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Pre-reg > Asthma, COPD, Cystic Fibrosis, Allergies and anaphlyaxis, Croup, CF > Flashcards

Asthma, COPD, Cystic Fibrosis, Allergies and anaphlyaxis, Croup, CF Flashcards

1
Q

what’s steps 1 - 5 in the asthma treatment pathway?

A
  1. intermittent reliever - SABA
  2. SABA + ICS
  3. LTRA (NICE) or LAMA (BTS/SGN)
  4. LABA if not already added - can be used with ot without LTRA. Convert fixed dose LABA + oderate ICS into MART
  5. Increase to high dose ICS or initiate
    - theophylline
    - tiotropium
    - oral corticosteroids
    - MAbs
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2
Q

what symptoms must a patient display for an ICS to be added into asthma regime?

A
  • needing SABA 3x a week
  • being symptomatic 3x a week
  • night waking 1x a week
  • using more than 1 inhaler a month
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3
Q

when can LABAs be given to children for management of aasthma?

A

in step 3 as per adult pathway but only for 12yrs+

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4
Q

whats the Clenil dose for children ?

A

50mcg 2PU BD

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5
Q

what age can tiotropium be used?

A

12yrs +

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6
Q

when is the course of action to take if child under 5 is using more than 1 inhaler a month?

A

urgent refferal

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7
Q

what is step 2 for children under 5 in the asthma pathway?

A
  • to start ICS if symptoms uncontrolled by SABA (symptoms 3x a week, night time waking x1 a week)
  • use a paediatric low dose for an 8 week trial
  • if ICS not tolerated use LTRA
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8
Q

when can you think about stepping down asthma treatment?

A

when asthma has been controlled for at least 3 months

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9
Q

how do you step down asthma treatment?

A
  • by maintaining patients are the lowest, effective ICS dose
  • reduce by 25 - 50% every 3 months
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10
Q

what defines complete control in asthma?

A
  • no daytime symptoms
  • no night time waking
  • no asthma attacks
  • no need for rescue medication
  • no limitations on activity including exercise
  • normal lung function (FEV1 and/or PEF >80% predicited or best)
  • minimal side effects from treatment
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11
Q

if someone with COPD has azithromycin prescribed as prophylaxis for the winter, what abx would you want to avoid using in thier rescue pack and why?

A

clarithromycin - becuase is another macrolide so use amoxicillin or doxycycline

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12
Q

what non-drug treatment can be used in COPD exacerbations?

A

positive expiratory pressure helps sputum clearance

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13
Q

what are the options for drug treatment in OCPD exacerbations in hosp and community?

A
  1. SAMA/SABA - withhold LAMA if SAMA given
  2. hospitalised - pred + other therapies (aminophylline, O2)
  3. community - only give pred if sevre breathlessness
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14
Q

why do you not give SAMA and LAMA at same time?

A

muscarininc SE be too much

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15
Q

how long do SABA work for? Name 2 examples

A

4 hours
salbutamol, terbutaline

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16
Q

how long do LABAs work for? Give 3 examples

A

salmeterol, vilanterol, formoterol

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17
Q

what are the cautions around SABAs/LABAs?

A
  • caution in diabetes, can cause DKA especially after IV
  • cause hypokalaemia, increase risk of QT prolongation, increased risk arrhythmias
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18
Q

alongside SABA/LABA what other drugs also increase risk of QT prolongation?

A

corticosteroids, diuretics, theophylline, citalopram, escitalopram

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19
Q

what interaction should you look out for with SABAs and LABAs (narrow TI drug)?

A

digoxin - increased risk of digoxin toicity due to hypokalaemia

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20
Q

what are the muscarininc side effects?

A

constipation, dry mouth, dry eye, increased ocular pressure (report halos or blurred vision)

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21
Q

name 5 ICS
what one is given OD?
how many times are the others given?

A

beclometasone, budesonisde, ciclesonide, fluticasone, mometasone
all BD except ciclesonide which is OD

22
Q

what ICS must be prescribed by brand and why?

A

Qvar and Kalhale - this is bcause these have extra fine particles so 2x strogner than other inhalers such as clenil

23
Q

what monitoring in children is needed if on prolonged ICS?

A

height and weight as can stunt growth - refer to paediatrician if stunted growth suspected

24
Q

what are the SE of ICS?

A
  1. taste and voice aleration
  2. sore mouth - oral thrush
  3. paradoxical bronchospasam
25
Q

do you manage paradoxical bronchspasams ith ICS?

A
  • if mild: use SABA before hand to prevent it happening
  • change from an aerosol to DPI
26
Q

what are the side effects and MHRA warnign with montelukast?

A

MHRA warning = risk of neuropsychaitric reactions - seek medical attention if speech and behavioural changes occur

Churg- Strauss syndrome - eosinophillia, vasculitc rash, worsening pulmonary symptoms, cardiac complications, perihperal neuropathy

27
Q

what are the main interactions with LTRA?

A

CYP450 enzyme substrate - thi means inducers will redcue the conc of montelukast and inhibitors will increase its conc

28
Q

whats the therapeutic range for theophylline? what is this the same as?

A

10 - 20mg/l
same as phenytoin

29
Q

when should you moniotr theophylline levels?

A
  • 4 - 6 hours after a dose
  • 5 days after starting treatment
  • at least 3 days after dose adjustment (increaing dose)
30
Q

do you need to prescribe by brand of theophylline?

A

yes - brands not bioequivelant

31
Q

what are the main SE of theophylline?

A

vomitting, tremour, palpitation, arrhythmias

32
Q

what are the interactions to look out for with theophylline?
what drugs increase and decrease the levels?

A

increased by: macrolides, cimetidine, ciprofloxacin (CYP inhibitors)
decreaed by: carbamazepine and st johns wort (CY{ inducers)
- drugs that cause hypokalaemia

33
Q

what are signs of theophylline overdose?
(Theophylline helps astronauts hide venus) SICK AND FAST

A

tachycardia
hyperglycaemia
agitation
haematemesis
vomiting

34
Q

what does stopping/starting smoking do to theophylline levels?

A

start = dose increases as smoking reduces clearance
stop smoking = dose decreases as cleared quicker

35
Q

how does having a fever affect theophylline?

A

reduces the clearane of theophylline so may need dose reduced

36
Q

whats the treatment for croup?
what setting is this often done in?

A

dexamethasone
usually community

37
Q

whats the management for severe croup?
what if pt can’t take oral steroids?
what is steroids don’t work?

A
  • hospital admission
  • single dose of dexamethasone or pred given orally whilst awaitng admission
  • if cant take oral = IM dexamethasone or nebulised budesonside
  • uncontrolled by steriod = nedulised adrenaline
38
Q

what antihistamine has undergone POM - P switch?

A

fexofenadine 120mg

39
Q

what antihistamines are aslo used as antiemetics?

A

cinnarizine, cyclizine, promethazine

40
Q

what antihistamine can be used for migraines?

A

buclizine

41
Q

what antihistamines can be used for insomnia?

A

1st generation (allmemazine?, promethazine)
diphenhydramine

42
Q

whats Omalizumab and when is it used?
what are the main SE’s? (also seen with LTRA)

A

monoclonal that binds to IgE for severe perissitent allergic asthma that cannot be controlled with ICS + LABA

SE = churg-strauss syndrome and hypersenstivity reactions

43
Q

what do vaccines contain that reduce the risk of severe anaphylaxis?

A

beewasp venom

44
Q

what is the managemt for anaphylaxis?

A
  1. use auto injection immediately (IM adrenaline)
  2. call 999 and state anaphylaxis - administer CPR if needed
  3. lie down and raise patients legs
  4. remove the trigger causing anaphlyactic reaction if possible
  5. repeat after 5min interval if no improvement
45
Q

why do you raise the legs in anaphylaxis?

A

prevent hypovolaemic shock

46
Q

how is anaphylaxis managed in hospital?

A
  • high flow O2
  • IV fluids to manage hypotension/hypovolaemic shock
  • following sedation of patinet, a non-sedating antihistamine (ceterizine - IM/IV chlorphenamine in NBM)
  • inhaled bronchodilator with salbutamol and/or ipratropium if problems persist
47
Q

how many autoinjectors should be carried at all times?

A

2

48
Q

whats the adrenaline dose for the following ages:
- child up to 6months
- 6months - 5yrs
- 6yrs - 11yrs
- 12yrs+

A
  • up to 6months = 100 - 150mcg
  • 6m - 5yrs = 150mcg
  • 6 - 11yrs = 300mcg
  • 12yrs + = 500mcg
49
Q

what is cystic fibrosis?

A

genetic disorder affecting the lungs, pancrease, liver, intestine and reproductive organs - viscous sputum, chest infections, malaborption

50
Q

what is the mucolytic used in CF?

A

dornase alfa

51
Q

what bacteria are you trying to supress with long term antibacterial therapy in CF?

A

S. Aureus

52
Q

what shoudl you monitor CF patients for?

A

bone density
liver disease
diabetes

Pre-reg (47 decks)

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