2154 Respiratory Flashcards
Codeine & dextromethorphan supply limit + CI
Limit to 240 mL within 4 days
CI: MAOi
cough drugs safe to use in pregnancy (2)
Dextromethorphan & Guaifenesin (lowest dose & shortest duration)
Oral Decongestant caution (4)
- uncontrolled BP
- Glaucoma
- BPH
- Hyperthyroidism
TOP Decongestant ADR + pregnancy alternative
rebound congestion = do not use > 5 days (pregnancy use saline)
Antihistamine caution (3)
- Avoid in elderly with BPH / glaucoma
- Avoid alcohol, opioids, antidepressant
- Pregnancy use chlorpheniramine
intranasal corticosteroids sprays caution (2)
worsen
1. Glaucoma
2. Cataract
Leukotriene antagonist (Montelukast) ADR (2)
- Neuropsychiatric SE
- Behavioural / mood changes
SABA (salbutamol) ADR
- Tremor, muscle cramp
- Tachycardia / palpitation
ICS (steroids) ADR (2)
- Oral Candidiasis –> rinse & spit out water after
- throat irritation, hoarseness, cough
LAMA (Umeclidinium) ADR
Anticholinergic (dry mouth, tachycardia, urinary retention)
COPD Groups & treatment (3)
- Group E: > 2 exacerbation or hospitalisation = LABA + LAMA +/- ICS
- Group B: mMRC > 2 = LABA + LAMA
- Group A: mMRC 0-1 = bronchodilator
mMRC score for COPD (5)
0 = least Sx, breathless when exercise
1 = SOB walking up hill
2 = walks slower, stop for breath when walking normally
3 = stops for breath 100m
4 = too breathless to leave house
Indication for ICS in COPD (3)
- Hx of hospitalisation / asthma
- COPD exacerbations > 2 / year
- Blood eosinophils > 300
Indications for Abx in COPD exacerbation (2)
- worsening SOB
- increase sputum purulence & volume
Criteria to start NRT (4)
- Smoke within 1h of waking
- > 10 cig /day
- Hx of craving / withdrawal in past quit attempts
- Nicotine dependence (>3 in score)
Cig per day (CPD) to NRT patch dose
< 10 CPD= 7 mg
10-20 CPD = 14 / 21 mg
21-30 CPD = 28 mg
31-40 CPD = 35 mg
> 40 CPD = 42 mg
Bupropion SR avoid (3)
- Psychiatric patients (seizure, schizo, bipolar)
- Pregnancy & breastfeeding
- Under 18
Varenicline avoid (3)
- Pregnancy
- ESCKD
- Sx of agitation, depression, suicidal thoughts, behavioural changes
Cisplastin & Carboplatin ADR (3)
- CINV
- Ototoxicity & nephrotoxicity
- Peripheral neuropathy
administration supp with cisplatin (3)
- Vigorous hydration
- IV NaCl pre & concurrent
- KCl & MgSO4 supp (electrolyte)
Pemetrexed avoid (2) + supp (3)
avoid NSAIDs & CrCl < 45
Supp: Folic acid + vit B12 + dexamethasone
Tyrosine Kinase inhibitor (Osimertinib) instruction & DDI
take on empty stomach
DDI with CYP3A4 (PPI, H2RA, statin, warfarin)
Red flag questions for respiratory (4)
- Unintentional weight loss, night sweat (TB)
- Dyspnoea / SOB
- Hemoptysis (vomit blood)
- Long lasting fever > 7d