ARIs
The first-line treatment for a cough related to an acute respiratory tract infection in a 4-year-old child is:
What are fluids and symptomatic care.
Twenty-year-old Annie comes to the clinic complaining of copious yellow-green eye discharge. Gram stain indicates she most likely has gonococcal conjunctivitis. While awaiting the culture results, the plan of care should be to administer:
IM Ceftriaxone
Doxycycline considerations
During an asthma exacerbation, the patient may need to increase the use of:
short-acting beta2 agonists
A single ICS used consistently, is an efficacious regime for patients with COPD (True/False)
False
When educating a patient about oral hygiene when starting inhaled corticosteroids (ICS), the provider will tell them to:
Rinse their mouths out after using the ICS to prevent thrush
Patients who should be cautious in using decongestants (sympathomimetics) for an ARI
Patients with cardiac disease/ and or HTN
First-line treatment for blepharitis is:
erythromycin ophthalmic ointment
First-line pharmacologic treatment is aimed at eradicating the pathogens causing staphylococcal blepharitis, and erythromycin 0.5% ophthalmic ointment should provide good coverage.
In the treatment of asthma, fluticasone and budesonide are examples of what type of drug?
inhaled corticosteroids (ICS)
Which class of inhaled medication is the preferred monotherapy for a patient with chronic obstructive pulmonary disorder (COPD) who describes few symptoms but has been hospitalized for an exacerbation in the prior 12 months?
long-acting muscarinic antagonists (LAMAs)
May consider if Sx worsen per CAT Score: LABA/LAMA or LABA/LAMA/ICS if EOS >300 micro/l
Long-acting muscarinic antagonists have the strongest evidence basis of all medication classes for exacerbation prevention in COPD. LABAs are a reasonable choice for monotherapy of patients with increased symptoms but are not as effective in preventing exacerbations. ICSs are not appropriate monotherapy in COPD.
Giselle is a 14-year-old patient who presents to the clinic with symptoms consistent with mycoplasma pneumonia. What is the preferred treatment for suspected mycoplasma pneumonia in an adolescent?
Azithromycin, 5D
Jacob has been diagnosed with sinusitis of bacterial etiology, >14D, and has NKDA. The First line ABX treatment is:
Amoxicillin-clavulanate 875/125mg, BID for 5-7D
What is the cause of the majority of conjunctivitis cases among adults?
Viruses
Causes of conjunctivitis vary among age groups. Among adults, viruses account for the majority of cases of conjunctivitis.
Which treatment is preferred as needed for exercise-induced asthma?
PRN Short Acting Beta2 Agonists (SABA) ex. albuterol INH, ProAir HFA, Ventolin HFA
Which two factors should be used to categorize a patient’s chronic obstructive pulmonary disease (COPD) severity category to guide treatment recommendations?
symptom score and exacerbations
COPD assessment to initiate therapy includes evaluation of symptom score and exacerbation risk. These items are considered in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy. Spirometry values are not considered in the initiation of therapy though play a role in the diagnosis and severity assessment of COPD.
A 9-year-old child who has been previously healthy presents for evaluation of a left ear problem. The child describes pain of the left ear and jaw, which started within the last 2 days. The child denies any change in hearing but notes some fullness. Since school dismissed for the summer, the child has been attending a day camp at a community center, where the child swims a few days per week. The child’s temperature is 97.5°F (36.4°C). Otoscopy reveals inflammation of the ear canal with a small amount of yellow cerumen. The tympanic membrane appears intact and freely mobile with pneumatic otoscopy. Tragal erythema with tenderness to palpation is noted. There is no periauricular erythema or lymphadenopathy.
What is the most likely diagnosis?
What pharmacologic treatment is the most appropriate for this child?
Otitis Externa;
ofloxacin or ciprofloxacin otic Gtts
First-line therapy for OE includes fluoroquinolone antibiotic drops- to cover P. aeuriginosa or S. aureus
A 4-month-old infant is diagnosed with acute otitis media (AOM), which necessitates ABX Rx. What is the most appropriate treatment?
Amoxicillin
All patients younger than 6 months with suspected AOM should receive antibiotic treatment due to diagnostic difficulty and high risk of complications in this age group. Amoxicillin is considered first-line therapy for AOM. Both clindamycin and the macrolides, including azithromycin, are no longer recommended as treatment for AOM due to limited efficacy against Streptococcus pneumoniae and Haemophilus influenzae.
A previously healthy 3-year-old child is diagnosed with bilateral acute otitis media (AOM), the symptoms of which started 2 days ago. Last year, the child received amoxicillin for AOM and developed a maculopapular rash 2 days into treatment.
What would be the safest option for AOM Rx?
Cefdinir oral (will accept cephalosporin)
This child had a reaction to amoxicillin, so use of medications in the penicillin family should be avoided until allergy testing is done. As the child’s reaction was not severe and there is limited cross-reactivity between penicillins and second- or third-generation cephalosporins, cefdinir is an appropriate choice.
Which drug is recommended as initial pharmacologic treatment in group A chronic obstructive pulmonary disease (COPD)?
Bronchodilator
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend use of a bronchodilator as initial pharmacologic treatment in group A COPD.
Use of a combination medication that includes an ICS or use of duel long-acting bronchodilators is the only appropriate choice for initial treatment in group D.
ICS monotherapy is not (not ever) recommended in the management of COPD.
Name a RISK with the use of inhaled corticosteroids (ICS) for the management of chronic obstructive pulmonary disorder (COPD
ICS are associated with an increased risk of pneumonia.
ICS may increase the incidence of pneumonia in individuals with COPD. Factors that support initiating ICS therapy in COPD are the history of hospitalization for COPD exacerbation, greater than or equal to 2 moderate COPD exacerbations per year, blood eosinophils greater than 300 cells/mcL (0.3 × 109/L), and a history of concomitant asthma. If a patient with recurrent exacerbations fails to respond to ICS therapy, use may not be indicated. For a single COPD diagnosis, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline recommendation is for symptomatic therapy with bronchodilators (LABA and/or LAMA) or combination therapy, but not ICS monotherapy. ICS may be tapered or discontinued in individuals who have no exacerbations or who fail to show benefit from their use.
Combining Benzos + diphenhydramine and concurrent etoh use, poses:
CNS Depression, Sedation, Synergistic SEs
Check your PDMP and verify any unknown polypharmacy < recommending first-generation histamines. Provide patient education on combining benadryl with sedatives.
The patient is 24 years old and has uncontrolled asthma, seeking care for an ARI. The patient uses the rescue inhaler on a daily basis. The healthcare provider knows that rescue inhalers should be used as rescue doses, not necessarily every day. What category of maintenance/controller medication would be appropriate monotherapy for stepping up asthma treatment for this patient?
ICS
Which agent reduces intraocular pressure (IOP) by reducing adenylyl cyclase activity, resulting in reduced aqueous humor production?
Timolol and or Ophth beta-blockers
Timolol is a beta-blocker. Ophthalmic beta-blockers act by reducing adenylyl cyclase activity, which in turn reduces the production of aqueous humor in the ciliary body.
Which preventative and annual intervention is recommended in the routine management of asthma in adults?
annual influenza vaccine
Will accept COVID
Which lifestyle intervention has been found to slow the progression of chronic obstructive pulmonary disease (COPD)?
Smoking Cessation
Smoking cessation is an important intervention to modify the disease trajectory in COPD.
Rx Use of ICS and LABA/LAMAs may reduce symptoms and exacerbation frequency and improve health status, but these are not known to alter the course of the disease.
A 62-year-old patient presents for evaluation of cough, which began within the past week. The patient reports bringing up yellow sputum and some chest discomfort with the cough. The patient notes some difficulty breathing, which grows worse with exertion. The patient’s temperature at home in the past 2 days has intermittently been as high as 101°F (38.3°C). The medical history includes hypothyroidism, type 2 diabetes, and anxiety. The patient had anaphylaxis to penicillin in the past. Vital signs in the office reveal a temperature of 100.8°F (38.2°C), heart rate of 104 beats/minute, respiratory rate of 22 breaths/minute, blood pressure of 118/70 mm Hg, and oxygen saturation of 97% on room air. Crackles are heard upon auscultation of the lungs. A chest x-ray reveals infiltrates in the right lower lobe. THe Dx is?
CAP (will accept PNA)
This patient most likely has community-acquired pneumonia. Although pneumonia and bronchitis have symptom overlap of cough, possible sputum production, and possible dyspnea, the patient’s pleuritic chest pain with fever, tachycardia, and tachypnea strengthen the case for pneumonia. Additionally, the chest x-ray shows infiltrates, which further supports a diagnosis of pneumonia. The patient has lower respiratory tract symptoms, which make a diagnosis of acute rhinosinusitis unlikely.