oxacin
fluoroquinolones
terol
beta agonist
tropium
inhaled anticholinergic "prevents bronchospasm" ipratropium (atrovent)
one or
... [Show More] ide
inhaled steriods
-lol
beta blocker
triptan
migraine (constricts cerebral arteries--to not overuse)
mycin
macrolide
-pam
benzo
-dine
h2 blockers (famotidine)
prazole
proton pump inhibitor
-ide
thiazide diuretic
-pril
ace inhibitor
-sartan
ARB
-lol
Beta Blocker
-pine
calcium channel blocker---first line for ISH
-gliptan
diabetic med--no hypoglycemia
-sin
alpha adrenergic blockers (tx BPH)
4 indications for cxr with acute cough
abnormal VS
rales, consolidation
>75 years old
fever
Who gets PPSV23 vaccine??
-single dose 65 or older
-single dose 19-64 if chronic illness, smoker, group home
-Immunocompromised receive another dose at 5 YEAR interval
-ALWAYS get dose at 65 even if received earlier doses as long as 5 Years has passed!!
Bacteria responsible for most pneumonia deaths
Strep pneumonae (Gram -)
Three most common bacteria - CAP
S. Pneumoniae
Mycoplasma pneumoniae (walking pneumonia)
Chlamydophila pneumoniae
Best initial antibiotics for pneumonia if no antibiotic exposure in last 3 months
Doxycycine or Macrolide (Azithromycin or Clarithromycin) ----because they cover for atypicals
Best initial antibiotics for pneumonia if comorbidities or antibiotics in 90 days
-Resp quinolone (levofloxacin, gemifloxacin, moxifloxacin) or IF ALLERGY
-Beta-lactam (PCN or cephalosporin) PLUS macrolide
How long course of antibiotics for pneumonia
3 days longer than s/s of infection.
Pneumonia severity index???
CRB-65
-Confusion
-RR >30
-BP low
-Age >65
What confirms COPD on PFTs???
FEV1/FVC <70%
COPD staging
Bigger number more severe
What med is crucial for COPD patient
SABA!!
Where are beta1 receptors
Heart
Where are beta2 receptors
Lungs
What is the maintenance drug of choice for all levels of asthma?
Inhaled corticosteroid.
What classifies persistent asthma ?
>2 days /wk symptoms; nighttime sx >3 x month
How do postitive PPD readings differ for immunocompromixed patients?
smaller size of induration positive if immunocompromized (>15 mm if healthy, >5mm if HIV)
What does Baciille Calmette Guerin vaccine protect against?
BCG vaccine for TB. Given in other countries.
At what age should you do a f/u CXR after treatment for pneumonia
Anyone over 40
Possible sequelae of long term inhaled steroid use
cataract formation
osteoporosis
rising A1C
What cardiac class is bad for COPD /Asthma
-lol; Beta Blockers...opposite affect of SABA and LABAs
Which patients typically should have higher h&h???
Hgh altitudes, smokers, COPDers
What population "generally" has lower h&h?
>65
Range of "normocytic" MCV rbc
80-90fl
<80 microcytic
>96 Macrocytic
on a cbc, the size of rbc is described by the
MCV
On a cbc, the hemoglobin content of RBCs is decribed by the
MCH (mean corpucular hgb) hypo/hyperchromic??
Normal Hgb
11-15g/dl
normal Hct
33-45%
RDW - what is it ? What is normal?
indicates degree of variation in RBC size (<15 is normal) ...do not want large variation in rbc sizes!
serum iron measures?
measure of iron in circulation (reciprocal with TIBC) egg carton
serum ferritin measures?
iron in storage
TIBC (transferrin)
total Iron binding capacity-reciprocal with iron level
Microcytic , hypochromic anemia
Iron deficiency anemia
Most common causes of iron deficiency anemia
hemolysis
impaired rbc production
blood loss
poor iron absorption (celiac disease)
What do the TIBC and RDW look like in Iron deficiency anemia
TIBC and RDW increased (spitting out small pale cells)
Hgb 8/1%; Hct 24%; MCV 74; MCH 26
Iron deficiency anemia
Foods other than meat rich in iron
dried peas and beans; dark green leafy veggies
When will iron deficient patient start to feel better after placed on supplement
in a few days
Replacement dose of Fe for anemia
150-200 mg/d of elemental iron
What lab value represents adequate iron supplementation has occurred (supplements can stop?)
serum ferritin (normal iron stores)
How do labs for anemia of chronic disease differ from IDA?
Normocytic, normochromic...but can be also Microcytic/ Hypochromic. Serum iron is decreased, but TIBC and Serum Ferritin are normal...Fe will not HELP!!!
Thalassemia
hereditary; microcytic, hypochromic...premature hemolysis. Will have normal Fe, TIBC, Ferritin, and RDW!!! DO NOT GIVE FE!!!!
Pernicious anemia
B12 deficiency often ABSORPTION problem..not dietary deficiency! Macrocytic
What other nutrient should you check with a B12?
Folate!!
Elevated levels of MMA and homocystiene indicate what ????
Sensitive measures of B12 deficiency...B12 needed for metabolism of these
MCV>100
Pernicious anemia
s/s of pernicious anemia
dementia, neuopathy, weakness, elderly, vegans, alcholics, bariatric patients
B12 supplementation
Vit B12 IM every day for one week----then weekly x4----than monthly for life
when do monocytes elevate?
after 24 hours of illness
what does it mean if polys and lymphocytes are close numerically?
think "viral"
Another name for Neutrophils
segs or polys
What if polys are high on WBC
bacterial [Show Less]