asthma + smoking cessation Flashcards
what are the symptoms of asthma
- shortness of breath
- chest pain/ tightness/pain
- coughing
- wheezing
usually more prevelant early in the morning/night. triggered by exercise/ allergens
what are the aims of asthma treatment
- 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
what are the counselling points for inhaler technique
- 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
name an example for a reliever inhaler
salbutamol / terbutaline
what is the difference between the Qvar and Clenil inhalers even though they both contain beclometasone
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
which serious reactions are associated with montelukast
- 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
why should you report any vasculitc rash (reddish/purple rash) when a patient is taking montelukast
it is a symptom of churg-strauss syndrome which is a serious reaction associated with montelukast
TRUE OR FALSE
neuropsychiatric reactions are a serious side effect of montelukast
TRUE
symptoms of neuropsychiatric reactions are: speech impairment, obsessive-compulsive symptoms
*the benefit of continuing treatment should be assessed if these symptoms happen.
what are the NHS endorsed stop smoking treatments
- nicotine replacement therapy (NRT)
- varenicline (champix)
- bupropion (Zyban)
- E-cigarettes
Why are patients usually on two products during nicotine replacement therapy (NRT)
the patch is baseline nicotine, other formulations used for urge control (PRN)
when would you use a 16 hour nicotine replacement therapy (NRT) patch
Nicotine transdermal patches are generally applied for 16 hours, with the patch removed overnight (standard practice)
which stop smoking treatments should not be prescribed together
- varenicline (champix)
- bupropion (Zyban)
when would you use a 24 hour patch in nicotine replacement therapy (NRT) patch
if smokers experience strong nicotine cravings upon waking, a 24-hour patch can be used instead
what is the difference between community acquired pneumonia (CAP) and hospital acquired pneumonia (HAP)
- HAP pneumonia started inside the hospital within 48 hours or more after hospital admission
- CAP pneumonia caught in the
what is VAP
ventilator acquired pneumonia
how you calculate mortality risk of pneumonia patient
what are the features in this assessment
CURB65/CRB65
The features in this assessment:
c= confusion u= urea R- respiratory rate b= blood pressure 65= age over 65
what is the first line treatment for acute asthma (asthma attack)
high dose SABA ( salbutamol)
- also, in all cases of acute asthma, patients should be prescribed an adequate dose of oral prednisolone
when do you step up treatment (add an ICS) for a patient on a SABA
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
when would you consider decreasing maintenance therapy for an asthma patient
when a patient’s asthma has been controlled with their current maintenance therapy for at least three months.
can asthma medication be used as normal during pregnancy + breastfeeding
yes
it is important to keep asthma under control during pregnancy for maternal and fetal health
what is a potentially serious side effect of salbutamol (at high doses)
Potentially serious hypokalaemia may result from beta2 agonist therapy
what are the common side effects of beta-2 agonists (salbutamol/ terbutaline)
Arrhythmias; headache; hypokalaemia (with high doses); muscle spasms, rash
why do diabetic patients taking beta-2 agonists (salbutamol/ terbutaline), need their blood-glucose monitored
risk of hyperglycaemia and ketoacidosis, especially when SABA given intravenously
how long does a dose of salbutamol inhaler usually provide relief for (duration of action)
3-5 hours
note: if a patient is not getting at least 3 hours relief from their salbutamol inhaler, need to speak to doctor
what are the common side effects of inhaled corticosteroids (beclomethasone, fluticasone, and mometasone)
- Headache
- oral candidiasis
- pneumonia (in patients with COPD
- taste altered
- voice alteration
what is exercise induced asthma usually a sign of
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 *
which patients normally use dry powder inhalers
adults and children over 5 years who are unwilling or unable to use a pressurised metered-dose inhaler
which type of inhalers can be used by any patients
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
which patients can use breath-actuated inhalers
suitable for adults and older children provided they can use the device effectively
when might parental drugs be used in asthma
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
what is “abrupt quitting” for smoking cessation
‘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
which strength nicotine gum is for people who smoke less than 20 cigarettes a day
2mg
which strength nicotine gum is for people who smoke more than 20 cigarettes a day
4mg
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
- patients may notice a lack of sensation in the mouth and throat previously associated with each actuation
- Coughing may also occur
