Respiratory Flashcards
Treatment of CAP
Previously healthy pts- Macrolides- azithromycin, clarithromycin, erythromycin or doxycycline.
Pts with co-morbidities, immunosuppressed or recent ABT- Respiratory fluroquinolones, advanced macrolide (azithromycin plus beta-lactam such as HD amoxicillin, HD augmentin , ceftriaxone, cefuroxime (Ceftin)
Atypical organisms in CAP
M. Pneumoniae
C. Pneumoniae
Legionella
Symptoms of asthma
Recurrent cough, wheeze, sob & chest tightness.
Sx WORSE AT NIGHT, WITH EXERCISE, with viral respiratory infections, allergens or pulmonary irritants (smoking)
Asthma definition
Chronic disorder of the airways, characterized by variable, recurrent sx of airflow obstruction, bronchial hypertesponsiveness, & underlying inflammation.
FEV1 >12 from baseline post SABA
Intermittent asthma classification
Sx = 2days/wk Nighttime awakenings = 2x/mth SABA use = 2days/wk Interference w/ daily life- none FEV1 >80% predicted FEV1/FVC normal
Mild persistent asthma classification
Sx >2 days/wk, but not daily Nighttime awakenings 3-4 x's/mth SABA use >2 days/wk not >1x/day Minor limitation of normal activity FEV1 >80% predicted FEV1/FVC normal
Moderate Persistent asthma classification
Sx daily Nighttime awakenings >1x/wk not wkly SABA daily Some interference with daily living FEV1 >60% but
Severe persistent asthma classification
Sx throughout the day Nighttime awakenings often 7d/wk SABA several times/day Extreme limitation with normal activity FEV1 5%
Risk factors/genetic characteristics for developing asthma (IgE)
The body’s predisposition to develop an antibody called Immunoglobulin IgE- in response to environmental allergens.
Includes allergic rhinitis, asthma, hay fever & eczema.
IgE is high in pts with allergic asthma, allergic rhinitis & eczema.
IgA and autoimmune conditions
IgA levels may be high in autoimmune conditions. IgA is found in high concentrations in the body’s mucus membranes, particularly resp. passages, GI tract, saliva & tears. IgA plays a role in allergic reactions.
Conditions that go along with asthma
Increased nasal secretions or nasal polyps.
Atopic dermatitis, eczema, or allergic skin conditions
Long term (controller) meds for asthma
Inhaled corticosteroids (Qvar, pulmicort, Flovent, asmanex)
Long-acting beta2 agonists (Formoterol, salmeterol)
Leukotriene modifiers (Singulair)
Quick relief (rescue) med for asthma
Short acting beta2 agonists (ProAir, ventolin, xopenex)
Xolair (omalizumab)
Anti-IgE injection injection 1-2 xmth to help the body from reacting to asthma triggers. May be used when other asthma meds have not worked.
Physical exam findings in COPD
Hyperresonance Decreased tactile fremitus Wheeze (expiratory, then inspiratory) Low, flat diaphragm Increased AP diameter (barrel chest-most often in COPD, also seen in poorly-controlled asthma.
Most common COPD sx
Chronic cough, chronic sputum production, chronic bronchitis, activity intolerance. Sx typically progressive over time.
Alpha-1 antitrypsin deficiency screening (COPD)
Test for enzyme deficiency that
leads to esophageal collapse.
(Check with strong family hx, European ancestry
COPD GOLD stage 1
Mild
FEV1>80% predicted
COPD GOLD stage 2
Moderate
50%-
COPD GOLD stage 3
Severe
30%-
COPD GOLD stage 4
Very severe
FEV1
COPD treatments
SABA- prn for bronchospasm
LABA- daily controller med
LAMA (muscarinic antagonist)-daily to reduce exacerbations
ICS-added if FEV1 falls
Indication to initiate long-term (>15 hrs/day) oxygen therapy
PaO256% [0.56 proportion ])
COPD exacerbation
Characterized by a change in the pts baseline dyspnea, cough, and/or sputum beyond the day to day variability sufficient to warrant a change in management.
Treatment of COPD exacerbation
Bronchodilators- SABA prn, consider adding LABA, LAMA (tiotropium bromide) if not already on one.
*If baseline FEV1
ABT tx for mild to moderate exacerbations
Amoxicillin
TMP-SMX
Doxycycline
ABT tx for severe exacerbations
Beta-lactam (Augmentin, Cephalosporins)
Macrolides (Azithromycin, clarithromycin)
Respiratory fluroquinolones (Moxifloxacin, levofloxicin)
Emphysema definition
Enlargement of air spaces secondary to alveolar wall destruction (secondary to neutrophil produced elastases)
Without elastin, the airways collapse upon expiration.
Cor pulmonale
Right ventricular enlargement, hypertrophy or dilation secondary to lung disease.
EKG changes- right ventricular hypertrophy & right axis deviation.
Tx of Cor pulmonale
Oral corticosteroids
Hospitalization
24 hour nocturnal requirements
Refer to pulmonology, poss cardiology
TB organism & sx
Mycobacterium tuberculosis
Sx- productive cough, purulent yellow sputum, repeated occurrences of cold like sx, with rhinorrhea, & nasal congestion. Hemoptysis
3 categories of positive reactions to PPD (mantoux) test.
5mm =positive in HIV pts
10mm= positive in recent immigrants
15mm= positive on everyone
Treatment of TB
Duration of treatment 6mths
- 2 month course isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), & ethambutol ((EMB)
- 4 month course of INH & RIF
Pulmonary HTN
Pulmonary artery pressure is inappropriately high for a given level of blood flow through the lungs.
Characterized by- right side heart failure, progressive dyspnea
Management of pulmonary HTN
Activity limitations
Low salt diet
Avoid OTC meds
Lasix/warfarin
Inhaled anthrax presentation
Cutaneous anthrax presentation
(Treatment)
Inhaled- widened mediastinum due to hemorrhage visible on CXR or thoracic CT
Cutaneous- pustular lesions that eventually forms ulcer with eschar
Treatment- Fluroquinolones, expert consultation
