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Pre Reg > Chapter 3 BNF (Respiratory System) > Flashcards

Chapter 3 BNF (Respiratory System) Flashcards

1
Q

What are the symptoms of asthma?

A

Coughing at night
SOB
Chest tightness
wheezing

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2
Q

What is the difference between BTS/SIGN Guidelines and NICE guidelines?

A

BTS/SIGN - Clinical relevant recommendation

NICE - Health economic

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3
Q

What is the first line preventer in adult asthma?

A

low dose corticosteroid

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4
Q

What is the first line add on therapy in adult asthma?

A

BTS/SIGN - LABA

NICE - LTRA

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5
Q

What is the additional add on therapy in adult asthma?

A

1: If LABA is not working, remove LABA and increase ICS dose
2. If LABA slightly works, keep LABA and increase ICS
3. If LABA works, keep both and consider LTRA, SR Theophylline, LAMA

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6
Q

What the next step after additional add on therapy in adults?

A

High dose ICS

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7
Q

whats the next stage after High dose ics in adults?

A

oral steroid

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8
Q

what is considered low dose of ICS in adults?

A 
Beclometasone 100-400mcg daily
Budesonide 400mcg daily
Fluticasone 200-400mcg daily
momatesone 400mcg 
ciclesonide 160mcg
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9
Q

what are the alternatives to SABA?

A

Ipratropium,

If 12+ SR Theophylline or Oral beta agonist

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10
Q

When should patients step up?

A

using inhaler more than 3 times a week
night time symptoms over 1 times a week
asthma attack requiring steroids in last 2 years

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11
Q

What is the general starting dosing regimen with ICS? Whats the exception?

A

BD then move to OD

except ciclesonide

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12
Q

What are the alternatives to ICS?

A

LTRA, Theophylline, sodium cromoglycate, Nedocromil

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13
Q

What are the options in regular preventer therapy in children?

A

very low dose ICS

Under 5 - LTRA

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14
Q

What are the options in initial add on therapy in children?

A

very low dose ICS

LABA if over 5

LTRA if under 5

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15
Q

What is the next stage after additional add on therapy in children?

A

high dose therapy
medium ics
sr theophylline

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16
Q

what is the next stage after high dose therapy in children?

A

Oral steroid

maintain medium ics

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17
Q

What doses of ics are very low in children?

A

beclometasone 200mcg
budosenide 200mcg
fluticasone 100mcg

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18
Q

what doses of ics are medium in children

A

beclometasone 400mcg-800mcg
budesonide 800mcg
fluticasone 500mcg
ciclosenide 360mcg

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19
Q

Whats the dose for SABA? when should the patient contact their GP?

A

QDS PRN

See GP if no result in 3 hrs

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20
Q

Whats the dosing for LABAs?

A

BD

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21
Q

Which beta agonists are mostly used in COPD?

A

Oladaterol
indacaterol
vilanterol

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22
Q

which beta agonists is used orally?

A

bambuterol

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23
Q

When should LABAs not be used?

A

rapidly deteriorating asthma

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24
Q

which laba has a quick onset?

A

formeterol

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25
Which brands can be used as reliever therapy?
symbicort duoresp fostair
26
what are the side effects of LABAs?
Tremors, hyperglycaemia, tachycardia hypokalaemia (esp with ICS or theophylline) cardiac effects (QT prolongation, arterial)
27
How long must ICS be taken until effect is seen?
3/4 weeks
28
whats the difference between qvar and clenil and fostair?
qvar is twice as potent due to extra fine particles and fostair is most potent
29
whats the age for easyhaler
18
30
whats the age for qvar
12
31
what are the side effects of ics
hoarse voice sore throat oral thrush paradoxical bronchospasms
32
when are large volume spacers used?
high doses | u15
33
How can paradoxical bronchospasms be aided?
stop and give alternative | if mild: use saba prior or transfer to dry powder
34
how dose smoking affect ics
reduce effectiveness
35
What are the side effects of LTRA?
``` Churg strauss syndrome liver toxicity (zafirlukast) ```
36
what are the symptoms of churg strauss syndrome?
eosinophilia, vasculitic rash, worsening symptoms
37
What is the mechanism of action of theophylline?
xanthine bronchodilator
38
what is the therapeutic range and when should sample be taken?
10mg/L - 20mg/L 4/6 hrs after dose
39
what increases the concentration of theophylline?
heart failure, hepatic impairment, viral infections, elderly, enzyme inhibitors
40
what reduces the concentration of theophylline?
smokers, alcohol, enzyme inducers
41
should theophylline be prescibed by brand?
yes
42
signs of theophylline toxicity?
fast and sick vomiting and gi issues tachycardia, arrythmia, hypokalaemia
43
what interactions would you expect from theophylline?
hypokaelamia; steroids, diuretics, b agonist convulsions: ciprofloxacin increase plasma levels: verapamil and ccb reduced plasma levels: st johns worts, rifampicin
44
How is an asthma attack treated in community
``` treat as severe Salbutamol aerosol with large volume spacer (mask if u3) 2-10 puffs every 10-20 mins or prn OR salbutamol every 20-30mins or prn ``` if symptoms persist after 15-30 mins call 999 repeat above then add nebulised ipratropium bromide
45
how are asthma attacks treated when in hospital?
prednisole tablets or iv hydrocortisone u12 - 3 days at least 5 days for adults (40-50mg daily)
46
whats the reliever therapy in COPD?
SABA OR SAMA
47
Whats the next step in COPD if FEV is below 50?
LABA/ICS or LAMA
48
Whats the next step in COPD if FEV is above 50?
LABA then LABA/ICS or LAMA
49
Whats the final step in COPD?
Triple therapy
50
what can be offered if symptoms persist or patient unable to use inhaler in COPD?
MR Theophylline or aminophylline
51
what can be used for chronic productive cough in COPD
MUCOLYTIC
52
What can be used in severe COPD with hypoxaenimia
``` oxygen therapy 15 hrs a day 88-92% saturation must carry oxygen alert card 24-48% venturi mask ```
53
Whats the dose of ipratropium?
TDS
54
Whats the dose of LAMAs?
OD except Eklira
55
which LAMA is licenced in asthma with 1 or mre severe excercabations in the last year as adjunct to LABA/ICS?
Spiriva
56
what condition are cautioned for LAMAs
angle closure glaucoma | prostatic hyperplasia
57
what are the side effects of LAMAs
dry mouth | paradoxical bronchospasms
58
What is the treatment for acute exercabation of COPD?
``` bronchodilator therapy (nebulised with oxygen) IV Aminophylline short course of prednisolone (30mg daily 7-14days) ```
59
Which antihistamines are most sedating?
promethazine | almemazine
60
which antihistamine cause qt prolongation
hydroxyzine
61
which antihistamine is indicated for nausea and vomiting associated with migraines?
buclizine
62
which antihistamines are used in anaphylaxis/ angioedema?
chlorphenamine | promethazine
63
when are antihistamines cautioned?
bph glaucoma severe liver impairemnt
64
whats the MHRA on hydroxyzine
qt prolongation short periods max dose 100mg
65
what are the contraindications for hydroxyzine?
``` qt drugs cvd history of sudden death hypokalaemia hypomagnesium bradycardia ```
66
when is allergen immunotherapy indicated?
hay fever unresponsive to drugs | hypersensitivity to wasp and venom
67
whats the mechanism of action of omalizumab
binds to igE
68
When is omalizumab used?
add on therapy: severe persistent allergic asthma, 6+ chronic spontaneous urticaria (hives) 12+
69
what are the side effects of omalizumab
chaug strauss
70
what are the goals in anaphylaxis?
restore BP, secure airways
71
whats solution of adrenaline is used in anaphylaxis?
1 in 1000
72
whats the dose of adrenaline in under 6 6-12 12-18
under 6 150mcg 6-12 300mcg 12-18 500mcg
73
how should beta blocker patients be treated in anaphylaxis
consider salbutamol
74
whats the treatment for angioedema?
adrenaline antihistamine steroid
75
whats the contraindication for mucolytics?
peptic ulcers

Pre Reg (37 decks)

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