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6020 Advanced Pharm Test 3 COMPLETE ☑️ > Module 5: Respiratory (b) > Flashcards

Module 5: Respiratory (b) Flashcards

1
Q

Asthma Management

-Step 1

A
  1. PRN SABA
    AND
  2. At the start of RTI: Add short course of daily ICS
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2
Q

Asthma Management

-Step 2

A
  1. Daily low-dose ICS & PRN SABA

Alternative:
-Daily Montelukast or Cromolyn & PRN SABA

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3
Q

Asthma Management

-Step 3

A
  1. Daily medium-dose ICS and PRN SABA
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4
Q

Asthma Management

-Step 4

A

Daily medium dose ICS-LABA & PRN SABA

Alternative:
-Daily medium dose ICS + Montelukast & PRN SABA

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5
Q

Asthma Management

-Step 5

A
  1. Daily high-dose ICS-LABA & PRN SABA

Alternative:
-Daily high-dose ICS + Montelukast & PRN SABA

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6
Q

Asthma Management

-Step 6

A

Daily high-dose ICS-LABA + oral systemic corticosteroid and PRN SABA

Alternative:
-Daily high-dose ICS + Montelukast + oral systemic corticosteroid & PRN SABA

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7
Q

Classification of Asthma Severity

-Changes from 0-4 yrs to 5-11 years

A

Charts are identical for both age groups with one addition

-5-11 year olds have LUNG FUNCTION tests for FEV/FVC rations

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8
Q

Classification of Asthma Control

->/= 12 years old Difference?

A
  1. Can use a validated questionnaire
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9
Q

COPD

-Definition

A
  1. Chronic lung dz characterized by small airway obstruction and reduction in expiratory flow rate.
  2. Spirometry required to make diagnosis
    - FEV/FVC <0.70 confirms airflow limitation
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10
Q

COPD

-Goals of Therapy

A
  1. Reduce Symptoms
    - Relieve symptoms
    - Improve exercise tolerance
    - Improve health status
  2. Reduce Risk
    - Prevent Dz progression
    - Prevent/treat exacerbations
    - Reduce mortality
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11
Q

COPD

-Pharm Therapy for Maintenance?

A
  1. SABA’s and LABA’s
  2. Anticholinergics/Antimuscarinics (short and long acting)
  3. Phosphodiasterase-4 inhibitors
  4. ICS
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12
Q

COPD

-Pharm Therapy for Exacerbations?

A
  1. Short-acting bronchodilators
  2. Systemic corticosteroids
  3. Antibiotics
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13
Q

COPD

-LABA’s?

A
  1. Salmeterol (Serevent)
    - 50mcg/actuation
    - Adults: 1 puff q12 hrs
  2. Formoterol (Performist)
    - 20mcg/2 ml neb
    - Adults 20 mcg per neb q12 hr (max 40 mcg daily)

LABA monotherapy is okay with COPD but NOT with Asthma
-NOT for Pregnancy/Lactation

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14
Q

COPD

-Antimuscarinic Antagonists?

A
  1. MOA
    - Relax bronchial muscles causing Bronchodilation; decrease mucous production.
  2. Contraindication/Caution
    - Allergies to atropine, soy, peanuts
    - Not for Acute Bronchospasm
    - Caution in narrow-angle glaucoma, BPH, pregnancy and lactation
  3. A/E’s
    - restlessness, dizziness, HA, GI, blurred vision, cough, urinary obstruction
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15
Q

COPD

-Short-Acting Antimuscarinics?

A
  1. Ipratropium (Atrovent)
    - Available as neb or inhaler
    - Caution in pregnancy/lactation
  2. Combivent (Ipratropium/Albuterol)
    -Caution in pregnancy/lactation
    —Albuterol can reduce uterine contractility**
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16
Q

COPD

-Long-Acting Antimuscarinics

A
  1. Tiotropium (Spiriva)
    - Delivery takes a lot of coordination d/t needing to put in and puncture med capsule
    - Not good for elderly with poor fine motor control**
  2. Aclidinium (Tudorza)
    - Need to be able to take a BIG DEEP breath in. Click heard when med is delivered
  3. Caution in pregnancy/lactation
17
Q

COPD

-Phosphodiesterase-4 Inhibitors (PDE4)

A
  1. Roflumilast (Daliresp) 500mg pó daily
  2. Indicated for SEVERE COPD associated with recurrent exacerbations
  3. Contraindication/Caution
    - Hepatic impairment
    - Caution w/ depression, and SI
  4. A/E’s
    - Diarrhea, nausea, weight loss, HA, back pain, dizziness, loss of appetite
  5. Caution in pregnancy/lactation
18
Q

Assessment of COPD

-Grading?

A

GOLD 1 = FEV >/= 80
GOLD 2 = FEV 50-79
GOLD 3 = FEV 30-49
GOLD 4 = FEV = 30

19
Q

COPD

-How to classify?

A
  1. Spirometry shows the Grade (GOLD 1-4)

2. Group is based on symptoms and exacerbations (Group A-D)

20
Q

COPD Treatment

-Group A

A

This patient is LESS symptoms and LOWER risk*

  1. Short-acting antimuscarinic SAMA
  2. Short acting beta agonist SABA
21
Q

COPD Treatment

-Group B

A

This patient is LOW Risk and MORE symptoms

  1. LAMA or LABA
    - both with severe breathlessness **
22
Q

COPD Treatment

-Group C

A

This patient is LESS symptoms and MORE risk
-Pt has had >/= 2 exacerbations or been hospitalized

  1. LAMA
23
Q

COPD Treatment

-Group D

A
  1. LAMA
    Or
  2. LAMA + LABA (For Highly symptomatic pt’s with CAT > 20
    Or
  3. ICS + LABA (If eosinophil >300 or hx of asthma)
24
Q

COPD

-Pharm Mgmt Follow up

A
  1. Review: symptoms (Dyspnea) and exacerbation risks
  2. Assess: inhaler technique and adherence
  3. Adjust: pharm treatment, including escalating or de-escalating
25
Q

Follow-up Pharm Management

-Persistent Dyspnea

A
  1. Persistent Breathlessness or Exercise Limitation on Monotherapy?
    - Two Long-acting bronchodilators recommended
  2. Persistent Breathlessness or Exercise Limitation on ICS/LABA?
    - Add a LAMA
  3. If symptoms still progress, INVESTIGATE other causes
26
Q

Follow-up Pharm Management

-Exacerbations continuing?

A
  1. Consider a LABA/LAMA or LABA/ICS combo if on mono-therapy
    - LABA/ICS for hx of asthma or Eosinophils >300
  2. On LABA/LAMA
    - escalate to LABA/LAMA/ICS (with eosinophils >300)
    - Or add Roflumilast
    - Or azythromycin for (Former smokers)
  3. On LABA/LAMA/ICS
    -Add Roflumilast
    Or
    -Azythromycin if former smoker
27
Q

COPD Exacerbations

-Presentation

A
  1. Increased airway inflammation and increased mucous production
  2. Symptoms:
    - Dyspnea
    - Increased sputum purulent and volume
    - Increased cough and wheeze
28
Q

COPD Exacerbations

-Classifications

A
  1. Mild
    - Treated w/ Short-acting bronchodilators
  2. Moderate
    - Treated w/ Short-acting bronchodilators + Antibiotics and/or oral corticosteroids
  3. Severe
    - Requires hospitalization or ER visit
    - May be associated w/ Acute Respiratory Failure
29
Q

Management of COPD Exacerbations?

A
  1. O2 if spo2 is = 88%
  2. Bronchodilators: SABA + SAMA (DuoNeb)
  3. Systemic Corticosteroids
    - Prednisone 40 mg daily x 5 days
    - Recommended for pt’s w/ exacerbations more than mild severity
  4. Antibiotics
    - Increased dyspnea, volume of sputum or smoker hx
    - AUGMENTIN, Macrolides or tetracycline 5-7 day course
30
Q

Management of COPD Exacerbations?

-Antibiotics?

A
  1. AUGMENTIN
  2. Macrolides
  3. Tetracycline

5-7 day course

31
Q

Acute Bronchitis

-State

A
  1. 95% of acute bronchitis caused by viral infections
  2. Evidence for cough suppressants is controversial
  3. NO ANTIBIOTICS**
32
Q

CAP

-Stats

A
  1. S. Pneumonia MOST COMMON pathogen

2. Amoxicillin, doxycycline, fluoroquinolones are agents of choice

33
Q

CAP Treatment

-No Comorbidities w/ NO recent antibiotic use?

A
  1. Amoxicillin 1 Tm TID x5-7 days

2. Doxycycline 100 mg BID x 5-7 days

34
Q

CAP Treatment

-Co-morbidities or antibiotic use in past 3 months?

A
  1. Levaquin 750 mg daily x5 days
  2. AUGMENTIN BID or Cefpodaxime or Cefuroxime
    PLUS
    Azithromycin Or Clarithromycin 5-7 days
35
Q

CAP

-Children Under 5 yrs?

A
  1. Bacterial Pneumonia
    - Amoxicillin
    - Azithromycin
  2. Infant 4-16 wks w/ suspected chlamydial PNA
    -Azithromycin 3 days
    OR
    -Erythromycin 14 days
36
Q

TB

-First Line Drugs?

A
  1. TB requires multi-drug regimen over 9 months.
  2. Initiation phase is first 2 months followed by continuation phase for 4-7 months.

Meds:

  • Isoniazid
  • rifampin
  • rifabutin
  • rifapentine
  • Pyrazinamide
  • Ethambuton
37
Q

TB

-Second line Drugs?

A
  1. Cycloserine
  2. Ethionaminde
  3. Moxifloxacin
  4. Gatifloxacin
38
Q

COVID-19 Referrals

-Monoclonal Antibody infusion/injection

A
  1. Indicated for 12 years and older PLUS
    - Treatment in high-risk individuals
    - Prophylaxis in High-risk individuals
  2. Give to individuals who are:
    - High risk + Not vaccinated or immune-compromised
    - No pre-exposure indication for treatment
    - NOT a substitute for vaccination
39
Q

COVID-19

-Things to avoid in clinic?

A
  1. Avoid nebulizer in clinic d/t spreading particles

2. Avoid Spirometry w/ confirmed or suspected COVID 19

6020 Advanced Pharm Test 3 COMPLETE ☑️ (7 decks)

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