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CPTP 4.15-17 > CPTP 4.15-17 > Flashcards

CPTP 4.15-17 Flashcards

1
Q

leukotrienes function

A

bronchoconstriction, mucous secretion, airway inflammation

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2
Q

6 types of bronchodilator

A

B2 agonists, muscarinic antagonists, phosphodiesterase inhibitors, leukotriene antagonists, mast cell stabilisers, anti-IgE monoclonal Ab

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3
Q

E.g. of a phosphodiesterase inhibitor

A

theophylline

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4
Q

onset and therefore indications for salmeterol

A

slow onset not for relief of acute asthma attack

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5
Q

adverse effects of b2 agonists

A

hypoK, tremor, anxiety

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6
Q

what non-resp condition can salbutamol treat

A

hyperkalaemia

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7
Q

e.g. of SAMA

A

ipratropium

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8
Q

e.g. of LAMA

A

tiotropium

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9
Q

how does theophylline work

A

inhibits phosphodiesterase to cause an increase in cAMP in smooth muscle leading to bronchodilation

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10
Q

theophylline administration

A

oral

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11
Q

narrow TI asthma drug

A

theophylline

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12
Q

What is montelukast

A

leukotriene receptor antagonist

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13
Q

efficacy/safety of leukotriene receptor antagonists

A

Because the leukotriene pathway is just one of several process responsible for the inflammatory response in asthma, they are less effective than inhaled corticosteroids, but have very few side effects

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14
Q

once sx improve should you stop taking steroids?

A

no - take a while to reduce inflammation

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15
Q

Treatment of severe persistent confirmed IgE-mediated asthma needing continuous or frequent (≥4 courses/yr) oral corticosteroids

A

IgE monoclonal Ab e.g omalizumab. Monoclonal Ab binds to IgE Ab and block the antibody causing mast cell activation

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16
Q

what is FeNO

A

Fractional exhaled nitric oxide (FeNO) can give a quantitative measure of airway inflammation to help identify, treat, and manage steroid-responsive patients

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17
Q

inhaled corticosteroids used in asthma

A

Beclometasone
Budesonide
Fluticasone

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18
Q

oral corticosteroids

A

prednisolone

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19
Q

Which asthma drug belongs in the Methylxanthine class

A

theophyllines

20
Q

pre-step 1 asthma mx

A

Consider initiating tx with low dose inhaled CS, evaluate then go to step 1 (SABA as required)

21
Q

step 1 asthma mx

A

regular preventer with low dose ICS (SABA as required)

22
Q

step 2

A

initial add on tx. add inhaled LABA to low dose ICS (comb inhaler seretide)

23
Q

step 3

A

increase ICS in no LABA response. consider trial of leukotriene receptor antagonist, S-R theophylline, LAMA

24
Q

step 4

A

increase ICS to high dose, add 4th drug (LTRA, theophylline, beta agonist tablet, LAMA)

25
Q

step 5

A

daily steroid tablet, maintain high dose ICS

26
Q

when to refer to specialist care

A

when get to stage 4 and 5

27
Q

when to consider moving up a level

A

when using SABA three doses or more per week

28
Q

how can glaucoma tx exacerbate asthma

A

beta blocker eye drops (give prostaglandin analogue as glaucoma tx if this happens)

29
Q

NSAIDs and asthma

A

can cause bronchospasm in those sensitive, espec if sensitive to aspirin

30
Q

when can you be discharged from ED in after asthma attack

A

PEFR >75%

31
Q

consider dose of IV what during asthma attack

A

magnesium sulphate

32
Q

ABx in asthma attack?

A

no

33
Q

if poor response to nebulinsed SABA in asthma attack?

A

add nebulised ipratropium bromide

34
Q

diurnal variation in COPD

A

no

35
Q

tx of COPD exacerbations

A

O2, short course oral steroids, ABx (simple and short), nebulised bronchodilators, NIV

36
Q

advantage of venturi mask?

A

can tell what o2 conc giving

37
Q

definition of acute severe asthma

A

1 of. PEF 33-50% best/predicted. RR >25. HR >110. Inability to complete sentences in one breath.

38
Q

cause of most asthma exacerbations

A

viral (reason why ABx not indicated)

39
Q

Why should you only give a single dose of magnesium sulphate?

A

Repeated doses could cause hypermagnesaemia - muscle weakness and respiratory failure

40
Q

What electrolyte should you measure after acute asthma tx?

A

Potassium (likely to be low after repeated salbutamol doses - inh/IV)

41
Q

If patient on theophylline develops pneumonia - caution?

A

Clarithromycin and ciprofloxacin inhibit metabolism therefore increase theophylline concentrations (reduce dose and monitor level - narrow TI)

42
Q

does theophylline reverse steroid insensitivity?

A

yes

43
Q

pathophys of type 1 respiratory failure

A

v/q mismatch

44
Q

pathophys of type 2 respiratory failure

A

ventilatory failure

45
Q

when is LTOT indicated in COPD

A

PaO2<7.3. PaO2 7.3-8 and cor pulmonale

CPTP 4.15-17 (1 decks)

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