Asthma
What guidelines are the 'gold standard' for asthma?
Global Initiative for Asthma (GINA)
What is the FEV1/FVC value to confirm COPD diagnosis?
< 70%
Which 4 typical bacteria are most common pathogens for community acquired pneumonia (CAP)?
Bonus:
Which 3 atypical bacteria are most common pathogens for community acquired pneumonia (CAP)?
Typical:
1. Streptococcus pneumoniae
2. Haemophilus influenzae
3. Moraxella catarrhalis
4. Staphylococcus aureus
Atypical:
1. Mycoplasma pneumoniae
2. Chlamydia pneumoniae
3. Legionella pneumoniae
What are some nicotine withdrawal effects that we should counsel patient's on should they want to quit smoking?
Restlessness, headaches, tremors, difficulty concentrating, insomnia, increased coughing, irritability, decreased heart rate, increased appetite, fatigue, depression, constipation/upset stomach, anxiety, cravings
Name brand for tiotropium bromide and olodaterol?
Stiolto Respimat
What are the two main stay treatment options for patients with asthma?
LOW DOSE ICS/FORMOTEROL
ALT: ICS (maintenance) + SABA (rescue)
What 2 criteria determine COPD groups for treatment (ABCD)?
1. Symptoms (mMRC or CAT)
2. Risk (exacerbation history)
Four antibiotic classes for outpatient treatment of CAP in adults?
1. Beta Lactams (EX: Amoxicillin, Amox/Clav, Cefuroxime)
2. Respiratory FQ's (EX: Levofloxacin, Moxifloxacin)
3. Tetracyclines (EX: Doxycyline)
4. Macrolides (Ex: Azithromycin, Clarithromycin)
What are the 5 A's of tobacco cessation approach for pharmacists?
1. Ask
2. Assess
3. Advise
4. Assist (Offer & connect)
5. Arrange (Follow Up)
Contraindications for Bupropion SR use in smoking cessation?
Seizures
Eating Disorders
Binge Drinking
MAO inhibitors
What are the initial treatments for patients with asthma exacerbation?
SABA 4-10 puffs q20m x1h
+
Prednisolone 40-50 mg (adult)
+
Supplemental oxygen sat goal >93%
What are the three cardinal symptoms of Acute COPD Exacerbations?
1. Dyspnea
2. Increased Sputum production
3. Increased Sputum purulence
General Treatment Approach in terms of coverage for HAP?
Antipseudomonal Beta Lactam
+
Antipseudomonal non-BL
+
MRSA Coverage
Duration: 7 days
Patient John Doe is interested in quitting smoking. He tried to quit 3 years ago using nicotine gum, but it didn't help. He now wants to try again and is interested in the patch due to his busy work life. He recently cut down to less than a pack a day. Currently smokes 15 cigarettes a day and starts right smoking about an hour after he wakes up after a shower and some coffee. Which strength patch should we suggest for John?
21m
> 10 cigarettes a day
Taper: 21 mg x6 wks > 14 mg x2 wks > 7 mg x 2 wks
Which inhalers need to be shaken before use?
MDI (usually HFA inhalers)
- Exception: Alvesco (not required but will not hurt)
Breath-Actuated Inhalers (Redihaler or autohaler)
- Ex: Qvar Redihaler
- Exception: Qvar autohaler (must be shaken)
Mary Lou is a 16 y/o female with significant PMH of asthma. She currently takes her Pulmicort (Budesonide) 180 mcg with the directions of 2 puffs twice daily (TDD = 720 mcg). What potency (low/medium/high) category would Mary Lou's dose fall into?
Medium
Budesonide (12 y/o or older)
Low: 200-400 mcg
Med: >400-800 mcg
High: >800 mcg
Vaccinations recommended for all COPD patients
Flu
Pneumococcal
Pertussis
Covid-19
RSV
Which MRSA coverage antibiotic cannot be used in pneumonia?
Daptomycin
Due to becoming inactivated in the binding of pulmonary surfactant and inability to have activity in the alveolar epithelial lining fluid.
Common drug interactions with smoking are caused by an interaction of which CYP gene?
CYP1A2
Ex: Clopidogrel (Increased metabolism of clopidogrel leads to significant increase of platelet inhibition and decrease of platelet aggregation and improved outcomes [smoker's paradox])
What are the two most common pneumonia severity scoring tools?
CURB-65
Pneumonia Severity Index (PSI)
Counsel a patient on how to use their Advair Diskus
1. Patients should first remove inhaler from foil pouch and write the use-by date on the Diskus (30 days from opening)
2. Diskus should be held horizontally, like a hamburger, and should not be tilted or shaken or the powder in the inhaler may be prematurely released from the device
3. Once the mouthpiece cover has been slid open, the lever should be pushed back to activate the Diskus
4. Patients should exhale completely away from the device, then place lips to cover the mouthpiece
5. Patients will then forcefully inhale through the mouth to deliver the dose into the lungs. Patients may hold the dose in the lungs for several seconds before exhaling
6. These inhalers should not be used with a spacing device or holding chamber
7. Because these inhalers contain a steroid, patients should rinse their mouth with water after each use
8. The dose indicator will show how many doses remain, and the inhaler should be discarded once 30 days have passed since opening
9. Given the dose is a powder inside the inhaler, patients should ensure inhaler is stored in a cool, dry space and not cleaned with water at any time. Instead, a dry cloth or tissue may be used to clean the mouthpiece
Reduces inflammation for patients with moderate to severe COPD via inhibition of intracellular cyclic AMP
Pearl: DO NOT COMBINE WITH THEOPHYLLINE
What laboratory marker (other than temperature + WBC) can be used to assess the severity of illness/response to therapy in HAP? When should it be used?
Procalcitonin (PCT)
Not necessary when duration of therapy is already ≤ 7 days
What is the starting taper dose and frequency for Varenicline?
Days 1-3: 0.5 mg daily
Days 4-7: 0.5 mg BID
Day >/= 8: 1 mg BID
Pearls:
CrCl < 30 mL/min: 0.5 mg daily > 0.5 mg BID
Name brand Chantix no longer available
What is Dupilumab?
Dupixent
An interleukin-4 receptor alpha antagonist, is a human monoclonal antibody of the IgG4 subclass.
Dupilumab is indicated as an add-on asthma maintenance therapy for moderate-to-severe asthma in patients with an eosinophilic phenotype or for moderate-to-severe oral corticosteroid (OCS)-dependent asthma but also has use for patients with COPD.