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AGACNP Board Review > Pulmonary Medicine > Flashcards

Pulmonary Medicine Flashcards

Review of common Pulmonary disease and disorders

1
Q

What is Asthma?

A

Enhanced resposiveness to stimuli in the trachea and bronchi

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2
Q

What is the pathophysiology of Asthma?

A
  1. Widespread narrowing of the airways
  2. Hypertrophy of smooth muscle
  3. Mucosal Edema
  4. Hyperemia
  5. Thickening of the epithelial basement membrane
  6. Hypertrophy of mucus glands
  7. Acute Inflammation
  8. Plugging of airways by thick, viscid mucus
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3
Q

Etiology of Asthma

A
  1. Dust Mites
  2. Pets
  3. Cockroaches
  4. Indoor Molds
  5. Exercise
  6. Cigarette Smoke
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4
Q

Name 5 S/S of Asthma

A
  1. Respiratory Distress at Rest
  2. Difficulty speaking in sentences
  3. Diaphoresis
  4. Use of Accessory Muscles
  5. Respiratpory rate of >28
  6. Pulse >110
  7. Pulsus Paradoxus >12 mmHg
  8. Hyperesonance
  9. Cough
  10. Chest Tightness
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5
Q

What are the ominous signs of Asthma?

A
  1. Fatigue
  2. Absent breath sounds
  3. Paradoxical chest/abdominal movement
  4. Inability to maintain recumbency
  5. Cyanosis
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6
Q

Laboratory/Diagnositics for Asthma

A

CBC
PFT
ABG

Leukocytosis, Respiratory Alkalosis, PF is <60 lpm

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7
Q

Agents for Asthma and COPD

A
  • Short-Acting Beta Agonist (SABA)
  • Long-Acting Beta Agonist (LABA)
  • Short-Acting Muscarinic Agonists (SAMA)
  • Long-Acting Muscurinic Agonists (LAMA)
  • LABA/ICS
  • LABA/LAMA/ICS
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8
Q

Mechanism of Action of SABAs

A

Binds to BETA2 adrenergic receptors in the airway. This leads to activation of adenyl cyclase resulting in increased levels of cyclic-3’,5’-adenosine monophosphate (cAMP). Increases in cAMP inhibits phosphorylation of myosin and decrease intracellar calcium. Decreased intracellar calcium relaxes smooth muscle airways.

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9
Q

Indication of SABAs

A
  1. Bronchospasm
  2. Asthma
  3. COPD
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10
Q

Therapuetic effect of SABAs

A

Bronchodilation

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11
Q

Side Effects of SABAs

A

Chest Pain
Palpitations
Nervousness
Restlesness
Tremor

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12
Q

Contraindications of SABAs

A

Cardiac Disease
Hypertension
Diabeties
Seizure
Excess inhaler use

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13
Q

SABA Agents

A
  • albuterol (ProAir)
  • levabuterol (Xopenex)
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14
Q

Mechanism of Action for LABAs

A

Produces accumulation of cyclic adenosine monophosphate at BETA2 adrenergic receptors

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15
Q

Indication for LABAs

A
  • Concomitant therapy for asthma uncontrolled with ICS
  • Prevention of bronchospasm in COPD
  • Prevention of exercise-induced bronchospasm
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16
Q

Therapuetic Effect of LABAs

A

Bronchodilation

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17
Q

Side Effects of LABAs

A

Headache
Palpitations
Tachycardia
Trembling
Paradoxical Bronchospasm

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18
Q

Contraindications of LABAs

A
  • Acute attack of Asthma
  • Not taking a long-term asthma control medication
  • Patient is currently controlled on a low- or medium-dose ICS
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19
Q

LABA Agents

A

salmeterol (Servent Diskus)
formoterol (Perforomist)
olodaterol (Striverdi Respiramat)

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20
Q

Mechanism of Action for SAMAs

A

Inhibits cholinergic receptors in bronchial smooth muscle. This results in decreased concentrations of cyclic guanosine monophophate (cGMP). Decreased levels of cGMP results in bronchodilation.

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21
Q

Indication of SAMAs

A

Maintenence therapy of reversible airway obstruction due to COPD, bronchitis, emphysema
Management of asthma induced bronchospasm

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22
Q

Therapuetic effect of SAMAs

A

Bronchodilation
Decreased Rhinorrhea

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23
Q

Side Effects of SAMAs

A

Hypotension
Palpitation
Dizziness
Headache
Bronchospasm

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24
Q

Contraindations of SAMAs

A

Acute Bronchospasm
Hypersensitiity to atropine, belladonna alkaloids, bromide

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25
Q

SAMA Agents

A

ipratropium solution (Atrovent)

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26
Q

Mechanism of Action of LAMAs

A

Acts as a anticholinergic by selectively and reversibly inhibiting M3 receptors in smooth muscle of airways

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27
Q

Indication of LAMAs

A

Long-Term maintenance of COPD and Asthma
Reduce exacerbations in COPD

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28
Q

Therapuetic Effects of LAMAs

A

Decrease incidence and severity of bronchospasm in COPD and Asthma

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29
Q

Side Effects of LAMAs

A

Dry Mouith
Tachycardia
Bronchospasm
Glaucoma
Urinary difficulty

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30
Q

Contraindications of LAMAs

A

Concurrent ipratropium

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31
Q

LAMA Agents

A

tiotropium bromide (Spiriva), glycopyrrolate (Lonhala), aclidinum (Tudorza)

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32
Q

Mechanism of Action of ICS

A

Potent, locally acting anti-inflammatory and immune modifier

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33
Q

Indication of ICS

A

Maintainence and Prophylatic treatment in Asthma

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34
Q

Therapuetic Effect of ICS

A

Improves asthma symptoms
Decreases frequency/severity of asthma attacks

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35
Q

Side Effects of ICS

A

Otis Media
Headache
Bronchospasm
Adrenal Suppresion

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36
Q

Contraindications of ICS

A

Acute attack of asthma or status asthmaticus

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37
Q

ICS Agents

A

Budesonide (Symbicort)
Fluticasone (Advair)

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38
Q

LABA/ICS

A

Symbicort & Advair

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39
Q

LABA/LAMA/ICS

A

fluticasone furoate/unmeclidinium/vilanterol
(Trelegy Ellipta)

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40
Q

mMRC Grade 0

A

Dyspnea with mild exercise

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41
Q

mMRC Grade 1

A

Dyspnea when hurrying or walking up a slight hill

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42
Q

mMRC Grade 2

A

Walks slower than people of the same age because of dyspnea or has to stop for breath when walking at own pace

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43
Q

mMRC Grade 3

A

Stops for breath after walking 100 yards (91 m) or after a few minutes

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44
Q

mMRC Grade 4

A

Too dyspneic to leave house or breathless when dressing

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45
Q

GINA: Track 1, Step 1

A

Symptoms less than 4-5 days a week

Low dose ICS-formoterol

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46
Q

GINA: Track 1, Step 2

A

Symptoms less than 4-5 days a week

Low dose ICS-formoterol

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47
Q

GINA: Track 1, Step 3

A

Symptoms most days or waking > 1 week

Low-Dose maintenence ICS-formoterol

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48
Q

GINA: Track 1, Step 4

A

Daily symptoms, Waking greater than once a week, or low lung function

Medium-Dose maintenence ICS-formoterol

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49
Q

GINA: Track 1, Step 5

A

Persistent symptoms/exacerbation despite good adherence w/ Step 4

Add LAMA, Consider Phenotypic assesmmet, Consider high-dose maintenence ICS-formoterol

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50
Q

GINA: Track 1, Reliever

A

PRN low-dose ICS-formoterol

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51
Q

GINA: Track 2, Step 1

A

Symptoms less than 2 timess a month

ICS taken whenever SABA used

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52
Q

GINA: Track 2, Step 2

A

Symptoms greater than 2 times per month but less than 4-5 days/week

Low-dose maintenence ICS formoterol

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53
Q

GINA: Track 2, Step 3

A

Symptoms most days or waking greater than one week

Low-Dose maintenence ICS-LABA

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54
Q

GINA: Track 2, Step 4

A

Daily symptoms, Waking greater than one week, Low lung function

Medium-High dose Maintence ICS-LABA

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55
Q

GINA: Track 2, Step 5

A

Persistent symptoms/exacerbation despite good adherence w/ Step 4

Add LAMA, Consider Phenotypic assesmmet, Consider high-dose maintenence ICS-formoterol

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56
Q

Inpatient Management of Asthma

A
  1. Supplemental low-flow 02
  2. Inhaled SABA: Albuterol (MDI or Nebulizer
  3. Inhaled SAMA: Ipratropium (MDI or Nebulizer)
  4. Systemic Glucocoticoids: Methylprednisone (IV or PO)
  5. Magnesium Sulfate
  6. Suspected anaphylais? Epinephrine (0.3-0.5 mg SQ)
  7. Mechanical Ventilation as needed
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57
Q

What is Status Asthmaticus?

A

Severe acute asthma presenting in an unremitting, poorly responsive, life-threatening manner

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58
Q

Inpatient Management of Status Asthmaticus

A
  1. Supplemental Oxygen
  2. IV D5 1/2 NS
  3. Inhaled and Parenteral sympathomimetics
  4. Methylprednisolone 60-125mg or Hydrocortisone 300 mg
  5. Atrovent
  6. Monitor REspiratory function
  7. Monitor ABG every 10-20 minutes
  8. Intubate
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59
Q

What is COPD?

A

Chronic Bronchitis and Emphysema

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60
Q

What is Chronic Bronchitis?

A

Excessive secretion of bronchial muscus manifested by productive cough for three months

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61
Q

Name 4 S/S of Bronchitis

A
  • Mild to Moderate Dyspnea
  • Onset after age 35
  • Copius sputum production
  • Stocky, Obese
  • Chest A-P Diameter Normal
  • Percussion Normal
  • Hyperinflation of Chest on CXR
  • Hematocrit Increased
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61
Q

What is Emphhysema?

A

Abnormal, permanent enlargement of the Alveoli

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62
Q

Name 4 S/S of Emphysema

A
  • Progressive, constant dyspnea
  • Onset of symptoms after age 50
  • Mild sputum
  • Thin, Wasted Body
  • Chest AP Diameter increased
  • Percussion hyperresonant
  • Hematocrit normal
  • Total lung capacity increased
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63
Q

How to confirm COPD

A

PFT stating FEV1/FVC ratio is less that 0.7

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64
Q

GOLD One

A

FEV1 >80% of predicted value

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65
Q

GOLD Two

A

FEV1 50-79% of predicted value

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66
Q

GOLD Three

A

FEV1 30-49% of predicted value

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67
Q

GOLD Four

A

FEV1 less than 30% of predicted value

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68
Q

Treatment of COPD: Category A

A

No or 1 moderate exacerbation that does not require hospitalization per year

mMRC between 0-1

CAT less than 10

Bronchodilator

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69
Q

Treatment of COPD: Category B

A

No or 1 moderate exacerbation that does not require hospitalization per year

mMRC greater than 2

CAT greater than 10

LABA+LAMA

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70
Q

Treatement of COPD: Category E

A

Greater than 2 moderate exacerbations or greater than 1 leading to hospitalization per year

LABA+LAMA

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71
Q

COPD Assessment Test

A

Scale symptom severity with 1 being the lowest and 5 being highest

  • Cough
  • Phlegm
  • Chest Tightness
  • Breathlessness
  • Activities
  • Confidence
  • Sleep
  • Energy
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72
Q

What is TB?

A

Systemic disease caused by M. tuberculosis

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73
Q

Name 4 groups at risk for TB

A
  • Incarcerated
  • HIV (+)
  • Diabeties Mellitus
  • Chronic Kidney Disease
  • Malignanacy
  • Malnutrition
  • Immunosupressed
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74
Q

Name 3 S/S of TB

A
  • Fatigue
  • Anorexia
  • Dry cough
  • Weight loss
  • Fever
  • Night Sweats
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75
Q

Laboratory/Diagnostics for TB

A
  • Cuture of M. tuberculosis x3
  • Small Homogenous infiltrate in upper lobes by CXR
  • Acid-Fast Smears
  • Purified Protien Derivative (PPD)
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76
Q

Management for TB

A
  • Notifiy local health department
  • Hospitalization not required
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77
Q

Antituberculars

A

Rifampin 600mg
Isoniazid 300mg
Pyrazinamide 1.5-2.0g
Ethambutol 15mg/kg

Typical treatment is for 6m. 9m for immunocompromised

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78
Q

MOA of Rifampin

A

Inhibits RNA synthesis by blocking RNA transcription in susceptible organisms

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79
Q

Indication for Rifampin

A

Active TB
Broad Spectrum ABX

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80
Q

Therapuetic Effect of Rifampin

A

Bactericidal action agaisnt:
Mycobacterium
S. Aureus
H. Influenzae
L. Pneumophila
N. Meningitidis

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81
Q

Side Effects of Rifampin

A
  • DRESS
  • SJS
  • TEN
  • Hepatotoxicity
  • Red Discolaration of Urine
  • NVD
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82
Q

Contraindications of Rifampin

A

Concurrent use of:
atazanavir, darunavir, fosamprenavir, praziquantel, saquinavir, tipranavir, or ritonavir-boosted saquinavir.

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83
Q

Drug Interactions for Rifampin

A

Decreases effect of ticagrelor, digoxin, warfarin, contraceptives, and numerous other drugs

Increases effect of clopidogrel, bactrim

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84
Q

Mechanism of Action for Isoniazid

A

Inhibits mycobaterial cell wall synthesis

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85
Q

Indication for Isoniazid

A
  1. TB
  2. TB prevention
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86
Q

Therapuetic Effect of Isoniazid

A

Bacteriostatic or Bacteriocidal action against mycobacteria

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87
Q

Side Effects of Isoniazid

A
  • Hepatitis
  • DRESS
  • TEN
  • Pancreatitis
  • Peripheral Neuropathy
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88
Q

Contrindications of Isoniazid

A

Acute liver disease
History of Hepatitis
Pregnancy

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89
Q

Mechanism of Action for Pyrazinamide

A

Lowers the pH of the mycobateria envirment by converting pyrazinoic acid in susceptable strains

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90
Q

Indication of Pyrazinamide

A

TB

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91
Q

Therapuetic Effect of Pyrazinamide

A

Bacteriostatic action against mycobateria

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92
Q

Side effects of Pyrazinamide

A

Hepatotoxicity
Hyperuricemia
Arthralgia
Photosensitivity
NVD

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93
Q

Contraindications of Pyrazinamide

A

Liver Impairment
Preganancy

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94
Q

Mechanism of Action of Ethambutol

A

Inibitis growth of mycobacteria

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95
Q

Indication for Ethambutol

A

Additive antitubercular agent with active TB

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96
Q

Side Effect of Ethambutol

A

Hepatitis
Optic Neuritis
Peripheral Neuritis
Confusion
Pulmonary infiltrates

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97
Q

Therapuetic Effect of Ethambutol

A

Tuberculostatic effect agaisnt susceptable organisms

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98
Q

Contraindications of Ethambutol

A

Optic Neuritis

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99
Q

TB Monitoring

A

First 6 weeks- Weekly sputum smears and cultures, then monthly

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100
Q

TB Baseline Labs

A

LFT
CBC
CMP
Visual Acuity
Red-Green Color Preception

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101
Q

PPD 5mm

A

Positive in HIV infected and the immunocompromised

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102
Q

PPD 10mm

A

Positive for healthcare workers, immigrants, and the incarcerated

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103
Q

PPD 15mm

A

Positive for the general public

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104
Q

What is Pneumomonia

A

Pathogens gain access to the lower respiratory tract through aspiration, inhalation causing inflammation of the respiratory tract

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105
Q

Name 4 S/S of Pneumonia

A
  • Fever
  • Rigor
  • Purulent Sputum
  • Lung Consolidation
  • Malaise
  • Increased Fremitus
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106
Q

Abnormal Labs in Pneumonia

A
  • CBC
  • ABG
  • CXR
  • Sputum Cultures
  • Blood Cultures
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107
Q

What scales help predict morbidity and mortality in CAP?

A
  1. Pneumonia Severity Index (PSI)
  2. Patient Outcomes Research Team (PORT)
  3. CURB-65 Criteria
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108
Q

PORT Class I-II

A

Score: Less than 70
Risk: Low
Mortality: Less than 1%
Treatment: Outpatient

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109
Q

PORT Class III

A

Score: 71-90
Risk: Low
Mortality: 3%
Treatment: Brief Inpatient

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110
Q

PORT Class IV

A

Score: 91-130
Risk: Moderate
Mortality: 9%
Treatment: Inpatient

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111
Q

PORT Class V

A

Score: Greater than 130
Risk: High
Mortality: 30%
Treatment: ICU

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112
Q

CURB-65 Criteria

A

Confusion
bUn greater than 19
Respiratory Rate greater than 30
SBP<90;DBP<60
**65 **years old or older

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113
Q

CURB-65: Low RIsk

A

Score: 0-1
Consider home treatment

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114
Q

CURB-65 Moderate Risk

A

Score: 2
PCU Admission

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115
Q

CURB-65: High Risk

A

Score: Greater than 3
ICU Admission

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116
Q

Empiric Therapy Outpatient CAP: Nonsevere

A

Amoxicillin 1g
or
Doxycycline 100mg BID
or
Azithromycin/Clarithromycin

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117
Q

Nonsevere Outpatient CAP Pathogens

A

C. pneumoniae
M. pneumoniae
S. pneumoniae
H. influenzae
M. catarrhalis

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118
Q

Empiric Therapy Outpatient CAP: Severe

A

Augmentin
or Cephalosporin + Macrolide/Doxycycline or Fluroquinolone

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119
Q

Viral PNA Treatment

A

Oseltamivir
Zanamivir
Remdesivir (COVID-19)

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120
Q

Severe Outpatient CAP Pathogens

A

Multi-Drug Resistant S. Pneumoniae

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121
Q

Empiric Therapy Inpatient CAP: Nonsevere

A

Beta-Lactam + Macrolide or Fluoroquinolone only

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122
Q

Macrolides

A

Azithromycin
Clarithromycin

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123
Q

Fluroquinolones

A

Levofloxacin
Moxifloxacin

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124
Q

Beta Lactams

A

Ceftriaxone
Cefotaxime
Ceftaroline
Ampicillin-Sulbactam

125
Q

Empiric Therapy Inpatient CAP: Severe

A

Beta Lactam + IV Fluroquinolone or IV Azithromycin

126
Q

Inpatient Nonsevere CAP Pathogens

A

S. pneumoniae
M. pneumoniae
C. pneumoniae
H. influenzae
Legionella

127
Q

Inpatient Severe CAP Pathogens

A

S. Pneumoniae
S. Aureus
Legionellla
Gram-Negative bacilli
H. influenzae

128
Q

What is the definition of HAP?

A

PNA that occurs 48h after admission

129
Q

Nonsevere HAP Empiric therapy

A

Piperacillin/tazobactam or
Cefepime or
Levofloxacin or
Imipenem or
Meropenem

130
Q

Severe HAP Empiric Therapy

A

All in nonsevere or
Ceftazidime or
Ciprofloxacin or
Azetreoname +
Vancomycin or Linezolid

131
Q

Lethal HAP Empiric Therapy

A

All in severe or
Amikacin or
Gentamicin or
Tobramycin

132
Q

Definition of VAP

A

PNA that presents in mechanically ventilated patients 48 post-intubation

133
Q

MRSA VAP

A

Vancomycin + Linezolid

134
Q

Gram Negative ABX w/ Beta-Lactam Activity

A

Piperacillin/tazobactam
Cefepime
Ceftazidime
Imipernem
Meropenem
Aztreonam

135
Q

Gram Negative ABX w/o Beta-Lactam Activity

A

Levofloxacin
Ciprofloxacin
Amikacin
Gentamicin
Tobramycin
Colistin
Polymyxin B

136
Q

What is a Pneumothorax?

A

Gas infitrated into the pleural space increasing pressure resulting in a collaspe

137
Q

Name 5 S/S of a Pneumothorax

A
  • Chest Pain
  • Dyspnea
  • Cough
  • Hyperresonance on affected side
  • Diminished breath sounds on affected side
  • Diminished Fremitus on affected side
  • Medianstinal Shift toward unaffected side
  • Hypotension
138
Q

Laboratory/Diagnositics

A

CXR
ABG

139
Q

Pneumothorax Management

A
  1. Chest Tube, 4th of 5th ICS and MAL
  2. Needle thoracostomy (Emergency), 2nd ICS and MCL
140
Q

What is Sarcoidosis?

A

A condition of unknown etiology causing interstial lung disease and noncaseating granulomas

141
Q

S/S of Sarcoidosis

A
  • Progressive Dyspnea
  • Nonproductive Cough
142
Q

Laboratory/Diagnositics

A
  • CXR
  • PFT
  • CMP
  • ABG
  • Bronchoscopy with biopsy
143
Q

Sarcoidosis Management

A

Corticosteroids

144
Q

What is a Pulmonary Embolus

A

An emboli in the lung parenchyma

145
Q

Risk Factors for PE

A
  • Prolonged immobility
  • Venous Statis
  • Hypercoagulable states
  • Oral Contraceptives
  • Surgery
  • Cardiac Thrombi
146
Q

Virchows Triad

A
  • Prolonged immobility
  • Venous Stasis
  • Hypercoagulable states
147
Q

Name 5 S/S of PE

A
  • Usually occur abruptly
  • Unexplained dyspnea and tachycardia
  • Chest Pain
  • Hemoptysis
  • Low Grade Fever
  • Hypotension
  • Cyanosis
148
Q

Laboratory/Diagnostics for PE

A
  1. V/Q Scan if no CT Angio
  2. ABG
  3. Spiral CT
  4. DDimer
  5. CT Angiography
149
Q

PE Management

A
  1. Oxygen
  2. IVF
  3. Possible intubation
  4. Heparin
  5. Fibrinolytics
150
Q

What is Acute Respiratory Distress Syndrome?

A

ALI due to multifactoral insults to the lung

151
Q

S/S of ARDs

A
  • Severe Dyspnea
  • Respiratory Distress
  • Cyanosis
  • Tachycardia
  • Rales/Wheezes
152
Q

Laboratory/Diagnostics

A

CXR
ABG

153
Q

ARDs Management

A
  1. Mechanical Ventilation
  2. Treatment of underlying disease
154
Q

Equation for reccomended Tidal Volume

A

4-6mL/kg to ideal body weight

155
Q

What is Control Mode?

A

Machine ventilates the patient. TV and RR are preset

156
Q

What is Assist-Control mode?

A

Machine ventilates the patient, but the patient can activate the machine resulting in delivery of a preset TV.

157
Q

What is SIMV/IMV Mode?

A

Machine ventilates the patient, but the patient can breathe inspiring their own TV

158
Q

What is CPAP?

A

Continours positive pressure during spontaenous breaths

159
Q

What is BiPAP?

A

Continous positive pressure during inspiratory and expiratory breaths

160
Q

What are the Key Ventilator Settings?

A
  1. The Mode
  2. FiO2
  3. Tidal Volume
  4. PEEP
  5. RR
  6. Pressure Support
161
Q

Obstructive Pulmonary disease causes what on PFT?

A

Reduced Airflow Rates

162
Q

Restrictive Pulmonary Disease causes what on PFT?

A

Reduced Volumes and expiratory flow rates

163
Q

Airflow Rates in PFT

A

FVC
FEV1
FEV25-75
PEFR

164
Q

Volume Rates in PFT

A

TLC
FRC
RV

165
Q

What is FVC?

A

Forced Vital Capacity

Volume of gas forcefully expelled from the lungs after maximal inspiration

166
Q

What is FEV1?

A

Forced Expiratory Volume in 1s

Volume of gas expelled in the first second of the FVC

167
Q

What is FEV25-75?

A

Maximal Mid-expiratory rate

168
Q

What is PEFR?

A

Peak Expiratory Flow Rate

Maximal airflow rate achieved in FVC maneuver

169
Q

What is TLC?

A

Total Lung Capacity

Volume of gas in lungs after inspiration

170
Q

What is FRC?

A

Functional Residual Capacity

171
Q

What is RV?

A

Residual Volume

Volume of gas remaining in lungs after max expiration

172
Q

What is a Pleural Effusion?

A

Transudate or Exudate in the plueral space

173
Q

Exudate Pleural Fluid

A
  • Pleural fluid protien to serum protien ratio is greater than 0.5
  • Pleural fluid LDH to serum LDH ratio is greater than 0.6
  • Pleural fluid LDH greater than two-thirds the upper limit of normal serum LDH
174
Q

Transudate Pleural Fluid

A
  • Pleural fluid protien to serum protien ratio is less than 0.5
  • Pleural fluid LDH to serum LDH ratio is less than 0.6
175
Q

Name the 4 types of Pleural Effusions

A
  1. Transudates
  2. Exudates
  3. Empyema
  4. Hemorrhagic
176
Q

Name 5 Physiologic Changes in the Elderly

A
  1. Lungs are stiffer
  2. Pulmonary strength is weaker
  3. Rigid chest wall
  4. Vital capacity decreases
  5. Residual volume increases
  6. Increased AP diameter
  7. Hyperresonance to percussion
  8. Alveolar Surface Area decreased
  9. Reduced oxygen uptake
  10. Aveoli collaspe easeier
  11. Inreased mucous
  12. Decreased response to hypoxia and hypercapnia
177
Q

Normal Pulmonary Laboratory/Diagnostics in the Elderly
(Reference)

A
  1. Reduced pulmonary function reserve
  2. Dyspnea on Extertion
  3. Exerise Intolerance
  4. Decreased chest/lung expansion
  5. Less effective exhalation
  6. Decreased mucus clearance
  7. Increased risk of ateletais
  8. Increased risk of Respiratory Infection
  9. Increased risk of Bronchospasm
178
Q

Pneumonia in the Elderly

A
  • Classic signs may be absent
  • Weakness
  • Decreased ADLs
  • Anorexia
  • Poor Appetite
  • Confusion
  • AMS
179
Q

Most Common Pathogens of PNA in the Elderly

A
  • S. Pneumoniae
  • Gram-negative Bacilli
  • Staph Aureus
180
Q

MOA of Amoxicillin

A

Binds to bacterial cell wall resulting in cell death

181
Q

Indication of Amoxicillin

A

H. Pylori
Skin Infection
Respiratory Infection
Genitourinary Infection
HEENT Infection

Endocarditis Prophylaxis

182
Q

Therapeutic Effect of Amoxicillin

A

Broad Spectrum bactericidal action

183
Q

Name 5 bacteria that Amoxicillin is active against

A
  • Streptococci
  • Pneumococci
  • Enterococci
  • Haemophilus influenzae
  • Escherichia coli
  • Proteus mirabilis
  • Neisseria meningitidis
  • N. gonorrhoeae
  • Shigella
  • Chlamydia trachomatis
  • Salmonella
  • Borrelia burgdorferi
  • H. pylori.
184
Q

Contraindications of Amoxicillin

A

Penicillin Allergy
Beta-Lactam Allergy

185
Q

Name 5 S/S of Amoxicillin

A
  • GEP
  • DRESS
  • SJS
  • TEN
  • CDAD
  • NVD
186
Q

MOA of Doxycycline

A

Inhibits protien synthesis at the level of the 30S bacterial ribosome

187
Q

Indication of Doxycycline

A

Gonorrhea
Syphyllis
Chronic Bronchitis
Acne
Anthrax-Post Exposure

Malaria prophylaxis

188
Q

Therapeutic Effect of Doxycycline

A

Bacteriostatic action against susceptable bacteria

189
Q

Name 3 Pathogens on the Spectrum of Doxycycline

A
  1. Some Gram + Activity
  2. Some Gram - Activity
  3. Mycoplasma
  4. Treponema pallidum
  5. Chlamydia
  6. Rickettsia
  7. Borrelia burgdorferi.
190
Q

Contraindications of Doxycycline

A

Pregnancy
Lactation

191
Q

Name 5 S/S of Doxycycline

A
  • DRESS
  • SJS
  • EM
  • ED
  • TEN
  • CDAD
  • Hepatotoxicity
  • Pancreatitis
  • NVD
192
Q

MOA of Azithromycin

A

Inhibits protien synthesis at the level of the 50S bacterial ribosome

193
Q

Indications for Azithromycin

A
  1. URI
  2. LRI
  3. HEENT Infection
  4. Skin Infection
  5. STI
194
Q

Therapuetic Effect of Azithromycin

A

Bacteriostatic action against bacteria

195
Q

Contraindications of Azithromycin

A

Allergy to Macrolides
Hepatic dysfunction
QT prolongation
Hypokalemia
Hypomagnemia
Bradycardia

196
Q

Drug Contraindications for Azithromycin

A
  • Quinidine
  • Dofetilide
  • Amiordarone
  • Procainamide
  • Sotalol

Quick, Dogs, Always, Play, Safe

197
Q

Name 5 S/S Effects of Azithromycin

A
  • Cardiac Death
  • TDP
  • GEP, DRESS, SJS, TEN
  • Hepatotoxicity
  • CDAD
  • NVD
198
Q

MOA of Clarithromycin

A

Inhibits protien synthesis at the level of the 50S bacterial Ribosome

199
Q

Indication of Clarithromycin

A
  • RTI
  • MAC
  • Skin Infection
  • HEENT Infection
  • H. Pylori

Endocarditis prophylaxis

200
Q

Therapeutic Effect of Clarithromycin

A

Bacteriostatic Action

201
Q

Name 3 Pathogens on the Spectrum of Clarithromycin

A

**Gram +/- aerobic bacteria **
Staphylococcus aureus,
S. pneumoniae,
S. pyogenes (group A strep)
Haemophilus influenzae,
Moraxella catarrhalis.

Mycoplasma, Legionella, H. pylori, M. avium

202
Q

Contraindications of Clarithromycin

A
  • Macrolide Allergy
  • Hepatic dysfunction
  • QT prolongation
  • Hypokalemia
  • Hypomagnemia
  • Bradycardia
203
Q

Drug Contradiction of Clarithromycin

A
  • Quinidine
  • Dofetilide
  • Amiodarone
  • Procainamide
  • Sotalol
  • Lomitapide
  • Lovastatin
  • Ergotamine
  • Simvastatin
  • Pimozide

Quick, Dogs, Always, Play, Safe; Let, Love, Everyone, SimPly

204
Q

Name 5 S/S of Clarithromycin

A
  • TDP
  • GEP, DRESS, SJS, TEN
  • CDAD
  • Hepatotoxicity
  • QT interval prolongation
205
Q

Action of Clavulanate Acid

A

Clavulanate resists action of beta-lactamase, an enzyme produced by bacteria that is capable of inactivating some penicillins.

206
Q

Indication of Oseltamivir

A

Influenza

207
Q

MOA of Oseltamivir

A

Inhibits the enzyme neuraminidase, which may alter virus particle aggregation and release.

208
Q

Contraindications of Oseltamivir

A

ESRD and not on dialysis

209
Q

Name 5 S/S of Oseltamivir

A

Seizure
Confusion
Insomina
Nausea
Vomiting

210
Q

Indication of Zanamivir

A

Influenza

211
Q

MOA of Zanamivir

A

Inhibits the enzyme neuraminidase, which may alter virus particle aggregation and release.

212
Q

Therapeutic Effect of Zanamivir

A

Reduced duration or prevention of flu-related symptoms

213
Q

Therapeutic Effect of Oseltamivir

A

Reduced duration or prevention of flu-related symptoms

214
Q

Contraindications of Zanamivir

A

Lactose Allergy

215
Q

Name 5 S/S of Zanamivir

A
  1. Seizure
  2. Bronchospasm
  3. Agitation
  4. Delirium
  5. Hallucinations
216
Q

MOA of Remdesivir

A

Remdesivir is metabolized to Remdesivir triphosphate (RT). RT acts as a ATP analog that competes with ATP for incorporation into RNA chains by SARS-CoV-2 RNA-dependent RNA polymerase which delays and terminates RNA SARS-CoV-2 replication

217
Q

Indication of Remdesivir

A

COVID-19

218
Q

Therapeutic Effect of Remdesivir

A

Reduced recovery time in COVID-19
Reduced mortality in COVID-19

219
Q

Contraindications of Remdesivir

A

Hypersensitivity

220
Q

Name 5 S/S of Remdesivir

A
  • Respiratory Failure
  • Nausea
  • Hyperglycemia
  • Increased LFTs
  • AKI
221
Q

MOA of Levofloxacin

A

Inhibits bacterial synthesis by inhibiting DNA gyrase enzyme

222
Q

Indications of Levofloxacin

A
  • UTI
  • HAP
  • CAP
  • Respiratory Infection
  • HEENT Infection
  • Skin Infection
223
Q

Therapeutic Effect of Levofloxacin

A

Death of susceptible bacteria

224
Q

Contraindication of Levofloxacin

A
  • QTC Prolongation
  • Hypokalemia
  • Hypomagnesmia
  • Bradycardia
225
Q

Drug Contraindications of Levofloxacin

A
  • Quinidine
  • Disopyramide
  • Amiordarone
  • Procainamide
  • Sotalol

Quick, Dogs, Always, Play, Safe

226
Q

Name 5 S/S of Levofloxacin

A
  • Aortic Dissection
  • TDP
  • QT Prolongation
  • SJS, GEP
  • Nausea
  • Elevated ICP
  • Seizure
  • Suicidal Thoughts/Behaivors
227
Q

MOA of Moxifloxacin

A

Inhibits bacterial DNA synthesis by inhibiting DNA gyrase enzyme

228
Q

Name 5 Pathogens on the Spectrum of Levofloxacin

A

Gram + pathogens
Gram - pathogens including Pseudomonas Aeruginosa
H. influenzae
E. Coli
E. Cloacae
Legionella
P. mirabilis
Staph
Strept
Mycoplasma

HEEELPSS

229
Q

Name 5 Pathogens on the Spectrum of Moxifloxacin

A

Gram + pathogens
Gram - pathogens
H. influenzae
E. Coli
E. Cloacae
P. mirabilis
Staph
Strept
Mycoplasma

230
Q

Contraindications of Moxifloxacin

A
  • QTC prolongation
  • Hypokalemia
  • Hypomagnesemia
  • Bradycardia
  • MG
231
Q

Drug Contraindications of Moxifloxacin

A
  • Quinidine
  • Dosipyramide
  • Amiordaron
  • Procainamide
  • Sotalol

Quick, Dogs, Always, Play, Safe

232
Q

Name 5 S/S of Moxifloxacin

A
  1. Aortic Dissection
  2. TDP
  3. QT prolongation
  4. SJS
  5. CDAD
  6. Elevated ICP
  7. Seizures
  8. Suicidal Thoughts
  9. NVD
233
Q

MOA of Ceftriaxone

A

Binds to the bacterial cell wall membrane causing cell death

234
Q

Name 5 Indications of Ceftriaxone

A
  • Skin Infection
  • Bone Infection
  • Respiratory Infection
  • Genitourinary Infection
  • Gastrointestinal Infection
  • HEENT Infection
  • Meningitis
  • Septecemia
235
Q

Therapeutic Effect of Ceftriaxone

A

Bacteriocidal action against susceptable bacteria

236
Q

Name 5 Pathogens on the Spectrum of Ceftriaxone

A

Acinetobacter
Enterobacter
H. influenzae
H. parainfluenzae
E. Coli
K. pneumoniae
M. morganii
Neisseria
Proteus
Providencia
Serratis
Moraxella catarhalis

DO NOT use for MRSA, MRE

3rd GEN Cephalosporin

237
Q

Contraindications of Ceftriaxone

A

Allergy to cephalosporin
Allergy to penicillin
Neonates

238
Q

Name 5 Side Effects of Ceftriaxone

A

Gallbladder Sludging
Cholelithiasis
Pancreatitis
CDAD
NVD
Seizure
IV Site Pain
Phelbitis

239
Q

MOA of Cefotaxime

A

Binds to bacterial cell wall membrane causing cell death

240
Q

Name 5 Indications for Cefotaxime

A
  • Integumentary Infection
  • Osseous infection
  • Geniturinary Infection
  • Pulmonary Infection
  • Gastrointestinal Infection
  • Septicemia
  • Meningitis
  • Lyme Disease
241
Q

Therapeutic Effects of Cefotaxime

A

Bactericidal action against susceptible bacteria

242
Q

Name 5 pathogens on the Spectrum of Cefotaxime

A

Acinetobacter
Citrobacter
Enterobacter
Haemophilus influenzae (including β-lactamase-producing strains)
Haemophilus parainfluenzae
Escherichia coli
Klebsiella pneumoniae
Morganella morganii
Neisseria gonorrhoeae and meningitidis
Proteus
Providencia
Serratia
Moraxella catarrhalis
Borrelia burgdorferi

No MRSA activity

243
Q

Contraindications of Cefotaxime

A

Allergy to cephalosporins
Allergy to penicillins

244
Q

Name 5 S/S of Cefotaxime

A
  1. CDAD
  2. NVD
  3. Seizure
  4. Pain at site
  5. Phelbitis
245
Q

MOA of Ceftaroline

A

Bind to bacterial cell wall membrane causing cell death

246
Q

Indication of Ceftaroline

A
  1. Skin Infection
  2. CAP
247
Q

Therapeutic Effect of Ceftaroline

A

Bacteriocidal action agaisnt susceptable bacteria

248
Q

Name 5 Pathogens on the Spectrum of Ceftaroline

A

Staphylococcus aureus
MRSA
Streptococcus pyogenes
Streptococcus agalactiae
Escherichia coli
Klebsiella pneumoniae
Klebsiella oxytoca
Streptococcus pneumoniae
Haemophilus influenzae

249
Q

Contraindications of Ceftaroline

A

Allergy to cephallsporin

250
Q

Name 5 Side Effects of Ceftaroline

A
  1. CDAD
  2. Seizure
  3. Encephalopathy
  4. NVD
  5. Hemolytic Anemia
251
Q

MOA of Unasyn

ampicillin/sulbactam

A

Binds to bacterial cell wall, resulting in cell death; spectrum is broader than that of penicillin.

Addition of sulbactam increases resistance to beta-lactamases, enzymes produced by bacteria that may inactivate ampicillin.

252
Q

Name 3 Indications of Unasyn

ampicillin/sulbactam

A
  • Intugermentary Infection
  • HEENT Infection
  • Abdominal Infection
  • Respiratory Infection
  • Genitourinary Infection
  • Meningitis
  • Septicemia
253
Q

Therapuetic Effects of Unasyn

ampicillin/sulbactam

A

Bactericidal action

254
Q

Name 5 Pathogens on the Spectrum of Unasyn

A

Streptococci
Pneumococci
Enterococci
Haemophilus influenzae
Escherichia coli
Proteus mirabilis
Neisseria meningitidis
N. gonorrhoeae
Shigella
Salmonella
Bacteroides fragilis
Moraxella catarrhalis

255
Q

Contraindication of Unasyn

A

Hepatic dysfunction
Renal Dose Renal Impairment

256
Q

Name 5 Side Effects of Unasyn

A
  1. EM, SJS, TEN, GEP
  2. Hepatotoxicity
  3. CDAD
  4. Seizure
  5. Pain at injection site
257
Q

MOA of Zosyn

A

Binds to bacterial cell wall causing cell death and inhibits beta-lactamase

258
Q

Indication of Zosyn

A

Appendicitis
Peritonitis
Skin Infection
Gynecologic Infection
CAP
HAP

259
Q

Therapeutic Effects of Zosyn

A

Death of susceptible bacteria

260
Q

Contraindications of Zosyn

A

Renal Impairment

261
Q

Side Effects of Zosyn

A

GEP, DRESS, SJS, TEN
CDAD
Seizure
Pain
Phlebitis at the IV site

262
Q

MOA of Cefepime

A

Binds to bacterial cell wall membrane causing cell death

263
Q

Indication of Cefepime

A

Skin infection
Bone infection
UTI
RTI
Abdominal Infection
Septicemia

264
Q

Therapeutic Effect of Cefepime

A

Bactericidal action against susceptible bacteria

265
Q

Contraindication of Cefepime

A

Hypersensitivity of penicillin

266
Q

Side Effects of Cefepime

A

Rash
CDAD
Encephalopathy
Seizure
Phlebitis at IV site

267
Q

MOA of Imipenem

A

Enzyme resistance
Binds to bacterial cell wall, resulting in cell death

268
Q

Indication of Imipenem

A

RTI
UTI
Abdominal Infection
Gynecologic infection
Skin infection
Bone infection
Bacteremia
Endocarditis

269
Q

TE of Imipenem

A

Bactericidal action against susceptible bacteria

269
Q

Contraindications of Imipenem

A

Sensitivity to penicillin and cephalosporin

269
Q

Side Effects of Imipenem

A

Rash
NVD
CDAD
Seizure
Phelbitis

269
Q

MOA of Meropenem

A

Enzyme resistance
Binds to bacterial cell wall, resulting in cell death

269
Q

Indication of Meropenem

A

Skin Infection
Abdominal Infection
Meningitis

269
Q

TE of Meropenem

A

Bactericidal action against susceptible bacteria

269
Q

SE of Meropenem

A

DRESS, SJS, TEN
CDAD
Seizure
Apnea
NVD

269
Q

MOA of Ceftazidime

A

Binds to the bacterial cell wall membrane causing cell death

270
Q

I of CEftazidime

A

Skin infection
Bone infection
UTI
Gynecological Infection
RTI
Abdominal Infection
Septicemia
Meningitis

271
Q

TE of ceftazidime

A

Bactericidal action against susceptible bacteria

272
Q

C of Ceftazidime

A

Hypersensitivity to penicillin

273
Q

SE of Ceftazidime

A

Rash
CDAD
Seizure
Pain
Phlebitis

274
Q

MOA of Ciprofloxacin

A

Inhibits bacterial DNA synthesis by inhibiting the DNA gyrase enzyme

275
Q

TE of Ciprofloxacin

A

Death of susceptible bacteria

276
Q

I of Ciprofloxacin

A

Skin infection
Bone Infection
Abdominal Infection
UTI
RTI
Bacterial Sinuitis
Bacterial Prostatitis

277
Q

SE of Ciprofloxacin

A

Aortic Aneurysm/Dissection
Hepatotoxicity
CDAD
Elevated ICP
Seizure

278
Q

MOA of Aztreonam

A

Binds to the bacterial cell wall membrane causing cell death

279
Q

I of Aztreonam

A

Septicemia
Skin Infection
Abdominal Infection
Gynecologic Infection
RTI
UTI
Pseudomonas aeruginosa

280
Q

TE of Aztreonam

A

Bactericidal Action against susceptible bacteria

281
Q

C of Aztreonam

A

Lactating Mothers

282
Q

SE of Aztreonam

A

CDAD
Seizure
Congestion
Nasopharyngeal Pain
Cough
Wheeze

283
Q

MOA of Vancomycin

A

Binds to bacterial cell wall, resulting in cell death

284
Q

I of Vancomycin

A

MRSA
Endocarditis
Meningitis
Osteomyelitis
Pneumonia
Septicemia
Soft Tissue Infection

285
Q

SE of Vancomycin

A

GEP, DRESS, SJS, TEN
Ototoxicity
Nephrotoxicity
Phlebitis
Vancomycin flushing syndrome

286
Q

MOA of Linezolid

A

Inhibits bacterial protein synthesis at the level of the 23S ribosome of the 50S subunit

287
Q

I of Linezolid

A

Nosocomial Pneumonia
CAP
Skin infection
VRE

288
Q

TE of Linezolid

A

Bactericidal agianst streptococci

Bacteriostatic against enterococci and staphylococci

289
Q

SE of Linezolid

A

TEN
CDAD
Serotonin Syndrome
Elevated LFTs
SIADH

290
Q

MOA of Amikacin

A

Inhibits protein synthesis in bacteria at the level of the 30S ribosome. Resists the action of the enzymes known to inactivate aminoglycosides

291
Q

TE of Amikacin

A

Bactericidal action against susceptible bacteria

292
Q

I for Amikacin

A

MAC
Serious infections unresponsive to less toxic antiinfectives

293
Q

SE of Amikacin

A

Ototoxicity
Nephrotoxicity

294
Q

MOA of Gentamicin

A

Inhibits protein synthesis in bacteria at the level of 30S ribosome

295
Q

I of Gentamicin

A

Serious gram-negative infections
Serious Infections

296
Q

TE of Gentamicin

A

Bacteriocidal Action

297
Q

SE of Gentamicin

A

Ototoxicity
Nephrotoxicity
Ataxia
Vertigo

298
Q

MOA of Tobramycin

A

Inhibits protein synthesis in bacteria at the level of the 30S ribosome

299
Q

I for Tobramycin

A

Serious Infection Gram-negative

300
Q

TE of Tobramycin

A

Bactericidal action

301
Q

SE of Tobramycin

A

Ototoxicity
Nephrotoxicity
CDAD
Paralysis

302
Q

Miscellaneous Dangerous Antibiotics

A

Colistin, Polymyxin E
Polymyxin B

AGACNP Board Review (5 decks)

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