Review session Flashcards
Tx options for acute asthma? (not doses)
1) Oxygen therapy (if <90% O2) or Heliox
2) Corticosteroids
-Prednisone, etc
3) B2-agonists (not for CVD or concomitant diuretics)
-Albuterol MDI or nebulizer, etc
4) Use face mask if under 6 for aerosolized meds
5) Ipratropium (anticholinergic)
How do you dose albuterol for acute exacerbations of asthma?
4-8 puffs every 30 mins up to 4hr (then every 1-4hr PRN)
What are the 5 vaccines recommended to ppl with COPD?
1) Influenza
2) TDap
3) RSV
4) COVID-19
5) Pneumonia
Older pts on high doses of ICSs should have what 3 things done routinely? Why?
1) Height measurements
2) Bone mineral density determinations
3) Ophthalmic examinations
-osteoporosis and cataracts risks
ICS use may contribute to what skin Sxs?
Skin bruising + thinning
A patient taking Montelukast should be monitored for:
A) Weight gain
B) Neuropsychiatric effects
C) QT prolongation
D) Hyperglycemia
B) Neuropsychiatric effects
1) List 3 local effects of corticosteroids
2) List 2 long-term systemic effects of corticosteroids
1) Cough, dysphonia, oropharyngeal candidiasis
2) Adrenal axis suppression; immunosuppression
What are some side effects of leukotriene modifiers?
1) HA, GI upset, psychiatric effects
2) INCREDIBLY Rare: idiosyncratic syndrome similar to the Churg–Strauss syndrome, HF, vasculitis
Osteoporosis, cataracts, and skin bruising can all be side effects of what?
ICSs
True or false: Tiotropium has anticholinergic side effects
True
Azithromycin can cause HL with what group?
COPD
Recommend a Tx for a pt with 2 cardinal Sx of an uncomplicated acute COPD exacerbation (so moderate/ type 2)
1) Prednisone 40 mg Qday x 5 – 7 days
+
2) Doxycycline (or Azithro. or cefdinir)
Recommend a Tx for a pt with 2 cardinal Sx of a complicated acute COPD exacerbation (so moderate/ type 2)
(complicated = > 4 exacerbations in year or ≥ 65 years old + comorbidities)
1) Prednisone 40 mg Qday x 5 – 7 days
+
2) Augmentin or Levaquin
Recommend a Tx for a pt with 2 cardinal Sx of a complicated acute COPD exacerbation (so moderate/ type 2) and has extra risk factors (> 14 days of OCS, hospitalization or IV abx in past 90 days, live in long-term care)
1) Prednisone 40 mg Qday x 5 – 7 days
2) PO: Levaquin
IV: Piperacillin / tazobatam or cefepime
Recommend a Tx for a pt with a mild (type 1, 1 cardinal Sx) COPD exacerbation
Bronchodilators
Estrogen replacement during menopause may exacerbate asthma; explain
1) Outcome absent when estrogen is given in combination with progesterone
2) Mechanism not understood; estrogen decreases may exacerbate asthma during PMS
Why can aspirin exacerbate asthma?
1) Cyclooxygenase-1 (COX-1) inhibition
2) Inhaled corticosteroids (ICSs) are the primary preventive treatment
What drugs do not precipitate bronchospasm in asthma, but prevent its reversal?
Nonselective β-blocking agents (e.g., propranolol)
What asthma drug has a narrow therapeutic index?
Theophylline
List some Theophylline interactions
“Fluoroquinolones may be a problem in particular”
1) Decrease clearance of theophylline: Cimetidine, clarithromycin, erythromycin, ciprofloxacin, levofloxacin
2) Increase clearance of theophylline: Smoking, phenytoin, phenobarbital, rifampin
What are the strongest inducers?
*(this is on EVERY EXAM)
Phenytoin
Smoking
Phenobarbital
Oxcarbazepine
Rifampin (and rifabutin / rifapentine)
Carbamazepine
St. John’s Wort
PS PORCS
What are the strongest inhibitors?
*(this is on EVERY EXAM)
Grapefruit
PIs (protease inhibitors)
Azoles
C–cyclosporin & cimetidine
Macrolides (not azithromycin)
Amiodarone (and dronedarone)
Non-DHP CCBs (diltiazem and verapamil)
G PACMAN
