1
Q
HFA
A
hydrofluroalkane
2
Q
LT
A
leukotriene
3
Q
MDI
A
metered-dose inhaler
4
Q
PDE
A
phosphodiesterase
5
Q
PG
A
prostaglandin
6
Q
Obstructive lung diseases:
A
- asthma
- COPD
- bronchiectasis
- bronchiolitis
7
Q
Restrictive patho- parenchymal diseases:
A
- idiopathic PF
- Asbestosis
- Desquamative interstitial pneumonitis (DIP)
- Sarcoidosis
8
Q
Restrictive patho - neuromuscular weakness diseases
A
- ALS
- Guillain-Barre syndrome
- Myasthenia gravis
9
Q
Restrictive patho - chest wall/pleural disease
A
- kyphoscoliosis
- ankylosing spondylitis
- chronic pleural effusions
10
Q
Pulmonary vascular diseases
A
- PE
- PAH
- Pulmonary vennocclusive disease
- vasculitis
11
Q
Malignancy pulm diseases
A
- bronchogenic carcinoma (NSC & SC)
- metastatic dz
12
Q
Infectious lung diseases
A
- pneumonia
- bronchitis
- tracheitis
13
Q
How much of medication is inhaled?
A
10-20%
14
Q
How much of medication is swallowed?
A
80-90%
15
Q
Describe pressurized Metered-Dose Inhalers
A
drug propelled from cannister w/ help of propellant.
50-200 doses of drug
16
Q
Why are space chambers used?
A
- reduce speed of particles entering airways & size of particles
- increased proportion of drug inhaled into lower airways
- good for small children >3yo
17
Q
What is the age limit for DPI?
A
< 7yo
18
Q
When do we used nebulizer therapy?
A
acutely ill & those who can’t use inhalers
19
Q
Define hypoxia
A
low tissue oxygenation
20
Q
Define hypoxemia
A
- low oxygen in blood
- a decrease in the partial pressure of O2 in the blood
21
Q
What does hypoxemia generally imply?
A
- Low FIO2
- Hypoventilation
- V/Q mismatch
- Shunt or venous admixture
- ^ diffusion barrier
22
Q
Causes of poor O2 deliever can be narrow to 3 categories
A
Low CO, Low Hgb, Low SaO2
23
Q
Accepted indication for acute O2 therapy
A
- doc. hyoxemia
- acute care situation, resp distress
- trauma
- acute MI w/ hypoxemia
- Low CO w/ metabolic acidosis
- Hypotension
24
Q
How is doc. hypoxemia defined
A
PaO2 < 60mmHg
SaO2 < 90%
25
Questionable indication for acute O2 therapy
- acute MI w/o hypoxemia
- dyspnea w/o hypoxemia
- sickle cell pain crisis
- pneumothorax
26
Too much O2 therapy causes
decr ventilation
27
what happens when 100% O2 is breathed?
HR & CO are slightly decr
28
High flows of dry O2 can...
dry out & irritate mucosal surfaces & eyes.
29
What should be done if O2 is used for prolonged therapy (>1hr)
it should be humidified
30
List the O2 therapy methods in order from least to greatest based on FiO2 per flow rate O2.
Nasal cannula-->O2 mask-->Mask w/ reservoir bag--> nonbreathing mask--> Venturi mask
31
Which method of O2 therapy delivers the highest FiO2 per flow rate O2?
Venturi mask
32
Which method of O2 therapy delivers the lowest FiO2 per flow rate O2?
nasal cannula
33
O2 indication summary: Acute
- measured hypoxemia
- potential hypoxia (trauma/low CO)
- Indications for hyperbaric O2
34
O2 indication summary: Chronic
- measured hypoxemia @ rest or w/ exertion
35
Patient has PaO2 < 55mmHg, SaO2 <88%, do they qualify for long-term O2 therapy?
absolutely, no qualifiers needed
36
Patient has PaO2 55 - 59mmHg, SaO2 <88-90%, do they qualify for long-term O2 therapy?
Relative w/ qualifier
- signs of Cor pulmonale (hx of edema, polycythemia, EKG)
37
Patient has PaO2 >/= 60mmHg, SaO2 >/=90%, do they qualify for long-term O2 therapy?
None unless qualifier
- exercise desaturation
- sleep desaturation (no help from CPAP)
- lung dz w/ dyspnea
38
Main to systems that are targeted by O2 toxicity?
1. resp tract--> w/n 8-12 hours of exposure
2. nervous system--> seizures & visual changes (babies can get retinopathy
39
O2 toxicity is usually reserved for
tracheobronchial & alveolar damage
40
A FiO2 value ____ is not likely to induce O2 toxicity
< 60%
41
Uses for O2 (resp oxygen)
- correct hypoxemia
- would healing (hyper baric O2)
42
What can cause hypoxemia that requires O2?
- Low FiO2
- hypoventilation
- V/Q mismatch
- shunt or venous admixture
- incr diffusion barrier
43
How much of room air is O2?
21%
44
Safety warning for O2?
- Pulm damage
[levels 0.5 [0.6] atm are safe
- retinopathy of prematurity (eye dz in premature infants
45
ECMO is used to....
support pts w/ cardiac failure or cardiac + resp failure
46
What does ECMO do?
removes blood from venous system, oxygenates it, & returns it to venous or arterial system.
47
VV ECMO is used to support what type of patient?
resp failure
48
VA ECMO is used to support what type of patient?
- cardiac failure
- or cardiac + resp failure
49
ECMO requires____ and is usually ____.
anticoagulation; heparin
50
What is the most common risk for ECMO
bleeding
51
What are thromboemboli?
small clots that can develop in the ECMO machine & become dislodged & enter circulation & possible do damage to organs
52
Define expectorants
reduces thickness of secretions which incr mucus coming out during coughing
53
Define mucolytics
break down the chemical structure of mucus molecules, which makes it thinner and removed during coughing
54
How does Acetylcysteine affect mucus?
uses its free sulfhydryl group, which opens the disulfide bonds & lowers mucus viscosity
55
Acetylcysteine can be used to decr mucus in what dz?
- COPD
- CF
- pneumonia
56
How does Acetylcysteine relate to acetaminophen OD?
it can be used to prevent or lessen liver injury of the acetaminophen OD
57
What should be given along w/ acetylcysteine?
a bronchodilator
58
Does acetylcysteine have an odor?
YES
59
Tx for bronchoconstriction of airways
- bronchodilator
- Methylxanthine drugs
- Muscarinic antagonist aka anticholinergics
60
Tx for inflammation/thickening of airways
- Corticosteroids
- Cromolyn & Nedocromil
- Leukotriene pathway inhibitors
61
Name bronchodilators
- Beta-adrenergic agonist (SABAs & LABAs)
- Anticholinergics [antimuscarinic agents] SAMAs & LAMAS
- Phosphodiesterase inhibitors
62
Name immunomodulators
- corticosteroids (inhaled & systemic)
- Mast cell inhibitors
- Leukotriene modifiers
- Targeted monoclonal antibodies
- Vax
63
Beta 2 agonist target what tissue?
- resp
- uterine
- vascular smooth muscle
64
Beta 2 agonists promote what action?
smooth muscle relaxation
65
Beta 2 agonist SEs
- muscle tremor
- tachycardia
- hypokalemia
- restlessness
- hypoxemia
- metabolic effects
66
What is the only OTC medication for asthma?
OTC epinephrine (Primatene Mist)
67
What is the most effective therapy for prompt relief of asthmatic symptoms?
SABAs
68
Name SABAs
- albuterol
- levalbuterol
- pirbuterol
69
How long does it take SABAs to kick in, peak, & lasting time?
onset: 5 mins
peak: 30-60 mins
last: 4-6 hours
70
NOTE
B-blockers can lessen effectiveness of SABA, but not contraindicated
71
Delivery mechanism of choice for all SABAs
MDI + spacer
72
What is an alternative delivery mechanism for SABAs for those who can't uses MDIs?
nebulizer
73
How many puff of an MDI equals one nebulizer tx?
10 puffs
74
What can be added to a SABA if pt. has severe asthma attacks or b/c of B-blockers in urgent care setting?
anticholinergic bronchodilators
75
Uses: Albuterol [Proventil] & Levalbuterol [Xopenex]
- bronchospasm
- exercise-induced bronchospasm
76
Interaction characteristics: Albuterol [Proventil] & Levalbuterol [Xopenex]
- HTN
- Hypokalemia
77
Age limits for Albuterol [Proventil]
- Neb form <2yo
- MDI form, 4 or >
78
Serious Rxns for both SABAs?
- hypersensitivity rxn
- angioedema
- hypotension
- anaphylaxis
- hypokalemia
- arrhythmia
- hypertension
- angina
- bronchospasm, paradoxical
- cardiac arrest
- hyperglycemia
79
Which drug can get confused w/ Levalbuterol {Xopenex]
Xanax
80
How many hours does do LABAs provide bronchodilation after a single dose?
12 hrs
81
List LABAs
- Salmeterol
- Formoterol
82
What other medication are LABAs usually added with and used as controller medication?
ICS
83
Can LABAs be used as monotherapy in asthma?
NO
84
Uses for both LABAs
- asthma, maintenance tx
- exercise-induced bronchospasm
- COPD, maintenance tx
85
BB warnings for both LABAs
- asthma-related death: when used as monotherapy
- can incr asthma-related hospitalization in peds & adolsc pts
86
Common Rxns for LABAs
- Headache
- throat issues
- Nasal issues
- Urticaria/rash
- Palpitations/Tachycardia
- Tremors
- Nervousness
87
Direct-acting cholinoceptor stimulants' do what to the lungs?
- bronchial muscle (contraction-bronchoconstriction)
- bronchial glands (secretion)
88
Muscarinic antagonist is given by which deliver mechanism?
inhaler
89
Muscarinic antagonist bind to what and do what?
- bind to muscarinic receptors
- block acetylcholine to lessen smooth muscle contraction
90
Name a SAMA?
Ipratropium bromide
91
How long does Ipratropium last?
4-6 hours
92
Name a LAMA?
Tiotropium
93
How long does Tiotropium last?
24 hours
94
How do muscarinic antagonist compare to B2-agonist?
- less effective for asthma
- more effective for COPD
95
Uses for Ipratropium [Atrovent]
- COPD, maintenance tx
- mod-severe asthma exacerbation
96
What is the drug of choice for patients w/ intolerance to SABA or bronchospasm due to B-block meds?
Ipratropium [Atrovent]
97
SEs: SAMAs & LAMAs
- glaucoma, angle-closure
- prostatic hypertrophy
- bladder neck obstruction
98
Uses: Tiotropium [Spiriva]
COPD, maintenance tx
99
Study Slide 114 & 115 10 mins
DONE
100
Name DOACs
- Dabigatran
-Rivaroxaban
- Apixaban
- Edoxaban
101
Which two DOAC can be used as monotherapy?
Rivaroxaban & Apixaban
102
patients treated w/ dabigatran or edoxaban must first receive ___.
- 5 - 10days or parenteral anticoag
- DOAC is started when the parenteral agent is stopped
(no overlap is req)
103
List the DOAC?
- Apixaban [Eliquis]
- Rivaroxaban [Xarelto]
104
Apixaban [Eliquis] Serious Rxns
- bleeding
- thrombocytopenia
- thrombosis
- hypersensitivity
- syncope
105
Apixaban [Eliquis] Common Rxns
- bleeding
- anemia
- nausea
106
Apixaban [Eliquis] & Rivaroxaban [Xarelto] Uses
Prophylaxis
- Thrombus/stroke
- DVT/VTE
- DVT/VTE tx
107
How long must you wait to remove an epidural catheter after last dose of rivaroxaban dose?
> 18hr
108
How long must you wait to give a dose of rivaroxaban after an epidural catheter?
> 6hr
109
What are the BB warnings for both direct oral anticoagulants?
Tx discont: incr thrombotic event & stroke risk
Epidural/Spinal Hematoma Risk
110
What can be given for life-threatening or intracranial hemorrhage due to heparin or LMWH?
protamine sulfate
111
Major bleeding from warfarin is best managed w/
prothrombin complex conc
112
With less serious bleeding what can be given instead of coag?
fresh-frozen plasma or intravenous Vit K
113
Describe the length & intensity of anticoag
a balance b/t risk of reoccurrence of VTE & risk of bleeding
114
Risk of VTE usually goes ___ over time
down
115
Risk of bleeding goes ___ w/ length of anticoag
up
116
Duration of tx of VTE: underlying significant thrombophilia
indefinite
117
Duration of tx of VTE: cancer-related
>/= 3-6 mos
or
as long as cancer is active
118
Duration of tx of VTE: recurrent unprovoked
indefinite
119
Duration of tx of VTE: unprovoked
at least 3mos
120
Duration of tx of VTE: provoked by major transient risk factor
3mos
121
What is the recommended anticoagulant of choice in pts. w/ cancer & venous thromboembolism
LMWH
122
After completing anticoagulation therapy, what should be recommended for pt. to take?
Aspirin
123
What should be used for the prevention of stroke in pts w/ Afib w/ mod-server mitral stenosis
Vitamin K
124
3rd most common CV cause of death in the US
VTE/PE
Block 2
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