Pharm 17 Flashcards
List names of controller medications
- ICS
- LABA
- Leukotriene-modifiers
- Cromolyn
- Oral theophylline
- Omalizumab
- Ipratropium, tiotropium
Step up when
therapy when asthma is uncontrolled
step down when
asthma has been well controlled for at least 3 months
Preferred therapy in step 2
Low-dose inhaled glucocorticoids
Alt therapy in step 2
Cromolyn, LTRA, or theophylline
Preferred therapy in step 3
Low-dose inhaled Glucocorticoids + LABA or medium-dose inhaled glucocorticoids
Preferred therapy in step 4
Medium-dose inhaled glucocorticoids + LABA
Preferred therapy in step 5
High-dose inhaled glucocorticoids + LABA
Preferred therapy in step 6
High-dose inhaled glucocorticoids + LABA + oral systemic glucocorticoids
Guidance on appropriately managing days in yellow zone
Mild-moderate asthma symptoms are present.
- Add quick relief/rescue medicine
with a spacer to attempt to get asthma symptoms under control.
- Use of low dose ICS or cromolyn, montelukast, or theophylline
- Contact provider
Guidance on appropriately managing days in red zone
- Severe asthma symptoms are present.
- Use of quick relief/rescue medicine if still in red zone after 15 minutes then call 911.
GOLD COPD group A
- Low risk and less symptomatic
- SAMA or SABA
GOLD COPD group B
- Low risk, but highly symptomatic
- LAMA or LABA + PRN use of SABA
GOLD COPD group C
- High risk, but less symptomatic
- LAMA
GOLD COPD group D
- High risk and highly symptomatic
- LABA + LAMA and/or ICS
COPD exacerbation tx if having 1 additional symptom
SABA and/or SAMA
COPD exacerbation tx if having 2 or 3 additional symptom
- Antibiotics
- <65 years, FEV1 >50% or fewer annual exacerbations, no cardiac disease = macrolide, 2nd generation cephalosporin, doxycycline, or SMZ-TMP
- > 65 years or more exacerbations = FQ or amoxicillin/clav
COPD exacerbation MC tx
Prednisone 40 mg daily x 5 days
Reversibility in asthma
- Confirmed by demonstrating the reversibility of airflow obstruction FEV1 to short-acting bronchodilator
Reversibility in COPD
- Depends on the bronchodilator type
- 34.6% reversability if using ipratropium and albuterol together.
What is the role of systemic corticosteroids in asthma and COPD.
- No role for inhaled steroids for the ACUTE treatment of either asthma or COPD
- Acute exacerbation or moderate/severe asthma may need to use a short course of systemic steroids
- ICS is first choice controller in chronic asthma
- Used as maintenance therapy in some COPD pts
Describe the typical txs used to treat CAP
- Macrolide (azithromycin or clarithromycin)
- Macrolide + cephalosporin
- Doxycycline
- Fluoroquinolone
- in hospital settings Beta-lactam IV plus macrolide or doxycycline
Atypical pathogens are more common in
- Smokers and patients with COPD
- Those hospitalized or in long term care
- Cystic fibrosis
- Aspiration, recent antibiotic use
Describe the typical txs used to treat HAP
- Receive antibiotics prior to onset of pneumonia
- Ceftizoxime (Antispeudomonal cephalosporin)
- piperacillin/tazobactam or carbapenem + Cipro (antipseudomonal fluroquinolone) or aminoglycoside
What should be avoided in immunosuppressed patients with pneumonia
Any antimicrobial agent used for prophylaxis should be avoided in empiric therapy for bacterial pneumonia as resistance may emerge
List the four first line drugs to treat tuberculosis
Rifampin Isoniazid Pyrazinamide Ethambutol (use for 2 months)
List the two first line drugs to treat tuberculosis continuously
Isoniazid + rifampin for a minimum of an additional 4 months
Impacts of drug resistance on drug selection and time course of therapy for TB
Multi-drug resistance or severe, active infection, courses of therapy may go much longer than 6 months and up to 7 different medications may need to be used
ASE of Isoniazid
- Liver injury- monitor liver enzymes
- Neruopathy- symmetric paresthesia
- limit tyramine intake
ASE of Rifampin
- Hepatotoxic
- discoloration of body fluids (red color)
- Enzyme inducer
ASE of Pyrazinamide
Polyarthralgias
ASE of Ethambutol
Optic neuritis
What is “DOT”
- Direct observation of therapy
- allows dosing to be 5 days per weeks instead of 7
The primary metabolic pathway of isoniazid
Primarily metabolized by the liver acetylation into acetylhydrazine
How does the phenotypic expression effect isoniazid plasma concentrations
- Two forms the enzyme are responsible for acetylation either rapid or slow acetylators
- can inhibit the metabolism of other drugs
The drug interaction of rifampin and warfarin or BC therapy
- Enzyme inducer (P450)
- Decreases the efficacy of anticoags and BC
- ex: if a decrease of efficacy occurs with thewarfarin that then cause the body to form clots because warfarin is not able to think the blood as well d/t rifampin
