Astham ~ acute vs chronic

Question 1

Asthma symptoms

Answer 1

~ coughing @night
~ SOB
~ Chest tightness
~ Wheeze

Question 2

SABAs

Answer 2

SHORT ACTING BETA AGONISTS
dilate bronchi in ~3.5h

~ Salbutamol (QDS, PRN)
~ Terbutaline (QDS, PRN)

Question 3

Stepping up asthma plan

Answer 3

~ using inhaler x3 a week
~ night time symptoms ONCE a week
~ asthma attack needing steroids in last 2y
~ >1 inhaler per month

Question 4

Low-dose ICS

Answer 4

start BD ==> OD if good control
~ Mometasone, Fluticasone, Beclomethasone, Budesonide (BD)
~ Ciclesonide (OD)a

Question 5

ICS brand specific on prescriptions

Answer 5

~ Qvar and Clenil NOT interchangeable
QVAR = x2 potent as fine extra particles
Fostair = more potent than Qvar/Clenil

Easyhaler = 18+
Qvar = 12+

Question 6

LABAs

Answer 6

LONG-ACTING BETA AGONIST
dilate bronchi in ~12h

usually in combo with ICS!!
~ Formoterol, Salmeterol (BD)
~ Olodaterol/Indacaterol/Vilanterol (COPD)

BRAND = Fostair, DuoResp, Symbicort (18+)

Question 7

Salmeterol

Answer 7

LABA
~ long onset + long action
~ NOT for acute relief / prevention of exercise-induced asthma

Question 8

Formoterol

Answer 8

LABA
~ short onset + long action
~ can be used as reliever + preventer

Question 9

SABA/LABA side effects

Answer 9

~ hand tremor
~ tachycardia
~ hyPERglycaemia
~ hyPOkalaemia
~ CV events (QT prolongation, tachycardia, MI, hypotension)

Question 10

ICS side effects

Answer 10

~ Hoarse voice
~ sore throat
~ oral thrush (rinse mouth/use spacer, or use antifungal gel (not with warfarin!!)
~ paradoxical bronchospasm

Question 11

Large volume spacers for

Answer 11

~ <15y
~ using high-dose ICS

Question 12

LTRA

Answer 12

block leukotriene receptors in lungs / bronchi = reduce bronchoconstriction/inflammation

e.g. Montelukast, Zafirlukast

Question 13

LTRA side effects

Answer 13

~ Churg Strauss syndrome (occurs on withdrawal/reduction of oral steroid)

Question 14

Theophylline is a

Answer 14

xanthine bronchodilator
10-20 mg/L …4-6h after dose

Cp ⬇ = smokers, alcohol, enzyme inducers
Cp ⬆ = HF, hepatic impairment, viral infec, elderly, enzyme inhibitor

BRAND specific !!!

Question 15

Theophylline signs of toxicity

Answer 15

~ Vomiting, GI (D, gastric irritation
~ Tachy, CNS (dilated pupils, agitation, restlessness)
~ arrhythmias, convulsions,
~ hyPOkalaemia

Question 16

Theophylline interactions

Answer 16

~ hyPOkalaemia
~ convulsions
~ Cp and toxicity

Question 17

Acute asthma attack

Answer 17

salbutamol via spacer 2-10 puffs every 10-20 mins or PRN
or
SABA (salbutamol/terbutaline) NEBs every 20-30mins or PRN

+
Prednisolone tabs or IV hydrocortisone
~ <12y = up to 3 days
~ adult = at least 5 days (40-50mg OD)

+ oxygen high flow

Question 18

Theophylline class

Answer 18

Xanthine bronchodilator

Question 19

IV aminophylline vs Theophylline

Answer 19

IV aminophylline = x 20 more potent / soluble
- also too irritant to give IM

Question 20

Theophylline drug range & sample test

Answer 20

10-20 mg/L (55-110 mmol/L)

sample 4-6 hours after dose

Question 21

Theophylline Cp increased in

Answer 21

• HF
• Hepatic impairment
• Viral infections
• Elderly
• Enzyme inhibitors

Question 22

Theophylline Cp decreased in

Answer 22

smokers
alcohol
enzyme inducers

Question 23

Theophylline toxicity

Answer 23

FAST AND SICK

Vomiting, Diarrhoea, GI irritation

Tachycardia, Agitated, Dilated pupils, Restlessness

Arrythmias
Convulsions
hyPO-kalaemia

Question 24

Theophylline + diuretics, steroids, beta-2-agonists

Answer 24

hyPO-kalaemia risk !!