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pulm drugs Flashcards

1
Q

salmeterol

A

beta 2 adrenergic receptor agonist
used for asthma & copd
long acting (8-10 hours)

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2
Q

formoterol

A

beta 2 adrenergic receptor agonist
used for asthma & copd
long acting (8-10 hours)

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3
Q

bronchodilators

A

beta adrenergic agents
ipratropium
methylxanthines

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4
Q

ipratroprium

A

anticholintergic bronchodilator tx
not anti-inflammatory
first line for COPD

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5
Q

theophylline

A

unclear MOA
PDE4 inhibiotr - increases cAMP but weak bronchodilator
used in COPD to enhance muscle fx, drive to breath and decrease pulm resistance
very narrow therapeutic window

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6
Q

montelukast, zafirlukast

A

leukotriene recptor antagonist
only 25% of asthma pts respond
anti inflammatory
pill

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7
Q

zileuton

A

rarely used except for extreme asthma
5-lypoygenase inhibitor –> blocks leukotriene synthesis
pill

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8
Q

prednisone

A

oral corticosteroid used only for acute flares of astma or for chronic severe asthma or COPD
first pass activation in liver

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9
Q

budesonide, fluticasone

A

inhaled corticosteroid with high receptor affinity

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10
Q

advair

A

salmeterol and fluticasone - first combination tx

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11
Q

mechanical defense mechanism

A

gag/cough
nasal hairs, turbinates
bronchial branching
muscous ciliary function

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12
Q

pathological condition association with defect in mech denfense & manifestations

A

endotrach intubation,t racheostomy – aspiration penumonia
stroke, seizure, alcohol/drug – lung abcess & VAP
CF,dysmotile cilia syndromes – bronchiectasis, airway obstruction
bronchiectasis – bacterial pneumo
endobronchial turmor– aytpical mycobacteria infection

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13
Q

innate immunity in lung

A

neutropenia
phagocyte function
complemetn cascade
defensins

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14
Q

pathological condition association with defect in innate denfense & manifestations

A

chemo.neutropenia – invasice aspergillosis
chronic granulomatous disease – chronic bacterial infection
complement def – encapsalated bacteria
CF (lack fo defensins) - bacterial infections

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15
Q

adapative immmunity in lungs

A

CD4
CD8
b cell

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16
Q

pathological condition association with defect in adaptive denfense & manifestations

A

AIDS/SCID/DiGeorge – TB & toher mycobacteria, PCP, crytococcus, fungi,
corticosteroids, transplant immunsuppre – hpv
myeloma, nephrosis, agammaglobuinemia, aspelnia, sickle cell – encapsulated bacterial infections

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17
Q

differential for diffuse alveolar-filling diseases

A

disseminated infection (pneumo)
pulm hemorrhage syndromes (Goodpastures)
pulm edema
neoplams
reactions to narcotics abuse
occupational lung diease (berllium, silcois)
sarcoidosis
fat embolism
pulm alveolar proteinosis

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18
Q

histoplama capsulatum

A

dimorphic
birds & bats
ohio-miss river valley, varibbean
lungs & spleen
narrow necked buds

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19
Q

cocciodiodes immitis

A

dimorphic
not carried by animals (soil)
SW US, Mexico
lungs
large spherules with small endospores

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20
Q

blastomyces dermatitidits

A

dimorphic
not carried by animals (soil)
central SE US
lungs & skin
thick walled yeast with wide necked bud

21
Q

cryptococcus neoformans

A

yeast only!
birds
universal in US
lungs, CNS
halo around yeast(capsule) & stains with mucicarmine

22
Q

candidiasis

A

oppportunitistic
football shaped
common commensal organism on skin, oropharynx and vagina
can cause thrush when normal bacteria gone
can enter via GI & GU
in immuncompromoised- purulent pneumo

23
Q

aspergillosis

A

narrow cylindrical septate hyphae with 45 degree branching
ubiquitious in environment
often cause infarct

24
Q

mucor, absidia, rhizpus

A

broad, flat nonseptate hyphae with right angle branching
ubiquitious in natures
vascular invastion infection in neutropenic pts
thrombosis (like aspergillus)

25
Q

pcp

A

mixed features of funal and protoxoal
reproduce via cysts - person to person transmission
provoke little inflammation btu cause foamy fluid accumulaition without inflam cells in alveoli
crushed ping pong ball

26
Q

cuases of diffuse bronchiectasis

A

1) post infections - measles, pertussis, mycobacteria
2) congenital - CF, primary ciliary dyskinesia
3) immunodef states
4) immune-mediate dz- ABPA, RA, Sjogren, IBD
5) gerd/aspiration

27
Q

specific tx for bronchiectasis

A

immunoglobulin replacement
corticosteroids, itraconazole (ABPA)
alpha 1 antitrypsin replacement
antrimycobacterial antibx

28
Q

how to clear airway in bronchiectasis

A

1) nebulized agent - bronchodilators (no long-term randomized trial data), hypertonic saline
2) chest physiotherpay
3) postural positioning

29
Q

when to use airway clearance tx in bronchiectaiss

A

symptom relief - cough, sputum production
impaired OL
frequent acute infectious exacerbations

30
Q

tiotropium & aclidinium

A

long acting muscarinic antagonist used for COPD
can: relieve symptoms
increase exercise capacity
reduce number and severity of exacerbations
improve health status

31
Q

roflumilast

A

PDE4 inhibitor used for COPD
unknown if reduces exacerbations in addition to ICS/LABA combo

32
Q

management of COPD exacerbations

A

short-acting bronchodilators
antibx
systemic glucocorticoids (oral or IV)
control o2
non-invasive ventilation

33
Q

o2goal for acute exacerbation of copd

A

90-93% sat bc supplemental o2 might precipitate co2 retenion

34
Q

good candidates for LVRS

A

severe COPD, fev1200%)

35
Q

stepwise tx for COPD

A

1) start with prn albuterol and/or ipratropim, smoking cessation and vaccinations
2) add LAMA or LABA and pulm rehab
3) add ICS to LABA ir severe dz or frequent exacerbations
4) access for hypoxemia and tx at any stage
5) if sever dz with apical predominant emphysema consider LVRS

36
Q

asthma tx for kids

A

1) SABA prn
2) low -dose ICS
3) either low-dose ICS + either LABA, LTRA or theophylline OR medium dose ICS
4) medium dose ICS + LABA
5) high dose ICS + LABA
6) high dose ICS + LABA + oral systemic corticosteroid

37
Q

palivizumab

A

engineered humanized RSV monoclonal Ab for children at high risk (provides passive immunoprophylaxis) for premies and chronic lung disease or congenital heart dz
monthly injection

38
Q

kalydeco (ivacaftor)

A

targets G551D cftr
CF tx

39
Q

VX-809

A

used in combo with kalydeco to tx f508 cf in phase III trials

40
Q

tx of allergic rhinitis

A

step 1 - mild episodic symptoms - oral h1 antagonist prn
2) moderate continuous symptoms - daily nasal corticosteroid (begin before season) & oral h1 antagonist, add alpha adrenergic oral decongenestant, leukotriene inhibitors or nasal antihistamine
3_ refractory - oral corticosteroid refer to specialist

41
Q

effects of histamine

A

pruritis
sneezing
rhinorrhea
conjuctival symptoms
respiratory symptoms
systemic symptoms
minimal effect on congestion

42
Q

loratidine, fexophenidin, ceterizine, levoceterizine

A

second gen antihistamine

43
Q

leukotriene inhibitors

A

never primary tx for allergic rhinitis - always adjunct for antihistamine
minimal side effects

44
Q

singulair, accolate

A

leukotrience inhibitor

45
Q

topical nasal steroid agents for allergic rhinitis

A

nasonex
flonase
veramyse
nasacort

46
Q

omalizumab

A

anti IgE antibody – used for allergic rhinitis
20,000/year so rarely used

47
Q

tx of allergic rhibitis - list

A

allergen avoidance
pharmaco - oral antihisatmine, oral decongestants, nasal antihistamine, nasal corticosteroid, ocular antiallegics/anithistamines
specific immunotx

48
Q

nivolumab

A

fully human IgG4 anti-human Pd-1 blocking Ab - high affinity for PD1
20% with lung cancer respond – limited to those expressing PD-L1 on their tumors

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