Pulmonary Case wrap-up Flashcards
What classes of meds can be used to treat common URI Sx PRN?
- Decongestants
- Pain and fever relievers
- Cough suppressants
- Cough Expectorants
- Vitamins and Supplements
Allergic Rhinitis: meds?
- Antihistamines
- Intranasal Corticosteroids (flonase)
Decongestants: MOA?
–activate _______ and ______ adrenergic receptors
activate alpha and beta adrenergic receptors
Decongestants: MOA
-directly stimulate **alpha-adrenergic receptors of the respiratory mucosa causing ________
** vasoconstriction** which reduces mucosal swelling and improves ventilation
Decongestants: MOA
-directly stimulate beta-adrenergic receptors causing ________
**bronchial relaxation
Decongestants: S/E
Vasoconstriction and tachycardia which can result in angina, HTN, and worsening of CV disease, increase glycogenolysis and gluconeogenesis, and produces CNS stimulation (nervousness, insomnia, dizziness, drowsiness), urinary retention
What Patient populations should AVOID decongestants?
Avoid in HTN pts, <6yo, and first trimester pregnancy
List 2 commonly used decongestant meds
- Pseudoephedrine (Sudafed)
- Phenylephrine (Sudafed PE)
Pseudoephedrine (Sudafed):
- Duration?
- ___% absorbed?
- 4-6 hrs
- 100% absorbed
What did Jaynstein say about Phenylephrine (Sudafed PE)?
- duration is 2-4 hrs
- 38% absorbed
Jaynstein said phenylephrine is worthless, dont even bother cuz it’s poorly absorbed
Cough Suppressants/Antitussives:
MOA: Act at one of two sites:
centrally on the ______
& locally at the _______
Centrally on the medullary cough center–> Dextromethorphan, opiates, Benzonate (Tessalon pearls)
Locally at the site of irritation–>
Lozenges, viscous preparations, menthol and camphor
Dextromethorphan:
- MOA: centrally or locally?
- S/E?
- safe in pregnancy?
Centrally acting (D-isomer of codeine)
–Lower addition profile
SE: **serotonin syndrome, nausea, dizziness, drowsiness
Safe in pregnancy
Dextromethorphan:
AVOID in pts on _____
MAOI’s; (MAOI + dextromethorphan= serotonin syndrome*
-caution in SSRI but not contraindicated
Codeine:
- MOA: centrally or locally?
- S/E?
- safe in pregnancy?
Centrally acting–HIGH abuse potential
SE: CNS depression, respiratory depression, common allergen
**Caution in pregnancy – category C (resp depression, addition risk)
Benzonate (Tessalon):
- MOA: centrally or locally?
- S/E?
- safe in pregnancy?
- Centrally acting
- No addictive properties
-SE: headache, dizziness, drowsiness
Caution in pregnancy – no data
-Either it Works for the Pt or it doesn’t
Expectorants (mucolytic):
list 2 medication ex’s & the MOA
Mucinex and guaifenesin (robitussin)
-MOA: dissolve thick mucus, enhance airway clearing, and promote cough
Robitussin DM=
combo med for dextromethorphan and guaifenesin
Expectorants (mucolytic):
- S/E?
- safe in pregnancy?
- Guaifenesin may exacerbate ______
SE: N/V, rash
Avoid in children <6
Safe in pregnancy
**Guaifenesin may exacerbate nephrolithiasis (kidney stones)
Vitamins and Supplements
for URI tx:
list ex’s and evidence supporting or contraindicating use
Vitamin C: Anecdotal evidence only
Echinacea: EBM does reveal benefit – appears to be most effective in pts with compromised immune systems
Zinc: **EBM contradictory – SE’s common but not life-threatening (nausea, mouth irritation)
Sinusitis: mild-moderate
-treatment?
- Amoxicillin/clavulanate 875mg PO BID 7 days
- Doxycycline 100mg BID x 7 days
Sinusitis: Severe (inpatient)
tx? (several choices)
- Ampicillin/Sulbactam 3gm IV QID
- Levofloxacin 500mg IV QD
- Ceftriaxone (Rocephin) 1gm IV BID
Sinusitis: Risk for resistance or abx failure
tx?
- **Amoxicillin/clavulanate 2000mg BID x 10-14 days
- Levofloxacin 500mg QD x 5 days
- Moxifloxacin 400mg QD x 10 days
Which classes of abx are NOT recommended for empiric therapy for sinusitis due to high rates of resistance to S. Pneumoniae?
Macrolides (clarithromycinorazithromycin),trimethoprim-sulfamethoxazole, and second- or third-generation cephalosporins are not recommended
17 yo female with uncontrolled asthma
–Currently treated w/ Albuterol PRN and Flovent HFA 44mcg
-what questions should you ask her?
- Medication Compliance? Proper use?
- Is she experiencing an acute exacerbation or worsening chronic asthma?–>Hospitalized twice in the last year for poorly controlled asthma; three visits to the ED in the last 6 months
- *uses Albuterol MDI approximately 3–4 days per week over the past 2 months
Pt was Hospitalized twice in the last year for poorly controlled asthma; three visits to the ED in the last 6 months
**uses Albuterol MDI approximately 3–4 days per week over the past 2 months
Asthma classification?
mild persistent/moderate
-categorized as not well controlled asthma
Classification of asthma control (>12 yo):
Well controlled is defined as _______
- Sx less than or equal to 2 days/week
- Nighttime awakenings less than or equal to 2x/month
- SABA use less than or equal to 2 days/week
FEV1= >80% predicted
-0-1 exacerbations per year
Recommended tx:
- maintain current step
- Regular f/u every 6 months to maintain control
- Consider step down if well-controlled for at least 3 months
Classification of asthma control (>12 yo):
Not well controlled is defined as ______
- Sx >2 days/week
- nighttime awakenings: 1-3x/week
- Some limitation of normal activities
- SABA use >2 days/week
- FEV!= 60-80%
- greater or equal to 2 exacerbations/year
Tx: step up 1 step, re-eval in 2-6 weeks
-For S/E: consider alt. tx options
Classification of asthma control (>12 yo):
Very poorly controlled is defined as ______
- Sx throughout the day
- greater or equal to 4 nighttime awakenings/week
- Extremely limited during the day
- SABA use several times a day
- <60% for FEV1
- 2 or more exacerbations per year
tx: Consider short course of PR systemic corticosteroids
- step up 1-2 steps, re-eval in 2 weeks
Step 1: asthma management
(For tx of intermittent asthma Sx)
-SABA PRN
Step 2: asthma management
- low-dose ICS + SABA PRN
- alt: Cromolyn, LTRA
Step 3: asthma management
-low dose ICS +LABA + SABA PRN
or
-Medium dose ICS + SABA PRN
Step 4: asthma management
-medium-dose ICS + LABA + SABA
Step 5: asthma management
high dose ICS + LABA
-IF this does not control Sx well, add in oral corticosteroid and consider Omalizumab
List Ex’s of Inhalation devices that asthma pts can use for asthma management
- Metered-dose inhalers (MDI)
- Dry powder inhalers (DPI)
- Nebulizers
- HFA-diskus