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Pulmonary > Pharm 17 > Flashcards

Pharm 17 Flashcards

1
Q

List names of controller medications

A
  • ICS
  • LABA
  • Leukotriene-modifiers
  • Cromolyn
  • Oral theophylline
  • Omalizumab
  • Ipratropium, tiotropium
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2
Q

Step up when

A

therapy when asthma is uncontrolled

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3
Q

step down when

A

asthma has been well controlled for at least 3 months

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4
Q

Preferred therapy in step 2

A

Low-dose inhaled glucocorticoids

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5
Q

Alt therapy in step 2

A

Cromolyn, LTRA, or theophylline

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6
Q

Preferred therapy in step 3

A

Low-dose inhaled Glucocorticoids + LABA or medium-dose inhaled glucocorticoids

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7
Q

Preferred therapy in step 4

A

Medium-dose inhaled glucocorticoids + LABA

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8
Q

Preferred therapy in step 5

A

High-dose inhaled glucocorticoids + LABA

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9
Q

Preferred therapy in step 6

A

High-dose inhaled glucocorticoids + LABA + oral systemic glucocorticoids

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10
Q

Guidance on appropriately managing days in yellow zone

A

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

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11
Q

Guidance on appropriately managing days in red zone

A
  • Severe asthma symptoms are present.

- Use of quick relief/rescue medicine if still in red zone after 15 minutes then call 911.

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12
Q

GOLD COPD group A

A
  • Low risk and less symptomatic

- SAMA or SABA

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13
Q

GOLD COPD group B

A
  • Low risk, but highly symptomatic

- LAMA or LABA + PRN use of SABA

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14
Q

GOLD COPD group C

A
  • High risk, but less symptomatic

- LAMA

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15
Q

GOLD COPD group D

A
  • High risk and highly symptomatic

- LABA + LAMA and/or ICS

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16
Q

COPD exacerbation tx if having 1 additional symptom

A

SABA and/or SAMA

17
Q

COPD exacerbation tx if having 2 or 3 additional symptom

A
  • 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
18
Q

COPD exacerbation MC tx

A

Prednisone 40 mg daily x 5 days

19
Q

Reversibility in asthma

A
  • Confirmed by demonstrating the reversibility of airflow obstruction FEV1 to short-acting bronchodilator
20
Q

Reversibility in COPD

A
  • Depends on the bronchodilator type

- 34.6% reversability if using ipratropium and albuterol together.

21
Q

What is the role of systemic corticosteroids in asthma and COPD.

A
  • 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
22
Q

Describe the typical txs used to treat CAP

A
  • Macrolide (azithromycin or clarithromycin)
  • Macrolide + cephalosporin
  • Doxycycline
  • Fluoroquinolone
  • in hospital settings Beta-lactam IV plus macrolide or doxycycline
23
Q

Atypical pathogens are more common in

A
  • Smokers and patients with COPD
  • Those hospitalized or in long term care
  • Cystic fibrosis
  • Aspiration, recent antibiotic use
24
Q

Describe the typical txs used to treat HAP

A
  • Receive antibiotics prior to onset of pneumonia
  • Ceftizoxime (Antispeudomonal cephalosporin)
  • piperacillin/tazobactam or carbapenem + Cipro (antipseudomonal fluroquinolone) or aminoglycoside
25
Q

What should be avoided in immunosuppressed patients with pneumonia

A

Any antimicrobial agent used for prophylaxis should be avoided in empiric therapy for bacterial pneumonia as resistance may emerge

26
Q

List the four first line drugs to treat tuberculosis

A 
Rifampin 
Isoniazid
Pyrazinamide 
Ethambutol 
(use for 2 months)
27
Q

List the two first line drugs to treat tuberculosis continuously

A

Isoniazid + rifampin for a minimum of an additional 4 months

28
Q

Impacts of drug resistance on drug selection and time course of therapy for TB

A

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

29
Q

ASE of Isoniazid

A
  • Liver injury- monitor liver enzymes
  • Neruopathy- symmetric paresthesia
  • limit tyramine intake
30
Q

ASE of Rifampin

A
  • Hepatotoxic
  • discoloration of body fluids (red color)
  • Enzyme inducer
31
Q

ASE of Pyrazinamide

A

Polyarthralgias

32
Q

ASE of Ethambutol

A

Optic neuritis

33
Q

What is “DOT”

A
  • Direct observation of therapy

- allows dosing to be 5 days per weeks instead of 7

34
Q

The primary metabolic pathway of isoniazid

A

Primarily metabolized by the liver acetylation into acetylhydrazine

35
Q

How does the phenotypic expression effect isoniazid plasma concentrations

A
  • Two forms the enzyme are responsible for acetylation either rapid or slow acetylators
  • can inhibit the metabolism of other drugs
36
Q

The drug interaction of rifampin and warfarin or BC therapy

A
  • 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

Pulmonary (12 decks)

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