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7118 - Clinical Therapeutics for Core Conditions > Asthma and COPD > Flashcards

Asthma and COPD Flashcards

1
Q

What are the typical symptoms associated with asthma?

A
  • worse at night or early hours of the morning
  • wheeze, breathless, cough
  • worsened by environmental factors
  • personal history of atopic disorder
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2
Q

what can make asthma worse?

A
  • emotion
  • beta blockers/nsaids
  • allergens
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3
Q

What is asthma mediated by?

A

immunoglobulin E and precipitated by allergic response to allergen, IgE is formed in response to exposure to allergens such as pollen or animal dander.
Releasing leucocytes etc
These inflammatory mediators cause bronchospasms which then lead to asthma attack

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4
Q

Main things to look at to diagnose asthma

A
  • physical examination
  • response to medication
  • lung function testing - Spirometry - FEV1
  • medical history
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5
Q

6 points which mean complete control of asthma

A
  1. No daytime symptoms or night time awakenings
  2. No need for rescue medication
  3. No exacerbations
  4. No limitations on activity including exercise
  5. Normal lung function
  6. Minimal side effects from medication
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6
Q

How many doses a week of a reliever inhaler would you need to warrant stepping up therapy in asthma?

A

3

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7
Q

High dose steroids should only be prescribed in asthma when…

A

…a patient has been seen in secondary care

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8
Q

LABA’s must not be prescribed in asthma without…

A

an inhaled steroid. They are an add on therapy.

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9
Q

side effect of beta 2 receptor agonist

A

tremor, palpitations, tachycardia

usually seen when people use higher doses via the nebuliser route

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10
Q

side effect of steroid inhaler

A

oral thrush

dysphonia (horse voice)

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11
Q

side effect of theophylline

A

gastro-intestinal disturbances are common.
These can be minimised by starting a lower dose and increasing to the patients target dose (10-20)
- Other adverse effects are tremors, palpitations, tachycardia, seizures
- Always monitor for drug interactions with theophylline.

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12
Q

Does giving up smoking increase or decrease the concentration of theophylline in the body

A

increase - which can increase side effects.

This is the same with interaction with erythromycin or ciprofloxacin which inhibits its metabolism.

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13
Q

Stages of treatment of an acute exacerbation of asthma

A
  • Oxygen
  • inhaled bronchodialtors (ipatropium may be add if there is not response)
  • systemic steroids (no evidence to say IV>oral however pt may not be able to swallow 8 oral tabs as breathless)
  • IV magnesium sulphate
  • IV aminophylline
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14
Q

what is a low dose corticosteroid

A

clenil modulate 200micrograms twice a day

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15
Q

Why is clenil (beclametasone) 200 , 2 puffs BD equal to symbicort turbohaler 200/12 - 2 puffs BD

A

Symbicort contains budesonide and budesonide is equivalent to the clenil brand beclomethasone.

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16
Q

Which inhalers are licensed for reliever and maintenance therapy in asthma management?

A
  1. Symbicort 100/6 turbohaler
  2. Symbicort 200/6 turbohaler
  3. Fostair 100/6 inhaler
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17
Q

The order of preventer treatments in asthma

A
  1. Budesonide
  2. salmeterol
  3. Montelukast
  4. Prednisolone
  5. Methotrexate
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18
Q

Which LAMA is licensed in chronic/severe asthma?

A

tiotropium respimat

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19
Q

What should all patients receive when having an acute asthma attack?

A

prednisolone

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20
Q

What may cause tachycardia in an acute asthma attack?

A

IV salbutamol

21
Q

What is used off-label in an acute asthma attack?

A

IV Mg sulfate

22
Q

COPD described several conditions including…

A

emphysema and chronic bronchitis

23
Q

COPD should be viewed as a multi-system disease since patients are at risk of extra-pulmonary effects such as…

A

muscle wasting, weight loss, pulmonary hypertension, anxiety, depression and cor pulmonate (right sided heart failure)

24
Q

rare genetic disorder that can contribute to COPD

A

alpha1 antitrypsin dificiency

25
Q

What are the aims of COPD management

A
  • slow the progression of the disease
  • improve the patient’s exercise tolerance
  • reduce the frequency of acute exacerbations
  • prevent premature death from the condition
26
Q

Describe the treatment regime for COPD…

A
  • smoking cessation
  • once off pneumococcal vaccine
  • annual flu vaccine
  • SABA - salbutamol - reliever
  • SAMA - ipatropium (not used as much now as evidence precedes titropium)
  • LABA - salmeterol & formoterol both BD formulations. Indaceterol, vilanterol and oldaterol are OD formulations.
  • LAMA - aclidinium is a BD regime. Tiotropium, glycopyronium and umeclidinum are OD regime. These are usually considered in patients with persistent breathlessness. LABA/LAMA formulations are available.
  • LABA + corticosteroid - severe disease < FEV1 50%. Not all strengths are licensed for COPD
  • Theophylline
  • Mucolytic - carbocisteine.
27
Q

Rofumilast can be used when….

A

Pt has FEV1 <50% and has had two exacerbations in a year despite being treated with LABA LAMA ICS. This can only be started on specialist advice.
This drug was originally rejected by NICE due to suicidal ideation.

28
Q

Side effects of a LAMA

A

Antimuscarinic side effects
dry mouth, urinary retention.
Minimise by suspending LAMA whilst on nebuliser SAMA

29
Q

Monitoring of COPS should include

A
  • FEV1 - although response to treatment may not be reflected in an improvement of this. Spirometry can identify disease progression
  • Quality of life scores (St georges respiratory questionnaire)
  • Exacerbation frequency
  • Exercise tolerance
30
Q

Acute exacerbation of COPD is defined as

A

A sustained worsening of the patient’s symptoms from their usual stable state which is beyond normal day-to-day variations and is acute in onset.

Symptoms include - worsening breathlessness, cough increase sputum production, change in sputum colour (usually green)

31
Q

Treatment of acute COPD exacerbation…

A
  • oxygen - To aim for 88-92%
  • nebuliser bronchodialators - usualyl driven by air
  • systemic corticosteroids (30mg for 7-14 days)
  • antibiotics
  • IV aminophyllline - only if patient does not respond to the above treatment. Loading dose given to patients who where not receiving theophylline prior.
32
Q

Which symptom is more suggestive of COPD than asthma….

A

Chronic productive cough

33
Q

Which is the only intervention proven to reduce mortality in patients with COPD

A

smoking cessation

34
Q

An inhalation treatment that is licensed for COPD not asthma

A

Tiotropium handihaler

35
Q

What treatment can be trialled in patients with persistent cough

A

carbocisteine

36
Q

Treatment which has been associated with an increased risk of pneumonia

A

sere tide accuhaler

37
Q

Inhaled treatment that may cause dry mouth

A

tiotropium (anticholinergic)

38
Q

Drug that may cause gastrointestinal ulceration

A

carbocisteine

39
Q

Which treatment licensed for long-term management of COPD can cause weight loss….

A

roflumilast

40
Q

List some strategies for monitoring patients with COPD

A
  • exacerbation frequency
  • exercise tolerance
  • st georges respiratory questionnaire
41
Q

montelukast is licensed in asthma or COPD

A

ASTHMA

42
Q

List two inhalers licensed in COPD

A

symbicort 400/12 - 1 puff BD

tiotropium respimat - 2 puffs OD

43
Q

What slows the decline in lung function associated with COPD

A

Oxygen therapy

44
Q

which inhaler clicks when you breath in?

A

next haler

45
Q

How do we calculate a pack year

A

Number of cigarettes per day / 20

X number of years smoked

46
Q

Are nebulisers more effective at reducing exaserbations?

A

No

47
Q

Which drugs can worsen a patients glaucoma?

A

Anticholinergocs - ipatropium

Prednisolone

48
Q

COPD & CAP

Appropriate ABX?

A

Doxycycline

It does cover staph aureus but that is irrelevant here

7118 - Clinical Therapeutics for Core Conditions (31 decks)

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