Pharm II Midterm

GOLD Grades (FEV1 % Predicted) for COPD

1: ≥ 80

2: 50-79

3: 30-49

4: < 30

≥ 2 moderate exacerbations or ≥ 1 leading to hospitalization initial treatment for COPD

LABA + LAMA

what does eosinophil level need to be equal or greater than to consider adding ICS to LABA + LAMA initial treatment for COPD

300

initial treatment for 0 or 1 moderate exacerbations (no hospitalizations) and mMRC is 0-1, CAT <10 for COPD

bronchodilator

initial treatment for 0 or 1 moderate exacerbations (no hospitalizations) and mMRC is ≥ 2, CAT ≥ 10 for COPD

LABA + LAMA

which LABA/LAMA has greater efficacy for COPD

indacaterol/glycopyrrolate

LOOK AT FOLLOW UP PHARM TREATMENT FOR COPD

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regular treatment with ICS for stable COPD increases the risk of __

pneumonia

blood eosinophil count < __ % increases risk of pneumonia, no matter if using ICS or not for COPD

2

long term ___ therapy reduces exacerbations over one year (esp. smokers) in COPD

azithromycin

what is the only biologic therapy for COPD

dupilumab

what to consider for treating dyspnea in COPD pts with severe disease

opioids

what is an add on therapy for COPD that is an inhaled PDE 3 & 4 inhibitor

Ensifentrine (Ohtuvayre)

SE of Ensifentrine (Ohtuvayre)

back pain, HTN, UTI, diarrhea, CYP2C9 inhibitor

which COPD medication is a PDE-4 inhibitor

Roflumilast (Daliresp)

SE of Roflumilast (Daliresp)

weight loss, suicidal ideations, diarrhea, weight loss, nausea, HA, back pain

when is Roflumilast (Daliresp) contraindicated

moderate to severe liver impairment and in nursing mothers

what is used in COPD for those with antitrypsin deficiency and established emphysema

ɑ1 - Antitrypsin Augmentation Therapy

which drug class for COPD can be used long term that reduces exacerbations and improves survival

beta blockers

acute management of mild COPD exacerbation

SA bronchodilator (Albuterol or ipratropium)

acute management of moderate COPD exacerbation

SA bronchodilators + antibiotics and/or oral corticosteroids

order of CF treatment

Albuterol

Hypertonic saline

Dornase alfa

Aerosolized antibiotic

which 3 drugs to use concurrently in CF for airway clearance and mucous thinning

Dornase Alfa (Pulmozyme)

Hypertonic Saline (7% NaCl)

Mannitol (Bronchitol)

which 2 antibiotics can be used for chronic suppressive therapy in CF

azithromycin or tobramycin (TOBI)

what to use for acute exacerbations of CF that targets infection control

IV antibiotics

what can you use PRN for CF inflammation reduction

ibuprofen or corticosteroids

CFTR modulator for G551D and other gating mutations

Ivacaftor (Kalydeco)

CFTR modulator for F508del homozygous mutations

Lymacaftor/Ivacaftor (Orkambi)

CFTR modulator for F508del (homozygous or heterozygous) and other mutations

Elexacaftor/Tezacaftor/Ivacaftor (Trikafta)

first line treatment for acute TB infection

Rifampin, Isoniazid, Pyrazinamide, Ethambutol + B6

Rifampin SE

orange/brown body fluids, yellow skin/eyes, CYP450 inducer

Isoniazid SE

decreased appetite, dark urine, yellow skin/eyes, pale stools, serotonin syndrome, vision changes rare (red/blue), peripheral neuropathy, hepatotoxicity, seizures

Pyrazinamide SE

decreased appetite, increased uric acid (joint/muscle pain) → gout, photosensitivity, hepatotoxicity

Ethambutol SE

vision changes (optic neuritis), red/green color blindness, vision blurring

which medications have a risk of SJS/TENS

lamotrigine, carbamazepine, ethosuximide

second line TB medication Amikacin - aminoglycoside SE

ototoxicity and nephrotoxicity

which drugs in RIPE can cause hepatotoxoicity

Rifampin, Isoniazid, Pyrazinamide

3 multiple choice options

preferred treatment for latent TB and length of time

Isonazid + Rifampin: 3 months

3 multiple choice options

what to always give with Isonazid to reduce SE

B6 (Pyridoxine)

after giving RIPE + B6 for 2 months in drug susceptible TB, give __ for __ months

Isonaizid, Rifampin, B6 for 4 months

which TB med needs B6 to limit SE

isoniazid

1st line treatment for MDR-TB

Bedaquiline, Pretomanid, Linezolid, Moxifloxacin for 6 months

NYHA PAH class with no symptoms

I

NYHA PAH class with no symptoms at rest, but symptoms with ordinary activity

II

NYHA PAH class with no symptoms at rest, but limitation of activity

III

NYHA PAH class with dyspnea/fatigue at rest, cannot perform activity without symptoms

IV

1st line treatment drug class in PAH for patients who test (+) in vasoreactivity test

calcium channel blockers

calcium channel blocker drugs

Nifedipine, Diltiazem, Amlodipine

calcium channel blocker SE

systemic hypotension, LE peripheral edema

which calcium channel blocker has significant negative chronotropic and inotropic effects, avoid with ↓HR

diltiazem

1st line therapy for moderate PAH (functional class II-III)

PDE-5 inhibitors

PDE-5 inhibitor drug examples

Sildenafil, Tadalafil, Vardenafil, Riociguat

PDE-5 inhibitor MOA

increases cGMP and cAMP by preventing their breakdown → dilation/relaxation

PDE-5 inhibitor SE

HA, dizziness, flushing, vasodilation, vision and hearing lost, priapism

which SE to know for Riociguat

syncope

what to avoid in those taking PDE-5 inhibitors and why

avoid nitrates and alpha adrenergic drugs due to hypotension

Prostaglandin I2 Analogs (PGI2) MOA

increases CAMP levels, vasodilation, antiaggregant of platelets, antiproliferative action on the cells

Prostaglandin I2 Analogs (PGI2) drugs

Iloprost, Epoprostenol, Treprostinil

Iloprost (inhaled) has which SE

dizziness, HA, flushing, syncope

which PGI2 is 1st line therapy for severe PAH (functional class IV)

Epoprostinol (IV)

Epoprostinol (IV) SE

HA, dizziness, flushing, nosebleed, increased risk for bleeding

which PGI2 can cause rebound PAH and death

Epoprostinol (IV)

1st line PGI2 for PH due to ILD

Treprostinil (IV)

Endothelin Receptor Antagonists (ERA) MOA

blocks effects of endothelian-1, a potent vasoconstrictor and promoter of smooth muscle proliferation, by inhibiting its action at ETA and/or ETB receptors

nonselective Endothelin Receptor Antagonists (ERA) drugs

Bosentan, Macitentan

selective Endothelin Receptor Antagonists (ERA) drugs

Abrisentan and Sitazisentan

Endothelin Receptor Antagonists (ERA) SE

hepatotoxicity

what drug should be given to all patients with PAH

warfarin

class of medications for HTN that target cardiac output

BB, CCB, diuretics

using BB in diabetics can mask symptoms of

hypoglycemia

ACE-i MOA

stop enzyme that converts angiotensin I to angiotensin II (stops constriction of blood vessels)

ACE-i medications end in ___

-pril

2 main SE of ACE-i

angioedema and cough

DO NOT combine __ with __ (2 HTN drug classes)

ACE-i, ARB

ARB MOA

block action of angiotensin, thus preventing constriction of blood vessels

ARB medications end in ___

-sartan

ARB SE

hyperkalemia, orthostatic hypotension

when to take ARBs due to SE of orthostatic hypotension

night

ARNi drug combo

Sacubitril/Valsartan (Entresto)

Sacubitril/Valsartan (Entresto) SE

AKI, angioedema, hyperkalemia, hypotension

B1 selective BB drugs

Bisoprolol, Atenolol, Nebivolol, Metoprolol, Esmolol

Non selective BB drugs

Carvedilol, Labetalol, Propranolol, Timolol (optic), Sotalol

SE of BB

sexual dysfunction, fatigue, depression

A1 selective blocker drugs

Prazosin, Terazosin, Doxazosin

which drug class is centrally acting, is last line, and needs to be tapered off for HTN

Alpha-2 Adrenergic Agonist

Alpha-2 Adrenergic Agonist drug examples

Clonidine, Guanfacine, Methyldopa

Alpha-2 Adrenergic Agonist MOA

binds to alpha-2 adrenergic receptors in the brain and reduces sympathetic outflow

hypertensive urgency treatment

clonidine

Clonidine and Guanfacine: used for ____ HTN

resistant

A2 Adrenergic Agonist SE

sodium and fluid retention on chronic use, orthostatic hypotension, dizziness, anticholinergic effects

if A2 Adrenergic Agonist (ex. clonidine) are d/c abruptly, risk for ___

rebound HTN

CCB MOA

dilate arteries to decrease peripheral vascular resistance, reduce workload of the heart, thus the blood pressure

when are CCB CI

heart failure, pts with pitting edema

LABA monotherapy BBW

death

ACEi/ARB BBW

avoid in pregnancy

which RIPE TB medication do you need to avoid tyramine rich fods

isoniazid

1st line HTN drug class for African Americans

CCB

Dihydropyridines end in

-pine

do dihydropyridines work at the heart or peripherally

peripherally

Non-Dihydropyridines drug examples

Phenylalkylamine - Verapamil (Isoptin, Calan, Verelan), Benzothiazepine - Diltiazem (Cardizem, Tiazac)