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Therapeutics > Thrp: Pulmonary > Flashcards

Thrp: Pulmonary Flashcards

1
Q

Cortisone

A

Endogenous Prodrug Glucocorticoid: Short acting (25)

Avoid in liver dz

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2
Q

Hydrocortisone

A

Glucocorticoid: Short acting (20)

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3
Q

Prednisone

A

Prodrug Glucocorticoid: Intermediate acting (5)
Avoid in liver dz

CF Tx: Not used chronically
CF Dose:1-2mg/kg on alternating days

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4
Q

Prednisolone

A

Glucocorticoid: Intermediate acting (5)

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5
Q

Methylprednisolone

A

Glucocorticoid: Intermediate acting (4)

No mineral-retaining potency

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6
Q

Triamcinolone

A

Glucocorticoid: Intermediate acting (4)
No mineral-retaining potency

Nasal Steroid AQ

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7
Q

Betamethasone

A

Glucocorticoid: Long Acting (0.6)
No mineral-retaining potency
6mg = 3.25 days HPA-axis suppression

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8
Q

Dexamethasone

A

Glucocorticoid: Long acting (0.75)
No mineral-retaining potency
5mg = 2.75 days HPA-axis suppression

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9
Q

Fludrocortisone

A

Glucocorticoid: Aldosterone mimetic (125X mineralocorticoid)
Tx: primary/secondary adrenal replacement

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10
Q

Steroid Dosing: Low Dose

A

5-15mg/day

Maintenance therapy

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11
Q

Steroid Dosing: Moderate Dose

A

0.5mg/kg/day

Non-Sx manifestations of mild to mod disease/Maintenance therapy

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12
Q

Steroid Dosing: High Dose

A

1-3mg/kg/day

Control active disease (two edge sword)

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13
Q

Colchicine

A

Anti-Gout: Steroid sparing therapy

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14
Q

Methotrexate

A

Chemo: Steroid sparing therapy

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15
Q

Albuterol

A

SAβA
Tx: Asthma & COPD & CF (neb)
MDI Dose: 2-4puff q4-6hr prn
Neb: 0.63-5mg udv q6-8hr prn

Proventil, Ventolin, ProAir HFA
Accuneb, Proventil Neb
Provental Tab/Syrup

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16
Q

Levalbuterol

A

SAβA: 0.63mg Levalbuterol = 1.25 Albuterol
MDI Dose: 2-4puff q4-6hr prn
Neb: 0.31-1.25mg udv q6-8hr prn

Xopenex MDI/Neb

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17
Q

Pirbuterol

A

SAβA
2 pffs q4-6h (max 12pffs/day)

Maxair autoinhaler

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18
Q

Epinephrine

A

SAβA: Systemic is an issue both alpha and beta
Dose: (>4hr: 0.5ml (11.25mg) via EZ breathe atomizer 1-3 inhalations q3hr prn (Max 12 inh/24hrs)

Asthamnefrine

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19
Q

Terbutaline

A

SAβA: only one formulated for parenteral use RARE
PO and SubQ dosing
Tx: Asthma also delay labor

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20
Q

Albuterol/Ipratropium

A

SAβA + AntiACH
Combivent MDI (off market 2013)
Combivent Respimat : 1 inh QID
Duoneb: 3ml neb QID

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21
Q

Arformoterol

A

LAβA
15mg/2ml neb bid
*Tx: ONLY COPD indication

(Brovana)

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22
Q

Formoterol

A

LAβA
(Foradil aerolizer) DPI: 1cap via inhaler BID
Tx: COPD indication only

(Perforomist) 12mcg puff bid OR 20mcg neb BID
Tx: COPD indication only

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23
Q

Salmeterol

A

LAβA
DPI: 1 puff BID
Tx: asthma, exercise induced bronchospasm, COPD

(Serevent Diskus)

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24
Q

Indacaterol

A

LAβA: Ultra-long
DPI 75mcg QD*
Tx: COPD indication only

(Arcapta Neohaler)

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25
Q

Ipratropium

A

SAMA
Asthma:
2-3pffs q6hr with SAβA

COPD:
2-6 inhalations QID (max 12/day)

Rhinitis:
primary tx if rhinorrhea is prominent Sx
1-2 sprays each nostril BID-TID
*Taper up to avoid Bloody Nose

AE: dry mouth, dryness
(Atrovent)

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26
Q

Beclomethasone

A 
Inhaled Corticosteroid
(Qvar)

Nasal Steroid AQ/mdi

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27
Q

Budesonide

A

Inhaled Corticosteroid

(Pulmicort Flexhaler)
or Neb = Pulmicort respules (0.25mg/2ml or 0.5mg/2ml)
0.5-1mg QD

Nasal Steroid AQ
(Rhinocort)

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28
Q

Ciclesonide

A

Inhaled Corticosteroid: “Soft Steroid” On Site activated (still SE)
(Alvesco)

Nasal Steroid AQ/mdi

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29
Q

Fluticasone

A

Inhaled Corticosteroid
(Flovent)

Nasal Steroid (prop and fur) AQ

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30
Q

Mometasone

A

Inhaled Corticosteroid
(Asmanex Twisthaler)

Nasal Steroid AQ (Nasonex)

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31
Q

Fluticasone/Salmeterol

A

Combo: Inhaled Corticosteroid + LAβA
DPI: (Advair Discus) 250/500mcg or 500/500mcg puff BID
MDI (Advair HFA) 115/21 or 230/21mcg 2 puffs BID

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32
Q

Budesonide/Formoterol

A

Combo: Inhaled Corticosteroid + LAβA
MDI : 2 puffs BID (80/4.5 or 160/4.5mcg)

(Symbicort HFA()

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33
Q

Mometasone/Formoterol

A

Combo: Inhaled Corticosteroid + LAβA
MDI: 2puffs BID (100/5 or 200/5mcg)

(Dulera)

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34
Q

Theophylline

A

Me-Xanthine: ~PDE-III/IV inhibitor
2nd/3rd line for chronic asthma: COPD use is controversial (added if pt fails other rx or is non-compliant)

Many SE/DDI

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35
Q

Zafirlukast

A

Leukotriene Modifier Leukotriene Receptor Antagonist (LTRA)
Tx: Asthma
20mg BID AC

Many DDI

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36
Q

Zileuton

A

Leukotriene Modifier
1200mg BID

Many DDI

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37
Q

Montelukast

A 
Leukotriene Modifier
Tx: Astma
10mg qpm or ≥ 2hrs before exercise
Allergic Rhinitis (only proven to be better than Px here)
10mg qpm

Less DDI

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38
Q

Omalizumab

A

MAb inhibits binding of IgE to Receptor (IgE highest on cascade)
Tx: Asthma
AE: *Anaphylaxis,
(Xolair$$$10,000/yr)

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39
Q

Asthma Tx: Step 1

A

SAβA PRN

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40
Q

Asthma Tx: Step 2

A

Low-dose ICS

41
Q

Asthma Tx: Step 3

A

Low-dose ICS + LAβA
OR
Med-dose ICS (if CI to β-Ag)

42
Q

Asthma Tx: Step 4

A

Med-Dose ICS + LAβA

43
Q

Asthma Tx: Step 5

A

High-dose ICS + LAβA
AND
Consider Omalizumab for pts who have allergies

44
Q

Asthma Tx: Step 6

A

High-dose ICS + LAβA + Oral corticosteroid
AND
Consider Omalizumab for pts who have allergies

45
Q

Nicotine gum

A

2mg for 25mg/day

Chew 1 piece q1-2hr (max 30 (2mg) piece/day; 20 (4mg)/day)
**Technique: Chew and park for 30 min then discard; “peppery” “park”

Avoid acidic beverages for 15 min before and after gum (impairs absorption)

46
Q

Nicotine patch

A

7,14,21mg: Step down therapy (Dose= 1mg/cig; max one 21mg patch)

1 patch/day
Technique: place on hairless location between the neck and waist. Rotate sites daily)

AE: Skin irritation: tx rotate sites or apply hydrocortisone crm

47
Q

Nicotine inhaler

A

10mg/cartridge (delivers 4mg nicotine)
puff like cig continuously for 20min

AE: Sore throat, cough
Electronic cig NOT healthy: an unregulated product

48
Q

Nicotine nasal spray

A

Rx: 0.5mg/spray
Use 1 spray each nostril per hr prn: max 5doses/hr; 40doses/day

AE: irritation Addictive

49
Q

Nicotine lozenge

A

2,4mg step therapy
sig:1 lozenge only q1-2hr wk 1-6; q2-4hr wk 7-9; q4-8hr wk 10-12

Taste bad

50
Q

Bupropion SR

A

150mg qd x 3d TH 150mg bid x 7-12 wks
Set quit date 1wk after starting the med
enroll in program
May be used with nicotine patch

AE: insomnia, dry mouth, tremor;
safe in pts with stable or acute CV dz

51
Q

Varenicline

A

sig: 0.5mg qd x 1-3 days th bid for 4-7 days th 1mg bid for 2-12 wks

Set quit date 1 wk from starting med

AE: n/v unusual dreams
STOP taking med if depressed mood suicidal thoughts or behavior

Safe in pts with stable CV w/o Hx of depression or psych Dz

52
Q

Nicotine Replacent CI’s

A

Tx: Heavier smokers (15 cig/day)

RELATIVE CI: Pregnancy, CV dz (recent MI, angina, arrhythmia)
DO NOT smoke while on replacement

53
Q

Tiotropium bromide

A

LAMA (m3 antagonist)
Handihaler: 1 puff qd

AE: dry mouth
(Spiriva)

54
Q

Aclidinium

A

LAMA (m3 antagonist)
1 puff BID

AE: dry mouth
(Spiriva)

55
Q

Roflumilast

A

PDE-4 inhibitor
500mg QDay
TX: COPD (limited efficacy and $$$)

AE: GI, HA, Dizziness, insomnia
MANY DDI: CYP 3A4

56
Q

Oxygen

A

COPD Tx: ONLY tx shown to red. mortality

on for 15hrs/day to be beneficial

57
Q

COPD pts Vaccinations

A

Annual seasonal
Pneumococcal
Tdap

58
Q

COPD: Group A Tx

A

SAMA prn OR SAβA

Essential: Smoking Cessation;
Physical exercise; flu and pneumococcal vaccine

59
Q

COPD: Group B Tx

A

LAMA or LAβA

Essential: Smoking Cessation; Pulmonary Rehab
Physical exercise; flu and pneumococcal vaccine

60
Q

COPD: Group C Tx

A

ICS + LAβA or LAMA

Essential: Smoking Cessation; Pulmonary Rehab
Physical exercise; flu and pneumococcal vaccine

61
Q

COPD: Group D Tx

A

ICS + LAβA or LAMA

Essential: Smoking Cessation; Pulmonary Rehab
Physical exercise; flu and pneumococcal vaccine

62
Q

Diphenhydramine

A

1st gen antihistamine

High Anti - H/ACH/Sedation

63
Q

Brompheniramine

A

First Gen Antihistamine

Slightly safer profile: Dec Sedation

64
Q

Chlorpheniramine

A

First Gen Antihistamine

Slightly safer profile: Dec Sedation

65
Q

Fexofenadine

A

2nd Gen antihistamine (OTC)

Allegra

66
Q

Loratadine

A

2nd Gen antihistamine (OTC)

Claritin

67
Q

Desloratadine

A

2nd Gen antihistamine

Clarinex

68
Q

Cetirizine

A

2nd Gen antihistamine (OTC)
Caution metabolized to Hydoxyzine (1st gen anti-H)

(Zyrtec)

69
Q

Levocetirizine

A

2nd Gen antihistamine

Xyzal

70
Q

Levocabastine

A

Ocular Antihistamine

1-2 gtt QID

71
Q

Emedastine

A

Ocular Antihistamine

1 gtt QID

72
Q

Bepostastine

A

Ocular Antihistamine

1 gtt BID*

73
Q

Azelastine

A

Ocular Anti-Histamine/Mast Cell Stabilizer
1 gtt BID

OR Nasal Anti-histamine
2 spray BID
*Taste Terrible
(Astelin, Astepro)

74
Q

Olopatidine

A

Ocular Anti-Histamine/Mast Cell Stabilizer
1 gtt BID
Minimal mast cell activity

OR Nasal Anti-histamine
2 spray BID
(Patanase)

75
Q

Ketotifen

A

Ocular Anti-Histamine/Mast Cell Stabilizer

1 gtt TID - QID

76
Q

Ketorolac

A

NSAID approved for eye (Acular)
1-2 gtt QID

Systemic Toxicity SE’s

77
Q

Phenylephrine

A

Oral and Topical Decongestant:

4 hr prep

78
Q

Naphazoline

A

Topical Decongestant:

4-6 hr prep

79
Q

Oxymetazoline

A

Topical Decongestant:

12 hr prep

80
Q

Xylometazoline

A

Topical Decongestant:

12 hr prep

81
Q

Pseudoephedrine

A

Oral decongestant

82
Q

Cromolyn

A

Mast Cell Stabilizer: Ocular and Nasal Preps

83
Q

Fluticasone prop/Azelastine

A

Combo Nasal Steroid/Antihistamine
1spray BID
Alone fluticasone takes 2wks to work, azelastine works immediately but bad taste
(Dymista)

84
Q

Tobramycin

A

Chronic CF ABx
IV or Nebulized
28 Days on 28 days off

85
Q

Aztreonam

A

Mono-lactam for Chronic CF ABx for pts w/ pseudomonas

86
Q

Azithromycin

A

CF Abx used chronically: has more of a anti-inflamatory MOA

87
Q

Dornase Alfa

A

(Pulmozyme) Cleaves DNA: loosens mucus
2.5mg Neb QD-BID

Protect from light
AE: Hoarseness and sore throat

88
Q

Hypertonic Saline

A

MOA: Replete sodium/water content w/in lung
7% neb BID

AE: Can cz bronchospasm: *Admin Albuterol prior to hypertonic saline

89
Q

Ivacaftor

A

MOA: Chloride channel potentiator
*Tx specific g551d mutation (squeaky gate)
150mg PO BID (daily in hepatic impairment)

Must monitor LFT quarterly 1st yr
DDI: 3A4 (monitor pts meds)
($294,000/yr)

90
Q

CF Tx Regim

A
  1. Albuterol
  2. Pulmozyme
  3. Hypertonic saline (can switch 2,3)
  4. Airway clearance technique
  5. Inhaled tobramycin/aztreonam
  6. Inhaled steroid
91
Q

Pancrealipase

A

Pancreatic enzyme:
Do Not Substitute no AB ratings
individual agents dosed based on LIPASE Enz

*DOSE:
500 U /kg/meal
250 U /kg/snack
Adjust: ±125-250 U /kg/meal until stool is normal

MONITOR: Stool freq, vol, appearance (normal 1-2 stools/day)

DNE: 2500 U/kg/meal => fibrosing colonapathy (>6000U/kg/meal=colonic stricture)

92
Q

Ranitadine

A

H2 Antagonist: Adjunct CF therapy
2-4mg/kg/dose to ic pH and allow for enzyme activity

Also to tx CF-GERD

Preferred over omeprazole

93
Q

ADEK

A

Vitamin A,D,E,K for CF pts

2T qDay

94
Q

GoLytely

A

To Tx CF DIOS

95
Q

Polyethylene Glycol 3350 NF

A

Prevent CF DIOS

17gm/day

96
Q

Ursodeoxycholic acid

A

“Liver Diuretic”

15-30mg/kg/day (NTE 900mg/day)

97
Q

CF Vaccinations

A 
Annual seasonal
Pneumococcal
Tdap
Hep A/B
HPV
98
Q

CF Ibuprofen Dosing

A

Typ: 25mg.kg BID
To tx asthma component
Test 20-30mg/kg and obtain blood leves 1,2,3 hrs later
Goal [ ] = 50-100mg/L

Therapeutics (10 decks)

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