Pleural Effusions: Causes and Medications
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Questions and Answers

What are the causes of pleural effusions (comorbidities)? (Select all that apply)

  • Pneumonia (correct)
  • Heart failure (correct)
  • Inflammatory disorders (correct)
  • Lung cancer (correct)

    • What medications are used to treat pleural effusions? (Select all that apply)

  • Chemotherapy (correct)
  • Furosemide (loop diuretic) (correct)
  • Zosyn (piperacillin and tazobactam sodium) (correct)
  • Nitroglycerin (vasodilator) (correct)
  • Gentamicin (correct)
  • Sclerosing agents (correct)

    • What is the mechanism of action of piperacillin and tazobactam sodium (Zosyn)?

    Broad-spectrum penicillin antibiotic

    What is the mechanism of action of gentamicin?

    <p>Aminoglycoside (potent antibiotic)</p> Signup and view all the answers

    What is the mechanism of action of furosemide and bumetanide?

    <p>Diuretics that work on the loop of Henle</p> Signup and view all the answers

    What lab tests are used to monitor the efficacy of warfarin?

    <p>PT/INR (A)</p> Signup and view all the answers

    What is the mechanism of action of heparin?

    <p>Binds to activated factors II, IX, and X, activates antithrombin to stimulate it to inactivate Factor Xa, stopping the clotting cascade.</p> Signup and view all the answers

    What is the mechanism of action of low molecular weight heparin (LMWH)?

    <p>Activates antithrombin to stimulate it to inactivate Factor Xa, stopping the clotting cascade.</p> Signup and view all the answers

    What is the mechanism of action of warfarin (Coumadin)?

    <p>Inhibits vitamin K synthesis which inhibits the production of clotting factors II, VII, IX, and X.</p> Signup and view all the answers

    When are heparin and warfarin used together?

    <p>Warfarin (delayed onset) is often started during the heparin infusion (rapid onset) and when warfarin therapeutic range is met, heparin is discontinued.</p> Signup and view all the answers

    What is the mechanism of action of fondaparinux (Arixtra)?

    <p>Only inactivates factor Xa, inhibiting thrombosis.</p> Signup and view all the answers

    What is the mechanism of action of alteplase and tPA?

    <p>Activate conversion of plasminogen to plasmin, which lyses thrombus.</p> Signup and view all the answers

    What is the normal aPTT range?

    <p>25-35 seconds.</p> Signup and view all the answers

    Which medications are used to treat COPD and asthma? (Select all that apply)

    <p>LABA (salmeterol) (A), Corticosteroid (Solu-Medrol) (B), SABA (albuterol) (C), Anticholinergic (ipratropium) (D), Antibiotic (oral, if infection) (E), Vaccines - flu, pneumonia (F), Oxygen (G)</p> Signup and view all the answers

    What is the mechanism of action of SABA (albuterol)?

    <p>Stimulate the B2 receptors on the outside bronchi muscles and cause relaxation and bronchodilation.</p> Signup and view all the answers

    What is the mechanism of action of methylprednisolone (solu-medrol)?

    <p>Decreases inflammation, helps with work of breathing.</p> Signup and view all the answers

    What is the mechanism of action of ipratropium (anticholinergic)?

    <p>Antagonizes acetylcholine resulting in bronchodilation.</p> Signup and view all the answers

    How do salmeterol and albuterol differ?

    <p>Salmeterol is a long-acting beta-agonist (LABA) used for prevention, while albuterol is a short-acting beta-agonist (SABA) used for quick relief.</p> Signup and view all the answers

    What is the IV antibiotic treatment for endocarditis? (Select all that apply)

    <p>Vancomycin + gentamicin (if penicillin allergy) (A), Ampicillin + gentamicin + flucloxacillin/oxacillin (D)</p> Signup and view all the answers

    What are the causes of infective endocarditis? (Select all that apply)

    <p>Fungi (A), Bacteria (C)</p> Signup and view all the answers

    What are the causes of non-bacterial endocarditis? (Select all that apply)

    <p>Autoimmune disease (A), Cancer (C)</p> Signup and view all the answers

    What medications are used to treat myocarditis? (Select all that apply)

    <p>Heart failure medications (ACE inhibitors, beta-blockers, loop diuretics) (A), Antivirals (acyclovir, ganciclovir) (B), Anti-inflammatory medications (ibuprofen, prednisone) (C)</p> Signup and view all the answers

    What is the mechanism of action of metoprolol?

    <p>Decreases blood pressure and heart rate</p> Signup and view all the answers

    What is the mechanism of action of ACE inhibitors?

    <p>Reduces ejection fraction, vasodilation.</p> Signup and view all the answers

    What is the mechanism of action of acyclovir?

    <p>Herpes virus myocarditis</p> Signup and view all the answers

    What is the mechanism of action of colchicine?

    <p>Prevent reoccurrence of pericarditis (dec inflammation)</p> Signup and view all the answers

    What medications are used to treat MI? (Select all that apply)

    <p>Alteplase (A), Beta-blockers (B), Aspirin (C), Nitroglycerin (D), ACE inhibitors (E)</p> Signup and view all the answers

    What is the mechanism of action of nitroglycerin?

    <p>Vasodilator, reduces preload and afterload overall decreasing myocardial oxygen demand.</p> Signup and view all the answers

    What is the mechanism of action of ACE inhibitors for hypertension?

    <p>Decreases blood pressure by vasodilation</p> Signup and view all the answers

    What is the definition of hypertensive urgency?

    <p>Rapid increase in blood pressure without immediate organ damage.</p> Signup and view all the answers

    What are the IV medications used to treat hypertensive urgency? (Select all that apply)

    <p>Labetalol (B), Hydralazine (C), Nitroprusside (D)</p> Signup and view all the answers

    What are the key considerations for managing hypertensive urgency?

    <p>Monitor BP every 15 minutes / target reduction of 25% in the first hour, but avoid rapid lowering to prevent organ hypoperfusion</p> Signup and view all the answers

    What is the mechanism of action of nitroprusside?

    <p>Vasodilator for rapid blood pressure control</p> Signup and view all the answers

    What is the mechanism of action of labetalol?

    <p>Combined alpha/beta blocker for quick blood pressure reduction.</p> Signup and view all the answers

    What is the mechanism of action of hydralazine?

    <p>Vasodilator for immediate lowering of blood pressure.</p> Signup and view all the answers

    Which medications are used to treat heart failure? (Select all that apply)

    <p>Digoxin (A), ACE inhibitors/ARBs (C), Beta-blockers (D), Diuretics (E)</p> Signup and view all the answers

    What are four things that contribute to cardiac dysfunction with heart failure?

    <ol> <li>Initial compensatory mechanism: activate SNS constantly, desensitize B-receptor 2. RAAS system: vasoconstricts (inc afterload), Na/H2O retention 3. Neuroendocrine: constant release of catecholamines 4. Myocardial stress: prevents relaxation</li> </ol> Signup and view all the answers

    The efficiency of loop diuretics depends on what?

    <p>Higher doses may be needed in severe renal insufficiency or low cardiac output to ensure drug delivery / There could be decreased absorption in the GI tract due to bowel wall edema.</p> Signup and view all the answers

    When is pulmonic regurgitation especially problematic?

    <p>When combined with pulmonary hypertension, it leads to the progression of right-sided heart failure</p> Signup and view all the answers

    What medications are used to treat valvular heart disease? (Select all that apply)

    <p>Endocarditis prophylaxis (amoxicillin or clindamycin) (A), Furosemide (B), Warfarin (C), Metoprolol or diltiazem (D)</p> Signup and view all the answers

    What is the mechanism of action of diltiazem?

    <p>It is used in valvular heart disease as an alternative to metoprolol.</p> Signup and view all the answers

    What medications are used for surgical management of valvular heart disease? (Select all that apply)

    <p>Hydromorphone (A), Metoprolol (B), Enoxaparin (C)</p> Signup and view all the answers

    What medications are used to treat aortic regurgitation? (Select all that apply)

    <p>Lisinopril (A), Valsartan (B)</p> Signup and view all the answers

    What medications are used to treat acute mitral regurgitation? (Select all that apply)

    <p>Furosemide (A), IV nitroglycerin (B)</p> Signup and view all the answers

    What medication is used to treat mitral valve prolapse?

    <p>Propranolol</p> Signup and view all the answers

    What medication is used to treat chronic aortic regurgitation?

    <p>Nifedipine XL</p> Signup and view all the answers

    What is a common side effect of tricuspid stenosis?

    <p>Liver congestion</p> Signup and view all the answers

    What are the types of tricuspid regurgitation? (Select all that apply)

    <p>Primary (A), Secondary (B)</p> Signup and view all the answers

    What are common side effects of mitral stenosis?

    <p>Paroxysmal nocturnal dyspnea and hemoptysis.</p> Signup and view all the answers

    Study Notes

    Pleural Effusions

    • Causes (Comorbidities): Pneumonia, heart failure (HF), lung cancer, inflammatory disorders
    • Pharmacological treatment: Furosemide (loop diuretic), Zosyn/Gentamicin (antibiotics), nitroglycerin (vasodilator), chemotherapy, sclerosing agents

    Medications (Pleural Effusions)

    Piperacillin-Tazobactam (Zosyn)

    • Mechanism of Action (MOA): Broad-spectrum penicillin antibiotic (powder dilution)
    • Therapeutic Uses (TU): Pleural effusions, empyema
    • Common Side Effects (C/SE): Diarrhea
    • Precautions (PC): Renal problems, penicillin allergy

    Gentamicin

    • MOA: Aminoglycoside (potent antibiotic)
    • TU: Pleural effusion
    • C/SE: Nephrotoxicity, ototoxicity
    • Monitoring: Peak levels (30 minutes after infusion), trough levels (30 minutes before next dose). Trough should be below 2mcg/mL

    Furosemide/Bumetanide

    • MOA: Diuretics, acting on the loop of Henle
    • C/SE: Dehydration, hypotension, hypokalemia, ototoxicity, kidney injury
    • IV administration: Onset (5 minutes), peak (30 minutes), duration (2 hours)
    • Administration instructions: Administer very slowly to prevent ototoxicity (20mg/min)

    Anticoagulation Medications

    Warfarin (Coumadin)

    • MOA: Inhibits vitamin K synthesis, affecting clotting factors II, VII, IX, X.
    • Monitoring: PT/INR, liver enzymes
    • Half-life: 0.5-3 days (long)
    • Dietary Considerations: Leafy greens can impact effectiveness

    Heparin (IV/SQ)

    • MOA: Binds to activated clotting factors; activates antithrombin, inactivating Factor Xa.
    • Dosage: Patient-specific
    • C/SE: Bleeding risk (monitor closely), toxicity (requires protamine sulfate)
    • Monitoring: aPTT, Anti-Xa frequently (every 4-6 hours) – kidneys

    Low-Molecular-Weight Heparin (LMWH) (Enoxaparin, Dalteparin)

    • MOA: Similar to heparin, inactivating Factor Xa.
    • C/SE: Bleeding, thrombocytopenia
    • Anti-dote: Protamine sulfate (1:1 ratio)
    • Precautions: Bleeding precautions

    Fondaparinux (Arixtra)

    • MOA: Targets factor Xa only.
    • Therapeutic Uses (TU): Pulmonary embolism (PE), Deep Vein Thrombosis (DVT)
    • Precautions (PC): Kidney disease (creatinine clearance <30 mL/min)

    Alteplase/tPA (IV)

    • MOA: Activates plasminogen to plasmin, dissolving thrombi.
    • Application: Hemodynamically unstable patients with ST-elevation myocardial infarction (STEMI) within 12 hours of symptom onset.
    • Route: IV (short half-life).
    • Critical Monitoring: Risk of significant bleeding.

    Lab Values

    • Heparin therapy: aPTT target range of 40-90 seconds (normal values 25-35 seconds).

    COPD/Asthma Medications

    • Short-acting bronchodilator (SABA): Albuterol
    • Long-acting bronchodilator (LABA): Salmeterol
    • Corticosteroids: Solu-Medrol (for inflammation)
    • Antibiotics: Oral (if infection present)
    • Anticholinergic: Ipratropium
    • Oxygen: Supplemental oxygen
    • Vaccines: Flu, pneumonia

    Specific Medication Details

    Albuterol

    • MOA: Stimulates beta2 receptors, relaxes bronchi, causing bronchodilation.
    • C/SE: Tachycardia, tremors, hyperglycemia
    • Interaction: Beta-blockers

    Methylprednisolone (Solu-Medrol)

    • MOA: Decreases inflammation, improves work of breathing (WOB).
    • C/SE: Hyperglycemia
    • Route: IV

    Ipratropium

    • MOA: Antagonizes acetylcholine (ACh), leading to bronchodilation.
    • C/SE: Dry mouth

    Other Conditions

    • Endocarditis: Infective (bacterial/fungal), Non-bacterial (cancer, autoimmune). Treatment: 4-6 weeks of pathogen-directed therapy (e.g., ampicillin + gentamicin + flucloxacillin or oxacillin; or vancomycin + gentamicin if penicillin allergy)
    • Myocarditis: Treatment: antivirals (acyclovir, ganciclovir), anti-inflammatory meds (ibuprofen, prednisone), HF meds (ACE inhibitors, beta-blockers, furosemide)
    • Pericarditis: Treatment: NSAIDs; corticosteroids (tapered doses); colchicine

    Heart Failure (HF)

    • Pharmacology: ACE inhibitors/ARBs, beta-blockers (e.g., metoprolol), diuretics (e.g., furosemide), digoxin
    • Pathophysiology: Compensatory mechanisms (SNS activation, RAAS) contribute to worsening cardiac function including myocardium stress and neuroendocrine changes

    Hypertension Urgency/Emergency

    • Urgency: Rapid increase in blood pressure without immediate organ damage. Symptoms: headache, nosebleed, blurry vision.
    • Treatment: IV medications (nitroprusside, labetalol, hydralazine). Monitor blood pressure closely. Aim for a 25% reduction in blood pressure in the first hour, avoiding rapid lowering to prevent organ hypoperfusion

    Valvular Heart Disease

    • General Pharmacology: Warfarin, beta-blockers for rate control (metoprolol, diltiazem), furosemide for fluid management. Possible endocarditis prophylaxis with antibiotics. In some cases, such as acute mitral regurgitation, IV nitroglycerin or furosemide may be used.
    • Specific Procedures: Refer to associated medications.

    Aortic Regurgitation

    • Pharmacology: Lisinopril, Valsartan (consider potential hypotension effects)

    Mitral Valve Prolapse

    • Pharmacology: Propranolol

    Other Considerations

    • CHF: Different treatment strategies in response to right-sided vs left-sided heart failure.
    • Valve flow and specifics: More detailed information is needed – these headings lack the content to summarize the specifics.
    • Dietary factors/considerations Refer to specific drug categories (e.g. Warfarin and leafy greens)
    • General considerations: Avoid repeating similar terms such as C/SE, MOA, and TU. It is better to provide concise and clear lists when multiple points need to be included..

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    Description

    Explore the pathophysiology of pleural effusions, including their causes such as pneumonia and heart failure. Learn about the pharmacological treatments available, focusing on antibiotics like Zosyn and Gentamicin, as well as diuretics like Furosemide. This quiz will test your understanding of medication mechanisms, side effects, and monitoring requirements.

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