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Clin Pharm > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

T/F: Longer rhinosinusitis lasts w/o pt getting ill- more likely its a virus

A

True. Can go 2wks

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2
Q

Purulent sinus drainage is definitive of a ___

A

URI

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3
Q

URI or Allergic Rhinitis Tx: Decongestants

A

URI

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4
Q

URI or Allergic Rhinitis Tx: Pain & Fever reducers

A

URI

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5
Q

URI or Allergic Rhinitis Tx: Cough suppressants

A

URI

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6
Q

URI or Allergic Rhinitis Tx: Cough Expectorants

A

URI

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7
Q

URI or Allergic Rhinitis Tx: Vitamins & Supplements

A

URI

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8
Q

URI or Allergic Rhinitis Tx: Antihistamines

A

Allergic Rhinitis

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9
Q

URI or Allergic Rhinitis Tx: Intranasal Corticosteroids

A

Allergic Rhinitis

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10
Q

URI MOA: Activates alpha & beta adrenergic receptors

A

Decongestants

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11
Q

URI:
MOA: Directly stim α-adrenergic receptor of resp mucosa→ vasoconstriction →
↓ mucosal swelling→ ↑ ventilation

A

Decongestant

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12
Q

URI:
MOA: Directly stim β-adrenergic receptors→ bronchial relaxation

A

Decongestant

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13
Q

Decongestants S/E (which 4 systems?)(monitor which 2 pt groups)

A

*Vasoconstriction & tachycardia
→ angina, HTN, & worsening CV dz
* ↑ glycogenolysis & gluconeogenesis (monitor your diabetics)
*CNS stim (nervous, insomnia, dizzy, drowsy)
* urinary retention (monitor BPH pts)

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14
Q

Decongestants(2) good & bad?duration?

A

*Pseudoephedrine (Sudafed)
Duration: 4-6hrs
100% absorbed
*Phenylephrine (Sudafed PE) GARBAGE
Duration: 2-4hrs
38% absorbed

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15
Q

Decongestants:
avoid in (3)

A

HTN pts,
<6yo,
1st trimester preg

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16
Q

___ is only Decongestant avail for HTN pts

A

*Coricidin

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17
Q

URI:
MOA: dissolve thick mucus, ↑ airway clearing, & promote cough

A

Expectorants (mucolytic)

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18
Q

Expectorants S/E (2)

A

N/V, rash

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19
Q

t/f: Robitussion (expectorant) safe in preg?

A

True

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20
Q

What two rx make up robitussin?

A

dextromethorphan & guaifenesin

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21
Q

t/f: Guaifenesin may exacerbate nephrolithiasis

A

Cough cough kidney stone

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22
Q

Expectorants (mucolytic) avoid:

A

<6yo

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23
Q

MOA: Acts centrally on medullary cough center

A

Cough suppressants/antitussives

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24
Q

URI MOA: Acts locally at site of irritaiton

A

Cough suppressant/antitussives

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25
Q

centrally acting antitussives

A

Dextromethorphan, opiates, Benzonate (tessalon)
“Central BOD”

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26
Q

locally acting antitussives

A

Lozenges, viscous preparations, menthol and camphor

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27
Q

Antitussive w/ low abuse potential

A

Dextromethorphan

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28
Q

Dextromethorphan S/E (4) ?

A

serotonin syndrome (caution w/SSRI), nausea, dizziness, drowsiness

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29
Q

Benzonate (Tessalon)
Opiate (Codeine)
Dextromethorphan
Ok in pregnancy?

A

Dextromethorphan
Caution w/others

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30
Q

T/F: Dextromethorphan is contraindicated with SSRI & MAOI?

A

False, caution w/SSRI (ZoProPro’s PaCe)
contraindicated with MAOI (MarNar)

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31
Q

Which vit/supplement does reveal benefit in URI?

A

Echinacea

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32
Q

T/F: zinc does have true benefit in URI

A

False. Contradictory.
WILL cause nausea & mouth irritation

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33
Q

Abx for Mild to mod bacterial sinusitis

A

DOC:Augmentin 875mg PO BID x 7d
2nd line: Doxycycline 100mg BID x7d

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34
Q

Abx for severe bacterial sinusitis

A

Severe = IV. “CAL” the ER
Ceftriaxone (Rocephin) 1g IV BID
Ampicillin/Sulbactam (Unasyn) 3g IV QID
Levofloxacin 500mg IV QD

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35
Q

ABX for Risk of resistance bacterial sinusitis

A

Resistant “AF” think high dose long duration!
*Augmentin 2g BID x 10-14d
*FQ (Respiratory):
Moxifloxacin 400mg QD x10d
Levofloxacin 500mg QD x 5d

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36
Q

Which 3 drugs are NOT recommended for empiric sinusitis tx b/c of high resistance to Strep pna?

A

“Make Better Choices”
Macrolides
Bactrim
Cephalosporins

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37
Q

T/F: SABA monotherapy is only ok with intermittent (Exercise) Asthma?

A

True

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38
Q

4 Inhalation Devices for Asthma

A

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

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39
Q

7 Drug Classifications for Asthma

A

*Inhaled β-2 Agonist (Short & Long Acting)
*Inhaled Corticosteroids
*Leukotriene Modifiers
*Mast Cell Stabilizers
*Anticholinergics
*Anti-IgE Antibody
*Theophylline

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40
Q

Asthma:
MOA: B2 agonist

A

SABA
LABA

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41
Q

Asthma:
MOA: Inhibits inflammatory cytokines via the glucocorticoid receptor

A

ICS

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42
Q

Asthma:
MOA: Blocks action of leukotrienes (constrict & mucous production)

A

Leukotriene modifiers

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43
Q

Asthma:
MOA: Alters function of delayed Cl- channels and inhibits cell activation

A

Mast Cell Stabilizers

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44
Q

Asthma
MOA: inhibits
*cough
*early response to antigens (mast cells)
* late response to antigens (eosinophils)

A

Mast Cell Stabilizers

45
Q

Asthma Rx:
Onset: 5 min; Peak: 30 – 60 min;
Duration: 4 – 6 hrs

A

SABA

46
Q

Asthma Rx:
Onset: approx. 30 min; Duration: > 12 hrs

A

LABA

47
Q

Asthma:
SABA S/E (7):

A

Tachycardia, QTc prolongation, tremor, anxiety, hyperglycemia, hypokalemia & hypomagnesemia (esp if used in high doses)

48
Q

Asthma
ICS S/E (4):

A

Oral candidiasis (thrush), dysphonia, reflex cough (this is ok) & bronchospasm

49
Q

Asthma:
LABA S/E (4):

A

“Labas exacerbate hypo breathing”
Paradoxical bronchospasm, asthma exacerbation, laryngospasm, hypokalemia

50
Q

Name 3 electrolyte abnormalities from inhaled SABA use?

A

hyperglycemia
hypokalemia
hypomagnesemia

51
Q

5 SABA Rx

A

Albuterol, Proventil, Proair, Ventolin, Xopenex

52
Q

What is the most effective long-term tx for sx control in asthma?

A

ICS

53
Q

ICS Rx (3)

A

Qvar, Pulmicort, Flovent

54
Q

Inhaled LABA rx (2) which is better?

A

Formoterol> Salmeterol (serevent)

55
Q

T/F: LABAs can be used as monotherapy in asthma?

A

HELL NO
↑ risk asthma-rel hospitalization, intubation & death!!!
the greatest risk was in children 4-11yo

56
Q

Asthma
LABA + ICS S/E (4):

A

Tremors, m. cramps, tachycardia, cardiac effects

57
Q

LABA + ICS Rx (3) which is best?

A

**FORMOTEROL + BUDESONIDE (Symbicort)
Salmeterol/fluticasone (Advair)
Formoterol/mometasone (Dulera)

58
Q

T/F: Leukotriene modifiers can be used as monotherapy for asthma?

A

FALSE. do not use as monotherapy

59
Q

Asthma:
Leukotriene modifiers S/E (5):

A

Abd pain, nausea, jaundice, itching, lethargy

60
Q

Asthma:
Mast cell stabilizers S/E (5):

A

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

61
Q

Asthma:
Leuktriene modifiers Rx

A

Montleukast (singular)

62
Q

Asthma
Mast cell stabilizer Rx

A

Cromolyn

63
Q

Failure of asthma Rx Tx may be attributed to (5):

A
  • Lack of adherence to Rx
  • airborne pollutants, allergens or irritants. (tobacco smoke)
  • Smoking & exposure to 2nd-hand smoke → airway hyperresponsiveness & ↓ ICS effectiveness.
  • ASA or other NSAIDs → asthma sx
  • Oral nonselective βB,
    ie. propranolol, timolol
    can precipitate bronchospasm in pts w/asthma & ↓ broncho-dilating effect of β- 2 agonists
64
Q

4 Rx class alternatives to propranolol for migraine Prophylaxis

A

Non-dihydropyridine CCB (Verapamil)
B1 selective BB (Metoprolol, Atenolol)
Anticonvulsant (Valporic acid, Topamate)
TCA (Amitryptiline, Nortriptiline)

65
Q

T/F: Valporic acid and Topirimate can decrease efficacy of OTC’s?

A

TRUE
Use condoms yall

66
Q

T/F: ICS causes thrush and can be reduced by using a spacer & rinsing mouth after use

A

yup!

67
Q

What is the tx for oral candidiasis?

A

Nystatin 5mL antifungal wash
QID x7-14d

68
Q

T/F: You should ALWAYS provide a Rx for albuterol

A

true

69
Q

follow up for the asthma pt after increasing flovent (fluticasone) or moving to symbicort?

A

2-4wks

70
Q

T/F; COPD is reversible

A

False, COPD is not fully reversible

71
Q

T/F: COPD is primarily caused by cigarette smoking?

A

True

72
Q

T/F: COPD air flow obstruction is usually progressive

A

True

73
Q

COPD
Airflow Obstruction parameters:
* FEV1 <__ predicted
* FEV1/FVC <__

A
  • FEV1 <80% predicted
  • FEV1/FVC <0.7
74
Q

4 goals of COPD therapy

A
  • ↓ symptoms
  • Control dyspnea
  • Improve exercise tolerance & QOL
    *↓ complications (ie. acute exacerbations)
75
Q

GOLD 1 (mild)
FEV1 >___ predicted
Category?

A

80%
A or B

76
Q

GOLD 2 (moderate)
__> FEV1 >__
Category?

A

b/w 50-80% predicted
A or B

77
Q

GOLD 3 (severe)
__> FEV>__
Category?

A

30-50%
C or D

78
Q

GOLD 4 (Very Severe)
FEV1<___
Category?

A

30%
C or D

79
Q

Category A risk & Sx
Rx?

A

Low risk, less Sx
SABA- Albuterol

80
Q

Category B risk & Sx
Rx?

A

Low risk, more sx
SABA-Albuterol
LABA or LAMA

81
Q

Category C risk & Sx
Rx?

A

high risk,
Less sx
SABA
ICS + LABA or LAMA

82
Q

Category D risk & Sx
Rx?

A

High risk,
More sx
ICS + LABA and LAMA

83
Q

COPD: Who gets a SABA?

A

EVERYONE! like oprah!

84
Q

Does Combo β2-agonist=SABA (albuterol) w/ muscarinic antagonist=SAMA (ipratropium) cause a (+) effect for COPD

A

yes!
SABA + SAMA = combivent
→ more effective than either drug alone &
is avail in a single inhaler.

85
Q

what is the name of the LAMA we know & love that is used for pts w/evidence of significant airflow obstruction & chronic sx?

A

Tiotropium (Spiriva)

86
Q

Are ICS 1st line in COPD?

A

NO! LABA/LAMA are!

87
Q

When do we use ICS in COPD?
What are 2 examples?

A

In pts w/ severe COPD (FEV <50%)
who experience freq exacerbations while receiving 1+ long-acting bronchodilators (LABA)
The addition of an ICS is recommended to ↓ the # of exacerbations
Formoterol/Budesonide (Symibcort) “budesonide better”
Salmeterol/Fluticasone (Advair)

88
Q

What are 4 risks of using long term ORAL corticosteroids for COPD?

A

Wt gain
Immunosuppression
myopathy
glucose intolerance

89
Q

What does long term supplemental O2 therapy do for COPD?

A

↑ survival and QOL

90
Q

when to consider O2 therapy in COPD (4)?

A

resting O2 <88%RA
evidence of:
*pulm HTN
*CHF
*polycythemia

91
Q

Benefits of pulm rehab for COPD are great! It can (4):

A

↓ dyspnea
improve functional capacity
improve QOL
↓ admissions

92
Q

When to f/u on a pt that is gold 2 (Group B)?

A

4wks

93
Q

DO you know the tic tac toe method for ABG?

A

yes ma’am

94
Q

What 2 bugs make up 60% of all CAP?

A

Strep pna & mycoplasma

95
Q

ABX for Strep pna- CAP

A

“F**k THE Community Mucous”
FQ- respiratory (Levo & Moxi)
TCN **DOXY!!!!!
3rd gen Cephs - “TRI TAXING me, you wont get a DIME”
Ceftriaxone, Ceftazidime, Cefdinir
Macrolides- Azithro & clarithro

96
Q

Abx for Mycoplasma CAP

A

“LETs go for a walk”
Levofloxacin
Erythromycin
TCN

97
Q

ABX for H. flu CAP

A

F- respiratory
M- Azithro & Clarithro

98
Q

What does IV vs PO depend on for CAP Tx
(main reason)?

A

**IV vs PO depend on bioavailability of Rx drug
ie FQ good bioavailability → no diff btw PO & IV

99
Q

What 2 parameters must be met for switching from IV to PO abx?

A

Pt is stable wit NL VS
For 24hrs

100
Q

Define Stable (6) when switching from IV to PO.

A

Afebrile
RR<24
HR <100
O2 >90%RA
SBP >90
AND no RESP DISTRESS

101
Q

**Approx __-__% of pts admitted for IV ABX can switch to PO ABX w/in __-__d

A

40-50%
2-3d

102
Q

t/f: if a pt is hospitalized for PNA, they need IV abx’s

A

So false

103
Q

When to give IV abx for PNA (3)?

A

Hypoxia/resp distress
Monitoring for improvement
Mod-high risk decompensation

104
Q

CURB-65
Grading and results?

A

Cofusion
Urea (BUN >19 or 7mmol/L)
RR (>30)
BP (<90/60)
Age >65

0pts-outpt
2pts-admit
3pts-ICU

105
Q

When to F/u w/PCP for pna?

A

5-7d post d/c

106
Q

Would you repeat a CXR for a PNA pt post d/c ?

A

duh! check for resolution

107
Q

Can PNA pts alternate APAP 1g w/ IBU 600mg Q4hrs for fever/body aches?

A

yes

108
Q

When to go to ER after d/c for pna?

A

CP
trouble breathing
Fever >102
leg swelling/calf pain

Clin Pharm (6 decks)

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