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4TH YEAR - CPTP > Asthma/COPD > Flashcards

Asthma/COPD Flashcards

1
Q

What is step 0 of the BTS asthma guidelines?

A

SABA (PRN) - salbutamol

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2
Q

What is step 1 of the BTS asthma guidelines?

A

+ Low dose ICS (daily) - beclometasone, fluticasone

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3
Q

In what case does a person move from step 0 to 1?

A

Using inhaler >3x a week

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4
Q

What is step 2 of the BTS asthma guidelines?

A

+ LABA (daily) - salmeterol

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5
Q

What is step 3 of the BTS asthma guidelines?

A

A few options

  • stop LABA, increase ICS
  • continue LABA, increase ICS
  • continue LABA, add montelukast, theophylline or a LAMA (tiotropium bromide)
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6
Q

How does montelukast work? Adv/Disadv?

A

Inhibit cysteinyl 4 receptor
Adv: very few side effects
Disadv: less effective

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7
Q

How does theophylline work? Adv/Disadv?

A

Phosphodiesterase inhibitor - raises cAMP and activates PKA, thus inhibiting leukotriene synthesis
Adv: very effective
Disadv: narrow therapeutic index

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8
Q

In which cases would you use a LAMA?

A

Patients who can’t tolerate adrenergic agonists, due to cardiac problems

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9
Q

What is step 4 of the BTS asthma guidelines?

A
  • Increase ICS dose to high
  • Addition of a 4th drug
    • LTRA
    • SR theophylline
    • LAMA
    • B agonist
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10
Q

What is step 5 of the BTS asthma guidelines?

A
  • Daily steroid tablet

- Consider other treatments eg. omalizumab

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11
Q

In what circumstances does a patient qualify for omalizumab?

A

Over 4 courses of oral steroids a year

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12
Q

What drugs are contraindicated in asthmatics, and what can you use instead?

A

NSAIDS - use clopidogrel

B blockers - use prostaglandin

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13
Q

Describe the pathway of synthesis of the inflammatory markers in asthma

A
  • Phospholipids are converted to arachidonic acid by phospholipase A1
  • Arachidonic acid is broken down to prostaglandins and leukotrienes by COX and 5-lipoxygenas respectively.
  • Inflammatory changes seen in asthma
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14
Q

What do prostaglandins do?

A

Bronchoconstriction

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15
Q

What do leukotrienes do?

A

Bronchoconstriction
Mucus secretion
Recruitment of immune cells

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16
Q

What features are indicative of a severe asthma attack? Should you admit?

A

PEFR < 50%
RR > 25
HR > 110
Cant complete sentences

Admit to hospital if features persist after initial therapy

17
Q

What features are indicative of a life-threatening asthma attack? Should you admit?

A

PEFR < 33%
02 <92%
Normally pac02 (means patient is tiring)
Silent chest

ADMIT

18
Q

How is an asthma attack managed in the community?

A
  1. Give 02
  2. Give beta agonist
  3. Give prednisolone

If secondary to bacterial infection, give amoxicillin

19
Q

How is an asthma attack managed in hospital?

A
  1. Give 02
  2. Give salbutamol + ipatroprium NEB
  3. Give prednisolone PO or hydrocortisone IV
  4. Do ABG
  5. Repeat nebs
  6. Consider IV mag sulphate (seizures)
  7. Abx if indicated

PEFR should be monitored 30 mins post treatment, also do oximetry and repeat ABGs if needed.

20
Q

Which abx should be avoided in a patient on theophylline?

A

Clarithromycin/ciprofloxacin as they will increase theophylline levels

21
Q

What should PEFR be before discharging someone after an attack?

A

> 75% of best and diurnal variability of <25%

22
Q

What should they leave hospital with after an acute asthma attack? Follow up appointments?

A
  • Correct inhaler technique
  • Own PEFR meter
  • Oral/INH steroids and bronchodilators
  • Written asthma action plan

See GP in 2 days and hospital in 4 weeks.

23
Q

Describe the stepwise approach to COPD management in a patient with FEV1> 50%

A
  1. Smoking cessation and provide pneumonia/flu vaccine
  2. SABA or SAMA
    • LABA or LAMA
  4. Pulmonary rehab
24
Q

Describe the stepwise approach to COPD management in a patient with FEV1/FVC < 50%

A
  1. Smoking cessation and provide pneumonia flu/vaccine
  2. SABA or SAMA
    • (LABA+ICS) or LAMA
  4. all of them
  5. Pulmonary rehab
25
Q

How are COPD exacerbations managed?

A
  1. Give 02 (aim 88-92%)
  2. Give oral steroids
  3. Give abx (doxy, amoxi)
  4. Give neb bronchodilators
  5. Give NIV
26
Q

What are the indications for NIV in COPD exacerbation?

A

ABG

pH<7.35, H+>45, pCO2>6

27
Q

What are the indications for LTOT?

A

Pa02<8

Pa02 7.3-8 with cor pulmonale

28
Q

What are the indications for ICS therapy in COPD?

A

FEV1 <50%

2 or more exacerbations in the past 12 months

4TH YEAR - CPTP (19 decks)

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