Chapter 3 BNF (Respiratory System) Flashcards
What are the symptoms of asthma?
Coughing at night
SOB
Chest tightness
wheezing
What is the difference between BTS/SIGN Guidelines and NICE guidelines?
BTS/SIGN - Clinical relevant recommendation
NICE - Health economic
What is the first line preventer in adult asthma?
low dose corticosteroid
What is the first line add on therapy in adult asthma?
BTS/SIGN - LABA
NICE - LTRA
What is the additional add on therapy in adult asthma?
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
What the next step after additional add on therapy in adults?
High dose ICS
whats the next stage after High dose ics in adults?
oral steroid
what is considered low dose of ICS in adults?
Beclometasone 100-400mcg daily Budesonide 400mcg daily Fluticasone 200-400mcg daily momatesone 400mcg ciclesonide 160mcg
what are the alternatives to SABA?
Ipratropium,
If 12+ SR Theophylline or Oral beta agonist
When should patients step up?
using inhaler more than 3 times a week
night time symptoms over 1 times a week
asthma attack requiring steroids in last 2 years
What is the general starting dosing regimen with ICS? Whats the exception?
BD then move to OD
except ciclesonide
What are the alternatives to ICS?
LTRA, Theophylline, sodium cromoglycate, Nedocromil
What are the options in regular preventer therapy in children?
very low dose ICS
Under 5 - LTRA
What are the options in initial add on therapy in children?
very low dose ICS
LABA if over 5
LTRA if under 5
What is the next stage after additional add on therapy in children?
high dose therapy
medium ics
sr theophylline
what is the next stage after high dose therapy in children?
Oral steroid
maintain medium ics
What doses of ics are very low in children?
beclometasone 200mcg
budosenide 200mcg
fluticasone 100mcg
what doses of ics are medium in children
beclometasone 400mcg-800mcg
budesonide 800mcg
fluticasone 500mcg
ciclosenide 360mcg
Whats the dose for SABA? when should the patient contact their GP?
QDS PRN
See GP if no result in 3 hrs
Whats the dosing for LABAs?
BD
Which beta agonists are mostly used in COPD?
Oladaterol
indacaterol
vilanterol
which beta agonists is used orally?
bambuterol
When should LABAs not be used?
rapidly deteriorating asthma
which laba has a quick onset?
formeterol
Which brands can be used as reliever therapy?
symbicort
duoresp
fostair
what are the side effects of LABAs?
Tremors, hyperglycaemia, tachycardia
hypokalaemia (esp with ICS or theophylline)
cardiac effects (QT prolongation, arterial)
How long must ICS be taken until effect is seen?
3/4 weeks
whats the difference between qvar and clenil and fostair?
qvar is twice as potent due to extra fine particles and fostair is most potent
whats the age for easyhaler
18
whats the age for qvar
12