Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacy School 2015-16 > PHAR 721 > Flashcards

PHAR 721 Flashcards

1
Q

Chronic Bronchitis occurs in patients with _________________? What time period defines chronic bronchitis?

A

COPD

Lasts longer than 3 months in each of 2 consecutive years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is acute bronchitis?

A

A self-limiting cough that persists more than 5 days. Involves bronchi inflammation and is usually viral.

Also one of the most common reasons for a primary care visit (14 million cases annually)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 2 causes of acute bronchitis, with examples from each?

A

Viruses (over 90 percent)
>influenza A and B
>parainfluenza
>rhinovirus

Bacterial
>Chlamydia pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Signs/symptoms of Acute Bronchitis

A

Cough (productive, persists more than 5 days and lasts 1-3 weeks)

Associated with prior upper respiratory infection, so make sure to get full PMI.

Wheezing, of Bronchi.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What signs/symptoms AREN’T typically associated with Acute Bronchitis?

A

Fever over 100, systemic symptoms, consolidation or crackles (aka rales)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is acute bronchitis treated?

A

Symptoms are treated:
>cough suppressants at night (dextromethorphan)
>expectorants (Guaifenisen, although not much evidence)
>beta-2 agonists if wheezing (helps with bronchodilation)
>high-dose inhaled corticosteroids in emergency

Alternative therapies include echinacea for cold “prevention”, pelargonium and honey

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How prevalent is the flu?

A

65.5/100,000 hospitalized in 2014-15 flu season, with highest rates occurring in those over 65. 141 pediatric deaths in same season.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does flu present?

A

Influenza like illness (fever over 100, cough and/or sore throat without a known cause)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the 2014-15 influenza virus

A

Influenza A: 83.5% (99.6% H3N2, 0.29% H1N1)

Influenza B: 16.5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How many influenza viruses does the CDC characterize?

A

355 influenza viruses, characterized antigenically or genetically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

High Risk Groups for Flu

A

Those over 65 or under 5, pregnant women, those with medical conditions (asthma, diabetes, heart disease, stroke, HIV or AIDS, cancer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How the flu is spread and how long it lasts

A

Large particle respiratory droplets can fly 1-2 meters and contaminate surfaces (hard, non-poris with high humidity are the most habitable for virus).

Viral shedding occurs 1 day before symptoms and can last from 5 to 10 days after symptoms onset.

Incubation is 1-4 days, with 2 being the average.

Duration is typically 3-7 days, although cough and malaise may persist for 2 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the flu FACTS?

A

Fever, Aches, Chills, Tiredness, Sudden Onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Flu Symptoms

A

Fever, nonproductive cough, myalgia, malaise (ill feeling), headache, sore throat, rhinitis is possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the different methods of flu diagnosis

A

Rapid influenza diagnostic test (takes less than 30 minutes, is 90% specific and 50-70% sensitive)

Viral cell culture (takes anywhere from 1 to 10 days)

Immunofluorescence (antibody stain) (takes 1-4 hours)

RT-PCR (1-6 hours)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What do we primarily use for flu diagnosis? What’s the downside?

A

Nasopharygeal swab

Unpleasant and false-positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Flu complications

A

Pneumonia, bronchitis, sinus infection, ear infections, worsening of chronic conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Flu treatment options

A

Neuraminidase inhibitors (start within 48 hours)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are 3 of the common neuraminidase inhibitors used?

A

Oseltamivir (Tamiflu) - 75 mg po bid for 5 days

Zanamivir (Relenza) - 10mg inhaled bid for 5 days

Peramivir (Rapivab) - 600mg IV as a single dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Flu Prevention

A

Seasonal vaccine is best.

Other measures: 
>avoid ill people
>frequently wash hands
>avoid touching eyes, nose  and mouth
>cover nose and mouth when sneezing or coughing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Types of pneumonia (based on how illness is acquired)

A 
Hospital acquired (HAP) - highly resistant
Community acquired (CAP)
Nonhospitalized patient with extensive healthcare contact (HCAP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe CAP (Community acquired) Risk Factors

A

Chronic lung disease, cigarette smoking, dementia, stroke or brain injury, immune deficiency, heart disease, diabetes or cirrhosis, recent surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Symptoms and Signs of CAP

A

Cough (rust colored, mucopurulent), fever, chills, dyspnea, lung exam yields crackles or consolidation.

Others include chest pain, malaise, headache, confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Define crackles or consolidation (at they pertain to the lungs)

A

Crackles are a result of fluid in the lungs

Consolidation is result of large fluid presence preventing air movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What 2 systems are used for CAP prognosis?

A

Pneumonia Severity Index (PSI) - predictive tool

CURB-65 (1 point given for each component)
>confusion
>urea (blood urea nitrogen above 7mmol/L)
>respiratory rate over 30
>BP (systolic under 90 and diastolic under 60)
>over 65 years of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What do the results of a CURB-65 mean?

A

0-1 outpatient; 2 hospital; 3 or greater ICU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

CAP causes

A

Bacteria are most common (streptococcus, mycoplasma and chlamydia [pneumoniae])

Viruses can include influenza, parainfluenza, respiratory syncytial virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

CAP treatment

A

Antibiotics for 5 days (macrolides common; fluoroquinolones and beta lactam/macrolide combos for those with comorbidities)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

CAP Prevention

A

Vaccinations for at risk groups:
>those at or over 65 yo (PCV13 and PPSV23)
>Children under 5 receive PCV7 as routine vaccines
>those high risk from 6-64

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the peak month for CAP

A

FEB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How likely is fever with acute bronchitis, flu and pneumonia?

A

Unlikely
Yes
Likely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How likely is cough with acute bronchitis, flu and pneumonia?

A

More than 5 days and mucopurulent
Common
Mucopurulent or rust colored

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How likely are other symptoms with acute bronchitis, flu and pneumonia?

A

Uncommon
Myalgia, malaise
Chills, dyspnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Typical cause of acute bronchitis, flu and pneumonia?

A

often viral
viral
often bacterial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Prevention of acute bronchitis, flu and pneumonia?

A

Hygiene
Vaccine/hygiene
Vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Treatment of acute bronchitis, flu and pneumonia?

A

Symptomatic based
Antivirals/symptomatic
Antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Define asthma

A

A chronic inflammatory condition of the lungs that results in bronchoconstriction, excess mucus production, periodic symptoms of shortness of breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Asthma prevalence

A

7.3% of population (1 in 13 Americans), 3,630 deaths per year in US, most common chronic disease of children (around 50 percent markedly improve or are symptom free as adults)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Describe child onset for asthma

A

More likely to be allergic based

Possible genetic predisposition to IgE mediated response to aeroallergens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Describe adult onset for asthma

A

More often non-allergic

Often negative family history and negative skin tests to common allergies

Possibly due to environmental exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Possible causes of asthma

A

Genetic factors (although no single genetic abnormality known causes asthma)

Environmental (hygiene, tobacco, sibling/daycare effect)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Asthma symptoms and triggers

A

Symptoms - coughing, wheezing, chest tightness, shortness of breath

Triggers - allergens, irritants, medicine, sulfites in foods and drinks, upper respiratory infections, physical activity, emotions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Anticholinergics target ____________

A

cGMP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Beta-agonists target ________

A

cAMP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Leukotrienes target ___________________

A

The leukotrienes that results from the lypoxygenase pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Leukotrienes are potent _________________

A

broncho-constrictors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Symptoms, short-acting beta agonist use and night time awakenings due to dyspnea with intermittent asthma

A

less than or equal to 2 days

less than or equal to 2 days

less than or equal to 2 days/month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Symptoms, short-acting beta agonist use and night time awakenings due to dyspnea with mild-persistent asthma

A

over 2 days a week

over 2 days a week

3-4 time a month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Symptoms, short-acting beta agonist use and night time awakenings due to dyspnea with moderate-persistent asthma

A

daily

daily

1-3 time weekly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Symptoms, short-acting beta agonist use and night time awakenings due to dyspnea with sever-persistent asthma

A

throughout day

several times per day

over 4 times a week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Objective asthma information can be obtained using these 3 methods

A

Peak flow meter (helps create asthma action plan), spirometry (lung volume, FEV1/FVC ratio, response to bronchodilation after albuterol administration) and lung sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Pharmaceutical options for Asthma

A

Rescue drugs:
Short acting beta adrenergic agonists (SABA)
Inhaled anticholinergics

Controller drugs:
Inhaled corticosteroids
Non-steroid controllers (mast cell stabilizers, leukotriene modifiers)

Therapy relievers or controllers:
Long-acting bronchodilators aka inhaled beta agonists (salmeterol, formoterol) - typically combined with inhaled corticosteroid

Additional therapy options include phosphodiesterase inhibitors, theophylline, allergy desensitization drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

How to decide to “step-up” or “step-down” in asthma step treatment

A

step up if needed (first check adherence, environmental control and comorbid conditions)

Step down if possible (and asthma is well controlled for AT LEAST 3 months)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Step 6 for Asthma Therapy

A

High-dose ICS + LABA and oral corticosteroid

Consider omalizumab for patients with allergies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Step 5 for Asthma Therapy

A

High dose ICS + LABA

Consider omalizumab for those with allergies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Step 4 for Asthma Therapy

A

Medium dose ICS + LABA (LTRA, Theophylline or Zileuton would be good alternatives for LABA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Step 3 for Asthma Therapy

A

Low dose ICS + LABA or Medium dose ICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Step 2 Asthma Therapy

A

Low dose ICS (Cromolyn, LTRA, Nedocomil or Theophylline are fine alternatives)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Step 1 Asthma Therapy

A

SABA PRN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Risk factors for death from asthma

A

Hospitalizations (2 or more for asthma in past year, 3 or more ED visits for asthma in past year, hospitalization or ER visit for asthma in past month)

Using over 2 canisters of SABA in 1 month

Difficulty perceiving asthma symptoms or severity

Lack of asthma plan, sensitive to alternate medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

How to manage exercise-induced asthma

A

SABA (prevention in more than 80% of patients)

LABA, LTRA and cromolyn or nedocromil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Define COPD

A

A commonly preventable and somewhat treatable disease characterized by persistent airflow limitation and obstruction, usually progressive and associated with enhanced chronic inflammatory responses in the airways and lungs to noxious particles or gases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Risk factors for COPD

A

smoking is number 1 risk factor.

Exposure to particles, gender and age, genes (antitrypsin-1-deficiency), and chronic asthma and reoccurring upper respiratory tract infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Emphysema characteristics

A

“PINK PUFFER”

Alveolar problem, increase CO2 retention, minimal cyanosis, pursed-lip breathin, dyspnea, increased respiratory rate, hyperresonance on chest percussion, orthopneic, barrel chest, exertional dyspnea, prolonged expiratory time, speaks in short jerky sentences, anxious, use of accessory muscles to breath, thin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Chronic Bronchitis Characteristics

A

“BLUE BLOATERS”

Color dusky to cyanotic, recurrent cough with sputum production, hypoxia, hypercapnia, acidosis, edematous, increased respiratory rate, exertional dyspnea, increase incidence in heavy smokers, digital clubbing, cardiac enlargement, use of accessory muscles to breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Goals of COPD treatment

A

Subjective - get patient to feel good since you can’t reverse disease

Objective: FEV1/FVC, mMRC, CAT; history of exacerbation or previous hospitalizations, lung sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Pharmacological principles and COPD

A

Medications may reduce or eliminate symptoms, increase exercise capacity, reduce exacerbation and improve quality of life (don’t really change lung volume though)

Current medications don’t slow or stop long term decline in lung function or prolong survival

Bronchodilation is primary approach

Once therapy added, it is rarely stopped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Low Risk, Less Symptoms Assessment Values of COPD

A

Spirometric Classification (GOLD 1-2)
Exacerbations per year (1 or less)
CAT (under 10)
mMRC (0-1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Low risk, more symptoms Assessment Values of COPD

A

Spirometric Classification (GOLD 1-2)
Exacerbations per year (1 or less)
CAT (10 or more)
mMRC (2 or more)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

High Risk, Less Symptoms Assessment Values of COPD

A

Spirometric Classification (GOLD 3-4)
Exacerbations per year (2 or more)
CAT (under 10)
mMRC (0-1)

71
Q

High risk, more symptoms assessment values of COPD

A

Spirometric Classification (GOLD 3-4)
Exacerbations per year (2 or more)
CAT (10 or more)
mMRC (2 or more)

72
Q

Describe GOLD stage 1 (mild)

A

FEV1 over 80

73
Q

Describe GOLD stage 2 (moderate)

A

FEV1 between 50-80

74
Q

Describe GOLD stage 3 (severe)

A

FEV1 between 30 and 50

75
Q

What do you add at GOLD stage 2?

A

Regular treatment with one ore more long-acting bronchodilators

76
Q

What do you add at GOLD stage 3?

A

Inhaled glucocorticosteroids if repeated exacerbations

77
Q

What do you add at GOLD stage 4?

A

Long term oxygen if chronic respirator failure and consider surgery

78
Q

What should be added for all stages of GOLD therapy

A

short-acting bronchodilator prn

79
Q

When should antibiotics be used in COPD?

A

When patient presents with 3 cardinal symptoms: increased dyspnea, increased sputum volume, and increased sputum purulence

As well as in those that require mechanical ventilation

80
Q

Onset differences between asthma and COPD

A

Early in life/later in life

81
Q

Etiology differences in asthma/COPD

A

immunologic stimuli, family history/smoking and other risk factors

82
Q

Course differences between asthma and COPD

A

intermittent/chronic and progressive

83
Q

Clinical features in asthma vs COPD

A

wheezing, chest tightness, dyspnea and cough/chronic cough/sputum, persistent or worsening dyspnea

84
Q

Inflammatory mediator in asthma vs COPD

A

eosinophils/neutrophils

85
Q

What guidelines are used for asthma? for COPD?

A

Asthma - National Asthma Education and Prevention Program (NAEPP)

COPD - GOLDs, American Thoracic Society (ATS) and European Respiratory Society (ERS)

86
Q

Which groups tend to have higher incidence of asthma?

A

children, boys, adult women, Puerto Ricans, residents in the northeast corridor of the US, those living in poverty, and those exposed to certain chemicals

87
Q

Severe viral respiratory infections during the first _____ years of life is a primary risk factor for asthma

A

3

88
Q

List some drugs that are common triggers for asthma

A

NSAIDs, Aspirin, beta-adrenergics

89
Q

A drop in ____ can be the first sign of an impending asthma exacerbation

A

PEF

90
Q

As far as symptoms are concerned, what is a key difference between asthma and COPD?

A

COPD presents with a productive cough; asthma may present with chest tightness (both present with wheezing)

91
Q

What is PEF?

A

Peak Expiatory flow (goal is at least 80 percent of personal best)

92
Q

What is the reason for the caution label on first-generation antihistamine agents for asthmatics?

A

Anticholinergic properties may thicken mucus and decrease mucociliary clearance

93
Q

Inhaled medications have _________ adverse effects compared with systemic medications

A

Fewer

94
Q

What are some of the characteristic symptoms of aspirin sensitivity??

A

itchy or watery eyes, itchy rashes, rashes around mouth, nasal congestion, hives, worsening asthma, coughing, wheezing or anaphylaxis

95
Q

Significant cross-sensitivity exists between aspirin and ______

A

NSAIDs

96
Q

What are some common side effects associated with non-selective beta-agonists? What is the mechanism that causes these side effects?

A

arrhythmias, nervousness, palpitations

beta-agonists can also act on alpha receptors, constricting blood vessels and increasing blood pressure, leading to the adverse effects listed above.

97
Q

Which vaccine should all patients with asthma (who are 6 months of age or older) receive yearly?

A

Influenza

98
Q

What does FEV1 measure?

A

The amount of air expired in the first second as the subject forcefully exhales from a maximum inspiration

99
Q

How does a patient determine PEF?

A

Twice daily, once in morning and once in early evening, 15-20 minutes after the use of a quick-relief inhaler

100
Q

Anyone using a MDI should use a _______ to ensure optimal medication delivery to lungs

A

VHC - Valved holding chamber

101
Q

The corneal epithelium is _______________, facilitating the passage of ___________ - soluble drugs.

A

Lipophilic, fat soluble

102
Q

The corneal stroma is _______________, facilitating the passage of ___________ - soluble drugs.

A

Hydrophilic, water-soluble

103
Q

Angle closure can be caused by any agent with __________________ or _________________ effects

A

antiocholinergic, dilating

104
Q

Miotic means ____________

Mydriatic means ____________

A

closing, opening

105
Q

The leading cause of blindness in the US is ______________________________

A

Macular Degeneration

106
Q

What is the difference between viscosity of products and severity of dry eye disease?

A

More viscous products for more severe form of disease

107
Q

For dry eye disease, what is the general recommendation for how often to use drops?

A

bid to start, with more sever cases qid

108
Q

If multiple medications are used in the eye, how long should you wait between drops? What if a drop and ointment are to be used?

A

5 minutes

Use drops 10 minutes before ointment

109
Q

This is a main counseling point for eye ointments

A

Blurred vision

110
Q

Should contacts be worn with allergic conjunctivitis?

A

No

111
Q

Nonpharmacologic therapy options for allergic conjunctivitis

A

Cold compresses, keeping doors and windows closed, checking the pollen count, using air filters, running air conditioners

112
Q

What are the recommended pharmacologic treatment options for allergic conjunctivitis?

A

First-line is artificial tears prn; opthalmic antihistamine/mast cell stabilizer should be used if symptoms persist

113
Q

What are the 4 OTC decongestants available for application to eye?

A

Phenylephrine, naphazoline, tetrahydrozoline, oxymetazoline

114
Q

Ocular decongestants should not be used for more than ___________________ due to risk of ________________________________

A

72 hours, rebound congestion

115
Q

Use of ocular decongestants in ___________________________ is contraindicated

A

angle-closure glaucoma

116
Q

Name the 2 OTC ophthalmic antihistamines

A

pheniramine maleate and antazoline phosphate

117
Q

Ophthalmic antihistamine/mast cell stabalzer

A

ketotifen fumerate

118
Q

Ophthalmic antihistamines may cause __________________ due to their ____________________________ properties. Therefore they are contraindicated in people with _________________________

A

pupil dilation

anticholinergic properties

angle-closure glaucoma

119
Q

___________ is the safest and most effective product for treatment of allergic conjunctivitis. Another effective alternative is ______________________

A

Ketotifen (bid), Naphazoline

120
Q

Rebound congestion is less likely in which ocular decongestants/antihistamines?

A

Naphazoline and tetrahydrozoline, compared with phenylephrine and oxymetazoline

121
Q

What is a hallmark symptom of corneal edema

A

halos or starbursts around lights

122
Q

What is the purpose of hyperosmotic agents as ophthalmic products?

A

increase tonicity of tear film, promoting movement of fluid from cornea to more osmotic tear film

123
Q

Minor eye irritation can be treated with _________________, a mild astringent.

A

Zinc sulfate

124
Q

Generally, patients treating ophthalmic disorders should see a physician if symptoms persist after _________

A

72 hours

125
Q

Currently, the only approved cerumen-softening agent is ________________________________

A

Carbamide peroxide 6.5% in anhydrous glycerin (approved for treatment in adults and children 12 and older)

126
Q

How does carbamide peroxide work as an otic product?

A

When exposed to moisture, nacent oxygen released slowly and acts as weak antibacterial; the effervescence along with effects of urea on tissue helps to mechanically break down and loosen cerumen

127
Q

How long can carbamide peroxide be used?

A

Generally bid up to 4 days since non-irritating

128
Q

What is the main difference between administering otic products to children compared with adults?

A

If patient is under 3, pull ear back and down (as opposed to back and up)

129
Q

_________________________________ is the only FDA approved ear-drying aid

A

isopropyl alcohol 95% in anhydrous glycerin 5%

130
Q

50:50 mixture of ________________ and _____________ has bactericidal and antifungal properties

A

acetic acid 5%, isopropyl alcohol 95%

131
Q

The majority of colds in children and adults are caused by _____________

A

rhinoviruses

132
Q

Describe the clinical presentation of a cold

A

Sore throat first, followed by nasal symptoms which dominate 2-3 days later, with cough appearing (sometimes) on day 4 and 5

133
Q

Rhinovirus cold symptoms persist for ___ to ___ days

A

7-14

134
Q

Nonpharmacologic therapy recommendations for cold

A

increase fluid intake, adequate rest, nutritious diet, increased humidification and steamy showers (for children, upright positioning)

135
Q

What are some exclusions for self-treatment for colds?

A

Fever over 101.5, chest pain or shortness of breath, AIDS, older more frail patients, infants under 9 months, hypersensitivity to recommended OTCs

136
Q

List the direct, indirect and mixed decongestants and describe differences

A

Direct (act directly on adrenergic receptors): Phenylephrine, oxymetazoline and tetrahydrozoline

Indirect (displace norepinephrine from storage vesicles): ephedrine

Mixed: Pseudoephedrine

137
Q

Systemic decongestants include ___________. How about short-acting (intranasal)? Long-acting (intranasal)?

A

pseudoephedrine, phenylephrine

naphazoline, phenylephrine

oxymetazoline

138
Q

Adverse effects associated with decongestants include

A

cardiovascular and CNS stimulation

139
Q

Therapy of ___ to ___ days is accepted to avoid rebound congestion

A

3-5

140
Q

Decongestants are contraindicated in patients receiving _____ inhibitors

A

MAO (since MAO metabolizes decongestants)

141
Q

_______-containing products should not be used in children with viral illnesses due to the risk of Reye’s syndrome

A

Aspirin

142
Q

Decongestants may decrease _____________________ in new mothers

A

milk production (counsel to drink plenty of liquids)

143
Q

FDA does not recommend non-prescription cold medications in children under ____

A

2

144
Q

What patient factors should be considered when treating a cold?

A

Symptoms longer than 7-14 days or suspected chronic condition should not self-treat; those overly sensitive to adrenergic stimulation (diabetes, cardiovascular diseases, etc.) should not self-treat

145
Q

____ and __________________ are popular complementary therapies for colds

A

Zinc, high-dose Vitamin C (doses of 4g/day are not recommended)

146
Q

Describe the pathogenesis (4 phases) of allergic rhinitis

A
  1. sensitization on initial allergen exposure, stimulating b-lymphocyte mediated IgE production
  2. Early phase - occurring within minutes of subsequent allergen exposure; rapid release of mast cell mediators and production of other mediators
  3. Cellular recruitment - circulating leukocytes, especially eosinophils, are attracted to nasal mucosa and cause release of more mediators
  4. Late phase (2-4 hours after allergen exposure) - mucus hypersecretion, congestion
147
Q

Systemic symptoms of allergic rhinitis

A

Fatigue, irritability, malaise and cognitive impairment

148
Q

How do you differentiate between intermittent and persistent allergic rhinitis? Mild or moderate/severe?

A

symptoms 4 days or less vs more than 4 days per week

impairment of sleep or daily activities is how you distinguish if allergic rhinitis is moderate-severe

149
Q

Nonpharmacologic recommendations for allergic rhinitis

A

Allergen avoidance, cat baths if you own a cat,

150
Q

Pharmacologic Therapy for allergic rhinitis

A

Intranasal corticosteroids are most effective; oral antihistamines, mast cell stabilizers; patients should regularly use these products and should take them at least 1 week prior to when symptoms typically appear

151
Q

What are the two INCSs that are approved for OTC use

A

Triamcinolone acetonide (Nascort) - adults and children over 2

Fluticasone propionate (Flonase) - adults and children over 4, 2 sprays per nostril/day and 1 spray per nostril/day, respectively

152
Q

What is an important counseling point for when symptom relief should be seen when using INCSs?

A

Complete symptom control may not be seen for up to 1 week

153
Q

What are the 2 major classes of antihistamines available for allergic rhinitis?

A

First generation (sedating, but come with anticholinergic effects) and second generation (non-sedating)

154
Q

In first-generation antihistamine use, children are more likely to experience _____________ CNS effects while adults are more likely to experience ______________ CNS effects

A

excitatory, depressing

155
Q

Fexofenadine should not be taken with any _______________

A

fruit juices

156
Q

Sedating antihistamines are contraindicated in patients with

A

Narrow-angle glaucoma, lactating women and premature infants

157
Q

Whats an important counseling point for sedating antihistamines?

A

Photosensitizing

158
Q

What are the primary first-generation antihistamines? Second?

A

Diphenhyramine, Doxylamine, brompheniramine, clorpheniramine

Loratadine, cetirizine (most potent but has been known to cause sedation), fexofenadine

159
Q

What is cromolyn sodium used for?

A

Mast cell stabilizer for treatment/prevention of allergic rhinitis (takes 3-7 days for initial efficacy and 2-4 weeks for max therapeutic benefits)

160
Q

What is the first-gen of choice in pregnant women?

A

Chlorpheniramine

161
Q

Antihistamines are contraindicated during __________

A

Lactation

162
Q

For children under 12, what are the antihistamines of choice?

A

Loratadine, followed by fexofenadine and cetirizine (sedating antihistamines should be avoided in children)

163
Q

What are the antihistamines/drugs of choice in older populations for allergic rhinitis?

A

Loratadine and cromolyn

164
Q

How do you differentiate between an acute, sub-acute or chronic cough?

A

3 weeks
3-8 weeks
over 8 weeks

165
Q

Drug of choice for non-productive coughs

A

Antitussives (codeine, dextromethorphan, diphenhydramine and chlophedianol [mild anesthetic with anticholinergic effects] hydrochloride)

166
Q

Cautious hydration is recommended for patients with…

A

lower respiratory tract infections, heart failure, renal failure, etc.

167
Q

The combination of dextromethorphan and MAOIs may cause _________________________

A

Serotonergic syndrome (should not be taken for at least 14 days after MAOI is discontinued)

168
Q

________________ is the only FDA approved expectorent

A

Guaifenesin

169
Q

What does the ACCP recommend regarding cough associated with a common cold?

A

First-generation antihistamine/decongestant combo; also suggests that the anti-inflammatory naproxen may reduce viral-associated cough

170
Q

What does the ACCP recommend for cough associated with acute and chronic bronchitis as well as postinfectious subacute cough?

A

Codeine or dextromethorphan

171
Q

Cough and cold medicines should not be used to treat infants under ____ years of age

A

2

172
Q

What can be said about diphenhydramine in lactating mothers and the elderly?

A

Not appropriate (can be excreted in breast milk)

173
Q

Dextromethrophan, diphenhydramine and chlophedianol should not be taken concurrently with _____

A

MAOIs

174
Q

What shouldn’t be given to children under 1 due to a risk of botulism?

A

Honey

Pharmacy School 2015-16 (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions