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Pulmonology And Special Topics > Pulmonology Pharm > Flashcards

Pulmonology Pharm Flashcards

1
Q

Community-acquired pneumonia-previously healthy Pt

A

Macrolide(Azithromycin, Clarithromycin or erythromycin)

Or Doxycycline

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2
Q

Community-acquired pneumonia with presence of co-morbidities

A 
Respiratory fluoroquinolone(moxifloxacin, levofloxacin) Or a beta-lactam(high dose amoxicillin, amoxicillin/clavulanate)
And a macrolide(Azithromycin, Clarithromycin or erythromycin)
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3
Q

Hospital Acquired Pneumonia Treatment-nonMRSA decreased risk for gram neg

A

One of the following:
Piperacillin-tazobactam 4.5g IV q 6hrs
Cefepime 2g IV q 8hrs
Levofloxacin 750 mg IV q 24 hrs

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4
Q

Hospital Acquired Pneumonia Treatment= MRSA risk and decreased risk for gram neg

A 
One of the following:
Piperacillin-tazobactam 4.5g IV q 6hrs
Cefepime 2g IV q 8hrs
Levofloxacin 750 mg IV q 24 hrs
Ceftazidime 2 g IV q 8hrs
Ciprofloxacin 400 mg IV q 8hrs
Aztreonam 2 g IV q 8hrs

Plus one of the following:
Vancomycin 15 mg/kg (max 2 g initial dose) q 8-12 hrs target of 15-20 mcg/ml
Linezolid 600 mg IV q 12 hrs

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5
Q

Most common pathogen for Community acquired Pneumonia

A

S Pneumoniae (MC), Haemophilus influenzas, Legionella

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6
Q

Common pathogen for Hospital acquired pneumonia

A

E. coli, klebsiella, Enterobacter, Pseudomonas, MRSA

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7
Q

Common pathogens for aspiration pneumonia

A

Pseudomonas, Bacteroides, peptostreptococcus, fusobacterium nucleatum, prevotella

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8
Q

Common pathogens for Bronchitis

A

Influenza A and B, parainfluenza, Coronavirus 1-3, rhinoviruses

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9
Q

Amoxicillin-class

A

Beta lactate antibiotic

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10
Q

Amoxicillin MOA

A

Inhibits bacterial cell wall synthesis

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11
Q

Amoxicillin Adverse effects

A

Headache
N/V/D
C diff

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12
Q

Amoxicillin Contra indications

A

Serious hypersensitivity

Super infections

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13
Q

Amoxicillin Indications

A

Community acquired pneumonia outpatient/inpatient along with macrolide
Treats Strep, staph and H. Influenza

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14
Q

Amoxicillin monitoring and special considerations

A

Pregnancy cat B
Excreted in breast milk
Prolonged therapy monitor renal, hepatic and hematologists function

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15
Q

Amoxicillin dosing

A

1g TID x min of 5 days should be afebrile>48hrs

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16
Q

Amoxicillin/Clavulanate (augmentin) Class

A

Beta lactam w/beta lactamase inhibitors

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17
Q

Amoxicillin clavulanate MOA

A

Beta lactam inhibits bacterial cell wall synthesis while the inhibitor stops betalactamase from breaking down beta lactam

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18
Q

Amoxicillin clavulanate indications

A

Community acquired Pneumonia caused by confirmed or suspected beta lactamase producing pathogens(H influenza, Moraxella catarrhalis, Klebsiella pneumoniae, MSSA, Strep Pneumoniae

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19
Q

Amoxicillin clavulanate dosing

A

ER-2g q12 hrs as dual therapy

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20
Q

Amoxicillin clavulanate adverse effects

A

Diarrhea, abdominal distress, nausea and vomiting

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21
Q

Amoxicillin clavulanate contraindications

A

Hypersensitivity, severe renal impairment

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22
Q

Amoxicillin clavulanate special consideration, monitoring and Pt education

A

Monitor liver functions

Take until 48 hrs without fever

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23
Q

Doxycycline class

A

Tetracycline derivative

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24
Q

Doxycycline MOA

A

Inhibits protein synthesis by binding with the 30s ribosomal subunit

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25
Q

Doxycycline Indications

A

Alternative agent for inpatient and outpatient treatment of CAP empiric treatment

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26
Q

Doxycycline adverse effects

A

HTN, anxiety, hyperglycemia, Diarrhea, and pain, nasopharyngitis

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27
Q

Doxycycline contraindications

A

Hypersensitivity, use in children <8, pregnant and breastfeeding

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28
Q

Doxycycline special considerations, monitoring and education

A

CBC, renal and liver functions periodically for prolonged therapy,

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29
Q

Azithromycin class

A

Macrolide

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30
Q

Azithromycin MOA

A

Inhibits RNA dependent protein synthesis at the chain elongation step

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31
Q

Azithromycin Indications

A

Empiric Treatment of CAP or due to Chlamydia pneumonia, H flu, Legionella, Morexella, Mycoplasma and Strep Pneumoniae

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32
Q

Azithromycin dosing for CAP

A

Outpatient 500mg x1 day, 250mg qday x 4 days

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33
Q

Azithromycin Adverse effects

A

Loose stools, nausea, vomiting, diarrhea, Abd pain, rash,

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34
Q

Azithromycin contraindications

A

Hypersensitivity

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35
Q

Azithromycin special considerations, monitoring and Pt education

A

CYP3A4

Liver functions, CBC with dif

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36
Q

Levofloxacin class

A

Respiratory Fluoroquinolone

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37
Q

Levofloxacin MOA

A

Inhibits bacterial DNA uncoiling and promotes breaking of DNA

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38
Q

Levofloxacin Indications

A

Treatment of CAP as monotherapy in hospital an outpatient

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39
Q

Levofloxacin dosing

A

750 mg PO/IV qday for 5 -7 days or until afebrile >48hrs

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40
Q

Levofloxacin Adverse effects

A

Tendonitis, Headache, dizziness, N/V/D

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41
Q

Levofloxacin contraindications

A

Hypersensitivity

Tendinitis Hx

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42
Q

Levofloxacin monitoring, special considerations and education

A

May prolong QT
Hypoglycemia
Hepatoxicity
Pregnancy class c
Monitor renal, hepatic and hematopoietic syste ms periodically
Crystalluria, AMS and tendonitis(especially elderly)

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43
Q

Cefdinir class

A

3rd gen cephalosporin

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44
Q

Cefdinir MOA

A

Inhibits bacterial cell wall synthesis

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45
Q

Cefdinir Indications

A

CAP-alternative for immunocompromised and co morbidity Pts

COPD exacerbation caused by H influenza, strep pneumonia and Moraxella

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46
Q

Cefdinir Adverse effects

A

Diarrhea

Nausea and rash

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47
Q

Cefdinir contraindications

A

Hypersensitivity

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48
Q

Cefdinir monitoring special considerations and education

A 
Monitor renal function 
Pregnancy class B
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49
Q

Ceftriaxone class(Rocephin)

A

3rd gen cephalosporin

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50
Q

Ceftriaxone MOA

A

Inhibits bacterial celll wall synthesis

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51
Q

Ceftriaxone Indications

A

CAP alternative for immunocompromised and commorbidities Pts

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52
Q

Ceftriaxone Adverse effects

A

Skin tightness, rash

Nausea, diarrhea

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53
Q

Ceftriaxone contraindications

A

Hypersensitivity

54
Q

Ceftriaxone special considerations, monitoring and education

A

May elevate INR, Hemolytic anemia, pancreatitis
Monitor INR
Pregnancy class B

55
Q

Oseltamivir Class

A

Antiviral-Neuraminidase inhibitor

56
Q

Oseltamivir MOA

A

Binds to Neuraminidase and does not allow virons to be released from infected cells

57
Q

Oseltamivir Indications

A

Influenza A and B post exposure prophylaxis and treatment

58
Q

Oseltamivir Adverse effects

A

Headaches, nausea and vomiting

59
Q

Oseltamivir contraindications

A

Hypersensitivity

60
Q

Oseltamivir special considerations, monitoring and education

A

Prophylaxis for high risk population(lung and cardiac disease, Immunocompromised, pregnant)
Treatment- start in first 48hrs, willl only shorten symptoms by couple of days, may lessen severity
Monitor for unusual behavior

61
Q

Exacerbation of chronic bronchitis(COPD)

A

Maintenance therapy-Long acting bronchodilator
**systemic corticosteroids(5-7days)
**Antibiotics 5-7 days-Based on severity-SimpleAmoxicillin, doxycycline, Azithromycin or SMXTMT
Complicated-Amoxicillin clavulanate or Ceftriaxone or doxycycline
Severe complicated-Levofloxacin

62
Q

5 A’s of smoking cessation

A 
Ask
Advise
Assess
Assist
Arrange
63
Q

Symptoms of Nicotine withdrawal

A

Cravings, nervousness, restlessness, irritability, mood lability,anxiety, sleep disturbances and weight gain

64
Q

Follow up after prescribing smoking cessation

A

Follow up within one week of quit date

65
Q

Smoking cessation treatment algorithm

A

Smoke in preparation/action phase—>Set quit date and begin behavioral therapy—>Start first line therapy(Bupropion SR, Varenicline and nicotine replacement—>Follow up with in 1 week of quit date—>Successfull—>follow up in 1 month—>still successful—>Provide follow up as needed

If not successful—>try combination therapy, switch to different monotherapy, intensify behavioral therapy

66
Q

Smoking cessation behavioral therapy

A

Important aspect for every Pt
Support groups
Behavior modification program

67
Q

Nicotine replacement therapy

A

Considered first line therapy

68
Q

Nicotine gum dosing

A

If first cigarette within 30 min of waking start at 4mg otherwise 2 mg
Week 1-6===1 piece every 1-2 hrs
Week7-9===1 piece every 2-4 hrs
Week 10-12==1 piece every 4-8 hrs

69
Q

Nicotine patch class and MOA

A

Long acting Nicotine replacement therapy

Replaces nicotine in blood stream from nicotine received from tobacco

70
Q

Nicotine Patch Indication

A

For Pt’s wanting smoking cessation

71
Q

Nicotine patch dosing Greater than 10 cigarettes/day

A

21mg/day x 6 weeks
14mg/day x 2 weeks
7mg/day x 2 weeks

72
Q

Nicotine patch dosing less than 10 cigarettes/day

A

14mg/day x6 weeks

7mg/day x 2 weeks

73
Q

Nicotine patch adverse reactions and contraindications

A

Erythema, burning or priorities at application site
Nightmares
Headache

Caution-recent MI(2 weeks)
Serious arrhythmia
Worsening angina
Active peptic ulcer disease

74
Q

Nicotine patch special considerations, monitoring and education

A

Apply to non hairy, clean dry skin upper body or outer arm-rotate site each day
Nicotine will continue to be delivered after patch is removed
Do not cut
Need to abstain from smoking

75
Q

Bupropion class/MOA

A

Non-nicotine aid to smoking cessation/antidepressant

Blocks neuronal resp take of dopamine and norepinephrine-metabolite is a nicotine antagonist

76
Q

Bupropion contraindications/precautions/adverse effects

A

CI:HIstory of seizure disorder
Coadministration with MAOI
Current or prior diagnosis of bulimia or anorexia nervosa

Precaution: Do not use with Wellbutrin/WellbutrinSR(antidepressant version)
Carbamazepine interactions-decreases serum concentrations of bupropion

AE: Seizures with high dose, insomnia, irritability, dry mouth, headache, weight gain/loss

77
Q

Bupropion dosing

A

150 mg SR PO qday for 3 days, then increase to 150 mg SR BID for 7-12 weeks

Initiate therapy while still smoking and have target quite date 7 days after starting
Decrease dose by 50% in Pts with renal and hepatic insufficiency
Can be combined with NRT

78
Q

Varenicline class and MOA

A

Alpha 4beta2 nicotine acetylcholine receptor agonist

Selectively blocks nicotine binding to A4B2 nicotine acetylcholine receptors
Reduces severity of cravings and withdrawals

79
Q

Varenicline adverse reactions

A

Nausea, sleep disturbances, head aches, abnormal dreams, suicidal ideation,
Possibly linked to MI, seizure, DM, dizziness and confusion

80
Q

Intermittent Asthma

A 
Symptoms-2 or fewer days a week
Night time awakenings-2 or fewer a month
Use of SABA-2or less days /week
Interference with normal activity-none
Exacerbation requiring systemic steroids-0-1
Normal FEV1 between exacerbation
81
Q

Mild persistent asthma

A

Symptoms-more than 2 days /week but not daily
Nighttime awakenings-3-4 nights per month
SABA use-More than 2 days per week but not more than 1 time per day
Interference with normal activity-Minor limitations
Exacerbation requiring systemic steroids-2 or more per year
FEV1>80%

82
Q

Moderate persistent asthma

A

Symptoms-daily
Nighttime awakenings-more than 1 time per week-not daily
SABA use-Daily
Interference with normal activity-Some limitiation
Exacerbation requiring systemic steroids-2 or more per year
8060

83
Q

Severe persistent asthma

A

Symptoms-throughout the day
Nighttime awakenings-often 7 times per week
SABA use-several times per day
Interference with normal activity-extremely limited
Exacerbation requiring systemic steroids-2 or more/year
FEV1<60

84
Q

Well controlled asthma

A 
Symptoms-2 or fewer days/week
Nighttime awakenings-2 or fewer nights/month
Interference with normal activities-none
SABA use-2 or fewer days per week
FEV1 or PEF->80%
Exacerbation-0-1/year

Treatment-Maintain current step
Regular follow up every 1-6 mo
Consider stepping down if well controlled for at least 3 mo

85
Q

Not well controlled Asthma

A 
Symptoms-More than 2 days per week
Nighttime awakenings-1-3 nights per week
Interference with normal activities-some limitations 
SABA use-more than 2 days per week
FEV1-60-80%
Exacerbation>2/year

Treatment
Step up one step
Reevaluate in2-6 weeks

86
Q

Very poorly controlled Asthma

A

Symptoms-through out the day
Nighttime awakenings-4 or more nights per week
Interference with normal activity-Extremely limited
SABA use-several times per day
FEV1<60%

Treatment
Consider short course oral CS
Step up 1-2 steps
Reevaluate in 2 weeks

87
Q

Asthma STep wise

Step 1

A

SABA PRN

88
Q

Asthma STep WIse

Step Two

A

Low Dose ICS

89
Q

Asthma STep Wise

Step 3

A

Low dose ICS + LABA

Or Medium DOse ICS

90
Q

Asthma STep Wise

Step 4

A

Medium DOse ICS+LABA

91
Q

Asthma STep WIse

STep 5

A

High Dose ICS+LABA and consider Omalizumab for Pt w/allergies

92
Q

Asthma STep Wise

Step 6

A

HIgh dose ICS +LABA +Oral CS and consider Omalizumab for Pt with allergies

93
Q

Goals of Asthma Therapy

A

Reduce impairment and reduce risk

94
Q

Proper MDI use technique

A

Exhale, puff MDI, inhale, hold for 10 seconds

95
Q

Proper use of DPI technique

A

Click DPI, hold level, exhale away from DPI, form seal around dpi, inhale

Always swish and spit after use

96
Q

Treatment for acute exacerbation of Asthma

A 
2-6 puffs on own SABA-repeat in 20 minutes and then in 3-4 hrs
Can Add short course of Oral CS
If not relieved by the personal SABA
Repetitive or continues SABA new/MDI
O2 if SPO2<90
SYstemic CS
Can add a SAMA for severe Pt
97
Q

Fluticasone propionate class

A

Inhaled Corticosteroid

98
Q

Fluticasone proprionate MOA

A

ASthma controller medication
Improves control more effectively than other long term control meds
Reduces impairment and risk of exacerbation
Reduces airway inflammation, decreases airway hyper-responsiveness
Not for Rescue purposes

99
Q

Fluticasone proprionate Indications and dosing

A

Pt on Step 2 or higher comes in 3 MDI 44, 110, 220mcg/puff
Low dose88-264mcg BID
Medium dose 264-440mcg BID
High Dose >440 mcg BID

100
Q

Fluticasone proprionate Adverse Effects and contraindications

A

Oral Candidiasis
Hoarseness
CI:Hypersensitivity t CS or lactose/dairy proteins

101
Q

Fluticasone proprionate Special considerations/monitoring/Pt ed

A 
Dose depends on severity
BID
Titrations to lowest effective dose once control has been achieved
Not for acute relief
Rinse/gargle and spit after use
102
Q

Albuterol class and MOA

A

SHort acting broncho dilator-beta 2 agonist

Short term stimulation of beta 2 adenergic receptors

103
Q

Albuterol indication and dosing

A

Most effective medication for relief of acute bronchospasm
PRN
Usually 2 puffs PRN
Acute exacerbation 4-8 puffs every 20 min for 3 doses

104
Q

Albuterol Side effects and contraindications

A

SE:

Tremor, increased HR, palpitations, Hyperglycemia, hypo Kalem is, hypomagnesemia

105
Q

Albuterol special considerations, monitoring and Pt ed

A

Use caution with cardiac Pts, Hx of dm, hyperthyroid seizures,and glaucoma

Beta blockers dismiss the effects
Concurrent sympathomemetics can enhance risk of adverse effects

106
Q

Prednisone class and MOA

A

Oral corticosteroids works on establishing control-anti inflammatory
Burst therapy

107
Q

Prednisone indication

A

SABA unresponsiveness
Gradual deterioration
Establish control in existing or newly diagnosed Pt

108
Q

Prednisone Side effects and contraindications

A

Sodium and water retention
Increased appetite, weight gain, CNS stimulation/nightmares, peptic ulcers and leukocytosis

CI: Hypersensitivity

109
Q

Salmeterol/fluticasone Class and MOA

A

Duo therapy LABA and ICS

Work on beta 2 receptors as an agonist and work to decrease the inflammation

110
Q

Salmeterol/ fluticasone Indication

A

And above, limiting amount of meds a Pt needs to purchase and increasing compliance

111
Q

Salmeterol fluticasone SE/CI

A

SE:Oral candidiasis, hoarseness, Tachycardia, palpitations, tremors
CI: Hypersensitivity

112
Q

Montelukast class and MOA

A

Leukotriene modifying

Blocks the conversion of arachiodonic acid into a broncho constrictor and a proinflammatory

113
Q

Montelukast indication

A

Long term controller to be added to ICS

114
Q

Montelukast ADverse effects/Contraindications

A

Headache, fatigue, dyspepsia, sleep disturbances, agitation

CI:
Hypersensitivity
Chewable-Pt with phenylketonuria

115
Q

Montelukast special considerations/Pt ed/ monitoring

A

Not for acute relief

Once daily in evening

116
Q

Ipatropium class and MOA

A

SAMA
Competitively blocks muscarinic receptors in lungs causing bronchodilator
Slower onset and longer duration than Beta 2 agonists

117
Q

Ipatroprium Inidications

A

Symptomatic relief from COPD

118
Q

Ipatropium adverse reactions and contraindications

A

Cough dry mouth, dry throat, throat irritation, blurred vision, mydriasis, dyspepsia
Metal taste

Use with caution with Pts with narrow angle glaucoma, myasthenia Gravis, prostatic hyperplasia,

119
Q

Tiotropium Class and MOA

A

LAMA, Competitively binds to muscarinic receptors causing broncho dilation
SLower action longer duration

120
Q

Tiotropium indication and dosing

A

18mcg qday spiriva handihaler

121
Q

Roflumilast CLass, MOA, Indications, Adverse reaction, contraindications and special considerations

A

C;Phosphodiasterase 4 inhibitor
M;Selectively inhibits PDE4, a major cAMP metabolizing enzyme, increasing intracellular cAMP in the lung cells
I:Decreases risk of exacerbations in Pt with severe COPD an h/o exacerbations
AE:SVT, weight loss, diarrhea, anxiety, depression and suicidal ideation
CI:Hypersensitivity, moderate-severe hepatic impairment
Special:Adjunct therapy with broncho dilators

122
Q

Oseltamivir treatment dosing

A

75mg BID x 5 days

123
Q

Oseltamivir Prophylaxis treatment

A

75 mg q day x 7-14 days

124
Q

4 drugs used as initial TB treatment

A 
RIPE
Rifampin
Isoniazid
Pyrazinamide
Ethambutol

Until susceptibilities come back

125
Q

Latent TB treatment

A

Isoniazid 9 months
Isoniazide with RFP 6 months
Rifampin 4 months

126
Q

Active T infection treatment

A

Isoniazid, pyrazinamide and rifampin- 6 months
INH/RIF-9 months
RIF/EMB/PZA 6 months
RIF/EMB 12 months

127
Q

TB treatment will be extended for

A

those with extrapulmonary TB, HIV and immunocompromised Pt

128
Q

Hospital-acquired pneumonia treatment

A

Piperacillin-tazobactam 4.5 g IV q 6hrs(alone if no MRSA and No Gram neg)
Plus Levofloxacin IV 750 mg q day ( if Gram neg and /or MRSA)
Plus Vancomycin 15mg/kg IV q 8-12 hrs (If MRSA risk)

129
Q

Salmeterol Class

A

LABA

130
Q

Salmeterol Contraindications

A

Monotherapy in Asthma

Pulmonology And Special Topics (3 decks)

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