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Clinical Pharm > Pulm cases > Flashcards

Pulm cases Flashcards

1
Q

What is a good indicator of whether or not a URI is bacterial or viral

A

Is the patient getting worse or better after certian amount of time

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2
Q

What classes of medications are appropriate to recommend or provide for URI

A

Decongestants

Pain and fever relievers

Cough suppressants

Cough expectorants

Vitamins and Supplements

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3
Q

What medication classes are appropriate to recommend or RX for allergic rhinitis

A

Antihistamines
Intranasal Corticosteroids

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4
Q

What is the MOA for oral decongestants

A

Activate alpha and beta adrenergic receptors

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5
Q

What is the effect of PO decongestants binding alpha adrenergic receptors

A

When bound to alpha receptors of resp mucosa it causes vasoconstriction which reduces mucosal swelling and improves ventilation

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6
Q

What effect do PO decongestants have when binding the beta receptors

A

Bronchial relaxation

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7
Q

What are the s/e of PO decongestants

A

Vasoconstriction/tachycardia leading to angina
HTN
Worsening of CVD
Increase BG
Nervousness
Insomnia
Dizziness
Drowsiness
Urinary retention

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8
Q

What population should you avoid PO decongestants

A
  • In pts with HTN
  • Pts less than 6 y/o
  • Pts in the first trimester of pregnancy
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9
Q

What should you look out for in pts taking PO decongestants

A

Urinary retention

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10
Q

what is the only decongestant for pt with HTN?

A

HBP

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11
Q

What are the two decongestants meds?

A

Pseudoephedrine

Phenylephrine

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12
Q

Which decongestant did jaynstein say “never use this”

A

Phenylephrine

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13
Q

What is the duration of action for pseudoephedrine

A

4-6h

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14
Q

What is the duration of action for Phenylephrine

A

2-4 hours

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15
Q

How much of the pseudoephedrine is absorbed vs phenylephrine

A

100% vs 38%

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16
Q

What are the MOA of cough suppressants/antitussives (2)

A
  1. Centrally act on the medullary cough center

OR

  1. Locally at the site of irritation
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17
Q

What antitussives act centrally on the medullary cough center

A

Dextromethorphan

Opiates

Benzonate

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18
Q

What antitussives act locally at the site of irritation

A

Lozenges
Viscous preps
Menthol
Camphor

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19
Q

Dextromethorphan is actually the D-isomer of what drug?

A

Codeine

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20
Q

What are the s/e of dextromethorphan

A

Nausea

Dizziness

Drowsiness

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21
Q

What is a DDI to watch out for with dextromethorphan

A

Serotonin Syndrome if Rxs with SSRIs and MOAIs.
Esp MOAIs

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22
Q

T/F

Dextromethorphan is contraindicated in pregnancy

A

False, it is safe

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23
Q

What medication is completely contraindicated with dextromethorphan

A

MAOIs bc greater risk for serotonin syndrome

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24
Q

Why is codeine not used often as an antitussive

A

High abuse potential

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25
Q

What are the s/e of Codeine

A

CNS depression
Resp depression
Common allergen

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26
Q

What category is codeine considered in pregnancy? Why?

A

Cat C- leads to resp depression and addiction risk

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27
Q

T/F
Benzonate has mildly addictive properties

A

False, they have no addictive properties

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28
Q

What are the s/e associated with Benzonate

A

HA
Dizziness
Drowsiness

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29
Q

T/F

Benzonate is safe to use in pregnancy

A

False- it is cautioned in pregnancy

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30
Q

Why does Jaynstein say you shouldn’t prescribe benzonate to pts with no insurance

A

They are expensive and there is only a 50:50 chance it will actually work for the pt

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31
Q

What is the MOA of expectorants?

A

Dissolves thick mucus
Enhances airway clearing
Promotes coughing

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32
Q

What are the s/e of expectorants

A

N/V
Rash

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33
Q

What meds are expectorants

A

Mucinex
Guaifenesin (robitussin)

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34
Q

What pt population should you avoid expectortants in?

A

Pts <6

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35
Q

T/F

Expectorants are safe in pregnancy

A

True

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36
Q

Guaifenesin may exacerbate ?

A

Nephrolithiasis

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37
Q

What is robitussin DM a combination of

A

Dextromethorphan/guaifenesin

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38
Q

What vitamins and supplements MAY be beneficial based on EBM

A

Echinacea

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39
Q

What vitamins/supplements have ANECDOTAL evidence of benefi

A

Vitamin C

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40
Q

What vitamins and supplements have contradictory EBM results

A

Zinc

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41
Q

Whats the s/e of zinc

A

Nausea
Mouth irritation

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42
Q

What are the recommended abx to tx mild to moderate bacterial sinusitis

A
  • Amoxicillin/Clavulanate 875mg PO BID 7 days
  • Doxycycline 100mg BID 7 days
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43
Q

What are the recommended abx to tx sinusitis that is risk for resistance of abx failure

A

Amoxicillin/clavulanate 2000mg BID, 10-14 days
Levofloxacin 500mg QD, 5 days
Moxifloxacin 400mg, 10 days

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44
Q

What are the abx recommended for severe cases of abx (inpatient)

A

Amp/sulbactam 3gm IV QID
Levofloxacin 500mg IV QD
Ceftriaxone 1gm IV BID

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45
Q

What abx are NOT recommended for sinusitis and why?

A
  • Macrolides
  • TMP/SMX
  • 2nd or 3rd gen cephalosporins

They all do not tx S. pneumo

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46
Q

What is the tx for intermittent asthma (step 1)

A

PRN SABA

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47
Q

What is the step 2 tx of mgmt of presistent asthma

A
  • low dose ICS
    or
  • low dose LABA PRN
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48
Q

What is the step 3 tx of mgmt of presistent asthma

A
  • Low dose ICS + LABA
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49
Q

What is the step 4 tx of mgmt of presistent asthma

A
  • Medium dose ICS + LABA
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50
Q

What is the step 5 tx of mgmt of presistent asthma

A
  • High dose ICS + LABA
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51
Q

What are the add ons for asthma?

A

Leukotriene modifiers

Mast Cell Stabilizers

Anticolinergics

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52
Q

What are example of leukotriene modifiers?

A

Montelukast (Singular)

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53
Q

What are example of mast cell stabilizers?

A

Cromolyn Sodium
Nedocromil

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54
Q

What are examples of anticholinergics?

A
  • Ipratropium Bromide (Atrovent) (SAMA)
  • Tiotropium (Spiriva) (LAMA)
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55
Q

What are different inhaled devices?

A

Metered-Dose Inhalers (MDI)
Dry Powder Inhalers (DPI)
Nebulizers
HFA - Diskus

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56
Q

What are the different asthma drug class

A
  • Inhaled Beta-2 Agonist (Short and Long Acting)
  • Inhaled Corticosteroids
  • Leukotriene Modifiers
  • Mast Cell Stabilizers
  • Anticholinergics
  • Anti-IgE Antibody
  • Theophylline
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57
Q

Whats the MOA for inhaled short acting?

A

Beta-2-agonist

58
Q

Whats the onset, peak and duration for short acting?

A

Onset: 5 min
Peak: 30-60min
Duration: 4-6hrs

59
Q

What is the s/e for short acting?

A

Tachycardia, QTc prolongation, tremor, anxiety, hyperglycemia, hypokalemia and hypomagnesemia, especially if used in high doses

60
Q

What are example of short acting?

A

Albuterol, Proventil, ProAir, Ventolin
Xopenex

61
Q

Whats the MOA for ICS?

A

Inhibits multiple inflammatory cytokines via the glucocorticoid receptor (Bring down inflammation)

62
Q

What are the s/e for ICS?

A
  • Oral candidiasis (thrush), dysphonia, and reflex cough and bronchospasm
  • Might cough, but don’t worry it’s a good thing meaning meds going to the right place
63
Q

What is the most effective long-term treatment to control asthma symptoms?

A

ICS

64
Q

What are names of common ICS?

A

Qvar, Pulmicort, Flovent

65
Q

Per updated asthma guidelines whats now the standard of care

A

PRN ICS at initial asthma dx

66
Q

What is the MOA of long acting?

A

Beta-2-agnoist

67
Q

Whats the onset and duration of inhaled long acting beta-2 agonist?

A

Onset: 30min
Duration >12hrs

68
Q

Whats the S/E of LABA

A

Paradoxical bronchospasm, asthma exacerbation, laryngospasm, hypokalemia

69
Q

What are the LABA names?

A

Salmeterol (Serevent)
Formoterol

70
Q

What med is monotherapy NOT recommended?

A

LABA

LABA was associated with an increased risk of asthma-related hospitalization, intubation and death; the greatest risk was in children 4-11 years old

71
Q

If a LABA is needed then what should you added?

A

ICS

72
Q

What are examples of LABA+ICS combos?

A
  • Salmeterol/fluticasone (Advair)
  • Formoterol/budesonide (Symbicort)
  • Formoterol/mometasone (Dulera)
73
Q

What are the s/e of LABA/ICS?

A

Especially if used in higher- than-recommended doses, can cause tremor, muscle cramps, tachycardia and other cardiac effects

74
Q

Whats the MOA for leukotriene modifiers?

A
  • Inhibits physiologic actions without any agonist activity.
  • Block the action of leukotrienes
75
Q

What does Leukotrienes cause?

A

constriction and mucus production

76
Q

T/F leukotrienes modifiers are more effective than low-dose ICS

A

False, less effective than ICS

77
Q

When are leukotriene modifiers used?

A

When pts are unable or unwilling to use ICS

78
Q

What is the s/e of leukotriene modifiers?

A

Abdominal pain, nausea, jaundice, itching or lethargy

79
Q

Common name of leukotriene modifiers?

A

Singular

80
Q

What is MOA of mast cell stabilizers?

A

Alters function of delayed Cl- channels and inhibits cell activation

81
Q

How does mast cell stabilizers work?

A
  • Inhibition of cough
  • Inhibition of early response to antigens (mast cells)
  • Inhibition of late response to antigens (eosinophils)
82
Q

What is the S/E of mast cell stabilizers?

A

Throat irritation, cough, dry mouth, wheezing, chest tightness

83
Q

What are the common mast cell stabilizers?

A

Cromolyn

84
Q

What can cause asthma treatment failure?

A
  • Lack of adherence to prescribed meds
  • Continued exposure to tobacco smoke and other pollutants
  • Smoking/exposure to second-hand smoke
  • Some pt taking aspirin/other NSAIDs
  • Oral non-selective beta-adrenergic blockers (propranolol, timolol) can cause bronchospasm in pt with asthma and cause decrease bronchodilating effects!
85
Q

What medications can lead to asthma exacerbations in some pts

A

NSAIDs
ASA

86
Q

What medications MAY be shown to ppt bronchospasm in pts with asthma when they are taking beta-2-agonists

A

Beta blockers

87
Q

What are some alternatives to beta blockers as a migraine prophylaxis medication

A
  • Non-dihydropyridine CCB (Diltiazem and verapamil)
  • Beta 1 selective Beta blocker
  • Anticonvulsants
  • TCAs
88
Q

What medications can decrease the efficacy of OCP

A

Anticonvulsants

89
Q

Whats the tx for oral thrush?

A

Nystatin 5mL swish and swallow QID for 7-14d

90
Q

T/F always provide refill for albuterol

A

TRUE

91
Q

When should you follow up after adjusting a pts asthma meds

A

Guideline = 2-6 weeks
Jaynstein = 2-4 weeks

92
Q

T/F Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease

A

True

93
Q

is COPD restrictive or obstructive?

A

Obstructive

94
Q

T/F

COPD is not fully reversible

A

True

95
Q

In COPD the FEV1 is < _____ and FEV1/FVC is < ________

A

80%

0.7

96
Q

What is the GOLD 1

A

Mild COPD

FEV >80% predicted

97
Q

What is the GOLD 2

A

Moderate COPD

FEV 50-80% predicted

98
Q

What is the GOLD 3

A

Severe COPD

FEV 30-50% predicted

99
Q

What is GOLD 4

A

Very Severe COPD

FEV <30% predicted

100
Q

What is the tx for all GOLD categories

A

Avoidance of risk factors

Influenza/Pneumococcal

101
Q

What is the tx for GOLD 1?

A

SABA PRN

102
Q

What is the tx for GOLD 2?

A

SABA PRN
LABA??
Pulm rehab

103
Q

What is the GOLD III tx

A

SABA PRN

LABA or LAMA

Rehab

ICS if significant sxs

104
Q

What is the GOLD IV tx

A

SABA PRN

LABA or LAMA

Rehab

ICS if significant sxs

Long term O2 therapy

105
Q

What is the mMRC/CAT scale

A

Ways to stratify a pt based on risk in COPD, to decide how to medicate

106
Q

Group A COPD treatment

A

Bronchodilator (SABA or SAMA)

107
Q

Group B COPD treatment

A

LABA or LAMA

108
Q

Group C COPD treatment

A

ICS + LABA or LAMA

109
Q

Group D COPD treatment

A

ICS +LABA +/or LAMA

110
Q

What are the tx goals for treating COPD

A

Reduce sxs

Control dyspnea

Improve exercise tolerance and QOL

Decrease complications and exacerbations

111
Q

What is the LAMA of choice for COPD

A

Spiriva (tiotropium)

112
Q

What are ICS most useful in treating, asthma or COPD

A

Asthma

113
Q

Whats the combination of ipratropium/albuterol?

A

combivent

114
Q

T/F Inhaled corticosteroid is recommended to reduce the number of exacerbations

A

True

115
Q

Review combo meds

A

slide 37

116
Q

T/F Oral steroids is recommended in COPD

A

False, NOT recommended in COPD.

The risks of such treatment include myopathy, glucose intolerance, weight gain and immunosuppression

117
Q

What are the things that can improve M+M in COPD

A

O2 therapy

Smoking cessation

118
Q

T/F Oxygen therapy may also increase exercise capacity in patients

A

True, but its long-term benefits in such patients are unclear

119
Q

When do you consider O2 therapy

A

O2 <88% on RA

Evidence of pulm HTN

CHF

Polycythemia

120
Q

What are the benefits of pulm rehab?

A

Reducing dyspnea

improving fxn capacity and quality of life

Reduce hospitalization

121
Q

ICS is reserve for which group A, B, C, D

A

C & D

122
Q

What orgs make up 60% of CAP

A

Strep and mycoplasma

123
Q

What are the PCN that MAY work for STrep CAP

A

Pen VK

Amox

Augmentin

Don’t RX these tho bc high resistance

124
Q

What gen of cephalosporin may be used to tx Strep CAP

A

3rd- cefdinir, ceftriaxone, ceftazadime

125
Q

What macrolide may be used to tx Strep CAP

A

Azithromycin and Clarithromycin

126
Q

What FQ may be used to tx Strep CAP

A

Levofloxacin and Moxifloxacin

127
Q

What med does Jaynstein love for Strep

A

Doxy (tetracycline)

128
Q

Tx for mycoplasma pna

A

Doxy

Erythromycin

Levofloxacin

129
Q

Tx for H. flu pna

A

Macrolides (clarithromycin/azithromycin)

FQs (levo and moxifloxacin)

130
Q

Tx for chlamydia PNA

A

Macrolides (clarithromycin/azithromycin)

FQs (levo)

131
Q

Tx of legionella pna

A

Macrolides

FQs (levo)

Second gen tetracycline (Doxy)

132
Q

IV vs PO should be decided based on what (for abx)

A

Bioavailability, point is you can RX PO abx for an inpatient tx

133
Q

When can you switch a pt who was on IV abx to PO abx

A

If they are stable with nl VS for 24 hours:

(Afebrile, RR <24, HR <100, SBP >90, O2 sat >90% RA AND NO RESP DISTRESS)

134
Q

What is the benefit of transferring a pt from IV to PO abx

A

Early transition decreases length of hospital stay and cost

135
Q

T/F just because they are in the hospital, they need IV abx

A

false, just bc a pt is hospitalized for PNA does not mean they need IV abx’s

136
Q

What scoring system is good for determining whether or not a pt should be admitted for the PNA

A

CURB-65

137
Q

What does CURB-65 stand for?

A

C = confusion
U = Urea (>7mmol/L)
R = RR >30
B = BP <90/30

65 = >65 y.o

138
Q

Score of what in a CURB-65 indicates need for admission

A

> 2

139
Q

When you discharge a pt for outpt tx of PNA when should they be seen again

A

After finishing course of Abx have them in ASAP

140
Q

When should you do CXR after d/c pt with PNA

A

just prior to D/C and again when they return after completion of PO Abx

141
Q

What is a good recommendation for body aches associated with PNA

A

APAP 1gm with IBU 600mg q4h

Clinical Pharm (8 decks)

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