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respiratory tract and infections > asthma + smoking cessation > Flashcards

asthma + smoking cessation Flashcards

1
Q

what are the symptoms of asthma

A
  • shortness of breath
  • chest pain/ tightness/pain
  • coughing
  • wheezing

usually more prevelant early in the morning/night. triggered by exercise/ allergens

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2
Q

what are the aims of asthma treatment

A
  • reduce daytime/ night time symptoms
  • no night-time awakening due to asthma
  • no need for rescue medications
  • no exacerbations or attacks
  • no limitations on activity including exercise
  • minimal side effects of medication
  • normal lung function ( >80% for FEV1 and/ or peak expiratory flow PEF
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3
Q

what are the counselling points for inhaler technique

A
  • shake inhaler before use
  • breathe out gently as far as comfortable
  • put inhaler in mouth + breathe in quickly + deeply until you’ve taken a full breath
  • hold breath for 10 seconds then breathe out
  • if you need a second puff, wait 30 seconds + shake inhaler before next dose
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4
Q

name an example for a reliever inhaler

A

salbutamol / terbutaline

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5
Q

what is the difference between the Qvar and Clenil inhalers even though they both contain beclometasone

A

They have different strengths. Qvar is around 2x more potent than clenil because QVAR has extra-fine particles.

Because of this, they are not interchangeable so should be prescribed by brand name

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6
Q

which serious reactions are associated with montelukast

A
  • neuropsychiatric reactions e.g speech impairment, obsessive-compulsive symptoms
  • churg-strauss syndrome e.g a vasculitic rash (reddissh/purple rash), worsening pulmonary symptoms, cardiac complications, peripheral neuropathy
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7
Q

why should you report any vasculitc rash (reddish/purple rash) when a patient is taking montelukast

A

it is a symptom of churg-strauss syndrome which is a serious reaction associated with montelukast

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8
Q

TRUE OR FALSE

neuropsychiatric reactions are a serious side effect of montelukast

A

TRUE

symptoms of neuropsychiatric reactions are: speech impairment, obsessive-compulsive symptoms

*the benefit of continuing treatment should be assessed if these symptoms happen.

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9
Q

what are the NHS endorsed stop smoking treatments

A
  • nicotine replacement therapy (NRT)
  • varenicline (champix)
  • bupropion (Zyban)
  • E-cigarettes
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10
Q

Why are patients usually on two products during nicotine replacement therapy (NRT)

A

the patch is baseline nicotine, other formulations used for urge control (PRN)

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11
Q

when would you use a 16 hour nicotine replacement therapy (NRT) patch

A

Nicotine transdermal patches are generally applied for 16 hours, with the patch removed overnight (standard practice)

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12
Q

which stop smoking treatments should not be prescribed together

A
  • varenicline (champix)

- bupropion (Zyban)

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13
Q

when would you use a 24 hour patch in nicotine replacement therapy (NRT) patch

A

if smokers experience strong nicotine cravings upon waking, a 24-hour patch can be used instead

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14
Q

what is the difference between community acquired pneumonia (CAP) and hospital acquired pneumonia (HAP)

A
  • HAP pneumonia started inside the hospital within 48 hours or more after hospital admission
  • CAP pneumonia caught in the
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15
Q

what is VAP

A

ventilator acquired pneumonia

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16
Q

how you calculate mortality risk of pneumonia patient

what are the features in this assessment

A

CURB65/CRB65

The features in this assessment:

c= confusion 
u= urea
R- respiratory rate
b= blood pressure
65= age over 65
17
Q

what is the first line treatment for acute asthma (asthma attack)

A

high dose SABA ( salbutamol)

  • also, in all cases of acute asthma, patients should be prescribed an adequate dose of oral prednisolone
18
Q

when do you step up treatment (add an ICS) for a patient on a SABA

A

if they are:

  • using a SABA/ symptomatic three times a week or more
    or
  • waking at night due to asthma symptoms at least once a week
  • BTS/SIGN`: if they have had an exacerbation in the last 2 years
19
Q

when would you consider decreasing maintenance therapy for an asthma patient

A

when a patient’s asthma has been controlled with their current maintenance therapy for at least three months.

20
Q

can asthma medication be used as normal during pregnancy + breastfeeding

A

yes

it is important to keep asthma under control during pregnancy for maternal and fetal health

21
Q

what is a potentially serious side effect of salbutamol (at high doses)

A

Potentially serious hypokalaemia may result from beta2 agonist therapy

22
Q

what are the common side effects of beta-2 agonists (salbutamol/ terbutaline)

A

Arrhythmias; headache; hypokalaemia (with high doses); muscle spasms, rash

23
Q

why do diabetic patients taking beta-2 agonists (salbutamol/ terbutaline), need their blood-glucose monitored

A

risk of hyperglycaemia and ketoacidosis, especially when SABA given intravenously

24
Q

how long does a dose of salbutamol inhaler usually provide relief for (duration of action)

A

3-5 hours

note: if a patient is not getting at least 3 hours relief from their salbutamol inhaler, need to speak to doctor

25
Q

what are the common side effects of inhaled corticosteroids (beclomethasone, fluticasone, and mometasone)

A
  • Headache
  • oral candidiasis
  • pneumonia (in patients with COPD
  • taste altered
  • voice alteration
26
Q

what is exercise induced asthma usually a sign of

A

it is normally a sign of poorly controlled asthma

An inhaled short-acting beta2 agonist (salbutamol, terbutaline) used immediately before exercise is the drug of choice.

*note: if this happens, regular treatment including an ICS should therefore be reviewed *

27
Q

which patients normally use dry powder inhalers

A

adults and children over 5 years who are unwilling or unable to use a pressurised metered-dose inhaler

28
Q

which type of inhalers can be used by any patients

A

pressurised metered-dose inhalers

Many patients can be taught to use them effectively but some many struggle (elderly + children)

note: if patients struggle, can add spacer

29
Q

which patients can use breath-actuated inhalers

A

suitable for adults and older children provided they can use the device effectively

30
Q

when might parental drugs be used in asthma

A

Drugs (e.g beta2 agonists, corticosteroids + aminophylline) can be given by injection in severe acute and life-threatening asthma when administration by nebulisation is inadequate or inappropriate

31
Q

what is “abrupt quitting” for smoking cessation

A

‘Abrupt quitting’ is when a smoker makes a commitment to stop smoking on or before a particular date (the quit date), rather than by gradually reducing their smoking

  • this offers the best chance of lasting success
32
Q

which strength nicotine gum is for people who smoke less than 20 cigarettes a day

A

2mg

33
Q

which strength nicotine gum is for people who smoke more than 20 cigarettes a day

A

4mg

34
Q

what counselling points may you need to give a patient who has switched from a pressurised metered-dose (pMDI) inhaler to a dry powder inhaler

A
  • patients may notice a lack of sensation in the mouth and throat previously associated with each actuation
  • Coughing may also occur

respiratory tract and infections (2 decks)

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