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FNP4 Review > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Which chest X-ray view(s) should be ordered for this ambulatory patient? With 4 days sickness productive cough and temp of 101.4?

A

PA and lateral views

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2
Q

Why PA and lateral views for chest xray for pt with respiratory sx?

A

PA = minimizes anterior features of the heart
Lateral= helps us see fluid line in the lungs

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3
Q

The patient’s chest X-ray report indicates “an opacity in the left lower lobe.” What is the nurse practitioner’s interpretation?

A

Pneumonia

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4
Q

Your patient is a 52-year-old man with pneumonia. He denies shortness of breath. Should he get an antibiotic?

A

yes

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5
Q

Pneumonia Abx recommendations for pt without comorbidities

A

Amoxicillin 1 gram three times daily (strong recommendation, moderate quality of evidence), OR

Doxycycline 100 mg twice daily (conditional recommendation, low quality of evidence), OR

Macrolide (azithromycin 500 mg on first day, then 250 mg daily or clarithromycin 500 mg twice daily or clarithromycin ER 1,000 mg daily) only in areas with macrolide resistance <25% (conditional recommendation, moderate quality of evidence).

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6
Q

Which 5-day antibiotic regimen is most likely to produce GI upset?

  1. Amoxicillin 1 gram three times daily
  2. Doxycycline 100 mg twice daily
  3. Azithromycin 500 mg once, then 250 mg daily for 4 days
  4. These are all well tolerated
A
  1. Doxycycline 100 mg twice daily

Recommended to take on empty stomach for absorption but causes GI upset

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7
Q

What should be avoided by patients who take doxycycline?

A
  • Milk Products (wait 1-2 hours bc affects absorption)
  • Pregnancy (can cause discoloration to fetal tooth enamel)
  • Prolonged exposure to sunlight
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8
Q

Treatment of CAP for outpatient adults WHO HAVE comorbidities:
(chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancy; or asplenia)

A

Monotherapy:
▪ Respiratory fluoroquinolone (levofloxacin 750 mg daily, moxifloxacin 400 mg daily, or gemifloxacin 320 mg daily)
▪ Strong recommendation, moderate quality of evidence

 Combination therapy:
▪ Amoxicillin/clavulanate or a cephalosporin (cefpodoxime 200 mg twice daily or cefuroxime 500 mg twice daily); PLUS
▪ Macrolide or doxycycline
 Strong recommendation, moderate quality of evidence for combination with macrolide
 Conditional recommendation, low quality of evidence for combination therapy with doxycycline

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9
Q

Which antibiotic should NOT be used to treat CAP in a patient who has comorbidities? Why

  1. Levofloxacin
  2. Moxifloxacin
  3. Ciprofloxacin
  4. Gemifloxacin
A

Ciprofloxacin= not a respiratory fluoroquinolone … only kills bugs below the belt

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10
Q

Which antibiotic should NOT be used to treat CAP in a patient who has comorbidities? Why

  1. Levofloxacin
  2. Moxifloxacin
  3. Ciprofloxacin
  4. Gemifloxacin
A

Ciprofloxacin= not a respiratory fluroquinolone … only kills bugs below the belt

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11
Q

issues might contraindicate use of a quinolone in a patient who has CAP?

A

Pregnancy= bone/ cartilage formation
Hx of QT prolongation – can make worse
Abdominal Aortic Aneurysm = can cause to develop/ rupture
Dehydration
CrCl <30 mL/min – kidneys excrete quinolones

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12
Q

How long to continue abx for pneumonia?

A

5-10 days … usually
Consider age, comorbidities

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13
Q

Is a follow-up chest Xray necessary for follow-up?

A

Not necessary if responding appropriately and symptom resolution n 5-7 days

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14
Q

What pneumococcal vax should generally adults greater than or equal to 65 receive

If immunocompromised?

A

PPSV23 (recommended) OR “shared decision making:”

PCV13 plus PPSV23

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15
Q

Diagnosis of COPD made when:

A

Risk factors present:
 Tobacco
 Occupation
 Pollution exposure

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16
Q

What confirms dx of COPD?

A

Spirometry shows post-bronchodilator FEV1/FVC ratio < 0.70 Confirms diagnosis

17
Q

Sx of COPD

A
  • Shortness of breath
    -Chronic cough and chronic sputum production (may be intermittent)
  • Midlife onset, symptoms slowly progressive, exposure to lung irritant
18
Q

Onset early in life, symptoms vary widely from day to day, symptoms worse at nighttime/early AM, allergic rhinitis, eczema, family history, obesity

A

Asthma

19
Q

Chest X-ray with dilated heart, pulmonary edema

A

Heart Failure

20
Q

Midlife onset, symptoms slowly progressive, exposure to lung irritant

A

COPD

21
Q

Onset all ages, chest X-ray with lung infiltrate, microbiologic confirmation

A

Tuberculosis

22
Q

Large volumes of purulent sputum, chest X-ray: bronchial wall thickening, bronchial dilation

A

Bronchiectasis

23
Q

An older adult is in your exam room. She has a 30 pack-year history of cigarette smoking and admits to progressive DOE and chronic cough. What facts support a diagnosis of COPD? Select all that apply.
1. Age
2. FEV1/FVC ratio <0.70
3. Smoking history
4. Progressive dyspnea
5. Chronic cough

A
  1. Age
  2. FEV1/FVC ratio <0.70
  3. Smoking history
  4. Progressive dyspnea
  5. Chronic cough
24
Q

What intervention has the greatest influence on slowing progression of COPD in this patient?
1. Change in locale
2. Flu and pneumococcal vaccines
3. Smoking cessation
4. COVID vaccine

A
  1. Smoking cessation
25
Q

This patient has agreed to attempt smoking cessation. Which pharmacologic interventions are considered first-line therapy?
1. Varenicline (Chantix)
2. Nicotine patch
3. Bupropion extended release (Zyban)
4. Combo nicotine patch and bupropion

A
  1. Varenicline (Chantix)
  2. Nicotine patch
  3. Bupropion extended release (Zyban)
26
Q

Which one would be a safe choice if the patient had a history of mental health issues?

A

nicotine patch

27
Q

<5 minutes
4-6 hours
8 hours
Albuterol
Levalbuterol
“Rescue agents”
Suffix is “terol”
Tachycardia

A

SABAs
Short-acting beta agonists

28
Q

10-20 minutes
12-24 hours

Salmeterol (Serevent) Indacaterol (Arcapta Neohaler) Olodaterol (Striverdi Respimat) NOT a rescue med!!! Suffix is “terol”

A

LABAs Long-acting beta agonists

29
Q

prevent bronchoconstriction (by blocking action of acetylcholine at muscarinic receptors)

Suffix is “-tropium”
Many potential side effects, interactions

A

Inhaled Anticholinergics (Inhaled Antimuscarinics)

30
Q

Ipratropium (Atrovent)
Kind? Length of effect?

A

(short-acting antimuscarinic: SAMA)
6 hours

31
Q

Tiotropium (Spiriva)
Kind? Length of effect?

A

(long-acting antimuscarinic: LAMA)
24 hours

32
Q

SAMA plus SABA
length of effect?

A

Ipratropium/albuterol (Combivent)
6 hours

33
Q

LABA plus ICS
length of effect?

A

Advair, Breo, Symbicort
24 hours

34
Q

Prescribing Strategy for Stable COPD

A
  1. SAMA (or SABA) PRN; both are superior to either alone in improving symptoms and FEV1
  2. LABAs and LAMAs significantly improve lung function, dyspnea, health status and reduce exacerbation rates, BUT LAMAs have a greater effect on exacerbation reduction vs LABAs; combos are better than either alone
  3. ICS + (LABA or LAMA)
  4. ICS + (LABA and/or LAMA)
35
Q

A patient with newly diagnosed COPD reports occasional dyspnea. What is appropriate to prescribe to treat his symptoms?
1. Ipratropium only
2. PRN oral prednisone
3. Tiotropium
4. Salmeterol

Key term?

A

“occasional”

  1. Ipratropium only
    Can use short acting drug (SAMA or SABA)
36
Q

A patient with newly diagnosed COPD reports symptoms of cough and dyspnea multiple times daily. What is appropriate to prescribe to treat these symptoms?

  1. Ipratropium only
  2. PRN oral prednisone
  3. Tiotropium
  4. Fluticasone BID

What could be used to treat acute symptoms?

A
  1. Tiotropium (Long acting bc. multiple x a day)
  • Albuterol or Ipatropium for acute sx.

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