Pulmonology 4

  1. Occurs when pleural fluid formation exceeds reabsorption
    pleural effusion
  2. for a pleural effusion to be seen on CXR generally requires ____
    300-400 cc fluid
  3. protein rich pleural effusions are
  4. usually/always bilateral, occasionally R>>L
    effusions due to CHF
  5. pus in pleural space (abscess)
  6. how do you treat an empyema
    chest tube drain
  7. causes of hemothorax
    TB, tumor, trauma, thromboembolism
  8. Acute hypoxemic respiratory failure that occurs after a direct or indirect pulmonary insult that cannot be attributed to heart failure
  9. ARDS chest x-ray is characterized by
    bilateral widespread pulmonary infiltrates
  10. ARDS is characterized by PaO2/FIO2 <= ____
  11. Aspiration, Lung contusion and trauma, Inhalational injury, Pneumonia, Near -drowning
    primary causes of ARDS
  12. Sepsis, Pancreatitis, Hypotension (shock)
    secondary causes of ARDS
  13. associated with a poorer outcome
    secondary causes of ARDS
  14. upon auscultation of lungs in ARDS you will hear
  15. Indications for Mechanical Ventilation typically involves a PaO2 <__mmHg, SaO2 <90% with a elevated PCO2
  16. Treatment of ARDS induced hypoxemia usually requires
    positive pressure ventilation
  17. ARDS: Mechanical Ventilation Lung Protective Strategies use
    small tidal volumes
  18. ARDS: Mechanical Ventilation Lung Protective Strategies consider _____ to minimize elevated lung pressures
    High Frequency Ventilation
  19. Normal mechanical ventilator tidal volume (___ ml/kg IBW)
  20. Large tidal volumes cause _____ in stiff lungs
    high inflation pressures
  21. mechanical ventilator tidal volume in ARDS patient (___ ml/kg IBW)
  22. Positive End Expiratory Pressure
  23. Used to keep alveoli open during the exhalation phase of respiration
  24. Maintains the Functional Residual Capacity (FRC). The FRC prevents atelectasis
  25. Too much PEEP can lead to
    decreased cardiac output and high airway pressure
  26. ARDS has a ___% mortality rate
  27. ARDS has a 90% mortality rate in those with
  28. Respiratory dysfunction resulting in abnormal oxygenation and ventilation severe enough to threaten the function of vital organs
    respiratory failure
  29. Arterial blood gas values consistent with RF: PaO2 value < 60 mmHg, PaCO2 value > __ mmHg, SaO2 value < 90%
  30. The tip of the endotracheal tube should rest at the level of the
    aortic arch
  31. The tip of the endotracheal tube should rest at the level of the
    2 cm above the carina
  32. Does not allow the patient to breathe between ventilator delivered breaths
    Controlled Mechanical Ventilation
  33. Ideal mode for patients that are sedated and paralyzed
    Controlled Mechanical Ventilation
  34. low VT and respiratory rates – allow hypercapnia – minimize high inflation pressures – oxygenation is maintained)
    permissive hypercapnia
  35. method employed to decrease the incidence of barotrauma
    permissive hypercapnia
  36. results when the lung can no longer accomplish adequate gas exchange, often fatal if left untreated
    acute respiratory failure
  37. respiratory compromise is evident when the PaO2 is < __mm Hg on room air
  38. respiratory compromise is evident when the PaCO2 is > __mm Hg
  39. patients in respiratory failure with evidence of severe distress, mental deterioration, or hemodynamic instability usually require _____
    intubation and mechanical ventilation
  40. the adequacy of ventilator settings needs to be determined with repeated ____
    arterial blood gas levels
  41. the current preferred mode of ventilation is
    assisted-control ventilation
  42. in ____ the clinician sets the tidal volume and the lowest allowed respiratory rate, however each spontaneous breath is supported
    assisted-control ventilation
  43. considered the more physiologic ventilatory mode and is associated with a decreased work of breathing
    assisted-control ventilation
  44. the most popular mode of ventilation in the 1980's. often associated with asynchrony of spontaneous breaths and assisted breaths
    intermittent mandatory ventilation
  45. A chronic inflammatory disorder of the airways in which various cells and cellular elements play a role, in particular, mast cells, eosinophils, T lymphocytes, neutrophils, and epithelial cells
  46. PEF or FEV1, PEF Variability > 80%, 20-30%; > 2/wk but < 1/day / > 2 nights/month
    Mild Persistent Asthma
  47. PEF or FEV1, PEF Variability > 80% < 20%;< 2 days/wk / < 2 nights/month
    Mild Intermittent Asthma
  48. Rules of Two: Quick-relief inhaler
    > 2x/wk
  49. Rules of Two: Awaken at night
    > 2x/mo
  50. PEF or FEV1, PEF Variability < 60% - > 30%Continual/Frequent
    Severe Persistent Asthma
  51. PEF or FEV1, PEF Variability > 60% - < 80%; > 30%; Daily /> 1 night/wk
    Moderate Persistent Asthma
  52. Rules of Two: Refill quick-relief inhaler
    > 2x/yr
  53. Inhaled corticosteroids (ICS)
    Long-term Control Medications
  54. Leukotriene modifiers
    Long-term Control Medications
  55. Mast cell stabilizers
    Long-term Control Medications
  56. Methylxanthines
    Long-term Control Medications
  57. Short-acting beta2 agonists
    Quick-Relief Medications
  58. Anticholinergics
    Quick-Relief Medications
  59. Systemic corticosteroids
    Quick-Relief Medications
  60. Potent anti-inflammatory agent
  61. Primary agent in adults with persistent asthma
  62. Prevent symptoms; suppress, reverse and control inflammation
  63. Inhaled route used in long-term management of asthma, Similar efficacy between ICS agents when given in equipotent doses
  64. Osteoporosis, Glucose intolerance, Fluid and electrolyte disturbances, Weight gain, Cushing’s syndrome, Peptic ulcers, Ocular cataracts, Behavioral disturbances
    Corticosteroids: Adverse Effects - Systemic
  65. Oral thrush (candidiasis), Dysphonia, Cough
    Corticosteroids: Adverse Effects -Inhaled
  66. Spacer, Rinse mouth, Use lowest effective dose, Monitor growth in children?
    Corticosteroids: Adverse Effects - Ways to ¯ Risk
  67. Only prescribe in combination with ICS in pts with moderate to severe persistent asthma
    Long-acting Inhaled B2-agonists
  68. Salmeterol (Serevent ®) and Formoterol (Foradil ®)
    Long-acting Inhaled B2-agonists
  69. Stimulate beta2 receptors in the airways smooth muscle relaxation, airway opening, decreased hyperresponsiveness
    Long-acting Inhaled B2-agonists
  70. ADR: tachycardia, tremor, EKG changes if OD, DO NOT USE FOR ACUTE SYMPTOMS
    Long-acting Inhaled B2-agonists
  71. Contains fluticasone and salmeterol
  72. Contains budesonide and formoterol
  73. Antagonize pro-inflammatory effects of leukotrienes
    Leukotriene Modifiers
  74. ADR’s: rare; few cases of LFT changes
    Leukotriene Modifiers
  75. Onset more rapid than inhaled corticosteroids
    Leukotriene Modifiers
  76. Potential role as alternative to low-dose inhaled corticosteroids in mild persistent asthma
    Leukotriene Modifiers
  77. class: Montelukast (Singulair®)
    Leukotriene Modifiers
  78. Class: Zafirlukast (Accolate®)
    Leukotriene Modifiers
  79. class: Zileuton (Zyflo®)
    Leukotriene Modifiers
  80. approved for allergic rhinitis***
  81. Mast Cell Stabilizers
    Mast Cell Stabilizers
  82. Inhibit inflammatory cell activation and mediator release, early and late allergen-induced bronchoconstriction
    Mast Cell Stabilizers
  83. Was first line anti-inflammatory agent in children due to safety profile (but now ICS)
    Mast Cell Stabilizers
  84. Takes 2 weeks for therapeutic response (4-6 week trial recommended)
    Mast Cell Stabilizers
  85. Takes 2 weeks for therapeutic response (4-6 week trial recommended)
    Mast Cell Stabilizers
  86. Potential beneficial effects include bronchodilation, attenuation of early and late phase response to allergen, steroid sparing effect, improved exercise tolerance
  87. Role as an alternative to salmeterol for pts inadequately controlled on inhaled corticosteroids
  88. Used as adjuvant to inhaled corticosteroids for management of nocturnal symptoms
  89. ADR’s and toxicity…
  90. Class: Albuterol (Ventolin®, Proventil®)
    Short-acting Inhaled beta 2-agonist
  91. Class: levalbuterol (Xopenex®)
    Short-acting Inhaled beta 2-agonist
  92. Class: pirbuterol (Maxair®)
    Short-acting Inhaled beta 2-agonist
  93. Indicated for intermittent episodes of bronchospasm
    Short-acting Inhaled beta 2-agonist
  94. Treatment of choice for management of EIB (albuterol 15 min before exercise)
    Short-acting Inhaled beta 2-agonist
  95. Used as needed for chronic asthma
    Short-acting Inhaled beta 2-agonist
  96. Increasing use or > 1 canister/month indicates need to intensify anti-inflammatory therapy
    Short-acting Inhaled beta 2-agonist
  97. Differences: Less forceful spray, Higher cost, Must be primed, Rinse actuator weekly in warm water, Equally efficacious
    HFA Inhalers
  98. May have added benefit with beta-agonist in severe exacerbations
  99. Ipratropium (Atrovent®) Short-acting
  100. Tiotropium (Spiriva®), Long-acting, No role defined for asthma
  101. Same mechanism as ICS
    Systemic Corticosteroids
  102. PO to gain prompt control
    Systemic Corticosteroids
  103. class: Prednisone
    Systemic Corticosteroids
  104. class: prednisolone
    Systemic Corticosteroids
  105. class: methylprednisolone
    Systemic Corticosteroids
  106. Continue until patient achieves 80% of personal best or symptoms resolve (usually 3-10 days)
    Systemic Corticosteroids
  107. Use of this to remove the need for good hand-breath coordination
    Spacers (Holding Chambers)
  108. Results in decreased oropharyngeal deposition and enhanced delivery to the lungs
    Spacers (Holding Chambers)
  109. Recommended for all patients using ICS
    Spacers (Holding Chambers)
  110. Turn liquid medication into a fine mist that is easily inhaled
  111. Pulmicort®, Xopenex®, albuterol, ipratropium available in
    nebulizer form
  112. Monitoring device that measures peak expiratory flow
    Peak Flow Meters
  113. Fastest speed at which one can blow air out of the lungs
    Peak Flow Meters
  114. Should be done in the am and between noon and 2:00pm for 2-3 weeks to establish personal best, then QD
    Peak Flow Meters
  115. >80%: : continue meds as prescribed
    green zone
  116. 50-80%: : double ICS and schedule short-acting beta-agonist
    yellow zone
  117. <50%: Go to ER; start PO steroid
    red zone
  118. URI, Smoke, Dust, Mold, Pollen, Exercise, Cockroaches, Cold air, Emotional extremes, Pet dander, Some foods, GERD, Allergies, Etc…
    Asthma Triggers
  119. a preventable and treatable disease with some significant extrapulmonary effects
  120. Characterized by airflow limitation that is not fully reversible, Progressive, Abnormal inflammatory response of the lungs to noxious particles or gases
  121. characterized by chronic and recurrent excess mucus secretion into the bronchiole tree
    Chronic Bronchitis
  122. occurs on most days during at least 3 months/year for at least 2 consecutive years
    Chronic Bronchitis
  123. characterized by abnormal, permanent enlargement of the airspaces distal to the terminal bronchiole
  124. accompanied by destruction of bronchiole wall, without obvious fibrosis
  125. COPD Staging: FEV1/FVC < 0.70, FEV1 > 80% predicted
    Stage 1 or Mild
  126. COPD Staging: FEV1/FVC < 0.70, 50% < FEV1 < 80% predicted
    Stage 2 or Moderate
  127. COPD Staging: FEV1/FVC < 0.70, 30% < FEV1 < 50% predicted
    Stage 3 or Severe
  128. COPD Staging: FEV1/FVC < 0.70, FEV1 < 30% predicted, or FEV1 < 50% + chronic resp failure
    Stage 4 or Very Severe
  129. double the chance of patients quitting smoking
    Provider intervention
  130. Reduce risk factors; influenza and pneumo vaccination, Short-acting bronchodilator PRN
    Mild (Stage 1)
  131. Scheduled long-acting bronchodilator(s), Rehab
    Moderate (Stage 2)
  132. Inhaled steroids (esp. if mult exac)
    Severe (Stage 3)
  133. Oxygen, Consider surgery
    Very Severe (Stage 4)
  134. beta 2-agonists - Albuterol
    Short-acting bronchodilators
  135. Anticholinergics - Ipratropium
    Short-acting bronchodilators
  136. beta 2-agonists - Salmeterol, Formoterol
    Long-acting bronchodilators
  137. Anticholinergics - Tiotropium
    Long-acting bronchodilators
  138. produce less bronchodilation in COPD patients compared to patients with asthma
    beta 2-agonists
  139. Bronchodilator of choice for acute exacerbations
    Rapid-Acting beta 2-agonists
  140. Produces greater bronchodilation than inhaled beta 2-agonists in COPD pts with fewer side effects; slower onset of action
    Ipratropium (Atrovent®)
  141. Use has not been associated with mortality benefit, 2 puffs QID
    Ipratropium (Atrovent®)
  142. Some studies have shown an improvement in FEV1 as compared to ipratropium, No acute relief of bronchospasm, One inhalation QD
    Tiotropium (Spiriva®)
  143. Combination of albuterol and ipratropium
  144. Toxicities: 60% of pts experience adverse effects at serum concentrations of 20-30 mg/LN,V,D, headache, nervousness, Arrhythmia, seizures (conc. > 35 mg/L)
  145. Shown to improve lung function and reported to improve symptoms
  146. Role is 2nd line: use in pts inadequately controlled on optimal bronchodilatory therapy
  147. Role is 2nd line: use in pts inadequately controlled on optimal bronchodilatory therapy
  148. Defined as Low TLC, VC and normal FEV1/FVC.
    Restrictive” Pattern on PFT’s
  149. Increased permeability, Disruption of basement membrane
    Alveolar Epithelial Injury.
  150. Intra- alveolar, Interstitial
    Fibrin Deposition.
  151. leading to fibrosis.
  152. asbestos, silica, CWP, and avian and organic antigens
    Occupational/Environmental - Exposures Interstitial Lung Disease
  153. bleomycin, methotrexate, cyclophosphamide, amiodarone, and nitrofurantoin
    Drug-induced Conditions - Interstitial Lung Disease
  154. SLE, RA, Scleroderma, and Polymyositis.
    Collagen Vascular Diseases - Interstitial Lung Disease
  155. 2+ hospitalizations/3+ ED visits in past year
    Risk of Asthma-related Death
  156. 2+ canisters SABA per month
    Risk of Asthma-related Death
  157. Poor awareness of asthma symptoms; Lower socioeconomic status; Prior exacerbation
    Risk of Asthma-related Death
  158. Illicit drug use; Major psychosocial or psychiatric illness; Other co-morbidities (CV disease, other lung disease)
    Risk of Asthma-related Death
  159. Frequent assessment; Maintain O2 sat; Use SABA frequently/continuously; Use of corticosteroids
    Asthma Exacerbations
  160. should be integrated into every step of care including:
    Patient education
  161. Xopenex HFA
  162. ProAir HFA, Proventil HFA, Ventolin HFA
  163. Foradil
  164. Serevent
  165. Atrovent HFA
  166. Spiriva
  167. Combivent
  168. NasalCrom
    Cromolyn sodium
  169. Beconase AQ, QVAR
  170. Rhinocort Aqua, Pulmicort Respules
  171. AeroBid
  172. Flovent HFA, Veramyst
  173. Nasonex, Asmanex
  174. Nasacort AQ
  175. Advair Diskus
    Fluticasone - Salmeterol
  176. Symbicort
    Budesonide - Formoterol
  177. Uniphyl
  178. Singulair
  179. Accolate
  180. Zyflo
  181. Isuprel
  182. Xolair
  183. CLASS: Albuterol
    β-2 agonist, short acting
  184. CLASS: Levalbuterol
    β-2 agonist, short acting
  185. CLASS: Formoterol
    β-2 agonist, long acting
  186. CLASS: Salmeterol
    β-2 agonist, long acting
  187. CLASS: Ipratropium
    Anticholinergic, short acting
  188. CLASS: Tiotropium
    Anticholinergic, long acting
  189. CLASS: Albuterol/ipratropium
    β-2 agonist-Anticholinergic
  190. CLASS: Cromolyn sodium
    Mast-cell stabilizer
  191. CLASS: Beclomethasone
  192. CLASS: Budesonide
  193. CLASS: Flunisolide
  194. CLASS: Fluticasone
  195. CLASS: Mometasone
  196. CLASS: Triamcinolone
  197. CLASS: Fluticasone - Salmeterol
    Long acting β-2 agonist Corticosteroid
  198. CLASS: Budesonide - Formoterol
    Long acting β-2 agonist Corticosteroid
  199. CLASS: Theophylline
  200. CLASS: Montelukast
    Leukotriene modifier
  201. CLASS: Zafirlukast
    Leukotriene modifier
  202. CLASS: Zileuton
    Leukotriene modifier
  203. CLASS: Isoproterenol
    β-2 agonist, short acting
  204. CLASS: Omalizumab
  205. ORAL drugs
    Theophylline, Montelukast, Zafirlukast, Zileuton
  206. INJECTION drugs
    Isoproterenol, Omalizumab
Card Set
Pulmonology 4
Pulmonology flashcards made by previous students