LA pulm 2 Flashcards by Mai Wells

Samter’s triad

(aspirin exacerbated resp ds): asthma, chronic rhinosinusitis with nasal polyps, sensitivity to aspirin/or NSAIDs

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3 component of asthma

bronchoconstriction, airway hyper-reactivity, inflammation

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atopic triad

pts with condition are likely to develop one or 2 of the other: asthma, atopic dermatitis(eczema), and allergic rhinitis

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extrinsic asthma trigger is Ig___

EEEEEEEEEEEEEEEEEE

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PE with asthma

prolong expiration with wheezing, hyperresonance to percussion, decreased breath sounds, tachycardia/tachypnea

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classic asthma triad s/s

dyspnea, wheezing, and cough especially at night

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severe asthma and status asthmaticus

inability to speak full sentences, tripod, SILENT chest, altered mental status

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bronchoprovocation to test asthma

methacholine challenge >20% decrease on FEV1 followed by bronchodilator challenge (increase of FEV1 >12%) expected

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best and most objective way to assess exacerabation severity and pat response to treatment

peak expiratory flow rate, discharge if PEFR>70% or PERF>15% initial attempt

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ABG in asthma

usually not ordered. repiratory alkalosis expected from tachypnea.

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FEV1 in 4 levels of asthma

over 80% in intermittent and mild
60-80% in moderate
under 60% in severe

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ratio if 4 levels of asthma

nml in intermittent and mild
5% reduction in moderate
>5% in severe

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tx for intermittent asthma

inhaled SABA as needed

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tx for mild asthma

inhaled corticosteroid plus inhaled SABA as needed

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tx for moderate asthma

low dose ICS plus LABA or

(increase ICS to medium dose or leukotrine modifier)

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tx for severe asthma

high dose ICS plus LABA

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MOA of theophylline

bronchodilator that improves respiratory muscle endurance

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what decreases theophylline levels

smoking

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what drug is NOT used in acute asthma exacerbations

theophylline, LABA(salmeterol)

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theophylline toxicity

arrhythmias and seizures

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omalizumab

IgE antibody. for severe asthma

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drug for allergic rhinitis/aspirin induced asthma

Leukotriene modifier: montelukast

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what has been associated with churg-strauss syndrome

zafirulkast, leukotriene modifier

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name anticholinergic

ipratropium, quick acting

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name long acting ICS

beclomethasone, flunisolide, triamcinolone

name LABA

salmeterol(sometimes with fluticasone), formoterol(with bodesonide),

name mast cell modifiers

long acting,cromolyn, nedocromil

what drug is used only for prophylaxis

cromolyn, mast cell modifier

what med for chronic maintenance for asthma

long acting ICS, beclomethasone, flunisolide, triamcinolone

SABA is a bronchodilator that works ____

peripherally

what med is useful in the first hour

anticholinergic, ipratropium

what med decreses relapse and reverses the late pathophysiology

prednisone,

when to use a LABA

if persistant asthma is not controlled with ICS alone

antivirals for who with the flu

hospitalized or high risk of complications, over 65 yo

main s/s for flu

abrupt onset ha, fever/chills, malaise, URI, myalgias of legs and lower back

neuraminidase inhibitor for flu

oseltamivir if initiated with 48 hours of symptom onset. good for type a and b

contraindication to zanamir

egg allergy

amantadine and rimantadine for flu

only for influenza a. high level of resistance.

when to start flu vaccine

6 months and older

attenuated flu vaccine for what ages

2-49 yo

contraindications to flu vaccines

guillain-barre syndrome within 6 weeks after previous flu shot, high fever, infants under 6 months

contraindications to attenuated flu vaccine

immunocompromised pts and their close contacts, PG, adults 50 and over, got other vaccine within 48 hours

rusty blood tinged sputum; gm + diplococci

strep pneumonia

1st and 2nd most common cause of CAP

1. strep pneumo 2. h. flu

purple colored sputum

klebsiella

pneumonia, chronic alcoholism

klebsiella

most common cause of atypical walking pneumonia

mycoplasma

pneumonia of young and healthy pts

mycoplasma

pneumonia with high incidence of hyponatremia and increased LFTs

legionella

pneumonia with complications of SJS, cold autoimmune hemolytic anemia

mycoplasmic

foul smelling sputum, rotten eggs

aspiration pneumonia; anaerobes

soil containing bat and bird droppings in Mississippi and Ohio rivers

histoplasmosis

name 3 atypical pneumonias

mycoplasma, chlamydia, legionella

rigors

strep pneumo

most common in right lower lobe of lung

aspiration pneumonia

CXR: reticulonodular pattern

mycoplasma

prominent GI sx: watery diarrhea

legionella

CXR: cavitary lesions hallmark

klebsiella

dx test for atypical pneumonias

PCR

which pneumonia lacks a cell wall

mycoplasma so naturally resistant to beta lactams

first line tx for aspiration pneumonia

ampicillin/sulbactram or augmentin

what pneumonia can mimick TB

histoplasmosis

histoplasmosis most specific test

cultures. antigen testing via sputum or urine high specific too

PCP pneumonia rf CD4 amount

under 200

PCP pneumonia sx triad

dyspnea on exertion, fever, non productive cough

oxygen desaturation with ambulation

PCP pneumonia

CXR: diffuse bilateral interstitial infiltrates

PCP pneumonia

labs in PCP pneumonia

increased LDH and beta D glucan

labs in PCP pneumonia

direct fluorescent antibody staining done for what

PCP pneumonia sputum from bronchoavleolar lavage

orange colored urine/tears

rifampin

SE of peripheral neuropathy

isoniazid, give B6 and ethambutol

SE photosensitivity dermatologic rash, hepatitis, hyperuricemia

pyrazinamide

SE of optic neuritis

ethambutol

SE of ototoxicity and nephrotoxicity

strepomycin; alternative for ethambutol

tx of latent TB infection

INH and pyroxidine, vit B6 for 9 months

tx of active TB infection

all 4 drugs x 2 months, then rifampin and isoniazid for 2 months

test for TB with a pt that had a BCG vaccine in the past

interferon gamma release assay

CXR of reactivation and primary TB

reactivation is apical/upper lobe fibrocavitary disease and primary TB is middle/lower lobe consolidation

anergy

false neg PPD test due to sarcoidosis or HIV

LA pulm 2 Flashcards

asthma, influenza, pneumonia, TB