Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Chapter 3 - Respiratory system > 1. Obstructive airway disease > Flashcards

1. Obstructive airway disease Flashcards

1
Q

What is asthma

A

Inflammation of the airways, due to hyperresponsiveness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Asthma symptoms

A
  • Cough - due to extra mucus
  • Dyspnoea
  • Wheezing
  • Chest tightness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Asthmatic triggers

A
  • Infection
  • Hay fever
  • Dust
  • Pets
  • Smoking
  • Chemicals
  • Air pollution
  • Drugs: NSAIDs, Beta-blockers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Referral criteria that may relate to asthma

A

A cough that wakes you up at night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Asthma guidelines (ADULTS)

A

Step 1: Reliever inhaler - SABA inhaler

Step 2: SABA + Low-dose ICS

Patients will go to step 3 if:
- they use their reliever inhaler 3x a week or more
- have asthma symptoms at least 3x a week
-asthma that waked them up at least 1x a week
-have had an asthma attack in the last 2 years that required oral steroids

Step 3: Low-dose ICS + LABA (as a fixed dose twice a day or as MART regimen composed of a steroid and a LABA)

Consider stopping LABA if there is no response and increase dose of steroid inhaler
or add leukotriene receptor antagonist

If still not controlled, refer to specialist as they may be prescribed theophylline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Asthma drugs treatment

A

Low-dose ICS:
- Beclometasone,
- Budesonide
- Fluticasone
- Mometasone
- Ciclesonide

SABA
-salbutamol, terbutaline

LTRA
-montelukast, zafirlukast

LABA
formoterol, salmeterol

Oral steroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Asthma guidelines (CHILDREN)

A

Regular preventer
Step 1: Very-low dose ICS OR LTRA (for children under 5 years)

Initial add on therapy:
Step 2: Very-low ICS or LTRA and LABA or LTRA
(LTRA for children under 5 years)
If in step 1 patient had LTRA, then in step 2 they would be offered a LABA

Additional controller therapies
Step 3: Increase to low-dose ICS and LABA/LTRA

Step 4 would be seeking specialist advice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Examples of Short-acting beta2 agonists and duration of action

A

Salbutamol
Terbutaline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Uses of short-acting beta2 agonists

A

Commonly used as reliever inhaler in asthma and COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Counselling point associated with short-acting beta2 agonists

A

Important to tell the patient that if the inhaler is not providing at least 3 hours of relief, must seek a doctor. It may mean they require a step up in treatment

Taking more doses of the inhaler may lead to CVS effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Short-acting beta2 agonists side effects

A
  • HypOkalaemia (can lead to hyperglycaemia), (theophylline, corticosteroids also cause HypOkalaemia)
  • Hand tremors (due to activation of the sympathetic system as salbutamol is a sympathomimetic)
  • CVS effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Examples of Long-acting beta2 agonists and duration of action

A

Formoterol - BD
Salmeterol - BD
Vilanterol

Effects last for 12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

LABA’s can be used alone. True or false

A

A LABA must be taken with a corticosteroid. It cannot be used alone. This is why combination inhalers are prefered. However the doses are fixed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Typical long-acting beta2 agonists dose

A

Twice daily (+ Reliever doses if MART)

If a previously effective dose is no longer managing symptoms, patient must visit the GP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Inhaled corticosteroids mechanism of action

A

Directly reduce inflammation on the bronchi and take 7-14 days to work

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Inhaled corticosteroids uses

A

Asthma, COPD

17
Q

Inhaled corticosteroids typical dose

A

Twice Daily (Once-daily if Ciclesonide)

18
Q

Prescribing of beclometasone CFC free inhalers

A

Must be prescribed by brand as QVAR is more potent than Clenil-modulite. QVAR has extra fine particles that better target the lungs.

This rule also applies to combination inhalers that contain beclometasone e.g fostair more potent than other combination inhalers

19
Q

Prescribing of easyhaler

A

Not licensed in patients under 18 years

20
Q

Inhaled corticosteroids side effects

A
  • Oral thrush - due to corticosteroids hitting the back of the throat when inhaling

Patients can use a spacer device or rinsing mouth/brushing teeth after using the inhaler.
It’s fine if patients use oral miconazole gel to manage this.

  • Hoarse voice and sore throat
  • Bronchospasm due to paradoxical effects. if this occurs, STOP treatment
    If it is mild: use SABA before use or dry powder inhaler
21
Q

Leukotriene receptor antagonist mechanism of action

A

Block leukotriene receptors in the lung —-> bronchodilation + anti-inflammatory

22
Q

Leukotriene receptor antagonist uses

A

Used in asthma, can only be used in hay fever

23
Q

Leukotriene receptor antagonist - Montelukast dose

A

Taken at night

Montelukast is the only leukotriene receptor antagonist available in the UK

24
Q

Leukotriene receptor antagonist - Montelukast side effects

A

-Neuropsychiatric reaction
presenting as speech impairment.
Patients must seek medical help if speech, behaviour changes, obsessive-compulsive disorders

-Churg-Strauss syndrome
Inflammation of blood vessels, restricting blood flow to organs/tissues
Usually occurs when steroid dose is stopped or withdrawn

25
Q

Theophylline mechanism of action

A

Causes bronchodilator

26
Q

Theophylline uses and dose

A

Severe asthma, COPD

Theophylline must be taken every 12 hours orally

27
Q

Theophylline therapeutic index

A

10-20mg/L

Plasma concentration is taken every 4-6 hours

Once stabilised, no need for continuous level monitoring

28
Q

Factors which impact theophylline levels

A

Smoking can increase clearance of theophylline and reduce theophylline levels

Heart failure, viral infection, elderly, liver impairment can increase theophylline levels

29
Q

Prescribing theophylline

A

Must be prescribed by brands, as brands are not bio equivalent

30
Q

Signs of theophylline toxicity

A

C - convulsons, CNS dilated pupils
H - HypOkalaemia, HypERglycaemia
A - arrhythmias
T - tachycardia
V - vomiting (severe haematemesis)

31
Q

Theophylline interactions

A

Theophylline is metabolised by cytochrome P450 enyzmes

Enzyme inhibitor Drugs which increase theophylline levels:
cimetidine, clarithromycin, erythromycin

Enzyme inducer drugs which increase theophylline levels:
carbamazepine, phenytoin, rifampicin, st John’s wort

Interacts with beta blockers. Beta blockers cause bronchospasm which antagonises the bronchodilating effect of theophylline

Theophylline interacts with ciprofloxacin, to increase the risk of seizures. Seizures are also a side effect of both drugs

Interacts with drugs which also cause hypOkalaemia: loop and thiazide diuretics, cortiosteroids, beta 2agonists e.g salbutamol

Interacts with drugs that prolong the QT interval:
antipsychotic drugs, anti-arrhythmic drugs (amiodarone, sotalol), clarithromycin, erythromycin, citalopram, escitalopram, clomipramine, hydroxyzine, lithium, methadone, quinolones, 5-HT3 antagonists e.g ondansetron

As drugs which prolong the QT interval and drugs which cause hypokalaemia, when combined, increase the risk of torsades de pointes

32
Q

Types of inhaler devices

A
  1. Pressurised metres-dose inhaler
    Requires breathing in slow and steady whilst actuating
    Important for patients to remove cover, shake inhaler before use and check mouthpiece to check for loose objects. Then replace cover
  2. Dry-powder inhaler
    Requires you to breathe in fast and deep
    No coordination needed between breathing and actuation
    However can cause coughing
  3. Breath-actuated inhaler
    Requires to breath in slow and steady
    Automatically releases a dose when breathing in, so overcomes co-ordination problem
33
Q

Benefits of a spacer

A

Spaces reduce the speed of the inhaler and prevent it from hitting the back of the throat (ideal for preventing oral thrush)

34
Q

How to use a spacer

A

Inhale ASAP after dose actuation

Must be replaced every 6-12 months

Can be cleaned once a month with warm water and mild-detergent then Air-dry.

Specific to certain devices

35
Q

What is ‘peak expiratory flow’

A

How quickly you can blow air out of your lungs, following a deep breath

36
Q

PEF (peak expiratory flow) targets

A

Good asthma control
PEF > 80%

If PEF<80%, patients must quadruple ICS dose, to prevent an asthma attack and reduce the risk of needing oral steroids

PEF < 60%, patient must start oral steroids

PEF<50%, URGENT MEDICAL ADVICE

37
Q

Medical emergency acute asthma

A

Mild-moderate cases

  • Salbutamol pMDI AND spacer
    Take 2-10 puffs every 10-20 minutes or PRN
  • Oral prednisolone
    Adult and child 12+: 40-50mg OD for at least 5 days
    Children 11 and under: up to 3 days

Severe, life-threatening, below 2 years or unresponsive:
-Hospital

38
Q

A serious side effect of tiotropium

A

Glaucoma

Patient’s must report blurred vision, red eyes, rings around lights

Acute angle closure-glaucoma has been reported with nebulised ipratropium

Chapter 3 - Respiratory system (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions