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Pharm 1 > Pulm > Flashcards

Pulm Flashcards

1
Q

What meds are First line for acute/chronic asthma symptoms and exercise-induced bronchospasm?

A

SABAs

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2
Q

What meds cause tachycardia, hypokalemia, tremors?

A

SABAs

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3
Q

should LABAs be used as monotherapy?

A

no

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4
Q

“ipratropium (Atrovent®)

Albuterol/ipratropium (Duoneb®, Combivent®)”

A

SAMA

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5
Q

what is 1st line for severe status asthmaticus ?

A

systemic corticosteroids

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6
Q

What causes Moon face, Buffalo hump, Hirsuitism (dark hair in abnormal places, poss deeper voice in F), Weight gain, Muscle wasting & weakness, Bruising, Skin thinning, Mood changes, Growth retardation, Peptic Ulcers, Hyperglycemia, Hypertension, Hypokalemia, Osteoporosis, Cataracts, Glaucoma, Immune suppression

A

systemic corticosteroids

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7
Q 
"Beclomethasone HFA (Qvar®)
Budesonide nebs, DPI (Pulmicort®)
Ciclesonide HFA (Alvesco®)
Fluticasone furoate (ArnuityEllipta ®) DPI
Fluticasone propionate (Flovent HFA® or Diskus® DPI), Mometasone (Asmanex®)"
A

ICS

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8
Q

1st line treatment as long-term controllers in persistent asthma.

A

ICS

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9
Q

Severe COPD w/ increased exacerbation risk that is not controlled by 1st line LAMAs and LABAs

A

ICS

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10
Q

Which meds cause Oral candidiasis, dysphonia, cough?

A

ICS

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11
Q

major 3A4 substrate.

Interaction with 3A4 inhibitors: ritonavir, itraconazole, ketoconazole

A

ICS

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12
Q

“Asthma + COPD: Formoterol (Perforomist® nebulization), Salmeterol (Serevent®)
COPD only: Indacaterol (Arcapta Neohaler®), Olodaterol (Striverdi Respimat®), Arformoterol (Brovana®)
1 inhalation Q12 hrs”

A

LABA

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13
Q

what is the BBW for LABAs?

A

BBW: do not use as monotherapy (increased mortality risk.

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14
Q

put LABA, LAMA, and ICS in order of use for ashtma and copd

A

“Asthma : use ICS, then add LABA, then LAMA.

COPD: use LAMA, the LABA, then ICS”

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15
Q

“Asthma + COPD: tiotropium (Spiriva®). Onset: 30 minutes; Duration: 24+ hours
COPD: Umeclidinium (Incruse Ellipta)
Aclidinium (Tudorza Pressair)
Glycopyrrolate (Seebri Neohaler)”

A

LAMA

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16
Q

what is 1st line in copd?

A

LAMA

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17
Q

“Montelukast (Singulair®), Zafirlukast (Accolate®), Zileuton (Zyflo CR®)
PO”

A

Oral leukotriene receptor antagonists (LTRAs)

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18
Q

what is the BBW for montelukast?

A

Black Box Warning for montelukast: neuropsych side effects (Agitation, depression, sleeping problems, suicidal thoughts and actions)

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19
Q

main SE of Zafilukast and Zileuton:

A

hepatotoxicity

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20
Q

meds for eosinophilic asthma

A

IL-5 receptor antagonists (type of mab biologic)

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21
Q

which drug for ashmta / COPD has many many interactions?

A

Theophylline (theo-24)

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22
Q

only drug that decreases mortality in COPD

A

O2

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23
Q

Roflumilast (Daxas®, Daliresp®)

A

Phosphodiesterase-4 (PDE-4) inhibitor

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24
Q

SEs: Arthralgias, fever, rash, increased risk of infection, new malignancy, anaphylactic reaction (rare)

A

biologics

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25
Q

what med should you look for in the charts of a kid w/ psych problems?

A

montelukast

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26
Q

CAp outpatient w/o comorbities

treatmetn

A

amoxicillin 1g PO tid X 5+ days, doxy, or macrolide (azithromycin, clarithromycin)

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27
Q

CAP outpatient w/ comorbities

treatment

A

“Monotherapy (1st line for COPD/PCN allergic): levofloxacin or moxifloxacin
Combo (1st line for others): augmentin OR cefuroxime OR cefpodoxime + macrolide OR doxy
Alt: lefamulin PO, IV”

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28
Q

CAP inpatient non-severe no MRSA or pseudo

treatmnet

A

resp fluoroquinolone OR [beta-lactam (cefotaxime, ceftriaxone, Unasyn, ertapenem) + macrolide/doxy/FQ] X 5d

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29
Q

for which CAP pts should you obtain cultures and treat empircally?

A

inpatient non-severe w/ prior MRSA/psuedo. inpatient severe w/ MRSA/psudo risk

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30
Q

for which CAP pts should you obtain cultures and wait to treat? no empiric treatment

A

inpatient non-severe w/ hospitalization and prior IV abx w/in 90d.

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31
Q

CAP inpatient MRSA or pseudo risk

A

“P: [levofloxacin OR cipro] + Zosyn / cefepime / meropenem / ceftazidime / imipenem X 7d
MRSA: [ceftriaxone + azithromycin, OR levofloxacin/moxifloxacin] + vancomycin OR linezolid”

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32
Q

CAP inpatient severe no MRSA or pseudo

A

beta lactam (ceftriaxone / Unasyn / cefotaxime / ertapenem) + macrolide/doxy / levofloxacin/moxifloxacin X 5d

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33
Q

list CAP comorbities

A

“DM; chronic heart, lung, liver, or renal disease; alcohol use disorder; malignancy; or asplenia; on immunosuppressants; or have been on antibiotics in the last 3 months

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34
Q

Aspiration PNA

outpatient

A

augmentin OR moxifloxacin

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35
Q

aspiration PNA hospitalisation + not severe

A

Unasyn

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36
Q

Tx for aspiration PNA hospitalisation + severe

A

Zosyn

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37
Q

flu antivirals

A

neuraminidase inhibitors: oseltamivir (Tamiflu) PO or susp, Peramivir (Rapivab) IV only, Zanamivir (Relenza) inhaled powder
baloxavir (Xofluza) PO 1 tab

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38
Q

flu antivirals must be started in what timeframe?

A

w/in 48 hrs of symtom onset

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39
Q

bronchitis non-opioid Rx

A

Benzonatate (Tessalon Perles) 100mg PO Q8 hr PRN cough

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40
Q

mod to severe croup tx

A

dexamethasone Po/IV/IM/inhaled + nebulized epi + supportive (humidified O2, fluid, antipyretics)

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41
Q

covid antivirals

A

Nirmatrelvir and ritonavir (Paxlovid) bid X 5d

Remdesivir (Veklury) Qd IV X 5-10d

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42
Q

covid mab

A

Bebtelovimab IV infusion

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43
Q

covid antivirals w/in what timeframe?

A

5 days of symptom onset

44
Q

covid mab w/in what timeframe?

A

7 days of symptom onset

45
Q

tamiflu dosing

A

bid for treatment, Qd for prophylaxis. Adult = 75mg X 5d. Kids <15 kg = 30mg; 15-23kg =45mg; 23-40kg =60mg. Infant <1yr = 3mg/kg.

46
Q

What med would you give to an asthma pt who cannot tolerate ICS?

A

OLTAs (montelukast)

47
Q

Arthus-Type vs Serum Sickness: which appears 24 hrs after vaccine?

48
Q

Arthus-Type vs Serum Sickness: which has systemic symptoms?

49
Q

Arthus-Type vs Serum Sickness: which can happen from bug bites?

50
Q

initial tetanus vaccine, given to kids<7 y/o

51
Q

when would you give a Tdap shot to a person w/ a dirty wound?

A

if last Tdap was >5 years ago or do not have access to their medical records

52
Q

What are the live vaccines?

A 
MMR (measles, mumps, rubella)
Varicella
Rotavirus
Intranasal FluMist
Smallpox
Yellow fever
BCG (Bacillus-Calmette-Guerin) for tuberculosis/treating bladder cancer
53
Q

who should not receive live vaccines? 2 groups

A

AVOID in immunocompromised patients (pregnant, stem cell transplant, organ transplant)

54
Q

Pts taking TNF-alpha inhibitors should be screened for what lung disease?

55
Q

etanercept, infliximab, adalimumab, golimumab, certolizumab pegol

A

TNF inhibitors

56
Q

gold standard test for Tb

A

QuantiFERON Gold, an Interferon-Gamma Release Assay (IGRA)

57
Q

first line agents against Tb

A

Isoniazid (INH)
Rifampin
Ethambutol
Pyrazinamide (=PZA)

58
Q

which 1st line TB drug is never given as monotherapy for active infx?

A

isoniazid (INH)

59
Q

how to you prevent peripheral nerupathy from INH?

A

give vitamin B6

60
Q

AE:
Peripheral neuropathy
Hepatitis/elevations in liver enzymes (transient elevation in ~20%,severe liver injury ~1%)
CNS toxicity (memory loss to psychosis or convulsions)
Hypersensitivity reactions; drug-induced lupus erythematosu

A

Isoniazid (INH)

61
Q

combining INH and rifampin increases risk of what?

A

elevated LFTS

62
Q

which TB drug turns all body fluids red/orange?

63
Q

rifampin alt therapy in HIV pt w/ used protease inhibitors

64
Q

which TB drug lowers the effectiveness of OCP?

A

rifampin (and that class(

65
Q

which 1st line TB drugs induce CYP450?

A

rifampin, rifabutin

66
Q

for which 1st line TB drug should you monitor LFTs monthly in pts w/ pre-existing liver dz?

67
Q

TB drug w/ AE: N/V, Moderate rises in LFTs to hepatotoxicity, Hyperuricemia

A

pyrazinamide (PZA)

68
Q

which 1st line TB drugs can affect the kidneys?

A

pyrazinamide (PZA) and ethambutol

69
Q

which TB drug causes optic neuritis?

A

ethambutol

70
Q

4 month active TB regimen is what drug combo?

A

rifapentine-moxifloxacin

71
Q

contraindications for 4 month TB regimen

A

kids under 12, weight <40kg, pregnant or breastfeeding, extrapulmonary TB, prolonged QT, on drugs w/ interactions

72
Q

treatment regimens for LTBI

A

3 mo of once weekly INH + rifapentine (3HP) for age 2+; 4 mo of Qd rifampin (4R), 3 mo of Qd isoniaxid + rifampin (3HR)

73
Q

2nd line TB drugs w/ AE: renal toxicity and ototoxicity

A

“Aminoglycosides (injectables)

Streptomycin IV, amikacin IV, and kanamycin”

74
Q

WHICH 2nd line TB drugs can cause cause bone/joint growth delay, pain, inflammation in children <18 years old. Use with caution.

A

fluroguinolones (levofloxacin, moxifloxacin)

75
Q

can FQ be used in pregnancy?

76
Q 
"Aminoglycosides (injectables)
Streptomycin IV, amikacin IV, and kanamycin"
Capreomycin (injectable)
"Fluoroquinolones PO or parenteral
Levofloxacin, moxifloxacin "
Cycloserine
Ethionamide
p-Aminosalicylic acid
Linezolid
Bedaquiline
A

2nd line drugs for TB

77
Q

AE: (long-term): Bone marrow suppression, Peripheral neuropathy, Blindness

78
Q

at least __ drugs must be used to treat MDR-TB

79
Q

what are the set 3 drugs that must be used to treat MDR-TB?

A

1) any 1st line PO that is likely to be effective, 2) injectable aminoglycoside or polypeptide (Kanamycin, amikacin, capreomycin, streptomycin), 3) FQ

80
Q

how often are sputum smears and cultures req’ed in MDR-TB?

A

monthly until conversion

81
Q

how long does treatment continue (non-injectables) after MDR-TB culture is negative?

A

minimum 18 months

82
Q

what vaccine can cause a + skin Tb test?

83
Q

is it ok to prescribe meds w/ low levels of known nitrosamine?

84
Q

what intake of meds w/ nitrosamines at or below acceptable daily intake limits is known to be ok?

A

a person taking a drug that contains nitrosamines at-or-below the acceptable daily intake limits every day for 70 years is not expected to have an increased risk of cancer.

85
Q

what meds have nitrosamines?

A

Rifampin, Zantac, Metformin,Losartan,Chantix

86
Q

active TB treatment regimen if 4 month option is contraindicated

A

6 or 9 month RIPE (all 4)

87
Q

AquADEKs, DEKAs, MVW Complete, Choiceful

A

fat soluble vitamins (for CF)

88
Q

Class: Creon, Pancreaze, Zenpep PO

A

Pancrealipase

89
Q

Ursodiol (Actigall, Urso Forte) role in CF

A

for liver dz in CF

90
Q

Class: Dornase alfa (Pulmozyme), Hypertonic saline for inhalation (HyperSal), N-acetylcysteine (Mucomyst)

A

mucolytics

91
Q

2 anti-inflammatories

for CF

A

high dose ibuprofen; azithromycin

92
Q

abx for CF

A

Inhaled tobramycin, aztreonam, colistin

93
Q

cyproheptadine, dronabinol, Mirtazapine(Remeron), Megestrol (Megace

A

appetite stimulants

94
Q

ivacaftor (Kalydeco®), lumacaftor/ivacaftor (Orkambi®), tezacaftor/ivacaftor (Symdeko®, Trikafta®(elexacaftor/ivacaftor/tezacaftor)

A

gene regulators in CF

95
Q

hepatic or renal adjustments necessary in pancrealipase?

96
Q

counseling: take w/ meals. Can mix microbeads for kids w/ food but NOT hot food

A

pancrealipase

97
Q

what CF med can prevent or dissolve gallstones?

A

Ursodiol (Actigall, Urso Forte)

98
Q

AEs of what CF drug? HA, dizziness, diarrhea, constipation, dyspepsia, n, back pain, URI

A

Ursodiol (Actigall, Urso Forte)

99
Q

would you use inhaled and IV abx together for CF?

100
Q

adrenal suppression is AE of what CF drug?

101
Q

which CF drugs? Contraindication with strong CYP3A inducers

A

ivacaftor (Kalydeco®), lumacaftor/ivacaftor (Orkambi®), tezacaftor/ivacaftor (Symdeko®, Trikafta®(elexacaftor/ivacaftor/tezacaftor)

102
Q

AE of what CF drugs? May cause elevated liver enzymes (LFTs)

A

gene regulators

103
Q

do CF gene regulators req dosage adjustment for hepatic impairment?

104
Q

how to prevent infusion reaction SEs of amphotericin B?

A

premedicate w/ acetominaphen and benadryl

105
Q

ICS that is ok for pregnancy

A

budesonide

Pharm 1 (17 decks)

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