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Therapeutics > Thrp: Pulmonary > Flashcards

Thrp: Pulmonary Flashcards

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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
Ipratropium
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)
26
Beclomethasone
``` Inhaled Corticosteroid (Qvar) ``` Nasal Steroid AQ/mdi
27
Budesonide
Inhaled Corticosteroid (Pulmicort Flexhaler) or Neb = Pulmicort respules (0.25mg/2ml or 0.5mg/2ml) 0.5-1mg QD Nasal Steroid AQ (Rhinocort)
28
Ciclesonide
Inhaled Corticosteroid: "Soft Steroid" On Site activated (still SE) (Alvesco) Nasal Steroid AQ/mdi
29
Fluticasone
Inhaled Corticosteroid (Flovent) Nasal Steroid (prop and fur) AQ
30
Mometasone
Inhaled Corticosteroid (Asmanex Twisthaler) Nasal Steroid AQ (Nasonex)
31
Fluticasone/Salmeterol
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
32
Budesonide/Formoterol
Combo: Inhaled Corticosteroid + LAβA MDI : 2 puffs BID (80/4.5 or 160/4.5mcg) (Symbicort HFA()
33
Mometasone/Formoterol
Combo: Inhaled Corticosteroid + LAβA MDI: 2puffs BID (100/5 or 200/5mcg) (Dulera)
34
Theophylline
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
35
Zafirlukast
Leukotriene Modifier Leukotriene Receptor Antagonist (LTRA) Tx: Asthma 20mg BID AC Many DDI
36
Zileuton
Leukotriene Modifier 1200mg BID Many DDI
37
Montelukast
``` Leukotriene Modifier Tx: Astma 10mg qpm or ≥ 2hrs before exercise Allergic Rhinitis (only proven to be better than Px here) 10mg qpm ``` Less DDI
38
Omalizumab
MAb inhibits binding of IgE to Receptor (IgE highest on cascade) Tx: Asthma AE: *Anaphylaxis, (Xolair$$$10,000/yr)
39
Asthma Tx: Step 1
SAβA PRN
40
Asthma Tx: Step 2
Low-dose ICS
41
Asthma Tx: Step 3
Low-dose ICS + LAβA OR Med-dose ICS (if CI to β-Ag)
42
Asthma Tx: Step 4
Med-Dose ICS + LAβA
43
Asthma Tx: Step 5
High-dose ICS + LAβA AND Consider Omalizumab for pts who have allergies
44
Asthma Tx: Step 6
High-dose ICS + LAβA + Oral corticosteroid AND Consider Omalizumab for pts who have allergies
45
Nicotine gum
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
Nicotine patch
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
Nicotine inhaler
10mg/cartridge (delivers 4mg nicotine) puff like cig continuously for 20min AE: Sore throat, cough Electronic cig NOT healthy: an unregulated product
48
Nicotine nasal spray
Rx: 0.5mg/spray Use 1 spray each nostril per hr prn: max 5doses/hr; 40doses/day AE: irritation Addictive
49
Nicotine lozenge
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
Bupropion SR
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
Varenicline
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
Nicotine Replacent CI's
Tx: Heavier smokers (15 cig/day) **RELATIVE CI**: Pregnancy, CV dz (recent MI, angina, arrhythmia) DO NOT smoke while on replacement
53
Tiotropium bromide
LAMA (m3 antagonist) Handihaler: 1 puff qd AE: dry mouth (Spiriva)
54
Aclidinium
LAMA (m3 antagonist) 1 puff BID AE: dry mouth (Spiriva)
55
Roflumilast
PDE-4 inhibitor 500mg QDay TX: COPD (limited efficacy and $$$) AE: GI, HA, Dizziness, insomnia MANY DDI: CYP 3A4
56
Oxygen
COPD Tx: ONLY tx shown to red. mortality | on for 15hrs/day to be beneficial
57
COPD pts Vaccinations
Annual seasonal Pneumococcal Tdap
58
COPD: Group A Tx
SAMA prn OR SAβA Essential: Smoking Cessation; Physical exercise; flu and pneumococcal vaccine
59
COPD: Group B Tx
LAMA or LAβA Essential: Smoking Cessation; Pulmonary Rehab Physical exercise; flu and pneumococcal vaccine
60
COPD: Group C Tx
ICS + LAβA or LAMA Essential: Smoking Cessation; Pulmonary Rehab Physical exercise; flu and pneumococcal vaccine
61
COPD: Group D Tx
ICS + LAβA or LAMA Essential: Smoking Cessation; Pulmonary Rehab Physical exercise; flu and pneumococcal vaccine
62
Diphenhydramine
1st gen antihistamine | High Anti - H/ACH/Sedation
63
Brompheniramine
First Gen Antihistamine | Slightly safer profile: Dec Sedation
64
Chlorpheniramine
First Gen Antihistamine | Slightly safer profile: Dec Sedation
65
Fexofenadine
2nd Gen antihistamine (OTC) | Allegra
66
Loratadine
2nd Gen antihistamine (OTC) | Claritin
67
Desloratadine
2nd Gen antihistamine | Clarinex
68
Cetirizine
2nd Gen antihistamine (OTC) Caution metabolized to Hydoxyzine (1st gen anti-H) (Zyrtec)
69
Levocetirizine
2nd Gen antihistamine | Xyzal
70
Levocabastine
Ocular Antihistamine | 1-2 gtt QID
71
Emedastine
Ocular Antihistamine | 1 gtt QID
72
Bepostastine
Ocular Antihistamine | 1 gtt BID*
73
Azelastine
Ocular Anti-Histamine/Mast Cell Stabilizer 1 gtt BID OR Nasal Anti-histamine 2 spray BID *Taste Terrible (Astelin, Astepro)
74
Olopatidine
Ocular Anti-Histamine/Mast Cell Stabilizer 1 gtt BID Minimal mast cell activity OR Nasal Anti-histamine 2 spray BID (Patanase)
75
Ketotifen
Ocular Anti-Histamine/Mast Cell Stabilizer | 1 gtt TID - QID
76
Ketorolac
NSAID approved for eye (Acular) 1-2 gtt QID Systemic Toxicity SE's
77
Phenylephrine
Oral and Topical Decongestant: | 4 hr prep
78
Naphazoline
Topical Decongestant: | 4-6 hr prep
79
Oxymetazoline
Topical Decongestant: | 12 hr prep
80
Xylometazoline
Topical Decongestant: | 12 hr prep
81
Pseudoephedrine
Oral decongestant
82
Cromolyn
Mast Cell Stabilizer: Ocular and Nasal Preps
83
Fluticasone prop/Azelastine
Combo Nasal Steroid/Antihistamine 1spray BID Alone fluticasone takes 2wks to work, azelastine works immediately but bad taste (Dymista)
84
Tobramycin
Chronic CF ABx IV or Nebulized 28 Days on 28 days off
85
Aztreonam
Mono-lactam for Chronic CF ABx for pts w/ pseudomonas
86
Azithromycin
CF Abx used chronically: has more of a anti-inflamatory MOA
87
Dornase Alfa
(Pulmozyme) Cleaves DNA: loosens mucus 2.5mg Neb QD-BID Protect from light AE: Hoarseness and sore throat
88
Hypertonic Saline
MOA: Replete sodium/water content w/in lung 7% neb BID AE: Can cz bronchospasm: *Admin Albuterol prior to hypertonic saline
89
Ivacaftor
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
CF Tx Regim
1. Albuterol 2. Pulmozyme 3. Hypertonic saline (can switch 2,3) 4. Airway clearance technique 5. Inhaled tobramycin/aztreonam 6. Inhaled steroid
91
Pancrealipase
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
Ranitadine
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
ADEK
Vitamin A,D,E,K for CF pts | 2T qDay
94
GoLytely
To Tx CF DIOS
95
Polyethylene Glycol 3350 NF
Prevent CF DIOS | 17gm/day
96
Ursodeoxycholic acid
"Liver Diuretic" | 15-30mg/kg/day (NTE 900mg/day)
97
CF Vaccinations
``` Annual seasonal Pneumococcal Tdap Hep A/B HPV ```
98
CF Ibuprofen Dosing
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

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