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Pharmacology > Unit 5 Textbook: Pulmonary > Flashcards

Unit 5 Textbook: Pulmonary Flashcards

1
Q

Examples of upper respiratory infections

A

Common cold and rhiosinusitis

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2
Q

Most common pathogen for common cold

A

Human rhinovirus

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3
Q

First line treatment for common cold

A

Nonpharmalogical–rest, increased water, saline gargles, menthol rubs on chest, vaseline

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4
Q

Nasal spray Decongestants

A

Oxymetazoline hydrochloride and phenylephrine hydrochloride
Work within minutes
Sympathomimetic agents that stimulate alpha and beta receptors causing vasoconstriction in respiratory mucosa to improve ventilation

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5
Q

Oral decongestants

A

Pseudoephedrine + phenylephrine
Work within 30 minutes
Sympathomimetic agents that stimulate alpha and beta receptors causing vasoconstriction in respiratory mucosa to improve ventilation

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6
Q

Decongestants contraindicated in

A

Glaucoma, uncontrolled htn, CAD, MAO inhibitor use within 14 days

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7
Q

Expectorants

A

Gualfenesin
Should not be used >1 week
Usually same effectiveness as water
Decreases adhesiveness and surface tension of respiratory tract and facilitates removal of viscous mucus

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8
Q

Antitussives

A

Dextromethorphan + Benzonatate
Typically ineffective in common cold
Direct inhibition of cough center in medulla

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9
Q

Anti inflammatory drugs for common cold

A

COX inhibitors inhibit prostaglandin secretions which can decrease headache, malaise, myalgias, cough, sneezing
Naproxen is DOC
Tylenol and NSAIDs may increase viral shedding

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10
Q

Anticholinergics for common cold

A

Ipratropium bromide as nasal spray to alleviate nasal congestion

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11
Q

Antihistamines for common cold

A

Not recommended as mono therapy
Diphenhydramine + Chlorpheniramine
Nonsedating antihistamines are not effective

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12
Q

Antihistamines are CI in

A

Breastfeeding and neonates and enlarged prostate

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13
Q

Rhinosinusitis

A

Inflammation of mucous membranes that line sinuses and nasal cavity causing nasal blockage, discharge, facial pain and pressure

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14
Q

Acute rhinosinusitis

A

<4 weeks
Usually infectious
d/t rhinovirus, influenza, parainfluenza
Hallmark symptoms: nasal congestion, nasal discharge, facial pain, headache, anosmia

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15
Q

Chronic rhinosinusitis

A

> 12 weeks

More inflammatory mediated

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16
Q

Symptomatic relief for acute rhinosinusitis

A

Analgesics, topical intranasal steroids, nasal saline

Only recommended to get cultures if supportive measures are not working

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17
Q

Antibiotics recommended for acute bacterial rhinosinusitis

A

Amoxicillin, Doxycycline, Levofloxacin, Moxiflocacin, Clindamycin
Amoxicillin-clavulonate: first line

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18
Q

Asthma

A

Characterized by airway narrowing and airway hyperresponsiveness due to interactions between activated EMTU and inflammatory mediators which activate cholinergic nerves causing bronchoconstriction and mucous secretion

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19
Q

Diagnostic criteria for asthma

A

Wheeze, SOB, cough, chest tightness, presence of variable airflow limitation

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20
Q

Testing for asthma

A

Methacholine and histamine

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21
Q

All people with asthma should receive

A

B2 agonist bronchodilator

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22
Q

How often should patient with asthma be re-assessed

A

every 3-12 months

Treatment can be lowered if symptoms are well controlled for 3 months

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23
Q

Stepwise approach for asthma in children over 12 years

A
  1. Short acting beta 2 agonist PRN
  2. Low dose Inhaled corticosteroid
  3. Low dose inhaled corticosteroid + long acting beta agonist OR medium dose ICS
  4. Medium dose inhaled corticosteroid + long acting beta agonist
  5. High dose inhaled corticosteroid + long acting beta agonist
  6. High dose inhaled corticosteroid + long acting beta agonist + oral corticosteroid
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24
Q

Short acting beta 2 agonist

A

albuterol

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25
Q

Long acting beta 2 agonist

A

Arformoterol, formoterol, salmeterol

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26
Q

Corticosteroids for asthma

A

Decrease airway inflammation by inhibiting or inducing production of end effector proteins
Short course of oral steroids recommended for acute asthma exacerbation

27
Q

Examples of inhaled corticosteroids

A

Beclomethasone, budesonide, ciclesonide, fluticasone, mometasone

28
Q

Zileuton

A

Leukotriene modifier drug

Inhibits 5-LOX preventing conversion of arachidonic acid to bronchoconstrictor and proinflammatory leukotrienes

29
Q

Montelukast and zafirlukast

A

Leukotriene modifier drug

Bind to cysteinyl leukotriene receptors

30
Q

Leukotriene modifier drugs are indicated for

A

Alternative medications for long term control of mild persistent asthma and long term control of moderate persistent asthma when combined with ICS

31
Q

Mast cell stabilizers

A

Cromolyn

Prevent release and synthesis of proinflamamtory mediators by inhibiting influx of calcium into activated mast cells

32
Q

Methylxanthines

A

Theophylline + Aminophylline

Relax bronchial smooth muscle, enhance diaphragmatic contractility and have slight anti inflammatory effects

33
Q

Amalizumab

A

Anti-IgG antibody that prevents IgE from binding to IgE receptors on mast cells
High risk of anaphylaxis

34
Q

COPD

A

chronic progressive airflow limitation
Usually due to smoking–results in lung inflammation, airflow obstruction, hyperinflation, mucous hypersecretion, ciliary dysfunction, gas exchange abnormalities

35
Q

Symptoms of COPD

A

Chronic cough with or without chronic sputum production and persistent progressive dyspnea

36
Q

nondrug therapy for COPD

A

Tobacco cessation, avoidance of irritants, energy conservation

37
Q

Drugs used to treat COPD

A

B2 agonists, anticholinergics, corticosteroids, methylxanthines, phosphodiesterase 4 inhibitors

38
Q

Anticholinergics for COPD

A

Ipratropium bromide–short acting

Tiatropium bromide–long acting

39
Q

Oral corticosteroids used for COPD

A

prednisone

Indicated for acute COPD exacerbation

40
Q

Phosphodiesterase 4 inhibitors for COPD

A

Roflumilast

Increases cAMP which relaxes bronchial smooth muscle

41
Q

When are antibiotics indicated for COPD

A

5-10 day course of antibiotics if all 3 cardinal symptoms are present: increased dyspnea, increased sputum production, purulent sputum
Most common pathogens: H. influenzae, strep pneumoniae, moraxella catarrhalis

42
Q

Group A COPD dx

A

mMRC 0-1
CAT <10
Give a SABA or SAMA for acute
No long term tx

43
Q

Group B COPD

A

mMRC >2
CAT > 10
SABA or SAMA for acute
LABA or LAMA for long term maintenance

44
Q

Group C + D COPD

A

mMRC 0-1
CAT <10
SABA or SAMA for acute
ICS + LAMA or ICS + LABA

45
Q

Acute bronchitis

A

Reversible inflammatory condition of the tracheobronchial tree; usually self limiting

46
Q

Usual causes of acute bronchitis

A

Rhinovirus, coronavirus, influenza, parainfluenza, adenovirus, RSV
Very few bacterial causes: Bodetella pertusis, chlamydophila pneumoniae, mycoplasma pneumoniae

47
Q

Diagnostic criteria for acute bronchitis

A

Cough that is initially dry and nonproductive but as secretions increase, cough becomes more mucoid, usually lasting 7-10 days
Coarse, moist bilateral crackles, ronchi, wheezing

48
Q

First line drug therapy for acute bronchitis

A

Supportive: fluids, best rest, mild analgesic and antipyretics (acetaminophen best), dextromethorphan

49
Q

When are antibiotics indicated for acute bronchitis

A

If patient has COPD, high fevers, purulent sputum, respiratory symptoms >4-6 days, >65 years old, chronic diseases present

50
Q

Which antibiotic for H. Influenzae

A

Amoxicillin

51
Q

Which antibiotic for Moraxella Catarrhalis

A

Amoxicillin + Clavulanate (Augmentin)

52
Q

Which antibiotic for M. Pneumoniae or C. Pneumoniae

A

Macrolide or doxycycline

53
Q

Which antibiotic for B. Pertussis

A

Macrolide

54
Q

Which drug for Influenza

A

Oseltamivir or Zanamivir

55
Q

Chronic bronchitis

A

Productive cough and sputum production for 3 months of the year for at least 2 years
Predominant factor is cigarette smoke

56
Q

Uncomplicated chronic bronchitis

A

Little to no lung impairment
Usually due to H. Influenzae, S. Pneumoniae, M. Catarrhalis
First line: Amoxicillin, doxycycline, macrolide or sulfamethoxazole/trimethoprim (Bactrim)

57
Q

Complicated chronic bronchitis

A

FEV1 <50%, lung impairment, elderly, comorbid illnesses, frequent exacerbations
Usually due to H. Influenzae, S. Pneumoniae, M. Catarrhalis
First line: amoxicillin-clavulanate, 2nd or 3rd gen cephalosporins, doxycycline

58
Q

Severe complicated chronic bronchitis

A

FEV1 < 35%, severe airflow obstruction and constant purulent sputum production
Usually due to H. Influenzae, S. Pneumoniae, M. Catarrhalis OR enterobacteriacea or Pseudomonas
First line: levofloxacin or ciprofloxacin (due to G- pathogens)

59
Q

Community acquired pneumonia

A

Infection of the lungs that leads to consolidation of the usually air filled alveoli

60
Q

Most common pathogen of community acquired pneumonia

A

S. pneumoniae

61
Q

Most common virus that causes community acquired pneumonia

A

Influenza

62
Q

Meds for pneumonia with no recent antibiotic use or other issues

A

Macrolide or doxycycline

63
Q

Meds for pneumonia with recent antibiotic use, presence of comorbiditis

A

Amoxicillin, augmentin, or fluoroquinolone

64
Q

Meds for pneumonia in children

A

Amoxicillin

Pharmacology (56 decks)

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