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Pharmacology > Week 5 Respiratory > Flashcards

Week 5 Respiratory Flashcards

1
Q

What organism is the main cause of pharyngitis?

A

Group A Strep (GAS)

streptococcus pyogenes

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2
Q

What might GAS cause? (2)

A

post streptococcal glomerulonephritis

acute rheumatic fever (now rare in US)

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3
Q

What is the presentations of GAS pharyngitis throat pain?

A

usually severe

often worse on 1 side

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4
Q

What is the initial treatment of GAS pharyngitis?

A

amoxicillin 20mg/kg/dose (max 500 mg/dose) given BID

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5
Q

How many days should amoxicillin be given for GAS pharyngitis?

A

10 days

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6
Q

Why should azithromycin be avoided in GAS pharyngitis?

A

strep rapidly develops resistance to macrolides

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7
Q

When should azithromycin be considered for GAS pharyngitis?

A

if PCN allergy

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8
Q

What is the newly recognized cause of pharyngitis?

A

fusobacterium necrophorum pharyngitis

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9
Q

What organism is endemic in adolescents and young adults and may cause up to 10% of pharyngitis in this age group?

A

fusobacterium necrophorum pharyngitis

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10
Q

What is a life threatening complication of fusobacterium necrophorum pharyngitis?

A

Lemierre Syndrome

mortality 5%

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11
Q

What is significant about the presentation of F. necrophorum pharyngitis?

A

lac of cough

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12
Q

What do you use for the treatment of F. necrophorum pharyngitis?

A

clindamycin or

PCN + metronidazole

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13
Q

What cough should you not suppress?

A

a productive cough

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14
Q

When should you typically suppress a cough?

A

if cough is tiring or sleep-limiting

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15
Q

When should you use antitussives for cough?

A

non-productive

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16
Q

What should be given for productive coughs?

A

expectorants

mucolytics

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17
Q

How should benzonatates (tessalon) be taken?

A

should be Swallowed without chewing

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18
Q

What is non-opioid antitussive that is the d-isomer of the codeine analog of levorphanol but lacks the analgesic and addictive properties?

A

dextromethorphan (Robutussin)

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19
Q

What is the MOA of dextromethorphan (Robutussin)?

A

inhibits the central (medullary) cough center

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20
Q

What type of medication is Guaifenesin (glyceryl guaicolate)?

A

cough-expectorant

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21
Q

What is the MOA of Guaifenesin (glyceryl guaicolate)?

A

increases respiratory tract secretions
helps loosen phlegm and bronchial secretions
reduces secretion viscosity
increases efficiency of mucociliary mechanism

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22
Q

What medication is a sulfhydryl group that opens disulfide bonds in mucoproteins thereby reducing viscosity?

A

N-Acetylcysteine (NAC, Acetadote, mucomyst)

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23
Q

What is an example of a cough-mucolytic?

A

N-Acetylcysteine (NAC, Acetadote, mucomyst)

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24
Q

How is N-Acetylcysteine (NAC, Acetadote, mucomyst) administered?

A

administer via aerosolization or nebulization

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25
Q

What organism causes pertussis (whooping cough)?

A

Bordatella pertussis

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26
Q

What do they call Pertussis in China?

A

cough of 100 days

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27
Q

What are the atypical presentations that are very common in Pertussis?

A

completely or partially immunized patients

adolescents or adults

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28
Q

What population usually experiences complications of pertussis?

A

infants less than 6 months old

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29
Q

What is the classic presentation of cough that occurs frequently?

A

paroxysmal cough

post-jussive emesis occurs frequently

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30
Q

What has caused the increase in pertussis incidence?

A 
waning immunity (maybe as short as 3-6 years?
worse with newer "acellular" vaccines (vs. older "whole cell")
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31
Q

Why is the whole cell pertussis vaccine no longer used?

A

many severe complications

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32
Q

When should you consider pertussis?

A

in ALL children with cough longer or equal to 14 days

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33
Q

What is the treatment for pertussis?

A

erythromycin

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34
Q

How long should erythromycin be given for pertussis to prevent relapse?

A

14 days

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35
Q

What are the alternative agents for pertussis?

A

clarithromycin
azithromycin
trimethoprim/sulfamethoxazole (bactrim)

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36
Q

What is the MOA of decongestants?

A

sympathomimetics (alpha agonists)

produce vasoconstriction

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37
Q

What can happen with prolonged use of decongestants? (>3-5 days)

A

may produce rebound congestion

therefore limit dose and frequency

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38
Q

What is a topical long acting decongestant? (up to 12 hours)

A 
Oxymetazoline HCl (Dristan)
Xylometazoline (Otrivin)
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39
Q

What is significant about systemic decongestants?

A

much lower incidence of rebound decongestion

results typically last longer than topicals

40
Q

What decongestant has restrictions by law behind the counter?

A

pseudoephedrine

41
Q

Why does pseudoephedrine have law restrictions?

A

used in the illegal making of methamphetamine

42
Q

What is MOA on alpha 1 and beta receptors of systemic decongestents?

A

potent selective alpha 1 agonist = vasoconstriction

activate beta receptors at HIGHER concentrations

43
Q

What are the phenylephrine CVS side effects? (Vicks)

A

htn
arrhythmia (rare)
stroke (rare)

44
Q

What are the phenylephrine CNS side effects? (Vicks)

A

headache
anxiety
tremor
restlessness

45
Q

What are the pseudoephedrine (sudafed, dimetap) CVS side effects?

A

htn
palpitations
tachycardia
stroke (rare)

46
Q

What are the pseudoephedrine (sudafed, dimetap) CNS side effects?

A

headache
insomnia
nervousness
excitability

47
Q

What should be avoided in htn?

A

BOTH phenylephrine and pseudoephedrine

48
Q

What are examples of systemic decongestants?

A

phenylephrine(Vicks Sinex) and pseudoephedrine (Sudafed, Contac, Dimetap)

49
Q

What medications are used for immediate-type hypersensitivity reactions?

A

antihistamines

50
Q

All antihistamines have varying degrees of what, which provides varying degrees of usefulness?

A

anticholinergic and antimuscarinic activity

51
Q

What is the MOA of antihistamines?

A

reversible, competitive H1- receptor antagonists

reduce or prevent physiologic effects of histamine release

52
Q

Antihistamines have no effect on what?

A

pre-released histamine

53
Q

What antihistamines bind toperipherpl & CNS receptors producing sedation?

A

first-generation agents

54
Q

What is significant about second-generation antihistamine agents?

A

are peripherally selective-therefore much less sedating

55
Q

What are examples of 1st generation antihistamine agents?

A

ethanolamines (Diphenhydramine-Benadryl)
Phenothiazines (Promethazine-Phenergan)
Piperazines (Hydroxyzine-Vistaril)

56
Q

What are examples of 2nd generation antihistamines?

A

Phthalazinone (azelastine-Astelin)
Piperazine (Cetirxine-zyrtec)
Piperidines (lartadine-claritin, desloratadine-Clarinex, fexofenadine-allegra)

57
Q

What medication is an active metabolite of hydroxyzine?

A

Piperazine-cetirizine (Zyrtec)

58
Q

What medication is an active metabolite of loratadine?

A

desloratadine (clarinex)

59
Q

What medication is contraindicated in those hypersensitive to loratadine (Claritin)?

A

desloratadine (clarinex)

60
Q

What medication is contraindicated in those hypersensitive to hydroxyzine (Vistaril)?

A

Citrizine (Zyrtec)

61
Q

What is important to remember about all antihistamines with varying degrees of sedation? (4)

A

usually less with 2nd generation
caution against driving or tasks require alertness
supervise children in hazardous activities
avoid co-administration of other CNS depressants (drugs or alcohol)

62
Q

What are the potential adverse effects of promethazine (Phenergan)?

A

may cause potentially fatal respiratory depression (not reversed by naloxone)
may lower seizure threshold
contraindicated in children less than 2 years
May prolong QT-interval
IV/SQ administration may cause tissue necrosis

63
Q

What is the key for influenza?

A

Prevention! promote and practice annual immunization

64
Q

What medication is chemoprophylaxis against s/s of influenza A OR treatment of uncomplicated RTI Influenza A?

A

Amantadine (Symmetrel)

65
Q

What medication is chemoprophylaxis against s/s of Influenza A and B OR treatment of uncomplicated RTI influenza A/B?

A

Oseltamivir (Tamiflu)

66
Q

What may decrease effective of Oseltamivir (Tamiflu)?

A

emergence of resistance

67
Q

When should treatment be started with oseltamivir (tamiflu)?

A

begin within 2 days of onset of the flu symptoms

68
Q

What medication is prophylaxis of the flu in patients older than 5 years of age for influenza A&B?

A

Zanamivir (Relenza)

69
Q

What mediation is treatment of the flu A&B in patients older than 7 years of age?

A

Zanamivir (Relenza)

70
Q

What mediation is prophylaxis and treatment of influenza A in adults AND prophylaxis against influenza A in children?

A

Rimantadine (Flumadine)

71
Q

When should rimantadine (Flumadine) be given?

A

begin as soon as possible after symptoms appear, preferably within 48 hours of onset and continue for 7 days

72
Q

What is the dose of rimantadine if renal function is <10 in elderly or nursing home patients

A

reduce to 100-mg daily

73
Q

What are the common organisms of community-acquired pneumonia?

A

streptococcus pneumonia

haemophilus influenzae

74
Q

What treatment should be given if gram positive cocci in clusters on gram stain?

A

possible staph aureus

add vancomycin

75
Q

What should be considered if positive cocci pairs or chains on gram stain?

A

possible strep pneumo

76
Q

What should be considered if gram negative?

A

pseudomonas sp.

consider adding anti-pseudomonal agent (Pip/Tazo, cefepime, imipenem)

77
Q

What is a good specimen on gram stain findings?

A

FEW epithelial cells

many epithelial cells-mouth specimen

78
Q

What are 2 other gram stain findings that may make pneumonia more likely?

A

Many WBCs

Many organisms with single morphology

79
Q

What is significant about community acquired pneumonia organisms?

A

generally NOT multi-drug resistant

80
Q

What are the factors that determine if pt is assigned to risk class I or MORE (II-V)

A

older than 50 years
h/o co-existing condition (neoplastic disease, liver disease, CHF, cerebrovascular disease, renal disease)
Any abnormalities such as AMS, resp >30, systolic BP <90, Temp <35 or >40 and pulse greater than 125

81
Q

What algorithm is used to determine severity of pneumonia?

A

Pneumonia severity index (PSI)

82
Q

How is age calculation in PSI algorithm?

A

men >50

women >50 - 10

83
Q

What characteristics add 10 pts to severity scale?

A 
nursing home resident
CHF
cerebrovascular disease
renal disease
pulse >125
glucose >250
Hematocrit <30%
oxygen saturation less than 90%
84
Q

What characteristics add 30 points to pneumonia severity scale?

A

neoplastic disease

arterial pH <7.35

85
Q

What characteristics add 20 points to the pneumonia severity scale?

A 
liver disease
AMS
Respirations >30
Systolic BP <90
BUN >30
Sodium <130
86
Q

Which risk class are considered “low”?

A

I-III

87
Q

What risk class is considered moderate?

A

IV

88
Q

What risk class is considered high?

A

V

89
Q

Based on algorithm what is the mortality of risk class V

A

27%

90
Q

Based on the algorithm what is the mortality of class IV?

A

9.3%

91
Q

Based on algorithm what is the risk of mortality of Class I?

A

0.1%

92
Q

According to the CAP treatment algorithm what are absolute contraindications to outpatient treatment?

A

hypoxemia
hemodynamically unstable
active coexisting condition during hospitalization
inability to tolerate oral medications

93
Q

What is the empiric abx treatment for inpatient typical pneumonia?

A

3rd generation cephalosporin (rocephin?) + macrolide (azithromycin?) OR doxycycline

94
Q

What is the empiric abx treatment for inpatient ATYPICAL pneumonia?

A

beta lactam-beta lactase inhibitor + macrolide/doxycycline

95
Q

What is new pneumonia after 3-5 days as inpatient?

A

hospital acquired pneumonia (HAP)

96
Q

What is significant about HAP and what should be done?

A

greater likelihood of multi-drug resistance. may need to consider adding vancomycin

97
Q

What provides broader MDR coverage for HAP?

A

high dose Pip/Tazo (Zosyn)
Cefepime (Maxipime)
Imipenum/cilastin (Primaxin)

Pharmacology (17 decks)

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