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Pharmacology > Lecture 10 (pulm)-Exam 5 > Flashcards

Lecture 10 (pulm)-Exam 5 Flashcards

1
Q

Pathophysio

Asthma:
* Allergen from an environmental trigger picked up by what?
* What do the cells present them to?
* What is released after that?

A
  • Allergen from an environmental trigger picked up by dendritic cells
  • Dendritic cells present them to TH2 cells
  • TH2 cells release cytokines causing inflammation-> Cytokines (IL4 and IL5)
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2
Q

Pathophysio

What does IL4 and IL5 cause?

A

IL4
* Stimulates B-cells to produce IgE which binds to Fc€RI receptors on mast cells
* Mast cells use phospholipase A2 to produce arachidonic acid (AA)
* AA metabolized by:
* COX to prostaglandins
* 5-LOX to leukotrienes

IL5
* Activates eosinophils
* Promotes immune response by releasing more cytokines and leukotrienes

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3
Q

Asthma
* Airway obstruction caused by what? (irreversible or not?)
* Part of what triad?

A
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4
Q

ASTHMA – GOALS OF TREATMENT
* Reduce impairment: Prevent what, require what, normal what?

A
  • Prevent chronic symptoms (if no txt: damage)
  • Require minimal use of reliever (ex: SABA)
  • Normal or near normal lung function and activity levels
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5
Q

Asthma: goals of treatment:
* Reduce risk: Prevent what? (2) Minimize what? (2)

A
  • Prevent exacerbations
  • Minimize need for emergency care and hospitalization
  • Prevent decreased lung function
  • Minimize pharmacotherapy adverse effects
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6
Q

What are the Nonpharmacologic treatment of asthma? (4)

A
  • Avoidance of environmental triggers
  • Avoidance of dietary triggers
  • Weight loss
  • Breathing exercise programs->Adults
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7
Q
A
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8
Q

Medication definitions
* What is a reliever?
* What is a controller? Use with what?
* What is maintenance treatment?

A

Reliever
* For symptom relief or before exercise or allergen exposure

Controller (kinda like a mix of reliever and maintence)
* For symptom control and exacerbation risk
* Used with ICS-containing treatment

Maintenance treatment
* Used daily to prevent symptoms and exacerbations (e.g., twice a day)

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9
Q

NIH treatment guidelines
* All asthma guidelines follow what?
* Specific steps of the ladder depend on what?

A
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10
Q

Asthma classification
* Classification based on what?(2)
* What is each one based on?

A
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11
Q

What is the classification of intermittent asthma? (Symptoms, nighttime awakings, SABA use, asthma excerbations for ages 0-4, 5-11, over 12)

A

This is step one

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12
Q

What is the step one or intermittent astma txt?

A

SABA (reliever) as needed for symptoms
* All ages
* Use throughout all steps for symptom control in addition to other therapies

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13
Q

What is new step one or intermittent asthma txt for 0-4 years old?

A

Consider short course ( 7 to 10 days) ICS at start of respiratory tract infection

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14
Q

What are the two SABA choices?

A

Albuterol and levalbuterol

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15
Q

Albuterol:
* What are the dosage forms?
* Usual dose rang for mild symptom control?
* Usual dose range for exacerbations?

Need to know the dosages for albuterol

A
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16
Q

Levalbuterol:
* What are the dosage forms?
* What is the usual dose range for mild symptom control?
* What is the usual dose range for excerbations?

A
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17
Q

What are the beta 2 adverse effects?

A
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18
Q

What is the classifcation for Mild persistent asthma? (Symptoms, nighttime awakings, SABA use, asthma excerbations for ages 0-4, 5-11, over 12)

A
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19
Q

Mild persistent or step 2:
* What is the preferred txt for all patients?
* What is the alternative txt for all patients?
* What do you with the controller? What does it not work as?

A

All Patients:
* Preferred treatment : low-dose ICS (controller)+ SABA for sx
* Alternative: montelukast

Controllers
* Take everyday regardless of symptomatic or not
* Will not work as rescue therapy

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20
Q

For mild persistent asthma or step two:
* What should you consider for allergic asthma (adults+children over five)

A

Consider SC immunotherapy for patients with allergic asthma

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21
Q

What are the different ICS? (you need to be able to recognize them)

A
  • Beclomethasone HFA (Qvar)
  • Budesonide DPI (Pulmicort)
  • Fluticasone propionate DPI (Flovent Diskus)
  • Fluticasone furoate DPI (Arnuity Ellipta)
  • Mometasone DPI (Asmanax Twisthaler)
  • Mometasone HFA (Asmanax HFA)

BE BUDs with FLUTtering MOM

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22
Q

ICS:
* What are the different doses?
* When does the dose change?

A
  • Low – Med – High dose ICS
  • changes with age groups

Multiple strengths exist

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23
Q

What is the classifcation for moderate persistent asthma? (Symptoms, nighttime awakings, and SABA use for ages 0-4, 5-11, over 12)

A
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24
Q

Moderaten persistent asthma or step 3:
* What is the txt for patients 0-4 years old?

A
  • Preferred: medium dose ICS + saba for sx
  • Consult asthma specialist
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25
Q

Moderaten persistent asthma or step 3:
* What is the txt for patients over 5 years old?
* What should you consider?

A

Preferred:
* Medium dose ICS or
* Low-dose ICS + LABA or LTRA (LTRA best for allergy or exercised indused asthma)
* plus SABA for sx

Consider SC immunotherapy for patients with allergic asthma

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26
Q

What are the different types of ICS/LABAs?

A
  • Fluticasone-salmeterol
  • Budesonide-formoterol
  • Mometason-formoterol
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27
Q

What is the classifcation for severe persistent asthma? (Symptoms, nighttime awakings, and SABA use for ages 0-4, 5-11, over 12)

A
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28
Q

Severe Persistent asthma:
* What is the treatment for patients of ages 0-4?

A
  • Same as Step 3 therapy: medium dose ICS
  • Consult asthma specialist
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29
Q

Severe Persistent asthma:
* What is the treatment for patients of ages 5-11?

A

Continue with Step 3 medium ICS option

OR

Step 4
* Preferred: medium dose ICS plus LABA
* Alternative: medium dose ICS plus montelukast

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30
Q

Severe persistent asthma
* What is the txt for 12+?

A

Step 4:
* Preferred: medium-dose ICS + LABA
* Alternative: medium-dose ICS + LTRA
* Consult asthma specialist

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31
Q

What is the txt for step 5 Severe persistent asthma?

A
  • High-dose ICS + LABA
  • Consider omalizumab for patients with allergies
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32
Q

What is the txt for step 6 severe asthma?

A

Same as step 5 with addition of oral corticosteroids

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33
Q

GLOBAL INITIATIVE FOR ASTHMA (GINA) GUIDELINES
* What is this?
* What is the evidence?

A

New evidence published in the last few years showing the benefit of ICS used with reliever agents
* Strongest evidence with adults and adolescents ≥ 12 years
* Some evidence and recommendations for 6 to 11 years
* Minimal evidence for 5 and under

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34
Q

GINA guidelines:
* What has been shown When compared to SABA alone, SABA + daily ICS, or daily ICS alone?

A
  • Decrease severe exacerbations
  • Decrease systemic corticosteroid use
  • Decreased ED visits / hospitalizations
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35
Q

What is an anti-inflammatory reliever (AIR)

A
  • E.g., ICS-formoterol, ICS-SABA
  • Provides symptom relief plus small dose of ICS
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36
Q

What is MART?

A

Maintenance And Reliever Therapy with ICS-formoterol = MART
* ICS-formoterol used as maintenance therapy AND PRN symptom relief
* One inhaler

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37
Q

Global initiative for Asthma (GINA) Guidelines
* What age group is it for?
* What is Step one and two?

A

Adults and adolescents ≥ 12 years

Steps 1 and 2
* As needed low dose ICS-formoterol

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38
Q

What is step 3 of gina?

A

Low-dose maintenance ICS-formoterol
plus PRN ICS-formoterol

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39
Q

What is step 4 of gina?

A

Same as step 3 but medium dose ICS-formoterol

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40
Q

What is step 5 of gina?

A

Same as step 4 (medium dose ICS-formoterol) but add LAMA

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41
Q

Give an example of the GINA stepwise

A
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42
Q

FOLLOW-UP ASSESSMENTS
* When do you re-evaluate?
* Control based on what? (What does the pt recall and what measurements?)

A

Re-evaluate every 2 to 6 weeks until well-controlled then every 3 to 6 months

Control based on most severe impairment
* ­ Patient / caregiver recall of events over last 2 to 4 weeks
* ­ Spirometry / peak flow measurements

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43
Q

Follow up assessment:
* Explain the use of stepwise approach?

A

Step down if symptoms controlled for at least 3 months

Step up if needed
* Check compliance, inhaler technique, environmental control and comorbidities first (before switching)
* If alternative therapy was used; switch to preferred therapy for current step before increasing a step

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44
Q

EXERCISE-INDUCED ASTHMA
* What does it describe?
* Exercise-induced bronchoconstriction occurs in how many people?
* Can be an indicator of what?

A
  • Exercise-induced bronchoconstriction (EIB) describes a transient airway narrowing occurring during physical exertion
  • Exercise-induced bronchoconstriction occurs in 40% to 90% of people with asthma and up to 20% of the general population without asthma
  • Can be an indicator of poorly controlled asthma
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45
Q

Exercise induced asthma:
* What is the txt?

A
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46
Q

ASPIRIN SENSITIVE ASTHMA
* Blocking the COX pathway increases what?
* What is the pathway/ what does this cause?
* What is there a cross reactivity between?

A
  • Blocking the COX pathway increases the production of lipoxygenase
  • ­Increases the production of leukotrienes
  • ­Induces bronchospasm
  • ­Cross reactivity between NSAIDS exists
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47
Q

PEAK FLOW METERS
* What does it measure? (2)
* What can it help determine?

A
  • ­Measures how fast a patient can push air out of lungs when blowing out as hard as they can
  • ­Helps measure how open the airways are
  • ­Helps determine when adjustments to home regimen are necessary
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48
Q

Peak Flow Meter
* May start to decrease when?
* Part of what?
* Zones can be set up initally based on what?
* Individualized zones can also be set up if what?

A
  • ­May start to decrease before other identifiable symptoms
  • ­Part of asthma action plan
  • ­Zones can be set up initially based on height and sex
  • ­Individualized zones can also be set up if patient healthy
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49
Q

What is an asthma action plan?

A
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50
Q

ASTHMA EXACERBATIONS
* What is it?
* Management may occur where? Depends on what?

A

Worsening of asthma symptoms requiring temporary increase in treatments

Management may occur at home or in the hospital
* Depends on severity of exacerbation and underlying
disease

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51
Q

Asthma exacerbations:
* What are the sxs of more severe exacerbation?

A
  • No breath sounds (no air mvt)
  • Taking in single words or no talking
  • Tachycardia / bradycardia
  • Perioral cyanosis
  • Hypoxemia
  • Hypotension
  • Patients at high-risk of poor outcomes->hospitalization
  • Most institutions – treatment protocolized
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52
Q

What are the factors that increase asthma related death?

A
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53
Q

MILD – MODERATE EXACERBATIONS
* What is the txt?

A
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54
Q

asthma

What are the sxs of mild-moderate exacterbations?

A
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55
Q

asthma

SEVERE EXACERBATION
* What are the first line initial therapies?

A
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56
Q

asthma

What are the sxs of servere exacerbation

A
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57
Q

asthma

What are some other therapies for severe exacterbations?

59
Q

What is the MOA of COPD and what are the subtypes?

61
Q

COPD:
* What does structural lung changes lead to? (3)

A
  • Increased resistance to airflow
  • Air trapping
  • Hyperinflation
62
Q

Fill in for COPD

63
Q

COPD GOLD GROUPS
* What is treatment based on?

A

Treatment decisions based on prior year history of:
* Symptoms – mMRC, CAT scores
* Risk (exacerbations)

64
Q

Fill in for GOLD

65
Q

What is MRC dyspnea score and list the levels

66
Q

What is the CAT score and what is the maximum score possible?

67
Q

What are the treatment goals of COPD?

68
Q

What is the pathophysio of Chronic bronchitis and emphysema?

69
Q

COPD treatment
* What are the non-pharmacologic therapy?

70
Q

COPD txt:
* What are the different vaccines that need? (give subtypes, and when they need them)

71
Q

Smoking cessation:
* How can you give behavioral support?

A
  • Ask-identify users
  • Advise - cessation
  • Assess - willingness
  • Assist - support
  • Arrange - follow-up
72
Q

smoking cessation:
* What is the first line pharm?

A

depends on patient preferences, cost, etc
* Nicotine (at least two products)
* Varenicline (Chantix)
* Bupropion (Zyban)

73
Q

What is the MOA, SE, dosage form and comments of Varenicline?

74
Q

What is the MOA, SE, dosage form and comments of Bupropion?

75
Q

What is the MOA, SE, dosage form and comments of Nicotine?

76
Q

What are all the different nicotine products?

A

Patch, gum, lozenge, inhaler, nasal spray

77
Q

Nicotine patch:
* What is the dosing and how do you administer?

A

Need to use patch then use gum or lozenge as needed

78
Q

COPD: Group A
* What are the txt?
* What are the effects?

A

SAMA or SABA
* ­ Prevent or reduce symptoms
* ­ Improve FEV1
* ­ Combination SAMA/SABA superior to either agent alone

LAMA or LABA
* ­ Improve FEV1, dyspnea, health status, reduced exacerbations
* ­ LAMAs – greater reduction in exacerbations and hospitalizations compared to LABAs
* ­ Combination LAMA/LABA superior to either agent alone

SABA/SAMA or both for rescue therapy for all groups!

79
Q

COPD: Group A
* What is preferred for all patients expect those with what?

A

Long-acting bronchodilator preferred for all patients except those with only occasional breathlessness
* LAMA or LABA

80
Q

COPD: Group A
* What do you give patients with only occasinoal breathlessness?
* What does that cause?

A

SABA or SAMA or SABA+SAMA as needed
* Increase airway diameter
* Decrease air trapping
* Improve air flow
* Decrease dyspnea

81
Q

Group B COPD:
* What is the txt?

A

LABA + LAMA

82
Q

Group B COPD with LABA+LAMA:
* When can agent can be tried alone?
* No literature supporting what?
* atient on monotherapy with a LABA or LAMA with persistent dyspnea should be escalated to what?

83
Q

Group E COPD:
* What is the txt?

A
  • LABA + LAMA
  • LABA + LAMA + ICS if blood eosinophils ≥ 300
84
Q

A WORD ABOUT ICS FOR COPD

  • What does regular use of ICS increase the risk of?
  • What does the studies show?
  • Patients with asthma should have what?
A
  • Regular use of ICS increases the risk of pneumonia
  • If ICS are utilized – studies show LAMA + LABA + ICS therapy superior to dual therapy with LAMA + ICS or LABA + ICS
  • Patients with asthma should have ICS incorporated into their treatment regimen
85
Q

What is the criteria what strongly favors use ICS, Favors use and against use?

86
Q

Fill in for COPD

87
Q

Follow up pharmacologic treatment-> What happens if it does not work:
* What do you check?
* What do you consider?
* Treat according to what?
* Follow which chart if both set of traits are present?

88
Q

What is the flow chart if patient is have dypnea at the follow up pharm appointment?

89
Q

What is the flow chart if patient is have Exacerabation at the follow up pharm appointment?

90
Q

ROFLUMILAST
* What is the MOA?
* What does it decrease?
* What is the route?

91
Q

ROFLUMILAST
* What are the SE?

92
Q

When is AZITHROMYCIN recommended?

A

Recommended for patients with COPD and ≥ 2 exacerbations / year despite optimal medical treatment (cannot be current smokers

93
Q

Azithromycin for COPD
* What types of effects?
* Increases what?
* Waht does it reduce?
* What does it improve?
* What are the SE?
* What is the dose?

94
Q

A WORD ABOUT INHALERS

  • When do you do education?
A

Education and training critical
* Prior to initial use
* ­ At each appointment

95
Q

A WORD ABOUT INHALERS

Inhaler type dependent on what? (3)

A
  • ­ Patient preference/ability (cognition, dexterity, strength, inhalation strength)
  • ­ Provider preference – should only prescribe inhalers they know how to use
  • ­ Cost
96
Q

A WORD ABOUT INHALERS

  • What should be limited?
  • What should be verifed before deeming regimen ineffective?
A
  • Inhaler types per patient should be limited (ex: ALL MIST)
  • Inhaler technique and adherence should be verified before deeming regimen ineffective
97
Q

What are the difficulties that elderly patients face?

99
Q

LONG-TERM OXYGEN THERAPY (> 15 HOURS PER DAY)
* Increase survival in who?
* Most improvement after what?
* What does it improve?

100
Q

What is the criteria for oxygen therapy in COPDers?

101
Q

Fill in for O2 and COPDers

102
Q

She said this is FYI but Idk about that lol

103
Q

COPD EXACERBATION

  • What is COPD natural history?
  • What is COPD exacerbation?
A
  • ­COPD natural history – recurrent exacerbations associated with increased symptoms and decline in health status
  • ­ COPD exacerbation - acute increase in symptoms beyond normal day-to-day variation
104
Q

What are the sx of COPD exacerbation?

105
Q

COPD EXACERBATIONS
* What are causes (3)

106
Q

COPD EXACERBATIONS
* What is the duration?
* What happens if not fully recovered in 8 weeks?
* Hospitalized for what?

107
Q

COPD EXACERBATION CLASSIFICATION
* What is Mild?

108
Q

COPD EXACERBATION CLASSIFICATION
* What is moderate?

109
Q

COPD EXACERBATION CLASSIFICATION
* What is sereve?

110
Q

COPD EXACERBATION TREATMENT
* What is the short term txt?

A
  • ­ Reduce symptoms
  • ­ Prevent hospitalizations
  • ­ Shorten hospital stay
  • ­ Prevent acute respiratory failure or death
111
Q

COPD EXACERBATION TREATMENT
* What is the long term txt?

A
  • Minimize negative impact of exacerbations
  • Prevent future exacerbations
    * Strongest predictor is past exacerbations
112
Q

What does CMS do/

A

CMS – incentives to reduce COPD readmissions

113
Q

The majority of patients treated as outpatients
* What is the General hospitalization criteria

114
Q

Fill in for COPD exacerbation txt

116
Q

Fill for COPD exacerbation txt

117
Q

COPD

CORTICOSTEROID THERAPY
* What are the benefits?

118
Q

copd

CORTICOSTEROID THERAPY
* What are the risks

119
Q

copd

What is the dose of CORTICOSTEROID THERAPY?

A

Prednisone 40mg/day or equivalent x 5 days

120
Q

ANTIBIOTIC THERAPY
* What does it decrease (3)?
* What is the duration?

A
  • Decreases short term mortality (77%)
  • Decreases treatment failure (53%)
  • Decreases sputum purulence
  • Recommended duration: 5 to 7 days
121
Q

Antibiotic:
* Who gets it?
* What pathogens?
* What is the recommended therapy?

122
Q

IDIOPATHIC PULMONARY FIBROSIS (IPF)
* What is it?
* What is the pathophysio?
* What is early disease sx?
* Managed how?

123
Q

IPF - TREATMENT
* What is the supportive care txt?

124
Q

What are the medical txt for IPF?

125
Q

IPF – ANTIFIBROTIC MEDICATIONS
* What do they do?

126
Q

Nintedanib
* What is the MOA?
* What are the SE?
* What do you need to monitor?

127
Q

Pirfenidone
* What is the MOA?
* What are the SE?

128
Q

SARCOIDOSIS
* What is it?
* Can affect what?
* Predominant in who?
* What are the complications of advance disease? (3)

129
Q

Sarcoidosis:
* What are the symptoms?

130
Q

What are the dx tests for sarcoidosis?

131
Q

SARCOIDOSIS STAGING
* What are each of the stages? What do they look like on x-ray?

132
Q

Mild disease of sarcoidosis:
* Who is in this group?
* Reevluate when?
* Resolve whan?
* May consider trial of what? But txt is normally what?

133
Q

Sarcoidosis: Symptomatic disease with more severe lung involvement
* Txt for what?
* How else may also benefit from txt?

A
  • ­Treatment indicated to reduce granulomatous inflammation and reduce permanent lung damage
  • ­Patients with multi-organ involvement may also benefit from treatment
134
Q

SARCOIDOSIS - TREATMENT
* What is first line?
* What should you consider for supplments?

135
Q

What is second line for sarcoidosis?

A
  • Methotrexate
  • Azathioprine
136
Q

PNEUMOCONIOSIS
* What is this?

138
Q

ACUTE SILICOSIS
* What does it show on CT?

139
Q

SIMPLE SILICOSIS
* What does it show on x-ray?

A

eggshell on x-ray

140
Q

SILICOSIS - TREATMENT
* What do you need to stop?
* Withdrawal from what?
* Supplemental what?
* What can be given (meds)
* What is prevention?
* Manage what?
* WHAT IS NOT RECOMMENDED?
* What is the cure?

141
Q

ASBESTOSIS - TREATMENT
* What do you need to stop?
* Withdrawal from what?
* Supplemental what?
* What needs to be treated?
* What is prevention?
* Manage what?
* Monitor for what?

142
Q

BERYLLIOSIS - TREATMENT
* What is the txt?

Pharmacology (14 decks)

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