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AANP Class - Leik, Sarah Michell, MedMastery, & Other > Respiratory / Pulmonary > Flashcards

Respiratory / Pulmonary Flashcards

(106 cards)

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1
Q

Pneumonia
s/s

A
  • cough, fever, fatigue, pleuritic chest pain
  • increased tactile fremitus (felt)
  • auscultate egophony which is increased resonance with eeeee that sounds like aaaaa indicating consolidation, decreased lung capacity, and pleural effusion
  • auscultate the lungs (crackles/rhonchi, decreased lung sounds over lower lobes with consolidation)
  • chest xray looking for areas of consolidation and infiltrates
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2
Q

PNA
diagnosis

A
  • chest xray looking for areas of consolidation and infiltrates
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3
Q

PNA prevention

A

flu vaccine (# complication is PNA)
pneumococcal vaccines

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4
Q

PNA prevention

When do I give PNA vaccines?

A

Healthy, immunocompetent persons 65 and older:
* a single dose of PPSV23
Persons with some chronic conditions asthma/copd, etc.:
* a single dose of PPSV23
Chronic kidney disease:
* both PCV13 and PPSV23
Sickle cell and asplenia (no spleen):
* both PCV13 and PPSV23
Immunocompromised:
* both PCV13 and PPSV23

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5
Q

Viral PNA

A

RSV
dry hacky cough
fatigue

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6
Q

Bacteria PNA

A

60-80% of PNA
- higher risk is asthma, COPD, cystic fibrosis

atypical PNA
Mycoplasma pneumoniae (walking PNA)
milder more persistent symtoms

typical PNA
Streptococcus PNA

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7
Q

Pneumonia
TX

  • 2 main choices (MAD Lung +)
A

MAD Lung

If patient is healthy and does not meet below criteria, treat with MAD
- Macrolides, such as azithromycin (Zithromax) - low resistance rates
- Amoxicillin (Amoxil)
- Doxycycline

If patient has co-morbidies OR taken any antibiotic in the last 90 days, treat with think
a) LUNG - levofloxacin/Levaquin (fluoroquinolones) - not cipro
OR
b) macrolide / azithromycin with amoxicillin

FOLLOW UP with chest x-ray at 8 weeks

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8
Q

Chronic obstructive pulmonary disease
COPD
Combination of 2 diseases

A

chronic bronchitis leads to cilia destruction
emphysema destroys alveoli = dyspnea + wheezing

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9
Q

COPD risk factors

A

occupational hazards
pollution
smoking

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10
Q

COPD
s/s

A

chronic cough
sputum production
dyspnea

  • percussion will be hyperresonate (hyper-expansion with increased thoracic gas)
  • feels like they have difficulty taking a good deep breath
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11
Q

COPD
COPD ASSESSMENT TEST = CAT
assessment components
Treat > 10

A

not used for diagnosis, measures quality of life with COPD and tracks changes over time

0–5 that reflects response, zero indicates no effect on quality of life, whereas a 5 suggests a very significant effect

  1. how often you cough
  2. how much mucus is in your cough/chest
  3. how much tightness you feel in your chest
  4. how out of breath you feel after walking uphill or climbing stairs
  5. how much your condition limits your activities at home
  6. how comfortable or safe you feel leaving your home with COPD
  7. how well you’re able to sleep
  8. how much energy you have

0–9 Low
10–20 Medium* significant disruption
21–30 High
31–40 Very high

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12
Q

COPD
Diagnosis

A

Spirometry
FEV1/FVC ratio
Score < 0.70 or 70% confirms diagnosis

Low FEV1/FVC ratio = obstructive airway disease
High FEV1/FVC ratio = reactive airway disease (asthma)

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13
Q

COPD
Group A = CAT < 10
tx

A

CAT < 10
0 or 1 exacerbation

Bronchodilators = drugs that open up airway
- TEROL
- SABA: albuterol (short)
- LABA: formoterol (long)

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14
Q

COPD
Group B = CAT >10
tx

A

CAT >10
0 or 1 exacerbation too (like group A but more significant)

Long Acting Medications:
LAMA: - PIUM = tiotropium
LABA: -TEROL = sameterol

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15
Q

COPD
Group C = CAT < 10
tx

A

CAT < 10
although CAT is less than 10, there are multiple exacerbations and/or hospitalizations

First Line
LAMA: -PIUM = start here!
Can also add: LABA/LAMA combo (remember LABA is -TEROL)

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16
Q

LABA/LAMA combination drugs

A

Tiotropium/olodaterol = Respimat = Once daily
Aclidinium/formoterol = Genuair = Twice daily
Umeclidinium/vilanterol = Ellipta = Once daily
Glycopyrronium/indacaterol = Breezhaler = Once daily
or Neohaler = Twice daily
Glycopyrronium/formoterol fumarate = Aerosphere = Twice daily

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17
Q

COPD
Group D = CAT > 10
tx

A

CAT > 10
multiple exacerbations and/or 1+ hospitalizations

First Line
LABA/LAMA combo
- remember LABA is -TEROL & LAMA is - PIUM

If symptoms are persistent may add ICS

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18
Q

Long Acting Beta Antagonists
LABA examples

A

salmeterol
formoterol
arformoterol
indacaterol
vilanterol
olodaterol

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19
Q

Long-acting muscarinic antagonists
LAMA

A

tiotropium
aclidinium
umeclidinium
glycopyrrolate (also called glycopyrronium)

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20
Q

Inhaled Corticosteroids
ICS examples

A

Beclomethasone Dipropionate
Budesonide
Ciclesonide
Fluticasone Furoate
Fluticasone Propionate
Mometasone
Mometasone Furoate HFA 100 or 200 mcg

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21
Q

COPD exasterbation s/s

A

increased difficulty breathing
increased sputum amount
increased sputum purulence (pus)

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22
Q

COPD exasterbation mild tx

A

SABA

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23
Q

COPD exasterbation moderate tx

A

SABA + antibiotics/steriods

Antibiotics
- macrolide
- tetracycline

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24
Q

COPD exasterbation severe tx

A

send to hospital

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25
COPD treatment order
Groups A to D A: bronchodilators SABA or LABA B: long acting medications LABA or LAMA C: LAMA D: LABA/LAMA combo likely with ICS
26
Asthma Diagnostic
forced expiratory volume FEV1 = amount of air forced out of lungs in one second HAG = Height, Age, Gender - this helps us with expected values * in children we take into account their weight
27
Asthma FEV1 Range
Step 1 & 2: Intermittent to Mild Persistent > 80% Step 3: Moderate 60% to 80% Step 4-5: Severe (refer) < 60% follow-up annually if not more
28
Asthma rescue inhaler
ICS/LABA combination - aka Budesonide/formoterol combination (Symbicort)
29
Asthma Symptom exacerbation number Step 1 Tx
Symptoms < 2x per month Treatment: 1. ICS-LABA PRN low dose inhaled corticosteroid (ICS) and formoterol - aka Budesonide/formoterol combination (Symbicort)
30
Asthma Symptom exacerbation number Step 2 Tx
Symptoms < 2x per month, but not daily L-ICS daily Treatment: 1. ICS-LABA PRN low dose inhaled corticosteroid (ICS) and formoterol - aka Budesonide/formoterol combination (Symbicort) OR 2. ICS-LABA Budesonide/formoterol combination
31
Asthma Symptom exacerbation number or... Step 3 Tx
Symptoms on most days or waking up 1x/week Treatment: ICS-LABA Budesonide/formoterol combination (Symbicort) L-ICS with LTRA Leukotriene receptor antagonist = montelukast = Singulair - great add on treat, but not an add on treatment
32
Asthma Symptom exacerbation number Step 4 Tx
Refer to pulmonology
33
Long Acting Beta Antagonists LABA examples
salmeterol formoterol arformoterol indacaterol vilanterol olodaterol
34
COPD treatment order
Groups A to D A: bronchodilators SABA or LABA B: long acting medications LABA or LAMA C: LAMA D: LABA/LAMA combo likely with ICS
35
Long-acting muscarinic antagonists LAMA
tiotropium aclidinium umeclidinium glycopyrrolate (also called glycopyrronium)
36
Long Acting Beta Antagonists LABA examples
salmeterol formoterol arformoterol indacaterol vilanterol olodaterol
37
COPD treatment order
Groups A to D A: bronchodilators SABA or LABA B: long acting medications LABA or LAMA C: LAMA D: LABA/LAMA combo likely with ICS
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Asthma main s/s
cough
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How do we determine success of asthma treatment?
Patients monitor symptoms daily and record s/s and reduction of symptoms shows what adjustments need to be made, but it's not based on rescue inhaler from before
40
What medication do we not prescribe by itself? Black Box Warning
Long-acting β-agonists (salmeterol and formoterol) received “black box” warnings because of severe with some associated death
41
What medication is now the cornerstone of asthma treatment?
- low dose inhaled corticosteroid (ICS) and formoterol - aka Budesonide/formoterol combination (Symbicort) - this is also our exacerbation treatment
42
What if the patient does not have full blown COPD but has symtoms?
presribe bronchodilator (SABA or LABA)
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COPD patient loses weight unintentional
Lung cancer is highest risk when pt has COPD (both genders) - high calorie, high protein, small meals if breathing is too much caloric output
44
CURB - 65
Confusion Urea (blood urea nitrogen) Respiratory rate > 20 or >30 depending on guidelines BP < 90/60 65 age 1 point each, great than 2 points = admission
45
Tuberculosis - TB - appearance on chest xray
consolidation in upper lobes
46
Tuberculosis - TB Diagnosis
* Confirmation of the TB diagnosis ◦ Acid-fast bacilli (AFB) smear, plus ◦ Three sputum cultures positive for mycobacterium tuberculosis
47
Tuberculosis - TB Mantoux
2 step test with 48-72 hours after the test - 15 mm + for general public - 10 mm + for individuals in high-risk settings or recent immigrants from high-risk countries - 5 mm+ for HIV-positive (CD4 count > 200) or immunocompromised patients taking tumor necrosis factor (TNF) inhibitors (4x) * note TNF Inhibitors are used to treat certain autoimmune diseases, Rheumatoid arthritis, Ankylosing spondylitis, Psoriatic arthritis
48
Differentiate mononucleosis from streptococcal pharyngitis (strep)?
1. splenomegaly for mono 2. palatal petechiae for strep
49
Streptococcal pharyngitis (strep) Tx
penicillins
50
Complication of untreated strep throat
Scarlett fever / Scarlatina (strawberry tongue), Rheumatic fever, Glomerulonephritis Rheumatic fever is a condition that can inflame or make the heart, joints, brain, and skin swell Glomerulonephritis is inflammation and damage to the filtering part of the kidneys (glomerulus)
51
Mononucleosis Tx
Symptom treatment
52
When can mono pt play sports?
Spleen ultrasound still enlarged
53
What if the patient has strep and mono? Tx
macrolide cephalosporin penicillin VK *not other penicillin to avoid morbilliform rash
54
Complication of strep throat...
Peritonsillar abscess which is a deviated uvula that are very painful and lead to sepsis
55
Bronchitis tx
- 95% are viral, do not treat with antibiotics unless it is pertussis (whooping cough) *dTap or Tdap prevents pertussis
56
Sinusitis tx
Amoxicillin Augmentin (amoxicillin/clavulanate)
57
Sinusitis s/s
upper respiratory s/s facial pressure toothache
58
Allergic Rhinitis tx
first line: avoid triggers 1. internasal corticosteroids - flonase 2. antihistamines - diphenhydramine (Benadryl) *avoid antihistamines in older population
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Allergic Reaction labs
IgE
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Anticholinergic Side Effects
dry mouth difficulty peeing - urinary retention sedating blurred vision constipation tachycardia confusion impaired memory
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Corticosteroids classic triad of atopy
asthma allergy atopic dermatitis
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AANP Class - Leik, Sarah Michell, MedMastery, & Other (20 decks)

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