Pharm Blessings Flashcards by Paige LaPointe

What is Samter’s triad?

ASA allergy, asthma, and nasyl polyps

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What is the DOC for acute asthma attacks?

short-acting beta-2 agonist

e.g. albuterol [ventolin hfa] or levalbuterol [xopenex hfa]

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What is the DOC for asthma maintenance?

inhaled corticosteroids

e.g. fluticasone [flovent]

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There are multiple dosages of asthma medications.

How should you prescribe them?

Start with lowest dosage and walk your way up if needed

(so as not to overmedicate)

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Which type of asthma medication slows progression of the disease?

corticosteroids

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What type of asthma medication helps to relieve sx, but does nothing for the progression of the disease?

long-acting beta agonists

e.g. salmeterol [serevent diskus] or formoterol [foradil]

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What’s the issue with prescribing LABA drugs like formoterol [foradil] for asthma?

(Like why should we NOT prescribe those?)

What are the LABA drugs that come with this warning?

Black Box Warning!

Increased risk of asthma-related deaths

Therefore, try to stay away from Formoterol [foradil], Salmeterol [servent diskus], Umeclidinium/Vilanterol [anoro ellipta], Fluticasone/Salmeterol [advair], and Budesonide/Formoterol [symbicort]

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Your patient needs a rescue inhaler. He is hypertensive with no other conditions. What should you give him?

Levalbuterol [xopenex hfa]

(Albuterol is c/i for HTN)

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What’s a huge issue with prescribing teenagers asthma inhalers?

They don’t want to do it in front of their friends

_{(tell them to suck it up)}

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How many times per day should a person take their inhaled corticosteroids?

2x per day

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How often should albuterol [ventolin hfa] be taken?

What’s the problem with long term use of it?

No more often than every 20 minutes during an attack.

However, wears out with long-term use. Does nothing to slow progression of disease, so must get patient on ICS (inhaled corticosteroids).

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What is the DOC for exercise-induced asthma?

What are the directions for taking it?

Albuterol [ventolin hfa]

Take 5 min before exercise and PRN

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What is the DOC for a person with a 1y history of wheezing, dyspnea with sports, and awakening with SOB 2-3 times per week?

So he’s got something MORE than intermittent asthma

Will give albuterol [ventolin hfa] for acute attacks, but will give fluticasone [flovent] for LT maintenance

(SABA + ICS)

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What combo products can you use for more severe cases of asthma that haven’t responded to initial tx?

Combo of ICS and LABA

e.g. fluticasone/salmeterol [advair] or budesonide/formoterol [symbicort]

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If a person doesn’t know their inhaler, what can you ask them so that YOU can know?

Whether their it’s a spray or a disk

What color it is

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How long do you put a patient on a long-term maintenance asthma therapy?

(And do you remember the DOC for long-term asthma maintenance?)

Usually for life because we always need to be slowing the progression of the disease.

And the DOC is inhaled corticosteroids like Fluticasone [Flovent]!

(Good job! and if you got it wrong, you’ll get it next time, champ)

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Fluticasone [flovent] comes in both MDI and diskus. How do you decide which to give?

Diskus is more expensive, so start with MDI.

If patient is having a hard time with MDI, can give diskus.

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How long does it take fluticasone [flovent] to start working?

2 weeks. def not a rescue inhaler.

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What should you do after using inhaled corticosteroids?

Rinse your mouth out to prevent flush.

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What are the options for a patient who wants to quit smoking?

Nicotine replacement via:

Nicoderm patch
Nicorette gum
Nicotrol inhalation
Nicotrol nasal spray

Drug options:

Varenicline [chantix]
Buproprion [wellbutrin/zyban]

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If your patient has dentures, which nicotene therapy is no longer available to them?

Gum

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Which nictotine cessation drug is better to begin with?

Buproprion [wellbutrin/zyban]!

Chantix - more expensive, results are iffy

psychological problem could occur with either, but it’s better to realize it when on the cheaper drug!

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What is the MOA of varenicline [chantix]?

partial nicotene agonist

prevents nicotene stimulation of the dopamine system

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What is the MOA of buproprion [zyban/wellbutrin]?

atypical antidepressant

unknown MOA, but believed to work on dopamine, serotonin, and NE receptors

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What is the most common side effect of varenicline [chantix]?

bad dreams

Which anti-smoking aide should you avoid in patients with seizure disorder?

Buproprion [zyban/wellbutrin]

What do you really need to pay attention to with patients on Varenicline [chantix] and Buproprion [zyban/wellbutrin]

Black box warning! Monitor for psychological symptoms including suicidal thoughts

What should you be sure to ask about when someone wants to quit smoking? (2 things)

1. Why they want to quit (can help you to reinforce their quitting) 2. If anyone else in the house smokes (both should try quitting)

How should you direct your pt to use the nicotene patch?

Move it around to different areas of your skin to avoid irritation

How do you confirm a diagnosis of COPD?

PFTs - irreversible obstructive pattern | (according to White)

What is the DOC to alleviate acute symptoms of COPD?

SABA - albuterol [ventolin hfa]

What drugs should you use for COPD? (this is a messy answer) (help)

Combo therapy with B2 agonists and anticholinergics **Attack: B2 agonists**: albuterol [ventolin], formoterol [foradil], salmeterol [serevent diskus] **Long term: anticholinergics:** tiotroprium [spiriva], ipratroprium [atrovent] theophylline, roflumilast [daliresp] (adjunct) If severe, consider steroids Or a Combo drug that includes them both Umeclidinium/Vilanterol [Anoro Ellipta], Budesonide/Formoterol [Symbicort MDI], ipratroprium/albuterol [Combivent]

What is the DOC for COPD maintenance?

long acting anticholinergic - ipratropium [atrovent hfa] or tiotroprium [spiriva]

If you patient has benign prostate hyperplasia (BPH) and also has COPD, which drug is safe to give?

LABA - salmeterol [serevent diskus] or formoterol [foradil]

If your patient has benign prostate hyperplasia (BPH), but he IS on a long-acting anticholinergic inhaler, what do you need to monitor closely?

urinary retention

If your patient is having a very severe COPD exacerbation, what can you give?

always depends on severity. 1. one time nebulizer tx with albuterol [ventolin] or ipratroprium/albuterol [combivent] 2. Consider 3-5 day course of steroids

Your patient has a COPD exacerbation which has developed over the course of 6 months. He also has HTN and DM. What should you give him?

Break it down: it has developed over 6 months, so he doesn't need abx This is an *exacerbation*, so you want a SABA He has **HTN** and DM, so albuterol [ventolin] is contraindicated Therefore, you give **levalbuterol [xopenex]**

Your COPD patient is not responding to his long acting anticholinergic. What is your next step?

rx a long acting cholinergic mixed with a LABA e.g. umeclidinium/vilanterol [anoro ellipta]

At what 02 sat does shit start going south fast?

88%

What COPD drug works better for night time sx? Day time sx?

Night: ipratroprium [atrovent hfa] Day: LABA like salmeterol [serevent diskus] and formoterol [foradil]

Which COPD drug is used primarily as **adjunct** therapy?

Theophylline [elixophyllin]

Which COPD drugs are C/I in patients with heart problems, esp. arrythmias?

LABA SABA PDE inhibitors (theophylline)

What are the 2 pneumonia vaccinations? What are the basic guidelines for giving them?

For those over 65 with COPD or 55+ with severe COPD Vaccines: pneumovax and prevnar Give 1 year apart from each other

What's the issue with using fluticasone in children with asthma?

growth delay/stunting

What is the DOC for sleep apnea?

Refer to pulmonology for a sleep eval study

A woman with asthma is currently on 44mcg Flovent and Albuterol PRN. Her asthmas sx have been worsening over the past year. What can you do for her?

Up her flovent to 110mcg Have her use up her 44mcg one first Could also try spacer

What do you rx if an asthma patient has Samter's triad?

Along with inhaler, oral prednisone

A person with an existing lung condition is having an exacerbation. What lab should you order before assuming that it's a pulmonary problem?

CBC to check for anemia.

What do you rx for acute bacterial sinusitis? What about if there is a PCN allergy?

augmentin if allergy: doxy

Your patient has COPD. What would you normally give him? But there's a plot twist and he has glaucoma. So what now

normal: long acting anticholinergic (ipratroprium or tioproprium) with glaucoma: LABA (salmeterol or formoterol) +/- inhaled corticosteroid (fluticasone) and MONITOR for IOP

Other than inhaler drugs, what might you also prescribe for a person with a COPD exacerbation?

antibiotics that cover S pneumo, M catarrhalis, H influenzae because it's likely due to infection

What do spacers do?

Assure more drug delivery to the lung tissue

How long does it take to see results with fluticasone [flovent]?

2 weeks

What is a major side effect of zafirlukast [accolade]?

liver disease

What is the MOA of Omalizumab [Xolair]?

anti IgE antibody and immunoregulator Binds to IgE Ab receptors on mast cells to prevent release of histamine

What are the indications for Omalizumab [Xolair]?

maintenance of **allergic** asthma **not** controlled by ICS (usually only in severe)

What are the side effects of Omalizumab [Xolair]?

The big thing is **anaphylaxis** so give the first dose in office (subQ)

What do you rx for inpatient CAP? | (2 options)

1. **cephalosporin + macrolide** (ceftriaxone + azithromycin) 2. **FQ** alone (levoquin)

How do you determine whether to admit someone with pneumonia? What is the criteria?

Curb65 criteria based on: **C**ognition B**U**N \> 19 **R**R \> 30 **B**P \< 90/60 (either number) **65**+ (or 55+ with comorbidities) (also consider whether 2+ lobes are infected)

In an elderly patient with COPD who gets pneumonia, what should you check in follow-up?

Get a CXR to make sure the pneumonia isn't masking lung CA

Hey ya'll let's not forget what methotrexate can cause....

pulmonary fibrosis! congrats you rock

Just because COPD is so effing confusing to me and there's like 18 cases about it, I'm making another card. Your pt. has COPD. What do you give for maintenance? Your pt. doesn't respond to that. Now what do you give? Your pt. doesn't respond to THAT. What's your next option? And what should you always give for rescue?

1st: long acting anticholinergic 2nd: long acting anticholinergic + LABA 3rd: long acting anticholinergic + LABA + ICS Rescue: SABA (everyone gets a SABA!)

Your patient has CF and comes to see you in family care for pnuemonia. What do you do?

Admit them asap!! You'll disadvantage them by treating them empirically - send to hospital to get sputum culture and specific treatment.

What happens when you mix COPD with narcotics?

decreased RR

Which enzyme system is alcohol involved with?

CYP3A4 duh

What are you?

A damn rockstar