Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Med - Respiratory system > Chronic asthma > Flashcards

Chronic asthma Flashcards

1
Q

Symptoms

A
  • Dyspnoea
  • Chest tightness
  • Wheezing
  • Cough
  • Symptoms typically happen more at night when asleep
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Triggers

A
  • Infection
  • Hay fever
  • Dust
  • Pets
  • Smoking
  • Chemicals
  • Medication: NSAID + Beta blocker
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Treatment: BTS/SIGN guidelines: adults + 12+

A

Offer SABA prn

→ Regular preventer: low dose ICS

→ Initial add on therapy: LABA (fixed dose or MART)

→ Additional controller therapies:
- (if no response to LABA consider stopping)
- Medium dose ICS OR
- LTRA

→ Refer patient for special care (oral steroid, theophylline)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Reasons to step up treatment: BTS/SIGN guidelines: adults + 12+

A
  • Taking 3 doses a week/more
  • Night time waking once a week
  • Asthma attack that needed oral steroids in the last 2 years

URGENT assess if >1 inhaler a month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Low dose ICS: adults

A
  • Beclometasone: 200-400mcg
  • Budesonide: 400mcg
  • Fluticasone: 200mcg
  • Mometasone: 400mcg
  • Ciclesonide: 160mcg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Drugs

A
  • SABA: salbutamol, terbutaline
  • LTRA: montelukast
  • LABA: formoterol, salmeterol
  • Oral steroid prednisolone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Low dose ICS: children

A
  • Beclomethasone: 200-400mcg
  • Fluticasone: 200mcg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

SABA: MOA

A

Acts on B2-adrenoreceptor on bronchi = bronchodilation for 3-5H

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

SABA: indication

A

reliever inhaler
- Asthma
- COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

SABA: Dose

A

2 puffs QDS PRN

  • Counsel: take dose immediately before exercise to prevent symptoms
  • Counsel: see doctor if dose fails to provide relief <3H
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

SABA: Side effect

A

Hypokalaemia
- Caution: diuretics, hypoxia
- Monitor:
- Potassium: severe asthma + COPD
- Glucose: diabetes

Hand tremors

CVS effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

LABA: MOA

A

Acts on B2-adrenoreceptors on bronchi = bronchodilation for 12H

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

LABA: drugs

A
  • Formoterol (BD: short onset reliever (fostair - fridge))
  • Salmeterol (BD: long onset)
  • Vilanterol (OD: combination inhaler with fluticasone)
  • Olodaterol + indacaterol (OD: COPD only)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

LABA: indication

A

not used alone, taken with ICS

Asthma (w regular ICS)

  • Add only if ICS fail
  • Stop if no benefit, step down when good control
  • Not for exercise induced asthma unless on regular ICS
  • Do not start in rapidly deteriorating asthma

COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

LABA: combination inhalers rationale

A
  • Stable dose
  • Minimise no. of inhalers
  • Improves compliance
  • Guarantees ICS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

LABA: dose

A

Twice daily (+ reliever doses if MART)
- Counsel: report any deterioration after starting a LABA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

ICS: MOA

A

local anti-inflammatory effects in bronchi, Takes 7 to 14 days to work

18
Q

ICS: drugs

A
  • Beclometasone
  • Budesonide
  • Ciclesonide (OD)
  • Mometasone (OD/BD)
19
Q

ICS: dose

A

Twice daily

MHRA: beclometasone CFC free inhalers: brand prescribed:

  • Qvar is twice as potent as clenil modulite because it has extra fine particles, which means more is delivered to the lungs
  • Beclomethasone - Fostair is more potent than other CFC free inhalers
20
Q

ICS: age restriction

A
  • Easyhaler: 18+
  • Qvar + clenil 200/250: 12+
21
Q

ICS: side effect

A

Oral candidiasis
- Counsel: Spacer, rinse mouth + brush teeth, technique

Hoarse voice + sore throat

Bronchospasm - Stop, if mild: SABA before use or DPI

22
Q

Leukotriene receptor antagonist: MOA

A

blocks leukotriene receptors in lungs = bronchodilation + anti-inflammatory

23
Q

Leukotriene receptor antagonist: indication

A
  • Asthma
  • Hay fever
24
Q

Leukotriene receptor antagonist: dose

A

At night (oral)

25
Q

Leukotriene receptor antagonist: side effect

A

Neuropsychiatric reaction

  • MHRA: reminder: speech impairment + obsessive compulsive symptoms
  • Seek immediate medical attention if speech + behaviour changes
  • MHRA: reminder: sleep disorders, hallucinations, anxiety, depression

Churg-strauss syndrome - inflammation of blood vessels → restrict blood flow to organs and tissues, sometimes permanently damaging them

26
Q

Theophylline: MOA

A
  • xanthine bronchodilator
  • aminophylline: mixture that contains theophylline (injected in medical emergencies)
    → prescribe by BRAND
27
Q

Theophylline: dose

A

Every 12H (oral)

28
Q

Theophylline: therapeutic index

A

10-20MG/L

  • Monitor 4-6H after dose
  • Regular monitoring isn’t needed once a patient is on a stable dose
  • INC levels: HF, viral infection, elderly, liver impairment
  • RED levels: smoker alcohol
29
Q

Theophylline: signs of toxicity

A
  • Convulsions
  • Hypokalaemia
  • HypERglycaemia
  • Arrhythmias
  • Tachycardia
  • Vomiting (severe haematemesis)
30
Q

Theophylline: interaction

A
  • Enzyme inhibitors → INC theophylline levels = toxicity
  • Enzyme inducers → RED theophylline levels = therapeutic failure
  • Betablockers → bronchospasm
  • Ciprofloxacin → seizures
  • Diuretic, corticosteroids, beta2 agonist → hypokalaemia
  • Drugs that prolong QT interval → torsade de pointes
31
Q

Pressurised metered dose inhaler (pMDI)

A

Slow + steady
- Oropharyngeal deposition + coordination problems
- Use Spacer

MHRA: obstruction from aspiration of loose objects: fully remove cover, shake device +check mouthpiece, store with cover

Counsel: after dose used up inhaler will still actuate but with propellant base only which affects the environment, use dose counter or gauge when likely to be empty

32
Q

Dry powder inhaler (DPI)

A

Fast + deep
- Alt to pMDI
- Can cause coughing
- Suitable for 5+ year old

33
Q

Who should use a spacer?

A

Children under 5:
- ICS, SABA/LABA (+ face mask)

Children 5-12years : ICS
- Poor inhaler technique, nocturnal asthma, oral candidiasis, high dose ICS

34
Q

How to use a spacer

A
  • Inhale ASAP after single dose actuation, tidal breathing as effective
  • Not interchangeable, replace every 6-12M
  • Clean once a month with warm water, mild detergent + air dry
35
Q

Peak flow diary

A

Peak expiratory flow - how quickly you can blow air out of your lungs after taking a deep breath. Repeated 3 times and highest measurement is recorded as the peak flow score

  • PEF >80%: good control
  • PEF <80%: quadruple ICS dose
  • PEF <60%: start oral steroids, same day medical advice
  • PEEF <50%: urgent medical advice
36
Q

Acute asthma (medical emergency): treatment

A

Salbutamol pMDI + spacer
- 2-10 puffs every 10-20mins or PRN

→ Prednisolone tablets
- Children 11 + under: upto 3 days
- Adult + child 12+: at least 5 days (40-50mg OD)

→ Hospital: unresponsive, severe + life threatening, under 2

37
Q

Treatment: BTS/SIGN guidelines: children

A

(LTRA can be added at any step in children under 5 who can’t take corticosteroid or LABA bc isn’t licenced in this age group)

Offer SABA prn

→ Regular preventer: low dose ICS OR LTRA (under 5)

→ Initial add on therapy: LABA OR LTRA (under 5)

→ Additional controller therapies:
- (if no response to LABA consider stopping)
- Inc to low dose ICS OR
- LABA OR
- LTRA

→ Refer patient for special care (oral steroid, theophylline)

38
Q

What classifies as moderate asthma?

A

PEF >50-75%
SpO2 >92%
Normal speech
Respiration <25
Pulse <110

39
Q

What classifies as acute severe asthma?

A

PEF 33-50%
SpO2 >92%
Can’t complete sentence
Respiration >25
Pulse >110

40
Q

What classifies as life threatening asthma?

A

PEF <33%
SpO2 <92%
Silent
Arrhythmia
Exhausted

Med - Respiratory system (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions