are Paxlovid, Molnupravir and Remdesivir MOA?

A

Viral replication blockers. Use to tx COVID.

31
Q

You are treating a child for AOM with Penicillin G but they are not improving. What might the pathogen be? What would be a better antibiotic?

A

PRSP - penicillin resistant strep pneumoniae.
Amoxicillin - 1st line DOC in AOM.

32
Q

1st line DOC in AOM?

A

Amoxicillin.

33
Q

Most prevalent bacteria in AOM?

A

S. Pneumoniae.

34
Q

If the patient has received amoxicillin the the past 30days or hx of recurrent AOM, try _______
If patient is allergic to PCN_____

A

Amoxicillin/clavulanate
Anaphylaxis: consider Macrolide or clindamycin
Non-anaphylaxis: cephalosporin

35
Q

The younger the patient the ______ the course for AOM.

A

Longer

36
Q

Ibuprofen should be avoided in children <_____

A

6mo

37
Q

DOC for pharyngitis? Alternatives? Allergy to PCN?
Duration of course?

A

Penicillin
Amox or Cephalosporins.
Azithromycin or clindamycin
5-10 days

38
Q

What are some patient education facts about intra nasal ipratropium (class?)

A

Anticholinergic
Only use with rhinorrhea - doesn’t improve congestion post nasal drip or sneezing. Can potentially cause nose bleeds and dry mouth.

39
Q

Limit intra nasal decongestants to _____ to prevent _______

A

3-5 days
Rebound congestion.

40
Q

Oral decongestants are CI in _____

A

CV, DM, hyperthyroid

41
Q

read book “KEY CONCEPTS” for TB, CF, ARDS meds

A
42
Q

Typical tx regimen for CF patient

A

Albuterol for bronchospasm
Mucolytic agent (Doran’s Alfa, Hypertonic saline)
Inhaled antibiotics (Azithromycin)
PERT
Vit DEAK
Ursodiol (prevent liver disease)
Insulin if pancreatic insufficiency
And a precision therapy CTFR potentiators/agonist (Ivacaftor, Orkambi, Symdeko and Trikafta)

43
Q

What is the MOA of Dornase Alfa? (Mycolytic agent)
\

A

Recombinant human DNase that selectively cleaves extracellular DNA released during neutrophil degradation in viscous CF sputum.

44
Q

When might Hypertonic saline nasal spray be contraindicated in CF patients?

A

It can cause bronchospasm, so it must be administered together with a bronchodilator, and some patients do not tolerate it.

45
Q

How can high dose ibuprofen benefit CF patients?

A

MOA: inhibits lipoxygegnase pathway to reduce neutrophil migration and reduce release of lysosomal enzymes.
20-30mg/kg BID.

46
Q

Treatment for AXTIVE TB = ______

A

RIPE
Rifampin x6mo
Isoniazid x 6mo
Pyrazinamide for 2 mo
Ethambutol for 2 mo

47
Q

A patient is at high risk for failure of TB tx if they:

A

Have cavitary lesions or have positive AFB culture after 2mo of therapy.

48
Q

Treatment of LATENT TB

A

Mono therapy
Isoniazid for 9mo
OR
Rifampin x4 mo

49
Q

Treating LTBI decreases lifetime risk of developing active TB from _____ to_____

A

10% to 1%

50
Q

Rifampin SEs
CI?

A

Orange discoloration of body fluids
GI issues,
Severe immune rxn
CI with anti-xa inhibitor anticoagulants.

51
Q

Isoniazid SEs?

A

Hepatitis, peripheral neuropathy, monoamine poisoning.

52
Q

Pyrazinamide SEs

A

Hepatotoxic, GI, no gout poly arthritis, rash, hyperuricemia.

53
Q

Ethambutol SEs and clinical considerations?

A

Retrobulbar neuritis and peripheral neuritis

Baseline and monthly visual acuity.

54
Q

What can minimize effects of peripheral neuropathy when on isoniazid tx?

A

Daily Pyridoxine (or Vit-B6)

55
Q

Rifampin MOA

A

Inhibits bacterial DNA-dependent RNA polymerase by binding to the subunit and blocks the elongating of the RNA. Bacteria is unable to reproduce.

56
Q

MOA for isoniazid

A

Inhibit bacteria cell wall synthesis after being activated by the MTB enzyme KatG catalase.

57
Q

MOA for Pyrazinamide

A

Disrupt MTB membrane transport and energetic by Pyrazinoic acid

58
Q

T/F: the treatment of choice for NON-hemorrhagic hypovolemia is colloid-containing solutions.

A

FALSE>

Crystal Lodi solutions (LR, NS or Plasma-Lyte)

59
Q

When would someone with Non-Hemorrhagic hypovolemia need blood products?

A

If their corrected Hgb was <7

60
Q

What is the sodium, chloride concentration and osmolarity of plasma?
Na/Cl concentration and osmolarity of NS?
LR?
PlasmaLyte?

A

Plasma = Na 135-145, Cl 94-111, Osm 275-295
NS = Na 154, Cl 154, Osm 308
LR = Na 130, Cl 109, Osm 273
Plasma-Lyte = Na 140, Cl 98, Osm 294.

61
Q

Since NS has a _____ Na, ____ Cl and a ______ Osm than plasma, it would create what in the body if too much was infused?

Anyone receiving > _____L of NS is at risk.

A

More Na
More Cl
Higher Osm

It is HYPERTONIC - it would draw water out of the cells and tissue, and put too many negative ions in circulation causing hyperchloremic metabolic ACIDOSIS.

> 3L

62
Q

The comparison “ Robbing Peter to pay Paul “ can be used in what scenario?

A

Use of Colloid containing solutions in hypovolemia or patients who are 3rd spacing.
you boost intravascular volume, but starve the tissue.

63
Q

Why should colloids NOT be used in hemorrhagic patients?

A

It may boost the intravascular volume and BP TOO much and “pop the clot”

64
Q

When is albumin good to consider?

A

If stable patient is low albumin (liver failure)

65
Q

The rate of fluid replacement in hemorrhagic shock and hypovolemia should be _______

A

Individualized
Weight based

66
Q

Rate of fluid replacement in hypovolemia:

A

30ml/kg completed by 3 hours following presentation. (same as sepsis)

67
Q

Patient presents to ER with severe hypovolemia. They weigh 86kg. Fluids started at 1900. How much should be infused by 2200?

A

30ml/kg = 2,580ml in 3 hrs = 860ml/hr.

Pharmacology (20 decks)

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