Pulm Pharm
Treating patients with long term ICS for ARDS, which of the following can be avoided by tapering steroids instead of an abrupt stop? A. HPA-axis B. immunosuppresion C. hyperglycemia D. fat redistribution
Answer: A HPA-axis
Which of the following is a LAMA? A. aliclidium B. budesonide C. cidesonide D. alformeterol
Answer: A aciclidium
PE is a 56 year old man who comes to the clinic with a 3-day history of fever, chills, pleuritic chest pain, malaise, and productive cough. In the clinic, his temperature is 102.1 (all other vital signs are normal). His CXR reveals consolidation in the right lower lobe. His WBC count is 14.400 (high), but all other laboratory values are normal. He is diagnosed with CAP. He has not received any antibiotics in 5 years and has no chronic disease states. He is allergic to sulfa drugs. What is the best antibiotic regimen? A. Doxycycline 100 mg BID for 5 days B. Cefuroxime 500 mg BID for 10 days C. Levofloxacin 750 mg QD for 5 days D. Trimethoprim. sulfamethoxazole double strength BID for 7 days
Answer: A doxycycline
A 23 year old woman has been coughing and wheezing about 3x weekly and she wakes up at night about 3x per month. She has never been given a diagnosis of asthma and has not been to a physician "in years". She uses her roommate's albuterol inhaler when she's wheezing. Her activities are not limited by her symptoms. Spirometry today reveals FEV1 82% of predicted. Which medication is best to recommend for her in addition to budesonide/ formoterol MDI every 4-6 hours as needed? A. no additional therapy needed B. oral montelukast 10 mg/day C. Mometasone DPI 220 mcg/puff 2 puffs daily D. Budesonide/ formoterol MDI 80/4.5 mcg per puff 2 puffs daily
Answer: A no additional therapy needed because her budesonide/ formoterol is an ICS + formoterol step 1/2 regimen and she is using it as needed
LC is a 6 year old male with presents with his mom to the clinic with a 24h history of fever and fatigue and decreased oral intake. He weighs 20 kg and has a history of asthma. He tests (+) on a rapid screen in the clinic for Flu A. Which would be the best first-line therapy? A. Zanamivir 10 mg BID for 5 days B. Oseltamivir 45 mg PO BID for 5 days C. Peramivir 240 mg IV single dose D. no treatment
Answer: B Oseltamivir
Which of the following is a soft mist inhaler and provides constant drug delivery? A. Ellipta B. HFA C. Respimat D. Twisthaler
Answer: C Respimat
A 25 year old male presents to the ED with shortness of breath at rest. He is having trouble with conversation. He used 4 puffs of albuterol MDI at home with no resolution of symptoms. His PEF is 38% of predicted. Which therapy, in addition to O2 is best for him initially in the ED? A. O2 alone is sufficient B. give albuterol MDI 8 puffs every 20 min for 1 hour C. give albuterol plus ipatropium by nebulizer every 20 min for 1 hour plus oral corticosteroids D. give albuterol plus ipatropium by nebulizer every 20 min for 1 hour
Answer: C give albuteral + ipatropium + oral corticosteroids because this is the regimen you would give for severe asthma exacerbations because O2 is already being added
Which adverse effect of ICS inhaler can by avoided by mouth wash after every use? A. pneumonia B. bone growth C. oral candidasis (thrush) D. HPA-axis
Answer: C oral candidasis (thrush)
LC's mother is concerned about her other son who is 8 years old with a history of Leukemia and lives in the same house. He weighs 30 kg. Which would be the best prophylaxis option for LC's brother? A. Zanamivir 10 mg BIG for 5 days B. Oseltamivir 45 mg PO BID for 5 days C. Peramivir 240 mg IV single dose D. Oseltamivir 60 mg PO daily for 7 days
Answer: D because the duration is correct and fits his weight category
BP is a 66 year old women who underwent a 2-vessel coronoary artery bypass graft 8 days ago and has been on a ventilator since then. Her temperature is now rising and her chest radiograph reveals a new infiltrate in the right lower lobe. Her medical history includes coronary artery disease with a MI 2 years ago, COPD, and hypertension. All antipseudomonal antibiotics in the instiutuion are active against at least 90% of strains. BP has no known drug alelrgies. Which is the best empiric therapy for BP? A. Cefriaxone 1g IV every 24 hours + gentamicin 7 mg/kg IV every 24 hours + linezolid 600 mg IV every 12 hours B. Piperacillin/tazobactam 4.5 g IV every 6 hours C. Levofloxacin 750 mg IV every 24 hours + linezolid 600 mg IV every 12 hours D. Cefepime 2g IV every 8 hours + tobramycin 8 mg/kg IV every 24 hours _ vancomycin 15 mg/kg IV every 24 hours
Answer: D because you want to have 2 drugs with pseudomonal coverage + 1 MRSA coverage
At first the patient's symptoms were well controlled on your recommended therapy. However, when winter arrived, her symptoms were no longer well controlled and she started using her budesonide/ formoterol MDI 3 or 4 days a week during the day. Which is the preferred treatment change? A. no additional therapy needed B. oral montelukast 10 mg/day C. Mometasone DPI 220 mcg/puff 2 puffs daily D. Budesonide/ formoterol MDI 80/4.5 mcg per puff 2 puffs daily
Answer: D budesonide/formoterol MDI 2 puffs daily because she now moved up to step 3 which is to take the medication daily not as needed since symptoms are most days and getting worse
What is safe to use with a PNC allergy?
Aztreonam
62 year old man was recently given a diagnosis of COPD. Spirometry reveals an FEV1/ FVC 60% of predicted. His symptoms are quite bothersome. He reports walking more slowly than others because of SOB and having to stop to catch his breath every so often when walking on level ground (CAT score 11). He had 1 exacerbation in the past year that did not require hospitalization. Which is the most appropriate patient group classification for him, according to the GOLD guidelines? A. GOLD 1, group A B. GOLD 2, group B C. GOLD 3, group E D. GOLD 4, group E
answer: B GOLD 2, group B based on his FEV1/FVC and CAT score and having 1 exacerbation last year
62 year old man was recently given a diagnosis of COPD. Spirometry reveals an FEV1/ FVC 60% of predicted. His symptoms are quite bothersome. He reports walking more slowly than others because of SOB and having to stop to catch his breath every so often when walking on level ground (CAT score 11). He had 1 exacerbation in the past year that did not require hospitalization. In addition to albuterol 2 puffs every 4-6 hours as needed, which pharmacotherapy option is most appropriate to initiate? A. no additional therapy needed B. Tiotropium/ olodaterol 2.5/2.5 2 puffs once daily C. Troptropium 2.5 mcg 2 puffs once daily D. Salmeterol/ fluticasone 50/500 1 puff twice daily
answer: B Tiotropium/olodaterol 2.5/2.5 2 puffs once daily because this is good for group B or E A. good for group A who only needs a bronchodilator and no other symptoms C. appropriate if he was in group A D. this is a LABA and steroid
64 year old woman with COPD in GOLD patient group A presents for a clinic visit. In the past few days, she has had a worsening of shortness of breath and a productive cough with more "cloudy" and more copious sputum than usual. Pulse oximetry is 95% on room air. She has a nebulizer at home. IN addition to regular use of albuterol plus ipratropium by nebulizer every 1-4 hours, which si the best course of action? A. No additional therapy is necessary B. Add oral prednisone 40 mg once daily for 5 days C. Add azithromycin 500 mg daily for 3 days D. add oral prednisone 40 mg once daily for 5 days and azithromycin 500 mg daily for 3 days
answer: D add oral prednisone 40 mg once daily for 5 days and azithromycin 500 mg daily for 3 days because she has purulent sputum so you have to give a steroid (given to everyone with exacerbation) and an antibiotic
What is the MOA of Dextromethorphan?
decreases the sensitivity of cough receptors and interrupts cough impulse transmission by depressing the medullary cough center
what is the AE of neuraminidase inhibitor that parents should be aware of when given to children?
neuropsychiatric effects (confusion, delirium, hallucination, and/or self-injury)
What is the AE of Linezolid?
short term --> bone marrow suppression/ thrombocytopenia long term --> serotonin syndrome (interaction with antidepressants), peripheral neuropathy, optic neuropathy