Pharmacology Test 3 Study Guide PDF

1. Estrogen effects on asthma (one slide) - Estrogen - Estrogen replacement during menopause may exacerbate asthma and outcome absent when given in combination with progesterone - Estrogen decreases may exacerbate asthma during PMS - Non-s...

1. Estrogen effects on asthma (one slide) - Estrogen - Estrogen replacement during menopause may exacerbate asthma and outcome absent when given in combination with progesterone - Estrogen decreases may exacerbate asthma during PMS - Non-selective beta blockers (propranolol) - These drugs do not precipitate bronchospasm but prevent its reversal- reduces the effects of albuterol when taken together - Aspirin allergies -- how to treat - ICS's are the primary preventative treatment 2. Acute asthma exacerbation -- identify the steroid you need to give them - Have to look at slide with the steps and memorize - **SABA (albuterol)**, then depending on the severity, systemic **corticosteroids (prednisone, prednisolone, methylprednisolone, dexamethasone)**, inhaled ipratropium (anticholinergic) , intravenous magnesium sulfate, and O2 - Severe gets IV option for steroids + optional IV magnesium + optional ICS + mild/moderate coverage - Mild/moderate -- remember to use oral route - Severe -- IV route due to airway being closed - Recommended dosage based on age - ICS for chronic asthma - Mometasone furoate DPI - Low dose: 110-220 - Medium dose: 220-240 - High dose: \>440 - Budesonide (Symbicort) 90-180 mcg/dose DPI - Can use the same inhaler when stepping up and down - Adults: max 12 inhalations/day - 12-17 y/o: 11 inhalations/day - 4-11 y/o: 8 inhalations/day - Advair (LABA/ICS) (fluticasone and salmeterol) - Diskus -- 1 inhalation BID (ages 4-11) and (12 and up) - HFA- 2 puffs BID (ages 12 and up) - Fluticasone and salmeterol 3. All info on Montelukast (Singulair) - LTRA -- leukotriene receptor antagonist - Reduction of production or action of leukotrienes in inflammation and allergy; reduces airway edema and smooth muscle contraction - Approved for exercise induced asthma - Treats chronic asthma - LTRA in GINA guidelines - Chewable, granules, and tablets - Administer at night - Dose is based on age - 12 months to 5 years (4 mg once daily) 6-14 years (5 mg once daily) 15 and up (10 mg once daily) 4. Asthma patient -- based on GINA guidelines determine what step they are in, what therapy you should give them - Symbicort (budesonide) - Mometasone - Advair (fluticasone and salmeterol) - Look for slide or review slide 5. Counseling points and devices that have extra info at the end of COPD and asthma lecture - Asthma products - Two pumps to prime if new or not used in 7 days (have to prime it) - For SABA, wait 15-30 seconds between puffs - You do not have to wait in between puffs for others - You can inhale with inhaler slightly outside of mouth, spacer, or whole mouth on it - Spacer typically used for ages under 6 - COPD products - Spiriva Respimat and Combivent - TOP -- Turn, Open, Press (soft mist inhalers) - Expiration date: 3 months after opened - Spiriva- Tiotropium (antimuscarinic aka anticholinergic) - Combivent- ipratropium and albuterol - Spiriva Handihaler - Capsule device - DPI -- breath it in on your own - Expiration date: 6 weeks after opening - Tiotropium (antimuscarinic) - Comes with side affects - Advair Diskus - DPI - Contains fluticasone and salmeterol - Have to rinse mouth out with water - Expiration date: 1 month after opening - Capsule - Trelegy - Fluticasone furoate, umeclidinium, and vilanterol) - DPI - Rinse mouth after use - Expiration date: 6 weeks 6. ICS therapy -- how do you step up and down - Review slides on asthma and COPD lecture - Stepping down ICS doses 25 -- 50% at 3 month intervals is considered feasible and safe - Avoid stepping down therapy during gestation in pregnancy 7. Which drugs are an option for an acute exacerbation of asthma - Albuterol and corticosteroids - Corticosteroids - Prednisone - Methylprednisolone - Prednisolone - Dexamethasone - Anticholinergics - Ipratropium bromide nebulizer and MDI - **Usually combined with albuterol** (Duoneb) - Albuterol and levalbuterol - Nebulizer and MDI 8. How to use nebulizer albuterol - Continuous nebulization is recommended for patients having unsatisfactory response (achieving less than 50% normal FEV1 or PEF) following the initial 3 doses (every 20 minutes) of aerosolized b-agonist and potentially for patients presenting initially with PEF or FEV1 less than 30% of predicted value 9. Know all of the guidelines - CBC- vaccines - Flu- every year during fall - Tdap- every 10 years - RSV- one dose - Covid- with flu - Pneumonia - 19-50 with COPD!! Encouraged to get vaccine - Shared decision making after 65 - After 50 you need an extra vaccine - IDSA- bacterial infections - AAP- Acute otitis media - RSV - GOLD - GINA 10. **Long-acting beta agonist (LABA) are not recommended for monotherapy in asthma** 11. MOA of medication and if it is a LAMA, LABA, SAMA, SABA - Asthma - SABA -- inhibition of immediate hypersensitivity mediators from mast cells - Albuterol - Levalbuterol - Epinephrine (OTC) - Corticosteroids -- reduce synthesis and release of pro inflammatory cytokines, reduce inflammatory cell activation, possible effect on beta receptors - Beclomethasone- inhaled - Budesonide- inhaled - Ciclesonide- inhaled - Flunisolide- inhaled - Fluticasone- inhaled - Mometasone -- inhaled - Anticholinergic -- competitive inhibitors of muscarinic receptors, Blockade of m2 receptors allows further release of presynaptic acetylcholine and may antagonize the bronchodilator effect - SAMA - Ipratropium - DuoNeb (albuterol and ipratropium) - LAMA - Tiotropium (Spiriva Respimat) - Do not use Spiriva handihaler for asthma - Leukotriene modifiers -Reduction of production or action of leukotrienes in inflammation and allergy; reduces airway edema and smooth muscle contraction - Montelukast - Zafirlukast - rare hepatotoxicity - Zileuton - 5-lipoxygenase inhibitor catalyzes the formation of leukotrienes from arachidonic acid - Biologics -- recombinant anti-IgE antibody -\> decreases inflammatory mediator release - Omalizumab - Anaphylaxis - Injection site reactions - Increased risk of infection - **Dosing based on weight and IgE levels** - **2-4 week does interval** - Dupilumab - Interleukin 4 antagonist -- decreases inflammatory mediator release - Same adverse effects - Benralizumab Il 5 antagonists - Mepolizumab - Il 5 antagonists - Reslizumab- Il 5 antagonists - Additional - Cromolyn - Mast cell stabilizer - Methylxanthines - Theophylline and aminophylline-- phosphodiesterase inhibitor to reduce bronchodilation, inhibition of release of mediators from mast cells and leakocytes - COPD -- can still use SABA, SAMA - LABA - Salmeterol - DPI - Formoterol - nebulized - Arformoterol - Nebulized - Indacaterol - DPI - Olodaterol - SMI - LAMA - Tiotropium - SMI and DPI - Aclidinium - DPI - Glycopyrrolate - Nebulized or DPI - Umeclidinium - DPI - Revefenacin - Nebulized - Corticosteroid -- ICS monotherapy not recommended for COPD - ICS/LABA not recommended -- go for LAMA/LABA or triple therapy - Phosphodiesterase 4 (PDE4) inhibitor -- relaxation of airway smooth muscle cells and decreased activity of inflammatory cells and mediators such as TNF and IL-8 - Roflumilast - Don't give with theophylline due to similar MOA - May be used If triple therapy doesn't work - Neuropsychiatric effects - Phosphodiesterase 3 and 4 inhibitor - - Ensifentrine - Macrolides - Azithromycin - **Increased risk of hearing loss** - **QTC prolongation** - Don't use while smoking - A1- antitrypsin replacement therapy - Exprensive 50,000 - Mucolytics- guaifenesin - Lack of evidence - Opioids -- morphine - End stage dyspnea 12. All info on Symbicort (used for chronic asthma) (ICS/LABA) - GINA guidelines recommend it for MART therapy (only one) - One inhaler for acute and one for maintenance - What's the total amount of dose a day of both maintenance and emergency - Budesonide (Symbicort + formoterol) 90-180 mcg/dose DPI - Can use the same inhaler when stepping up and down - Low-medium = 80 mcg - Med-high = 160 mcg - Maintenance - 1-2 inhalations one or twice daily - Adults: max 12 inhalations/day - 12-17 y/o: 11 inhalations/day - 4-11 y/o: 8 inhalations/day - 13. Recommended vaccines for someone with COPD - 19-50 pneumococcal vaccine - 50 + get an additional vaccine 14. Identify drug formulation (focus on combination PowerPoint or very specific ones from the last PowerPoints) 15. Short- and long-term effects of using steroids and special points for geriatrics (cataracts, osteoporosis, skin thinning) 16. COPD patient with CAP or MMRc -- identify the group and selective therapy; if therapy fails which options would you want to do 17. Adverse effects of drugs (more than one question on this) - Monoclonal antibodies - - Beta agonist - Anticholinergics - Etc - Azithromycin -- increased risk of hearing loss for people with COPD 18. Recommended antibiotics, steroid, or both for someone with acute COPD exacerbation (1 slide) - 3 cardinal symptoms -- dyspnea, cough, or sputum production - 1 cardinal symptom (mild) - Only bronchodilator - 2 or 3 cardinal symptoms - Bronchodilator - Prednisone 40 mg Qday x 5-7 days - Uncomplicated (less than 4 exacerbation in a year - Azithromycin, cefdinir, doxycycline) - Complicated (\>4 exacerbations in a year or 65 and up with comorbidities) - Augmentin or Levaquin - \>14 days of OCS, hospitalization or IV Abx in past 90 days, or live in long term care - PO Levaquin or - IV Piperacillin / tazobactam or cefepime 19. **Theophylline has a narrow therapeutic index (5-15 mcg/mL)** - toxicities ( \>20 mcg/mL) - **arrythmias and seizures** - Drug interactions -- CYP 1A2, CYP 3A4 - Fluoroquinolones - Decreases clearance - Smoking and CYP 3A4 inducers - Increase clearance - Oral beta agonist (theophylline and albuterol syrup) not preferred for use in Asthma per GINA guidelines 20. Recommend a smoking cessation product for someone with COPD -- identify products and contraindications - **NRT contraindicated with recent (in past two weeks) stroke or MI** - Bupropion SR - Avoid with PMH of seizures or eating disorders - Nicotine gum - Nicotine patches - Varenicline - Moa: partial agonist on nicotinic receptors - Other: tricyclic antidepressents, behavioral therapy, hypnosis 21. Bacterial Abx overview slides with diagnosis, treatment, second line options, allergic reactions - Know the dosage and duration of each 22. Someone with CAP with pneumococcal resistance rates, patient allergy info, here is past medical history -- what do you recommend? Review curb score and appropriate drugs and dosages - If severe - Treat empirically for MRSA or Pneumonia - 3+ minor or 1 major is severe CAP - Major - Septic shock with need for vasopressors - Respiratory failure requiring mechanical ventilation - Minor - hypotension - Uremia 20+ - confusion - Resp rate 30+ - PaO2/flo2 \30 mg QID x 10 days - 48 hours - Exception: If you have flu and pneumonia and have been sick for more than 48 hours, they will treat you with oseltamivir - Nursing homes- on Tamiflu for a long time 25. Recommended treatment of patients with acute otitis media -- what's there age (6 moths-12 years) old), fever (102.2), ear pain greater than 48 hours - 1^st^ line - Amoxicillin 80-90 mg/kg/day BID - Augmentin 90 mg/kg/day BID - Only if patient has taken Abx in past 90 days, purulent conjunctivitis, history of recurrent infection, unresponsive to amoxicillin - Cefdinir - Type ii PCN allergy - Or clindamycin for type i - Therapy failure 48-72 hours - Augmentin - Clindamycin + or -- cefdinir - \6 years old 5-7 days mild-mod, 10 if severe 26. Which bacteria are associated with each infection - S. Pneumonia - Acute bacterial rhinosinusitis - pneumonia - H. influenza - Acute bacterial rhinosinusitis - pneumonia - M. catarrhalis - Acute bacterial rhinosinusitis - Klebsiella - Alcoholics - e\. coli - pneumonia - p\. aeruginosa - pneumonia - S. Pyrogens (group A) - Strep throat (pharyngitis) 27. Neuraminidase inhibitor slide -- compare oseltamivir to the others - Inhibits the release of new viral particles from host cells by stopping catalyzing the cleavage of linkages to sialic acid - Neuropsychiatric complications - Oseltamivir - Capsule and solution - 5 day treatment - Preferred drug for influenza - Can take 2 weeks old and up - Can take while pregnant and lactating - Renally dosed - Zanamivir - Diskhaler - 5 days treatment - Not renally dosed - 7 years and up - Peramivir - 2 years and up - IV - 1 day treatment - Renally dosed 28. Calculate a Curb-65 score including using minor criteria - CURB-65 - Confusion - Uremia (BUN \> 20) - Respiratory rate = or \> 30 - Blood pressure (less than 90/60) - = or \> 65 years old - Scores - \