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Pharmacy Practice 5 > Lung > Flashcards

Lung Flashcards

1
Q

Asthma is confirmed by airflow limitation with a reduction of FEV1/FVC below what value for adults and for children?

A

0.8 for adults
0.9 for children

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2
Q

where does air get trapped during an asthmatic attack?

A

in alveoli

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3
Q

what would you find upon inspecting a patient with asthma?

A

-hyperexpansion of thorax
-use of accessory muscles
-hunched shoulders
-nasal secretions, mucosal swelling and/or nasal polys
-atopic dermatitis/Eczema

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4
Q

what would you find upon palpating a patient with asthma?

A

usually nothing abnormal

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5
Q

what would you find upon using percussion on a patient with asthma?

A

usually nothing abnormal

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6
Q

what would you find upon using auscultation on a patient with asthma?

A

-wheezing
-prolonged phase of forced expiration

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7
Q

what assessment tool do we use for asthma?
what is the one exclusion criteria when using this assessment?

A

GINA
excludes reliever taken before exercise

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8
Q

what is the dosing for an albuterol nebulizer?

A

2.5 mg 3-4 times as needed

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9
Q

what is the dosing for a levalbuterol inhaler?
how about nebulizer?
when would we use it over albuterol?

A

2 puffs q4-6h prn
0.63 mg tid q6-8h
pts with a history of tachycardia to albuterol

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10
Q

according to GINA guidelines, what is the preferred inhaler to use as pts reliever inhaler?

A

low dose budesonide/formoterol in place of albuterol

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11
Q

For severe asthma, what is the recommended treatment plan according to GINA guidelines?

A

add-on LAMA and consider high-dose ICS-formoterol

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12
Q

all asthma patients should have an action plan which includes:

A

-pts usual asthma meds
-when/how to incr meds or start oral corticosteroids
-when/how to access medical care if symptoms fail to respond

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13
Q

what are symptoms of a pt experiencing a mild-moderate asthma exacerbation?

how would you treat the pt?

if treatment doesn’t work what should you do?

A

-resp rate increased
-not using accessory muscles
-pulse 100-120 bpm
-talks in phrases
-O2 sat 90-95%

SABA: 4-10 puffs with MDI + spacer q20 minutes
Prednisolone: adults 1 mg/kg up to 50 mg (or prednisone 40 mg)
children 1-2 mg/kg up to 40mg
*continue treatment with SABA and reassess within 1 hour

transfer to hospital: give inhaled SABA, ipatropium, O2, and systemic corticosteroid

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14
Q

what are symptoms of a pt experiencing a severe or life-threatening asthma exacerbation?

how would you treat pt?

A

-resp rate over 30/min
-talks in words, hunched forward
-accessory muscles in use
-pulse 120bpm or more
-O2 sat less than 90%

transfer to hospital: give inhaled SABA, ipatropium, O2, and systemic corticosteroid

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15
Q

after an asthma exacerbation, what treatment plan should be arranged for discharge?

A

-reliver continue prn
-controller: start, restart, or step up
-check inhaler technique and adherence
-corticosteroids continue for 5-7 days (adults) or 3-5 days (children)

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16
Q

what are the two types of COPD and describe them

A

chronic bronchitis “blue bloater”: inflammation of the bronchioles
emphysema “pink puffer”: destruction of alveoli

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17
Q

how do we diagnose COPD based on the patients FEV1/FVC?

A

if it is below 0.7 after using a bronchdilator

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18
Q

Physical Exam Findings for COPD:
Inspection?
Palpation?
Percussion?
Auscultation?
*Signs may not be present until disease has progressed, so a lack of physical signs does not exclude COPD diagnosis

A

I: cyanosis, barrel chest, use of accessory muscles
Palp: usually normal
Perc: hyperresonance
Aus: possible wheezing, crackles, prolonged expiration

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19
Q

what is the assessment tool used for COPD

A

mMRC Dyspnea scale (grades 0-4:)

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20
Q

if a patient with COPD states they only get breathless with strenuous exercise, what mMRC grade would you mark them under?

A

grade 0

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21
Q

if a pt with COPD says they get short of breath when walking up a slight hill, what mMRC grade would you mark them under?

A

Grade 1

22
Q

if a pt with COPD says they walk slower than normal due to breathlessness or have to stop for breath, what mMRC grade would you mark them under?

A

Grade 2

23
Q

if a pt with COPD says they have to stop for breath after walking about 100 meters or after a few minutes, what mMRC grade would you mark them under?

A

Grade 3

24
Q

if a pt with COPD says they are too breathless to leave the house or when dressing/undressing, what mMRC grade would you mark them under?

A

Grade 4

25
Q

if pt has had 2 or more exacerbations or 1 or more leading to hospitalization, what category are they considered using the GOLD assessment?

what meds are in this category?

A

E
LABA + LAMA
*consider adding ICS if blood eosinophil count is over 300

26
Q

if pt has had 0-1 moderate exacerbations not leading to hospitalization, what category are they considered using the GOLD assessment?
what if their mMRC is 0-1/ CAT <10?
what meds are in this category?
what if their mMRC is 2 or more/ CAT 10 or more?
what meds are in this category?

A

A or B
A: a bronchodilator
B: LABA + LAMA

27
Q

what drug is used in COPD to treat exacerbations if the pt is a former smoker?

A

azithromycin

28
Q

what would be considered a mild COPD exacerbation in regards to:
RR, HR, resting SaO2

A

RR: less than 24
HR: less than 95
O2: over 92

29
Q

what would be considered a moderate COPD exacerbation in regards to:
RR, HR, resting SaO2
if obtained, ABG may show?

A

RR: more than 24
HR: more than 95
O2: under 92
ABG may show hypoxemia and/or hypercapnia (PaCO2 over 45 with no acidosis)

30
Q

what would be considered a severe COPD exacerbation?

A

same as moderate except ABG shows hypercapnia and acidosis (PaCO2 over 45 and pH less than 7.35

31
Q

what are the nonpharm treatments for COPD?

A

-smoking cessation
-physical activity
-pulomonary rehabilitation
-oxygen therapy
-vaccines
-lung cancer screenings
-nutrition support

32
Q

what are common viruses that cause community-acquired pneumonia?

A

influenza, adenovirus, respiratory syncytial virus, and parainfluenza

33
Q

what are typical bacterias that cause community-acquired pneumonia?

A

H. influenza, M catarrhalis, and staph

34
Q

when do we hospitalize patients with community-acquired pneumonia?

A

we hospitalize based on the CURB-65 assessment

35
Q

what is the CURB-65 assessment and how do we interpret the results?

A

Confusion: increased
Urea: over 7
RR: 30 or more breaths/min
BP: systolic < 90 or diastolic < 60
Age: 65 or older
each factor that attributes to the pt is worth 1 point. if they score at least 2 they should be hospitalized

36
Q

what antibiotic treatments are used in otherwise healthy pts?

A

Amox 1g tid (preferred)
doxy 100mg bid
azithro 500mg od1 then 250mg days 2-5.
clarithromycin 500mg bid

37
Q

what antibiotic treatments are used in pts with comorbidities/risk factors for antibiotic resistant pathogens for penumonia?
(list the comorbidities)

A

comorbidities: chronic heart, lung, or renal disease, alcoholism, asplenia, diabetes, or malignancy
Amox/clav, cefpodox, or cefurox with macrolide or doxy

38
Q

what are symptoms of pulmonary edema caused by heart failure?

A

orthopnea (trouble breathing while laying down), wheezing, rapid weight gain, swelling of lower extremities

39
Q

what signs of heart failure might you see upon a physical examination in regards to:
inspection?
palpation?
percussion?
auscultation?

A

I: cyanosis
Palp: normal
perc: possible dullness
auc: crackles

40
Q

what assessment of symptoms tool is used for heart failure?

A

NYHA class I-IV

41
Q

exacerbations of HF are usually treated with?

A

loop diuretics, potassium supp (if needed), and sodium/fluid restriction

42
Q

Tuberculosis is a multi-system disease caused by?

A

Mycobacterium tuberculosis

43
Q

which drug class is a TB risk factor?

A

TNF-alpha antagonists

44
Q

what are the treatment options for TB?

A

isoniazid 6-9 months qd or rifampin 4 months qd

45
Q

pertussis is caused by?

A

bordatella pertussis

46
Q

what are the 3 stages of pertussis?

A

catarrhal stage (mild cough)
paroxysmal stage (2-6 weeks, worsening cough, cyanosis, vomiting)
convalescent stage (cough lessens)

47
Q

how is pertussis diagnosed?

A

culture tests

48
Q

what is bronchitis?

A

an inflammatory condition caused by bacteria, viruses, allergens, smoke, or irritants

49
Q

what are symptoms of bronchitis?

A

fever, N/V/D not common
conjunctivitis (pink eye), adenopathy (Large or swollen lymph glands), and runny nose

50
Q

for chest percussion, interpret the following:
Hyperresonance
Resonance
Dullness

A

increased thoracic gas, suggests hyperexpansion caused by: asthma, emphysema, or pneumothorax
vibration of the lung parenchyma. Normal percussion note
fluid or soft tissue within pleura or lung parenchyma caused by: pneumonia, pulmonary edema, or lung cancer

Pharmacy Practice 5 (8 decks)

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