Term
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Definition
| *Chronic Inflammatory Disease with Airway Hyper-responsiveness, Airflow obstruction, and Airway inflammation |
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Term
| What is the most chronic dz in children? |
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Definition
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Term
| Asthma can either be mild, moderate or severe, what are the 4 different kinds of therapies? |
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Definition
*SABA (inhaled short-acting beta 2-agonist)
*LABA (long-acting inhaled beta 2-agonist)
*LTRA (leukotriene receptor antagonist)
*ICS (inhaled corticosteroid)
Other pharmacologic and non-pharmacologic
Consider SQ allergen immunotherapy for those with allergic asthma |
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Term
| In general, what percent of medications are never even picked up? |
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Definition
40%
-asthma is usually not one of these bc if can't breathe ppl are going to want their meds. |
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Term
| What is the biggest problem with taking medications? |
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Definition
| pt is not using them correctly |
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Term
| Why aren't non-specific agonists used? |
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Definition
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Term
| Which drug is going to take longer to work: ones that work at the cell level or ones that work right on the site? |
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Definition
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Term
| If you put a pt on a medication slowly, how are you going to want to take them off of it? |
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Definition
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Term
| What are some of the combination products used for asthma? |
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Definition
Advair (Fluticasone & Salmeterol)
Symbicort (Budesonide & Formeterol) |
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Term
| What are risk factors for COPD? |
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Definition
| *CIGARETTE SMOKING, genetics, environmental pollutants, lung growth (low birth weight, respiratory infections) |
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Term
| How many unknown chemicals are in cigarettes? |
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Definition
| 200 unknown chemicals in cigarettes… don’t know much about them, we do know that some are carcinogenic. |
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Term
| What are the stages of management of COPD? (*steps 1&2 are the most important) |
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Definition
*Stage 1: active reduction of risk factors, Flu Vaccination (also maybe pneumonia vaccine), add SABA when needed (same as asthma)
*Stage 2: Add regular treatment with LABA and rehabilitation
Stage 3: Add ICS if repeated excerbations
Stage 4: Add long term oxygen, if chronic consider surgical treatments |
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Term
| When trying to determine what antibiotics to use on a person with COPD, you must determine if they are complicated or uncomplicated... what defines them being complicated? |
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Definition
Complicated: 1 or more risk factors >65 yo, FEV <50%, > 3 exacerbations/year, cardiac disease
Complicated so would use a whole different list of antibiotics. |
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Term
| What is a complication with the 90% of inhaler meds that get swallowed? |
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Definition
| They undergo the first pass inactivation by the liver after absorbed into the gut. |
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Term
| What should a child be using when using an inhaler? |
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Definition
| spacer-- inhaled aerosol gets enriched in small particles to be more readily transferred to small airways. |
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Term
| Should start on mast cell inhibitors ___ to ___ weeks before allergy season. |
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Definition
3-4
work via early IgE antibody (on the mast cell) exposure to antigen |
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Term
| What is empiric therapy of acute bronchitis symptoms? |
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Definition
| antibiotics before actually knowing the true pathophys of the dz. |
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Term
| Acute bronchitis is mostly viral, is there any evidence that bacteria can cause acute bronchitis in pts w/o underlying pulmonary dz? |
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Definition
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Term
| Does mucous production in acute bronchitis have to be colored? When is mucous production worse? |
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Definition
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Term
| Acute bronchitis is usually self- limited and resolves in __ to __ weeks. |
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Definition
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Term
| Why can a cough persist 6-8 wks after acute bronchitis infection is cleared? |
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Definition
| airway is increasingly reactive. |
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Term
| In treating acute bronchitis, is this dz usually self-limited? |
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Definition
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Term
| In acute bronchitis, what should be avoided unless pt is sleeping? why? |
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Definition
cough suppressants
-bc mucous can't be coughed up. |
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Term
| When are the only times that you should give abx in acute bronchitis? |
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Definition
elderly
underlying cardiopulmonary dz
persistent cough (>7-10 days)
immunocopromised |
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Term
| When should you start treating influenza when it presents in acute bronchitis? |
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Definition
| 48 hours, hard to know when this 48 hours started. |
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Term
| How is acute bronchitis defined? |
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Definition
| Chronic productive cough for ≥3 consecutive months every year for 2 consecutive years |
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Term
| In chronic bronchitis what are the 3 most common agents that could colonize? |
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Definition
45% are colonized with Haemophilus influenzae
20% strep pneumoniae
30% M. catarrhalis |
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Term
| What are the causes of acute exacerbations during chronic bronchitis? |
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Definition
Most acute: Viral (25-50%) *
Streptococcus pneumoniae (20%)
Haemophilus influenzae (45%)
Moraxella catarrhalis (30%) |
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Term
| During an acute exacerbation of chronic bronchitis, what occurs? |
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Definition
| inc sputum production and changes to green or purulent. Inc shortness of breath & fatigue, chest tightness, possible fever, hemoptysis. |
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Term
| What should you always encourage when treating chronic bronchitis when patient suffers from acute infections? |
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Definition
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Term
| When treating acute exacerbations of chronic bronchitis, what does smoking do? bronchodilators? mucolytics? |
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Definition
Stopping smoking dec the continued irritation of the epithelial lining , dec sputum production within weeks of stopping
Bronchodialators can inc mobilization of secrestion
Mucolytics can be irritants and inc sputum production. Coughing helps clear secretions |
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Term
| When using abx on cute exacerbations of chornic bronchitis, what is resistant to amoxicillian? What is beta-lactamse resistant? |
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Definition
-H. flu and M. cattarhalis
-M. cattarhalis
*should then use third generation abx such as cephal0, amo/clauv, bactrin, clarithromycin, azithromycin of fluoroquinolone |
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Term
| What is the principle site of infection in pneumonia? (2) |
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Definition
| alveolus and surrounding interstitial tissues. |
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Term
| What are the 3 types of pneumonias? |
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Definition
Community-acquired (CAP)
Hospital-acquired (HAP)- ventilator associated (VAP), healthcare associated (HCAP)
Aspiration |
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Term
| What is the seventh most common cause of death and MOST common cause of death from an infectious disease in US? |
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Definition
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Term
| What is the difference in disease rates in CAP and HAP? |
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Definition
In US, 2-4 million cases of CAP per yr
Hospitalized pts have mortality rate of 25%
1 out of 4 goes in for pneumonia
HAP
300,000 pts per year
Increases hospital stay by 7-9 days and costs addition $2 billion per yr |
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Term
| What is the empiric tx of CAP for outpatients? |
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Definition
Azithromycin or clartihromucin
age 17-50: consider doxycycline
Roecphin and azithromycin
*this is an animal that keeps moving so know what is being used currently in your area. |
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Term
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Definition
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