T1-Pulm/Tobacco/Vaping Flashcards
Review 9 links/pdfs/pages resources on Canvas
What model approach is used to help patients quit smoking?
Transtheoretical: Precontemplation
Contemplation
Preparation
Action
Maintenance
Review slide 16 for medication to assist smoking cigarettes.
Chantix/Zyban - 12 week therapy. Think ______ for anxiety
Think _____ for depression
Chantix
Zyban - this can aggravate anxiety symptoms.
STAR for quitting
5As
Set a quit date
Tell family and friends for support
Anticipate challenges + Remove tobacco products.
Ask, advise, assess, assist and arrange.
S/s of EVALI
E-cig or vape associated lung injury
SOB, cough, CP, N/V/D, abd px, fever, tachypnea, tachycardia, low O2 salts
A cough that persists beyond ____ is more indicitatve of acute bronchitis.
7 days.
Prior to that it is difficult to distinguish between simple URI and acute bronchitis
How can you assess level of asthma control?
Daytime symptoms > x2/week?
Night waking due to asthma?
Reliever med needed > 2x/week?
Activity limitations due to asthma?
Yes to 1-2 = partly controlled, yes to 3-4 = uncontrolled.
COPD group A, B, C and D
A = low risk, few symptoms ( GOLD 1-2, 0 or 1 exac/year and no hospitalization for exacerbation, CAT <10)
B = low risk, more symptoms (GOLD 1-2, 0 or 1 exac/year and no hospitalization for exacerbation, CAT >10)
C = high risk, low symptoms (GOLD 3-4, >2exac/year, >1 admission, CAT <10)
D = High risk, high symptoms (GOLD 3-4, >2exac/year, >1 admission, CAT >10)
Scores used to rule out/in PE
Wells, PERC
What is CURB-65
A tool to determine if a PNA patient warrants hospitalization:
Confusion of new onset
BUN >20
Resp rate >30bpm
BP <90Systolic or <60diastolic
Age 65 or older.
Patients that score 3-5 usually require hospitalization.
What is MATCH-65?
COVID admission decision tool
Myalgia/malaise (+1), Anosmia/ageusia (+2.5), Temp or fever (+0.5), Coryza/sore throat (-1), Hypoxia <97% on RA (+1), 65 or older (+1)
>2pts = high risk.
Treatment for acute bronchitis
Symptom control
Cough for acute bronchitis lasts for ______
1-3 weeks
When should a fever in acute bronchitis warrant evaluation?
If it occurs after the first couple days.
What should you NOT see in acute bronchitis?
High fever, hypoxia, crackles, egophony, increased tactile fremitus or decreased lung sounds.
If wheezing or Rhonchi is present, it should clear with a cough.
Acute Bronchitis Management:
Abx ______ helpful
Codeine _____ helpful
Ibuprofen/Tylenol ____ helpful
Antitussives (DM/Thessaloniki pearls) _____ helpful
Expectorants (guaifenesin) ——helpful
Beta2Agonist _____ helpful
Atrovent ____ helpful
Honey _____ helpful
NOT
NOT
NOT
Can be when used together
Helpful for those with chronic lung disease and chronic symptoms (MUST be hydrated)
Helpful for Those with wheezing on presentation and chronic lung disease
Helpful to reduce cough frequency and severity (caution prescribing in isolation because it is NOT a rescue inhaler).
Better than placebo! Reduce frequency and severity of cough
5 questions for asthma control asssessment
- Symptoms/week
- Use of rescue inhaler/week
- Night time awakenings/week
- Interference with activity
- Exacerbations requiring oral systemic corticosteroids (#/year)
Top 3 reasons for chronic cough
Chronic = >8weeks
Post nasal drip syndrome
Asthma
GERD
SARS-COVID
ACE inhibitor (<5-38%)
Check out chronic cough diagnostic decision tree in Buttaro.
Most common pneumonia pathogen
Streptococcus pneumonia.
1st line Abx for CAP w/out co morbidities
Macrolides (Azithromycin, clarithromycin) or doxy
If patient has comorbid factors or has received abx in the past 3 months, then consider what abx?
FQ WITH Macrolides.
If a patient has a low severity CURB-65 score, then treat for _____ days
If mod to high score then treat for ____ days.
5
7-10
USPSTF guidelines for lung cancer screening CT
Age 50-80 with =>20pack year history or quit within past 15 years. Annual LDCT offered
What is alpha1 antitrypsin and what does it have to do with pulmonary pathology?
A protective enzyme that protects lung tissues from the enzymes of inflammatory cells especially neutrophil elastase which breaks down the protein elastin responsible for lung elasticity.
Smoking also deactivates this enzyme and increases elastase activity
Cause of COPD in young non smokers.
Most common presenting complaint of COPD?
Dyspnea on Exertion (DOE).
Threshold for O2 therapy in COPDers: FEV1 < ——-
35%
COPD have _____ FEV1 and ______ residual volume
Decreased
Increased
GOLD classification measures _____ , CAT measures ______
And mMRC measures _____
Airflow restriction severity based on FEV1 (Gold 1 >=80%, 2 = >=50-80, 3 = <50, >=30, 4 =very severe = <30%
CAT = COPD Assessment Test
mMRC = modified British Medical Research council.
Slides 75-87 on Pulm Disorders PPT
ACT/ACQ used to assess level of asthma control
Look up “allergic shiners”
Get spirometry in all patients at ___ and older. For asthma, you should see an improvement of _____ or _____ after bronchodilator use.
5
12% or 200ml improvement in FEV1. OR FVC 80% or more of predicted LLN.
Slide 17-20 -review! Great asthma charts
How often should you obtain lung function with spirometry in patients with asthma?
When should their f/u appointment be if you stepped up with treatment.
Q1-2 years or more frequently if not controlled
2-6 uncontrolled, 1-6mo if controlled, every 3 mo if step-down is anticipated.
GINA suggests ICS while NIH does not yet. More evidence to suggest intermittent ICS is. Better for patient.
ICS/LABA/SABA _____ in pregnancy
Safe
Covid most commonly transmitted through _____
Droplet
Less commonly airborne (>6ft) even less commonly fomites (residual left in a room)
Progression of severe covid
Inhalation (binding to ACE2 alveoli cells)
Viral replication (in lungs with immune response)
Interstitial inflammation + edema = pneumonia
Cytokin storm (day 10) = multi organ involvement
- ARDS
-HF, STEMI, arrhythmias, cardiac tampon are
-Thromboembolsim
-kidney injury
-GI manifestations
-Neuro manifestations
Why are patients with comorbidities more susceptible to severe COVID PNA?
They already have a baseline ACE2 Downregulation and baseline activation of AT1R axis, baseline cytokine release and inflammation
Coupled with COVID cytokine storm = not good.
Derm findings with COVID
COVID toes, itchy patchy rash, hives, vesicular-like on feet.
T/F: antibody testing is recommended for acute COVID dx.
False. It takes about 14days from onset of symptoms. PCR(Type of NAAT) is recommended for acute testing.
Which is more sensitive: PCR or antigen test for COVID?
PCR is more sensitive. They are BOTH highly specific (true negatives)
1st line COVID tx
Paxlovid (ritonavir and nirmatrelvir)
Strong CYP 3A4 inhibitor - boosts HIV protease inhibitors.
very important to do what prior to treating COVID?
ENTIRE Med Rec. Paxlovid is CYP 3A4 inhibitor (may make other med concentration higher in their blood stream)
Cannot give Paxlovid in ____ and ____
eGFR <30 or severe hepatic impairment (class C)
What med class is NOT good to give for COVID?
Steroids in mild-moderate disease (non-o2 requiring patients)
Can increse duration of fever, increased duration to viral clearance and longer hospital stays
Can give steroids in very sick, hospitalized patients.
COVID Dos and Don’ts
Anticoagulants
FQ
Lopinavir/ritonaiver
Antibiotics
Paxlovid
Supportive care
Don’t
Dont
Dont
Dont
Do
Do
Give Paxlovid w/in ____ days of symptom onset
5
