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Respiratory > Respiratory Exam 1 - CYSTIC FIBROSIS > Flashcards

Respiratory Exam 1 - CYSTIC FIBROSIS Flashcards

1
Q

Aerosolized Antibiotics

A

Activity against Pseudomonas aeuroginsoa

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2
Q

Tobramycin Inhaled Solution (TOBI)

A

Aerosolized Antibiotic

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3
Q

Tobramycin Inhaled Solution (TOBI) - SPECTRUM

A

Gm(-) spectrum

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4
Q

Tobramycin Inhaled Solution (TOBI) - DOSING

A

> 6yo: 300mg Q12H
(QD in renal impairment)

Takes 15-20min to administer

28 days on, 28 days off

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5
Q

Tobramycin Inhaled Solution (TOBI) - AEs

A

Bronchospasm
Hoarseness
Pregnancy Category D

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6
Q

Aztreonam Inhaled Solution (Cayston)

A

Aerosolized Antibiotic

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7
Q

Aztreonam Inhaled Solution (Cayston) - DOSING

A

> 7yo: mix 1 vial of medication with 1 ampule of saline and add to ALTERA nebulizer handset

75mg TID (at least 4h between doses)

2-3min to administer

28 days on, 28 days off

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8
Q

Aztreonam Inhaled Solution (Cayston) - AEs

A 
Bronchospasm
Sore throat
Nasal congestion 
Fever
Pregnancy Category B
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9
Q

Colistimethate (Colistin)

A

Aerosolized Antibiotic

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10
Q

Colistimethate (Colistin) - DOSING

A

75-150mg BID

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11
Q

Colistimethate (Colistin) - AEs

A

Bronchospasm:

Use Albuterol after reconstitution to decrease

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12
Q

Mucolytics

A

Decrease viscosity of pulmonary secretions

Increase clearance of sputum

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13
Q

Dornase alfa (Pulmozyme)

A

Mucolytic

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14
Q

Dornase alfa (Pulmozyme) - MOA

A

Presence of DNA produces viscous mucus
-Selectively cleaves DNA & decreases mucus viscosity
Increase airflow and decrease risk of infection

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15
Q

Dornase alfa (Pulmozyme) - DOSING

A

2.5mg QD via nebulizer

Not approved in children <40)

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16
Q

Dornase alfa (Pulmozyme) - CONSIDERATIONS

A

Improvement in lung function in 8 days
-Increases adherence
Preserves lung function

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17
Q

Hypertonic Saline

A

Mucolytic

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18
Q

Hypertonic Saline - MOA

A

7% saline solution

Increases volume of fluid on epithelial lining of the airway to maintain normal ciliary flow and increase sputum expectoration

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19
Q

Hypertonic Saline - AEs

A

Bronchospasm

-Pretreatment with albuterol

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20
Q

Inhaled Corticosteroids

A

Anti-Inflammatory Agent

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21
Q

Inhaled Corticosteroids - INDICATIONS

A

Reserved for patients with reactive airways (asthma)

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22
Q

Oral Corticosteroids

A

Anti-Inflammatory Agent

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23
Q

Oral Corticosteroids - INDICATIONS

A

Long term:
Benefit lost shortly following DC

Short term:
Used in pts with aspergillus colonization
Helpful in acute exacerbations

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24
Q

Oral NSAIDS (Ibuprofen)

A

Anti-Inflammatory Agent

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25
Q

Oral NSAIDS (Ibuprofen) - INDICATIONS

A

Benefit not seen immediately

Shows slowed rate of pulmonary decline
Does not improve lung function

26
Q

Oral NSAIDS (Ibuprofen) - DOSING

A

20-30mg/kg BID

27
Q

Azithromycin

A

Anti-Inflammatory Agent

28
Q

Azithromycin - INDICATIONS

A

Decreases sputum production

Preserves lung function & decreases pulmonary exacerbations

29
Q

B2-Adrenergic Receptor Agonists

A

Bronchodilators

30
Q

SABA (Albuterol) - INDICATIONS

A

Used in combination with airway clearance to stimulate mucociliary clearance

Used in combination with other inhaled therapies to prevent bronchospasm

31
Q

LABA (Salmeterol)

A

Benefit for pts with recurrent wheeze or dyspnea

32
Q

Inhaled Anticholinergic Agents (Impratropium)

A

Bronchodilators

33
Q

Inhaled Anticholinergic Agents (Impratropium) - INDICATIONS

A

Act to decrease bronchospasm

34
Q

Ivacaftor (Kalydeco)

A

CF Transmembrane Conductance Regulator Potentiator

35
Q

Ivacaftor (Kalydeco) - MOA

A

Potentiates epithelial cell Cl- ion transport of defective G551D mutant cell-surface CFTR protein

Improves regulation of salt and water absorption and secretion in various tissues

Improves lung function

36
Q

Chest Physical Therapy (CPT)

A

The traditional form

Percussion & Postural drainage

Takes about 30min

36
Q

Chest Physical Therapy (CPT)

A

The traditional form

Percussion & Postural drainage

Takes about 30min

37
Q

CPT - Percussion

A

Chest is clapped to dislodge mucus

Done in various positions

38
Q

CPT - Postural drainage

A

Pt gets into different positions

Allows gravity to assist with mucus drainage

39
Q

Oscillating Positive Expiratory Pressure (PEP)

A

Vibrates small and large airways

Pt blows into device multiple times

Pt coughs or huffs

Repeat multiple times

40
Q

High Frequency Chest Compression (HFCC)

A

Most commonly used technique

Inflatable vest that uses external oscillation

Every 5min pt stops machine and coughs

41
Q

Sweat Cl- concentration <39mmol/L

A

CF unlikely

42
Q

Sweat Cl- concentration 40-59mmol/L

A

CF possible

43
Q

Sweat Cl- concentration >60mmol/L

A

CF diagnosis

44
Q

Mutation of CF gene

A

Dysfunctional CFTR protein

45
Q

Dysfunctional CFTR protein leads to

A

Decreased Cl- secretion

Increased sodium reabsorption

Altered viscosity of fluid secreted by exocrine gland

46
Q

Early pathogens of CF

A

***Pseudomonas
Staph. Aureus
Non-typical H. Flu

47
Q

CFF Guideline Recommendations - tobramycin for mild disease

FEV1 70-89%

A

Recommend the chronic use of inhaled tobramycin to reduce exacerbations - >/=6yo

48
Q

CFF Guideline Recommendations - tobramycin for moderate to severe disease
FEV1 <69%

A

Strongly recommend the chronic use of inhaled tobramycin to improve lung function & reduce exacerbations - >/=6yo

49
Q

CFF Guideline Recommendations - Other antibiotics

A

Not recommended

50
Q

CFF Guideline Recommendations - Dornase Alfa for mild disease
FEV1 70-89%

A

Recommend chronic use to improve lung function & reduce exacerbations - >/=6yo

51
Q

CFF Guideline Recommendations - Dornase Alfa for moderate-severe disease
FEV1 <69%

A

Strongly recommend chronic use to improve lung function & reduce exacerbations - >/=6yo

52
Q

CFF Guideline Recommendations - hypertonic saline

A

Recommend chronic use to improve lung function & reduce exacerbations - >/=6yo

53
Q

CFF Guideline Recommendations - inhaled corticosteroids

A

Not recommended

54
Q

CFF Guideline Recommendations - oral corticosteroids

A

Not recommended in children

Insufficient evidence in adults

55
Q

CFF Guideline Recommendations - NSAIDS

A

> /=6yo with FEV1 >60% recommends chronic use of ibuprofen to slow the loss of lung function

56
Q

CFF Guideline Recommendations - azithromycin

A

Recommend chronic use to improve lung function & reduce exacerbations - >/=6yo

57
Q

CFF Guideline Recommendations - leukotriene modifiers

A

Insufficient evidence

58
Q

CFF Guideline Recommendations - B2-agonists

A

Recommend chronic use to improve lung function - >/=6yo

59
Q

CFF Guideline Recommendations - anticholinergic agents

A

Insufficient evidence

Respiratory (4 decks)

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