LA pulm 2 Flashcards
asthma, influenza, pneumonia, TB
Samter’s triad
(aspirin exacerbated resp ds): asthma, chronic rhinosinusitis with nasal polyps, sensitivity to aspirin/or NSAIDs
3 component of asthma
bronchoconstriction, airway hyper-reactivity, inflammation
atopic triad
pts with condition are likely to develop one or 2 of the other: asthma, atopic dermatitis(eczema), and allergic rhinitis
extrinsic asthma trigger is Ig___
EEEEEEEEEEEEEEEEEE
PE with asthma
prolong expiration with wheezing, hyperresonance to percussion, decreased breath sounds, tachycardia/tachypnea
classic asthma triad s/s
dyspnea, wheezing, and cough especially at night
severe asthma and status asthmaticus
inability to speak full sentences, tripod, SILENT chest, altered mental status
bronchoprovocation to test asthma
methacholine challenge >20% decrease on FEV1 followed by bronchodilator challenge (increase of FEV1 >12%) expected
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
ABG in asthma
usually not ordered. repiratory alkalosis expected from tachypnea.
FEV1 in 4 levels of asthma
over 80% in intermittent and mild
60-80% in moderate
under 60% in severe
ratio if 4 levels of asthma
nml in intermittent and mild
5% reduction in moderate
>5% in severe
tx for intermittent asthma
inhaled SABA as needed
tx for mild asthma
inhaled corticosteroid plus inhaled SABA as needed
tx for moderate asthma
low dose ICS plus LABA or
(increase ICS to medium dose or leukotrine modifier)
tx for severe asthma
high dose ICS plus LABA
MOA of theophylline
bronchodilator that improves respiratory muscle endurance
what decreases theophylline levels
smoking
what drug is NOT used in acute asthma exacerbations
theophylline, LABA(salmeterol)
theophylline toxicity
arrhythmias and seizures
omalizumab
IgE antibody. for severe asthma
drug for allergic rhinitis/aspirin induced asthma
Leukotriene modifier: montelukast
what has been associated with churg-strauss syndrome
zafirulkast, leukotriene modifier
name anticholinergic
ipratropium, quick acting
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
- strep pneumo
- 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
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
