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Pre-reg Exam 2021 > Asthma > Flashcards

Asthma Flashcards

1
Q

What is chronic asthma?

A

Reversible obstructive airways disease

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2
Q

What are the symptoms of chronic asthma?

A

Coughing, especially at night
Shortness of breath
Chest tightness
Wheezing

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3
Q

What are the SABAs?

A

Short acting bronchodilators

Salbutamol
Terbutaline

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4
Q

What steps in the guidelines do you use a reliever for chronic asthma?

A

All steps

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5
Q

What are the alternatives to SABAs?

A

Ipratropium bromide (SAMA)

If over 12 - Theophylline or oral B2 agonist (bambuterol)

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6
Q

When should you step up the management of asthma?

A

If using inhaler or symptomatic at least 3 times a week

Night time symptoms at least once a week

Asthma attack requiring systemic steroids in last 2 years

Refer is using > 1 inhaler a month

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7
Q

What is step 1 of the asthma guideline?

A

Low dose inhaled corticosteroids

Start BD then reduce to OD if good control

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8
Q

What are the low dose ICS used in step 1 of asthma management?

A 
Mometasone
Fluticasone 
Beclometasone
Budesonide
Ciclesonide
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9
Q

What are the alternatives to low dose ICS used in step 1 of asthma management?

A

Leukotriene receptor antagonist

Theophylline

Inhaled sodium cromoglicate

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10
Q

What is step 2 of the asthma management guidelines?

A

Add LABA to low dose ICS

Combination inhaler

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11
Q

What are the LABAs used in step 2 of the asthma management?

A

Formoterol

Salmeterol

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12
Q

What is step 3 part 1 of the asthma guidelines?

A

No response - stop LABA and increase ICS dose

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13
Q

What is step 3 part 2 of the asthma guidelines?

A

If benefit but control still adequate

Continue LABA

Increase to medium dose ICS

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14
Q

What is step 3 part 3 of the asthma guidelines?

A

If benefit but control still inadequate

Continue LABA

Trial LTRA
LAMA
Or SR theophylline

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15
Q

What is step 4 of the asthma management guidelines?

A

Add fourth drug + high dose ICS

SR theophylline

LAMA - tiotropium bromide

LTRA - montelukast, zafirlukast

Oral B2 agonist tablet - bambuterol

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16
Q

What is step 5 of the asthma guidelines?

A

Add oral prednisolone

Single dose OM to prevent insomnia
Gradually withdraw when stepping down

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17
Q

What is the mechanism of action of the selective B2 agonists?

A

Causes bronchodilation of the bronchi

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18
Q

What are the inhaled short acting B2 agonists?

A

Salbutamol QDS PRN

Terbutaline QDS PRN

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19
Q

What are the inhaled long acting B2 agonists?

A

Formoterol BD

Salmeterol BD

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20
Q

What are the other LABAs used in COPD?

A

Olodaterol
Indacaterol
Vilanterol with umeclidinium

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21
Q

What is vilanterol used with in asthma?

A

Fluticasone

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22
Q

What is the oral B2 agonist tablet?

A

Bambuterol

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23
Q

What is salmeterol used for?

A

Long onset + long action

Not for acute relief or prevention of exercise induced asthma

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24
Q

What is formoterol used for?

A

Short onset + long action

Relievers and preventer
Rv if using more than once a day

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25
Q

What is in fostair?

A

Beclometasone + formoterol

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26
Q

What is in duoresp spiromax?

A

Budesonide + formoterol

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27
Q

What is in symbicort?

A

18 years +

Budesonide + formoterol

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28
Q

What are the side effects of selective B2 agonists?

A 
Hand tremors
Tachycardia
Hyperglycaemia 
Hypokalaemia
CV events
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29
Q

How do the inhaled corticosteroids work?

A

Reduces inflammation in the bronchi

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30
Q

Which inhaled corticosteroids have a twice daily dosing?

A

Beclometasone
Budesonide
Fluticasone
Mometasone (BD/OD)

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31
Q

Which inhaled corticosteroids have a once daily dosing?

A

Ciclesonide

32
Q

Which ICS is a pro drug and so can be used if patient is at risk of oral thrush?

A

Ciclesonide

33
Q

What is step 1 for asthma control in children?

A

Low dose ICS

LTRA if < 5

34
Q

What is step 2 for asthma management in children?

A

Very low dose ICS
LABA if > 5
LTRA if < 5

35
Q

What is step 3 part one for asthma management in children?

A

No response to LABA then stop and increase ICS to low dose

36
Q

What is step 3 part two of asthma management in children?

A

If benefit from LABA but control still inadequate then continue LABA and increase ICS to low dose

37
Q

What is step 3 part 3 for asthma management in children?

A

If benefit from LABA but control still inadequate continue LABA and ICS and consider trial of LTRA

38
Q

What is step 4 for the asthma management in children?

A

Medium dose ICS

Add fourth drug e.g. SR theophylline

39
Q

What is step 5 for asthma management in children?

A

Oral steroid

Maintain medium dose ICS

40
Q

What are the very low dose ICS inhalers used in children?

A

Beclometasone - 200mcg

Budesonide - 200 mcg

Fluticasone - 100 mcg

41
Q

What are the medium dose ICS inhalers used in children?

A

Beclometasone - 400-900 mcg

Budesonide - 800 mcg

Fluticasone - 500 mcg

Ciclesonide - 320 mcg

42
Q

What are the LTRAs used in children?

A

Montelukast

Zafirlukast

43
Q

What are the LABAs used in children?

A

Vilanterol

Formoterol

Salbmeterol

44
Q

What are the oral steroids used in children for asthma?

A

Prednisolone

45
Q

What are the low dose ICS used in adults for asthma?

A

Beclometasone - 100-400 mcg

Budesonide - 400 mcg

Fluticasone - 200-400 mcg

Mometasone - 400 mcg

Ciclesonide - 180 mcg

46
Q

What are the high dose ICS used in asthma for adults?

A

Beclometasone - 800-2000 mcg

Budesonide 1800 mcg

Fluticasone - 1000 mcg

47
Q

What are the LAMAs used in asthma for adults?

A

Tiotropium bromide

48
Q

How long does ICS need to be used for to have an effect on the prevention of asthma?

A

Must take regularly for 3-4 weeks

49
Q

Which inhalers do you need to prescribe by brand name?

A

Beclometasone

Qvar and clenil are not interchangeable

Qvar is twice as potent as clenil as has extra fine particles

Fostair is even more potent than Qvar

50
Q

What age are the beclometasone easyhalers licensed in?

A

18+

51
Q

What age are the qvar inhalers licensed in?

A

12+

52
Q

What are the side effects of ICS?

A

Hoarse throat

Sore throat

Oral candidiasis

Paradoxical bronchospasm

53
Q

How do you prevent oral thrush with ICS?

A

Rinse mouth and brush teeth after using

Treat with daktarin gel

54
Q

Who should you use a large volume spacer for?

A

High dose ICS

Patients under 15

55
Q

What do you do if paradoxical bronchospasm occurs with ICS?

A

Stop and give alternative

Mild bronchospasm - use SABA before or transfer from pMDI to dry powder inhaler

56
Q

Which inhalers should be refrigerated?

A

Trimbow

Fostair

57
Q

Does smoking reduce or increase effectiveness of ICS?

A

Reduces effectiveness

Patient may need higher dose

58
Q

What is the mechanism of action of leukotriene receptor antagonists?

A

Blocks action of leukotriene on the cysteinyl leukotriene receptor in the lungs and bronchi

Reduces bronchoconstriction and inflammation

59
Q

What are montelukast and zafirlukast used for?

A

Chronic asthma

Symptomatic relief of hay fever in asthma

60
Q

What are the side effects of the LTRAs?

A

Churg Strauss syndrome - occurs on withdrawal or reduction of ICS

Zafirlukast - liver toxicity

61
Q

What are the counselling points for zafirlukast?

A

Report signs of liver toxicity

62
Q

What is theophylline?

A

Xanthine bronchodilator

63
Q

Is aminophylline given IM or IV?

A

20x more soluble and too irritant to give IM

64
Q

What is the range for theophylline?

A

10-20 mg/L

Sample 4-6 hours after dose

65
Q

What increases the Cp of theophylline?

A 
Heart failure
Hepatic impairment
Viral infections
Elderly
Enzyme inhibitor
66
Q

What decreases the Cp of theophylline?

A

Smoking
Alcohol
Enzyme inducers

67
Q

Does theophylline need to be prescribed by brand?

A

Yes

68
Q

What are the toxicity signs of theophylline?

A

Vomiting and GI
Tachycardia, CNS stimulation
Arrhythmias, convulsions, hypokalaemia

Fast and sick

69
Q

What are the interactions that cause an increased risk of hypokalaemia when used with theophylline?

A

Loop/thiazide diuretics

Corticosteroids

B2 agonists

70
Q

What are the interactions that cause an increased risk of convulsions when used with theophylline?

A

Ciprofloxacin

Quinolones are enzyme inhibitors and they lower seizure threshold

71
Q

What are the interactions that cause an increased plasma concentration and risk of toxicity when used with theophylline?

A 
Verapamil
CCB
Cimetidine
Phenytoin
Fluconazole
Macrolides
72
Q

What are the interactions that cause a reduced plasma concentration when used with theophylline?

A

St Johns Wort

Rifampicin

73
Q

Is an acute asthma attack an emergency?

A

Yes

Failure to respond requires transfer to hospital

74
Q

How do you treat acute asthma?

A

Salbutamol aerosol inhaler 2-10 puffs every 10-20 mins PRN

OR

Salbutamol/terbutaline nebuliser every 20-30 mins or PRN

If symptoms persist after 15-30 mins - 999
Repeat above and add nebulised ipratropium bromide

75
Q

What do you give in all cases of acute asthma?

A

Prednisolone tablets or IV hydrocortisone

Children < 12 - up to 3 days
Adult - at least 5 days (40-50mg OD)

Pre-reg Exam 2021 (79 decks)

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