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respiratory system > chapter 3 > Flashcards

chapter 3 Flashcards

1
Q

what are the 3 advantages of the inhalation route?

A
  • delivers drug to airways
  • smaller dose than oral
  • less side effects
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2
Q

what are the 3 types of inhaler devicers?

A

pressurised metered dose inhaler [pmdi]
breath actuated inhaler
dry powder inhaler

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3
Q

which device can be used with a spacer?

A

pmdi

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4
Q

which inhaler devices do adults with mild to moderate asthma normally use?

A

pmdi with spacer

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5
Q

what is the mhra warning with inhaler devices?

A

some patients inhaled objects to back of throat and causing obstruction. make sure to remove mouthpiece fully and shake device and check outside and inside of mouthpiece is clear before inhaling

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6
Q

what do the spacer devices do? why are they beneficial?

A

removes need for coordination with pmdi

allows larger proportion of particles to be inhaled

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7
Q

who are spacer devices most suitable for?

A

children
pt with nocturnal asthma
high doses of corticosteroids
pt with poor inhalation technique

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8
Q

how should a patient use a spacer device effectively?

A

tidal breathing
single dose actuation only - press it once
inhale from spacer as soon as you press inhaler

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9
Q

how should you care and clean your spacer?

A

clean it once a month with mild detergent and allow to air dry

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10
Q

how do nebulisers work?

which condition is it mostly used for?

A

converts drug into aerosol mist

severe acute asthma

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11
Q

when are parenteral respiratory drug delivery recommended?

A

for pt with severe asthma
treated in hospital
used when nebulisers not appropiate

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12
Q

what can be used to manage asthma and and identify if current management is not working?

A

peak flow meter

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13
Q

what is chronic asthma?

what symptoms are associated with it?

A

inflammation of airways

cough, wheeze, tightness of chest, SOB

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14
Q

what are the reasons for uncontrolled asthma?

A

poor inhaler technique, lack of adherence, seasonal/environmental, smoker

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15
Q

what lifestyle changes can improve asthma control?

A

weight loss
stop smoking
breathing techniques

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16
Q

when a pt starts or is adjusted to a new asthma medication, when should you review their response to treatment?

A

after 4-8 weeks

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17
Q

what approach is used in the management of asthma?

A

stepwise approach

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18
Q

what is step 1 treatment of asthma in adults aged 17 years or over?
give examples

A

a reliever: short acting beta2 agonist eg salbutamol or terbutaline

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19
Q

when would you move to step 2 in asthma for adults aged over 17?

A

would move if they still getting woken up at night, symptoms occur 3 or more times a week, asthma uncontrolled with saba alone

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20
Q

what is step 2 treatment of asthma for adults aged over 17?

A

reliever + preventer/maintenance therapy

ADD low dose inhaled corticosteroid

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21
Q

what is step 3 add on therapy for asthma for adults aged 17 or over?
when should you review the response to treatment?

A

reliever, low dose ics

then ADD leukotriene receptor antagonist [LTRA] eg montelukast.

review after 4-8 weeks

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22
Q

what can you add on if asthma is uncontrolled with a low dose ics and leukotriene receptor antagonist for adults over 17?

[step 3 add on therapy]

A

add on long acting beta 2 agonist [LABA] eg salmeterol

you can choose to remove or keep the leukotriene receptor antagonist

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23
Q

if a adult over 17 is still having uncontrolled asthma with low dose ICS, LABA, with or without Leukotriene receptor antagonist, what can be the next option in treatment?

A

change the ICS and LABA treatment to maintenance and reliever therapy [MART regimen].

this consists of 1 inhaler that is both a maintenance and reliever. it contains both an ICS and a fast acting LABA eg fostair

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24
Q

what is the next step if asthma for adults still uncontrolled following change to MART regimen?

A

increase dose of ICS to moderate. can choose to still be on the MART or just do fixed dose of ICS with LABA and SABA

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25
Q

what is next treatment step if asthma is uncontrolled on moderate dose ICS and laba and saba? [for adults over 17]

A

increase dose of ICS from moderate to high dose

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26
Q

what is the next treatment step if asthma still uncontrolled on high dose ICS? [adults over 17]

A

cannot change dose of ics anymore but can add long acting muscarinic antagonist [LAMA] eg tiotropium

OR add theophylline

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27
Q

what is the next step if asthma in adults still uncontrolled following theophylline or a LAMA?

A

seek asthma healthcare specialist

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28
Q

what is step 1 of asthma management for children under 5 years?

A

SABA - reliever

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29
Q

what is the next step if asthma is uncontrolled with SABA for children under 5?

A

offer paediatric moderate dose of inhaled corticosteroids for 8 weeks.
after 8 weeks stop and monitor child. if symptoms do not resolve, offer alternative diagnosis

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30
Q

if a child under 5 had moderate ICS and their asthma was controlled but symptoms came back WITHIN 4 weeks, what would be the next step?

A

restart ICS at paediatric low dose as first line therapy

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31
Q

if a child under 5 had moderate ICS and their asthma was controlled but symptoms came back BEYOND 4 weeks, what would be the next step?

A

Restart the 8 week trial of moderate dose ICS

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32
Q

if a child under 5 asthma is still uncontrolled on paediatric low dose of ICS, what is the next step?

A

to the low dose ICS, add LTRA [leukotriene receptor antagonist]

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33
Q

if a child under 5 asthma is still uncontrolled using a ICS and LTRA, what is the next step?

A

stop the LTRA, refer to specialist

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34
Q

what is step 1 treatment for asthma management in children aged 5-16?

A

SABA

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35
Q

What is the next step treatment if SABA is not enough to cause controlled asthma for children aged 5-16?

A

add low paediatric dose of ICS to the saba

36
Q

for a child aged 5-16: their asthma is uncontrolled when on low dose ics and saba, what is the next step?
when shuould treatment be reviewed?

A

add LTRA to the ICS

review in 4-8 weeks

37
Q

for a child aged 5-16: their asthma is uncontrolled when on ICS and LTRA, what is the next step?

A

STOP the LTRA, offer long acting beta 2 agonist with the ICS

38
Q

for a child aged 5-16: their asthma is uncontrolled when on low dose ics and LABA what is the next step?

A

change to MART regimen [maintenance and reliever in one] using low dose ICS

39
Q

for a child aged 5-16: their asthma is uncontrolled when on MART regimen with low dose ICS what is the next step?

A

change low dose ICS to moderate dose. can either be kept on MART or just fixed dose of ICS, SABA and LABA therapy

40
Q

for a child aged 5-16: their asthma is uncontrolled when on moderate dose ICS [either as MART or with saba and laba], what is the next step?

A

seek specialist help

can either change ICS to high dose or add another drug eg theophylline

41
Q

what is SABA and give an example of it?
what is LABA and give an example of it?
what is ICS and give an example of it?
what is LTRA and give an example of it?

A

short acting beta agonist - salbutamol
long acting beta agonist - salmeterol
inhaled corticosteroids - beclomethasone
leukotriene receptor antagonist - montelukast

42
Q

give an example of xanthine

what is included in a MART? give an example of A MART

A

theophylline

steroid and fast acting LABA eg symbicort

43
Q

NICE guidelines recommend that children and adults over 17 must be started with a SABA. how does this differ from BTS guidelines?

A

bTS says initiate with low dose ICS as well as saba cannot be taken alone

44
Q

when should you start decreasing a patients asthma treatment?

A

if asthma been controlled for at least 3 months then start decreasing their maintenance therapy

45
Q

which inhaler should be used immediately before exercise to prevent exercise induced asthma?

A

SABA

46
Q

what should the peak flow range be for the asthma to be considered moderate severity?

A

over 50-75%

47
Q

what should the peak flow range be for the asthma to be considered severe severity?

A

35-50%

rlly sob , unable to complete sentances in one breath

48
Q

what should the peak flow range be for the asthma to be considered life threatening severity?

A

under 33%

49
Q

where should moderate acute asthma be treated?

where should serious/life threatening asthma be treated?

A

home/primary care

hospital

50
Q

what should be given to patients experiencing hypoxemic with severe asthma?

A

oxygen

51
Q

what drug should be given for life threatening acute asthma?

what is the alternative to this if the pt cannot have inhaled version?

A

beta 2 agonist nebuliser

iv beta 2 agonist

52
Q

what oral steroid should be given to all acute asthma patients?
what is the alternative if patients cannot take oral version?

A

oral prednisolone

intramuscular methylprednisolone or parenteral hydrocortisone

53
Q

what are side effects of short and long acting beta 2 agonists eg salbutamol?

A 
tremor
hypokalaemia
palpiations
headache
tachycardia
54
Q

what are the cautions of short and long acting beta 2 agonists?
what are their contraindicaitons?

A

cautions: arrythmia, hypokalaemia, qt interval prolongation
contraindication: pre eclampsia [pregnancy]

55
Q

which patients are long acting beta agonists [eg formoterol and salmeterol] only suitable for?

A

ppl who also take ics regularly

56
Q

salbutamol and terbutaline [saba] can be given IV. but when is this suitable?

A

for severe or life threatening acute asthma

57
Q

which age in children is a pmdi and spacer advised for?

A

children over 5

58
Q

give an example of an antimuscarinic bronchodilator

when are these used?

A

ipratropium bromide

used for short term relief of asthma but salbutamol better

59
Q

what risk can be increased when beta 2 agonists and theophylline are given together?

A

hypokalaemia risk

60
Q

which patients is azithromycin suitable for in asthma?

what is the dose?

A

for pt aged 50-70 with uncontrolled asthma despite use of high dose ics

500mg once daily 3 times a week

61
Q

what is the contraindications/cautions of azithromycin?

what is the side effects?

A

contraindication/caution: hepatic impairment

s/e: gi [diarrhoea/vomiting] and nervous system [headache/dizziness], rash

62
Q

how do beta 2 agonists work?

A

act on beta 2 receptors to cause muscle relaxation and dilate the airways

63
Q

give some examples of inhaled corticosteroids

A

beclomethasone
budesonide
fluticasone
mometasone

64
Q

what are the side effects of inhaled corticosteroida?

A

candidiasis of mouth, hoarseness, throat irritation

65
Q

give examples of leukotriene receptor antagonists

what are the side effects?

A

montelukast and zafirlukast

s/e: abdominal pain, hepatoxicity/ churg strauss syndrome [inflammation of blood vessels]

66
Q

give some examples of antimuscarinics?

what are the side effects?

A

tiotropium, ipratropium

s/e: dry mouth, cough, headache

67
Q

what are the side effects of theophylline?

A

nausea, tremor, headache

68
Q

give examples of cromones.

A

sodium cromoglicate

nedocromil sodium

69
Q

what is chronic pulmonary obstructive disease copd?

A

preventable disease. persistant respiratory symptoms that are progressive eg coughing, sob, sputum
airflow obstruction caused by things like tobacco

70
Q

what is step 1 treatment for all patients with copd?

A

saba or short acting muscarinic bronchodilator [sama eg ipratropium]

71
Q

what is the step 2 of treatment of copd WITHOUT asthmatic features?

A

stop the Short acting anti-muscarinic bronchodilator [sama]
can continue the saba
offer long acting b2 agonist [laba] AND a long acting antimuscarinic [LAMA] eg tiotropium

72
Q

what would you need to do if a person with copd without asthmatic features had a severe exacerbation within a year and needed to go to hospital?

A

add ICS

73
Q

WHAT is step 2 treatment of COPD with asthmatic features?

A

pt is on SAMA or SABA. can continue the saba but stop the sama
add ICS and LABA

so they will be on ics , laba and saba

74
Q

what should you add if a pt with copd WITH asthmatic features had a severe exacerbation within a year and needed to go to hospital or got treated with prednisolone/antibiotics?

A

add a LAMA

75
Q

WHAT is croup and give one distinctive symptom?

A

childhood respiratory disorder characterised by a barking cough

76
Q

what is the management of mild croup?

how should severe croup be treated?

A

mild= single dose of corticosteroid by mouth eg dexamethasone

severe: nebulised adrenaline

77
Q

how do corticosteroids work in asthma?

A

reduce airway inflammation, reduce oedema and secretion of mucus in airways

78
Q

when during the day should the corticosteroid be taken and why?

A

in the morning to not disrupt the circadian cortisol secretion

79
Q

how can you reduce risk of oral candidiasis with ICS?

A

rinse mouth with water after use
use spacer device
use anti-fungal oral suspension

80
Q

give some examples of older sedating antihistamines

give examples of newer antihistamines

A

older: promethazine
newer: loratadine, acrivastine, cetirizine, fexofenadine

81
Q

what are the cautions of antihistamines? [4]

A

prostate enlargement
urinary retention
open angle glaucoma
epilepsy

82
Q

in which disease should sedating antihistamines be avoided bc of risk of coma?

A

liver disease

83
Q

what are some side effects of antihistamines?

A 
dry mouth
drowsiness
headache
urinary retention
blurred vision
gi disturbance
84
Q

what is cystic fibrosis and what are the symptoms?

A

genetic disorder affecting lungs, pancreas, reproductive organs and liver

symptoms include: pulmonary disease, infection, sputum, malabsorption

85
Q

what is 1st line and 2nd line treatment of cystic fibrosis?

A

dornase alfa

mannitol dry powder

86
Q

what type of drugs can be used for cystic fibrosis in patients with lung disease?
when must you stop treatment if it is of no benefit?

A

mucolytics

stop after 4 weeks if it is not of benefit

87
Q

how often should spacer devices be replaced?

A

every 6-12 months!

respiratory system (1 decks)

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