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BNF Respiratory > Chronic obstructive pulmonary disease > Flashcards

Chronic obstructive pulmonary disease Flashcards

1
Q

Symptoms of COPD

A

dyspnoea, wheeze, chronic cough, regular sputum production

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2
Q

Main risk factor for developing COPD

A

smoking

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3
Q

Risk factors for developing COPD

A

Smoking, environment, occupational exposure, genetic factors (hereditarty alpha 1 antitrypsin deficiency), poor lung growth during childhood

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4
Q

Non drug treatment of COPD

A
  • smoking cessation
  • pulmonary rehabilitation
  • breathing techniques
  • Diet (to lower BMI)
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5
Q

What should all patients with COPD be offered annually?

A

Flu vaccine

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6
Q

Initial management of COPD

A
  1. Short acting bronchodilator SABA/ SAMA
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7
Q

Step up COPD treatment for patients without asthmatic features

A
  1. LABA or LAMA (continue SABA alongside but discontinue SAMA if starting a LAMA)
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8
Q

What criteria must a COPD patient (no asthma sx) meet before being initiated on ICS?

A
  • Patients who are on a LABA/LAMA and require hospitilisation
  • at least 2 moderate exacerbations (requiring systemic steroids / antibiotics) within a year
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9
Q

How often should COPD patients on ICS be reviewed?

A

Annually

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10
Q

If a patient has COPD (no asthma sx) and is on LAMA and LABA who feels their symptoms adversely effect their QOL what can be trialled?

A

ICS for 3 months

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11
Q

What can be offered as step up treatmetn for COPD patients with asthmatic symptoms

A

LABA + ICS

- if patient on a LABA + ICS has a severe exacerbation or 2 moderate exacerbations in a year add in a LAMA

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12
Q

What prophylactic antibiotic can be used in COPD?

A

Azithromycin ( used in patients who are non smokers and have had all other treatment options and continue to have frequent exacerbations)

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13
Q

What tests should be carried out before starting prophylactic Azithromycin in COPD patients?

A 
ECG (rule out QT prolongation) 
sputum culture sensitivity 
CT scan of thorax 
LFTs at baseline 
review at 3 motnhs, 6 months
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14
Q

What drug can be used as an add on therapy to bronchodilator therapy in patients with severe COPD + chronic bronchitis?

A

Roflumilast

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15
Q

When should oral theophylline be used in COPD managment?

A

Only after a trial of SA + LA bronchodilators / if patient unable to use inhaled treatment

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16
Q

How is a severe COPD exacerbation managed?

A
  • Rescue packs with an antibiotic + steroid
  • prophylactic azithromycin can be continued during an acute exacerbation
  • SABA via a nebuliser (withold LAMA if SAMA given)
  • short course of pred 30mg
  • Aminophylline should only be used as add on therapy if there is inadequate responce to nebulised bronchodilators
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17
Q

Example of a respiratory stimulant used in acute respiratory failure

A

Doxapram

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18
Q

What is the target concentration of oxygen in patients with carbon monoxide poisoning or in cardiac arrest?

A

Highest possible

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19
Q

If a patient is at risk of hypercapnic respiratory failure, what oxygen target should we aim for?

A

88-92%

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20
Q

Exmaple of a LAMA MDI

A

Spiriva ( tiotropium) Respimat 2.5mcg 2puffs OD

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21
Q

Example of a LAMA DPI

A

Eklira (aclidinium) Genuair - 1puff BD
Incruse (umenlidinium) Ellpipta - 1puff OD
Spiriva (tiotropium) handihaler 1puff OD
Seebri (glycopyrronium) Breezhaler - 1 ouff OD

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22
Q

Example of LABA MDI

A
  • Atimos (Formoterol) MDI 1 puff BD

- Striverdi (Olodaterol) Respimat 2 puff OD

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23
Q

LABA DPI examples

A

Oxis (formoterol) 1 puff OD

Fomoterol easyhaler 1puff BD

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24
Q

LAMA + LABA MDI examples

A

Spiolto (tiotropium + olodaterol) respimat 2 puff OD

25
Q

LAMA + LABA DPI example

A 
Duaklir (aclidinium / formoterol) Genuair 1 puff BD 
Anoro Elipta (umeclidinium / vilanterol)
26
Q

LAMA + LABA + ICS MDI therapy examples

A

1) Fostair (beclomethasone /formertol) PLUS spiriva respimat
2) Symbicort (budesonide / formoterol) mdi PLUS spiriva respimat

27
Q

LAMA + LABA + ICS DPI therapy examples

A

1) Symbicort turbohaler + Eklira Genuair (aclidinium)

2) Revlar (fluticasone furoate / vilanterol) PLUS Incruse elipta

28
Q

LAMA + LABA + ICS all in one inhaler examples

A

1) MDI - trimbow (beclomethasone, glycopyronium + formoterol) 2 puffs BD
2) DPI - Trelegy (fluticasone, umeclidinium + Vilanterol) 1 puff OD

29
Q

How should a patient be counselled to breathe with MDI?

A

Long and slow

30
Q

How should a patient be counselled to breathe with DPI?

A

Quick and fast

31
Q

What device can help determine the correct inhaler device?

A

In-check dial

32
Q

What may be required to treat croup?

A

Single dose of Dexamethasone

33
Q

What is croup?

A

Childhood condition that mainly affects babies - characterised by a barking cough

34
Q

What drug class is ipratropium and how long is its duration of action?

A

a short acting muscarinic antagonist (SAMA)
with maximal effects between 30-60mins. It has a sloweronset of action to short acting beta agonists (SABA). Durationof action = 3-6 hours.

35
Q

Examples of LAMAs

A

Tiotropium, aclidinium glycopyrronium and umeclidinium

36
Q

Duration of action of tiotropium

A

24 hours

37
Q

What conditions are LAMAs cautioned in?

A

-Prostatic hyperplasia and bladder outflow obstruction
worsened urinary retention reported
-Angleclosure glaucoma n bulised mist can
precipitate/worsen. Use a mouthpiece rather than a mask

38
Q

What tiotropium inhaler had an MHRA alert warning in may 2018?

A

Braltus - risk of inhalaton of capsule if placed in the mouthpiece of the inhaler

39
Q

What age are salbutamol syrup and tablets not licensed for use in?

A

<2 year olds

40
Q

Injection and infusion of salbutamol is not licensed for what age group?

A

<12 years

41
Q

MHRA warning for corticosteroids (inhaled + systemic)

A

Rare risk of central serous chorioretinopathy. Patients should report ant blurred vision / visual disturbances

42
Q

Side effects of inhaled corticosteroids

A

oral candidiasis, voice alteration, taste alteration, headache, growth suppression in children, glaucoma

43
Q

How can the risk of candidiasis be reduced wiht ICS?

A

Wash mouth before and after use

44
Q

If a patient experiences paradoxical bronchospasm with ICS what does the BNF suggest?

A

discontinue and an alternative therapy should be considered

45
Q

If a child is using ICS what should be monitored?

A

Height and weight annually

46
Q

What is the MHRA warning regarding QVAR and Clenil modulite?

A

They are not brand interchangable (differing bioavailibilities) as QVAR has extra fine particles and is more potent than traditional beclomethasone ( twice as potent as Clenil)

47
Q

What is the only OD ICS?

A

Ciclesonide

48
Q

Mepolizumab is a biological medicine used in eosinophilic asthma - how are these prescribed / dispensed?

A

By brand name (record batch number and name after each administration)

49
Q

What is the MHRA warning associated with LTRA?

A

Risk of neuropsychiatric reactions (speech impairment and OCD)

50
Q

What drug class is Nedrocromil sodium?

A

Mast cell stabiliser

51
Q

Example of a phosphodiesterase 4 inhibitor used in asthma as bronchodilator

A

Roflumilast

52
Q

How should Aminophylline / Theophylline be prescribed

A

By brand name

53
Q

Therapeutic range required for theophylline

A

Therapeutic range 10 20mg/L (sometimes 5 15mg/L is effective)

54
Q

In what instances can Theophylline level be increased ?

A

congestive HF, hepatic impairment, viral infections, drugs p450 inhibitors

55
Q

In what instances can theophylline levels be decreased?

A

smokers and by alcohol consumption - care and monitoring required during smoking cessation, drugs p450 inducers

56
Q

Theophylline toxicity symptoms

A

Vommiting, agigtation, restlessness, dilated pupils, sinus tacycardia, hyperglycaemia

57
Q

when is taking a theophylline level essential?

A

When giving IV loading dose

58
Q

How long after the IV dose should a theophylline level be taken?

A

4 - 6 hours

59
Q

What electrolyte derrangment can occur from theophylline?

A

Hypokalaemia

BNF Respiratory (6 decks)

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