Allergy + Asthma Pharm
This is a condition developed by overusing OTC nasal decongestants such as Afrin
rhinitis medicamentosa
In COPD, rescue inhalers can be _______, _______, or __________ combo
SABAs, SAMAs, or SABA/SAMA
Why should supplemental oxygen be used with caution in patients with COPD?
While humans usually have a hypercapnic respiratory drive, chronic hypercapnia in COPDers desensitizes the body and they switch to a hypoxic respiratory drive. Therefore, too much oxygen can depress respiratory drive in COPD patients
The three most common causes of pleural effusion are _______, ______, and ________. Are each transudative or exudative?
Heart failure- transudative
Parapneumonic- exudative
Cancer- exudative
1.
2.
3.
4.
1. consolidation
2. interstitial
3. nodule/mass
4. atelectasis
FEV1/FVC ratio shows obstruction if z-score _______ or percentage ________
A percent change of ______ indicates improvement post bronchodilator
<-1.65; <70%
12
Describe an Allen's test, then describe a negative result
restrict blood flow of both ulnar and radial arteries, then release ulnar artery. Negative result = hand remains blanched for > 15 seconds
For allergic rhinitis, first line treatment is ________. If that is not successful, consider adding __________.
INGCs; Antihistamine spray
Which of these is NOT an acceptable medication combo?
ipatropium/indacaterol
albuterol/aclinidium
ipatropium/revefenacin
ipatropium/revefenacin- DO NOT COMBINE SAMA AND LAMA!
In COPD, inflammatory cells promote mucous gland ________ and airflow obstruction in the _______. This is in part due to loss of elasticity which is an effect of ________
hyperplasia; bronchioles; elastase
On PE in pleural effusion you may find ______ to percussion, _______ tactile remits, and _________ on auscultation
Consolidation is due to pathology that fills __________ with fluid, pus, blood, or cells. ___________ are commonly seen on CXR
airspaces (alveoli)
air bronchograms
Z-score of FEV1 in obstruction:
Mild-
Moderate-
Severe-
Mild: -1.65 to -2.5
Moderate: -2.5 to -4
Severe: < -4.0
Normal ranges for
pH
pCO2
HCO3
PO2
pH: 7.35-7.45
pCO2: 35-45
HCO3: 22-26
PO2: 80-100
Omalizumab (Xolair) is a monoclonal antibody which inhibits the binding of ______ to ________ and _____. It is given as a sub-q injection every _______
IgE; mast cells and basophils; 2-4 weeks
Unlike in asthmaasthma, ________ should not be used as a monotherapy in COPD. They are typically reserved for GOLD Group _
inhaled corticosteroids; E
Asthma is _________ mediated while COPD is ______ mediated
IgE; neutrophil
Describe the 3 components of Light's Criteria
2. Pleural to serum LDH ratio >0.6
3. Pleural fluid LDH > 2/3rd ULN for serum LDH
Infectious pneumonia is classically pneumococcal (caused by ___________). Aspiration pneumonia is typically caused by ____________ and treated with clindamycin
strep pneumoniae
anaerobic organisms
______ is a characteristic shape indicating obstruction on flow volume loops
Coving
underventilation causes:
hyperventilation causes:
respiratory acidosis
respiratory alkalosis
2 days per week; 2 nights per month
Theophylline is a _________ which has a narrow therapeutic index and can cause ____, ______, or ______ at high doses. ________ decreases serum levels
methylxanthine; seizures, arrhythmias, and death; smoking
COPD is most often caused by smoking, but the more specific pathophysiological explanation is an imbalance between ________ and _______.
Proteinases and anti-proteinases
In evaluation of exudative pleural fluid, you discover glucose of 42, pH 7.1, and a predominance of mononuclear cells. This leads you to suspect one of three issues: _______, ________, or ________.
Is this process likely acute or chronic?
infection, malignancy, rheumatic disease
chronic
Enlarged pulmonary vessels on CXR are suspicious for
pulmonary hypertension
DLCO uses _______ to differentiate types of lung disease
Bronchoprovocation challenges use _______ to assess airway responsiveness
carbon monoxide
Methacholine
CO2
ipatropium bromide is contraindicated in patients with (3)
narrow-angle glaucoma, prostatic hyperplasia, or bladder neck obstruction
_______ is a phosphodiesterase-4 inhibitor used as an adjuvant in order to _________. Adverse effects include (8 but name 3 for points)
Roflumilase (Daliresp); prevent exacerbations;
diarrhea, nausea, abdominal pain, weight loss, headache, insomnia, anxiety, depression
While most COPD is caused by smoking, rarely it can be caused by ________. This is genetic with _______ _______ inheritance. Treatment is IV supplementation with ___________
alpha-1 antitrypsin deficiency; autosomal recessive; AAT (alpha-1 antiprotease)
If concern for tuberculosis, add ____________ test
If concern for esophageal rupture or pancreatitis, check pleural fluid _______ level
If concern for chylothorax, check pleural fluid ______ and ______ levels
If concern for SLE, check ________
adenosine deaminase
amylase
triglyceride; cholesterol
pleural ANA
Interstitial opacities involve lung ________. Interstitial or diffuse pneumonias are causative, with the former being caused by ______, ______, or _______ agents
mycoplasma, viral, fungal
Increased residual volume in the setting of obstructive disease suggests _______. The z-score should be ______ to be considered increased
air trapping; > +1.65
Diarrhea causes __________ and vomiting causes ________
metabolic acidosis; metabolic alkalosis
You place a patient on a combination inhaler with a LABA/ICS and does not have noticeable improvement in their symptoms. You want to switch them to a different combination inhaler. Should the LABA, ICS or both be different in the new inhaler? Why?
LABA only; all ICS are equally effective in equipotent doses
Which LAMA cannot be used in hepatic impairment and has not been studied in end-stage renal disease?
Revefenacin (Yupelri)
______ T lymphocytes contribute to inflammation in asthma, as opposed to ______ T lymphocytes in COPD
CD4; CD8
In total and differential cell counts in pleural fluid, a high lymphocyte count usually suggests _______ or _______, but can also be seen after what procedure?
cancer or tuberculosis; CABG
Atelectasis is seen as increased ______ on CXR but represented decreased ________. The apex is usually seen at or near the ________
density; volume; hilum
The gold standard for measurement of lung volumes is
body plethysmography
Interpret this ABG
pH 7.2
pCO2: 32
HCO3: 19
Anion Gap: 16
HAGMA