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Nurp 423 Exam 1 > Week 2 > Flashcards

Week 2 Flashcards

1
Q

Characterized by infection of the tracheobronchial tree that results in hyperemic and edematous mucous membranes, yielding an increase in bronchial secretions .

A

Acute bronchitis

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2
Q

Most common virus causing acute bronchitis:

A

Rhinovirus

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3
Q

Hallmark of acute bronchitis:

A

Dry/nonproductive cough

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4
Q

General treatment for acute bronchitis:

A

Symptomatic and supportive care, antitussives, bronchodilators

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5
Q

Productive cough and sputum production for 3 months per year for at least 2 consecutive years

A

Chronic bronchitis

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6
Q

3 cardinal symptoms of COPD exacerbations:

A
  1. Increase in dyspnea
  2. Increase in sputum production
  3. Increase or presence of sputum purulence
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7
Q

An infection in the lungs that leads to consolidation of the usually air-filled alveoli.

A

CAP

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8
Q

Most common pathogen of CAP:

A

S. Pneumoniae

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9
Q

Diagnostic criteria for CAP:

A

Patients present with cough, fever, dyspnea, malaise, pleuritic chest pain, CXR

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10
Q

Antibiotic treatment for patients with CAP without recent antibiotic use or existing Comorbidity:

A

Macrolides- azithromycin or clarithro

Or doxy

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11
Q

Antibiotics in treatment of CAP in patients of comorbidity:

A

High-dose amoxicillin, augmentin, or 2nd/3rd generation cephalosporin plus a macrolide, or a fluoroquinolone alone.

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12
Q

With CAP what antibiotic can be used in patients allergic to azithromycin?

A

Doxycycline

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13
Q

What antibiotic should not be used in CAP treatment:

A

Cipro

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14
Q

In children, antibiotics are typically not required; however, if needed what do you use?

A

Amoxicillin

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15
Q

Characterized by airway narrowing and Airway hyper-responsiveness.

A

Asthma

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16
Q

Airflow obstruction is present when the FEV1/FVC ratio is less than:

A

0.70

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17
Q

All patients with asthma, regardless of severity, require:

A

Short-acting beta2-adrenergic agonist (SABA) bronchodilator for quick relief of acute symptoms

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18
Q

When can treatment be stepped down with asthma?

A

When symptoms have been well controlled for 3 months

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19
Q

How to step down asthma treatment:

A
  1. Oral corticosteroids are reduced and d/c’d first
  2. Dose of inhaled corticosteroids May then be reduced by 50%
  3. Long-term control regimen may be stopped if the person with asthma has been free of symptoms for 6-12 months and has no risk of exacerbations
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20
Q

MOA of beta2-adrenergic agonist:

A

Stimulate the beta2-adrenergic receptors, increasing production of the cAMP. Increased cAMP relaxes the airway smooth muscle and increases bronchial ciliary activity.

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21
Q

All beta2-adrenergic agonists have:

A

Slight CV stimulatory effects including increased HR, cardiac contractility, and increased cardiac conductivity

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22
Q

Examples of SABAS:

A

Albuterol and levalbuterol

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23
Q

Example of long-term beta2-adrenergic agonist:

A

Salmeterol- used in chronic maintenance

Formoterol- quicker onset of action

Both have duration of action of 12 hours.
Both are beta2 selective.

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24
Q

Contraindications with beta2-adrenergic agonist:

A

Use in caution in patients with CV disease, arrhythmia, DM, glaucoma, hyperthyroidism, or seizure disorder

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25
Q

Adverse events with both SABAS and LABAs:

A

Tachycardia, skeletal muscle tremor, nervousness, dizziness, hypokalemia, and hyperglycemia.

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26
Q

What antibiotic given for H. Flu bronchitis?

A

Amoxicillin

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27
Q

What antibiotic given for m. Catarrhalis bronchitis?

A

Augmentin

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28
Q

What antibiotic given for m. Pneumoniae bronchitis?

A

Macrolides or doxy

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29
Q

How long to treat with antibiotics for CAP?

A

At least 5 days and must be afebrile 48-72 hours prior to stopping.

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30
Q

When to order an CXR?

A 
Any pt with at least one of the following:
1. Temp greater than 100
2. Heart rate over 100
3. RR over 20
Any patient with at least 2 of the following:
1. Decreased BS
2. Crackles 
3. Absence of asthma
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31
Q

Hospital admission criteria: CURB-65

A 
C: confusion- perform mini mental
U: uremia- BUN greater than 20
R: RR greater than 30
B: low BP- systolic less than 90; diastolic less than 60
65: 65 years of age and older

Typically need 2 of these for admission

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32
Q

Asthma classification with exacerbations 2 times a week or less:

A

Intermittent

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33
Q

Asthma classification with more than 2 exacerbations a week but not daily:

A

Mild persistent

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34
Q

Asthma classification with daily symptoms and daily use of SABA:

A

Moderate persistent

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35
Q

Asthma classification with symptoms throughout the day and use of SABA several times daily:

A

Severe persistent

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36
Q

Bronchodilators in asthma are:

A

Relievers

37
Q

Anti-inflammatory agents in asthma are:

A

Controllers

38
Q

Drug/drug interactions with beta2-adrenergic agonist:

A

MAOIs or tricyclic antidepressants increase BP and risk of stroke. Must be discontinued at least 14 days prior to initiating a beta2-adrenergic agonist.

39
Q

The most potent airway smooth muscle relaxant that is not beta2 selective:

A

Epinephrine

40
Q

LABAs in asthma must always be used with:

A

ICS

41
Q

What is safest SABA in kids under 4 and infants?

A

Albuterol

42
Q

Most potent ICS:

A

Flovent

43
Q

ICS with beta2-agonist have what type of effect:

A

Synergistic

44
Q

ICS are indicated for all persons with persistent asthma t/f?

A

True
Low dose- mild persistent
Med dose- moderate persistent
High dose- severe persistent

45
Q

Timing of inhalers:

A

Administer beta agonist first: opens the airway

46
Q

MOA of inhaled steroids in asthma:

A

Anti-inflammatory action- binds to glucocorticoid receptors in the airway
Also inhibits mucus secretions in airways

47
Q

A chemical mediator that can cause inflammatory changes in the lungs.

A

Leukotriene

48
Q

MOA of leukotriene receptor antagonists:

A

Reduce inflammatory symptoms of asthma triggered by allergic and environmental stimuli.

49
Q

Are leukotriene modifiers used for acute attacks?

A

No

50
Q

Examples of leukotriene modifiers:

A

Singulair (montelukast)
Accolate (zafirlukast)
Zileuton (zyflo)

51
Q

Adverse events of leukotriene modifiers:

A

HA*, churg-Strauss syndrome, systemic vasculitis, and behavioral changes

52
Q

Montelukast is approved for ages:
Zafirlukast is approved for ages:
Zileuton is approved for ages:

A

Greater than 1 year of age
Greater than 5
Greater than 12

53
Q

MOA of mast cell stabilizers:

A

Prevent release of inflammatory and bronchoconstricting substances from mast cells.

54
Q

Examples of a mast cell stabilizer:

A

Cromolyn (intal) inhalation, prophylactic, take daily, good for kids

55
Q

Methylxanthines MOA:

A

Relax smooth bronchial muscle, enhance diaphragmatic contractility, and have alight anti-inflammatory effect.

56
Q

Examples of methylxanthines:

A

Theophylline and aminophylline

57
Q

Methylxanthines are contraindicated in:

A

Use in caution In patients with Tachyarrhythmias, PUD, seizure disorders, and hyperthyroidism.

58
Q

Adverse events of methylxanthines:

A

Tachyarrhythmias, HA, restlessness, insomnia, tremor, N/V*, gastroesophageal reflux, and peptic ulcer aggravation.

59
Q

Monitor serum levels in methylxanthines due to:

A

Narrow therapeutic window

60
Q

Immunomodulators:

A

Omalizumab (Xolair)

61
Q

Xolair MOA:

A

Decreases binding of IgE on surface of the mast cells which decreases allergic response

62
Q

Xolair indications:

A

Patients with severe allergies and severe persistent asthma

63
Q

Xolair is given:

A

SubQ every 2-4 weeks

64
Q

Adverse events of Xolair?

A

High risk of anaphylaxis

65
Q

What to do for exercise induced bronchospasm?

A

SABA 15 minutes prior to exercise

A mast cell stabilizer of short acting anticholinergic can be given when SABA is ineffective

66
Q

Mild-intermittent asthma managed with:

A

SABA

67
Q

Mild persistent asthma (step 2) managed with:

A

Low dose ICS

Alternative: cromolyn, montelukast

68
Q

Moderate persistent (step 3-4) asthma managed with

A

Low to medium dose ICS plus LABA or medium dose ICS

69
Q

Severe persistent (5-6) asthma managed with:

A

High dose ICS plus LABA

70
Q

Xolair May be added for what type of asthma?

A

Confirmed allergic asthma

71
Q

Systemic corticosteroids are used In asthma for:

A

Treatment of acute asthma exacerbation

72
Q

Systemic corticosteroids used in exacerbation administration info:

A

40-60 mg daily x 5 days
Administer at 3 pm
Can cause insomnia

73
Q

SABA can be given how frequently during an exacerbation:

A

2-6 puffs every 20 minutes

74
Q

Diagnostic criteria for COPD:

A

A post-bronchodilator FEV1/FVC less than 70% signifies a fixed airway obstruction

75
Q

A post-bronchodilator FEV1/FVC with asthma will:

A

Increase by greater than 12% or 200 ml

76
Q

Group A treatment in COPD:

A

Bronchodilators

77
Q

Group B treatment in COPD:

A

Initial- LAMA or LABA

If continued breathlessness- 2 bronchodilators (LABA and LAMA)

78
Q

Group C therapy in COPD:

A

Initial- LAMA

Persistent exacerbations- add LABA or LABA and ICS

79
Q

Group D treatment in COPD:

A

Initial- LABA/LAMA combo or LAMA and LABA/ICS

80
Q

Phosphodiesterase 4 inhibitors MOA:

A

inhibits phosphodiesterase 4, this inhibition increases cellular cAMP, modifying the inflammatory response.

Causes bronchodilation with anti-inflammatory effects

81
Q

Phosphodiesterase 4 inhibitors include:

A

Daxas (dalisrep)

82
Q

Adverse events with phosphodiesterase 4 inhibitors:

A

Increase risk of suicide and weight loss

83
Q

COPD exacerbation cardinal signs:

A

Increase in dyspnea
Increase in sputum volume
Increase in sputum purulence**

84
Q

Treatment if COPD exacerbation:

A

Increasing dose/frequency of SABA or SAMA
5 day course of oral steroids: 40mg
Antibiotics 5-10 days

85
Q

Antibiotics for COPD exacerbation:

A

1st line- macrolides
Augmentin
Doxycycline

86
Q

Do not take oral steroids with:

A

Antacids due to decreases absorption

87
Q

What beta2 agonist is ok in pregnancy?

A

Terbutaline

88
Q

Salmeterol should never:

A

Be used in children under 4 or as monotherapy

89
Q

Beta agonists can increase the QT prolongation when given with what drugs?

A

Loop/thiazide diuretics, other sympathomimetics

Nurp 423 Exam 1 (3 decks)

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