LOW RESPIRATORY TRACT Flashcards
Which of the following inhaled medications is/are (a) short-acting beta agonist(s?
a) Salmeterol
b) Salbutamol
c) Fenoterol
d) Formoterol
e) Terbutaline
B
Which of the following local side-effects is most associated with
inhaled beclometasone?
a) Dry mouth
b) Oral candidiasis
c) Metallic taste
d) Dental caries
B
what is bronchitis?
inflammation of the bronchi
Acute bronchitis
common clinical conditions characterized by an acute onset but persistent cough, with or without sputum production.
chronic bronchitis
chronic inflammatory condition, characterized by thickened, oedematous bronchial mucosa with mucous gland and hypertrophy
what normally causes chronic bronchitis?
caused by smoking
Often co-exists with
emphysema – both what?
airflow limitation and COPD
Acute bronchitis vs pneumonia
acute bronchitis: caused by mycoplasma pneumonia. mucus in the airway. inflamed and edematous large airway.
pneumonia: caused by streptococcal pneumonia. inflamed and edematous of small and large airways. pus, mucus and alveoli filled with fluid leading to lung consolidation.
symptoms of acute bronchitis
- acute onset, persistent cough, concurrent upper respiratory tract infection and mild dyspnea.
symptoms of pneumonia
dyspnea
lung consolidation
abnormal vitals
high temperature
acute/ subacute onset cough.
Acute bronchitis: treatment approach
resolve in about 1-3 weeks.
antibiotics are not recommended.
nonpharmacological options for cough relief?
such as throat lozenges,
hot tea, honey, steam inhalation, adequate hydration and/or smoking
cessation or avoidance of second-hand smoke is a reasonable first
step. * Cough preparations
* Paracetamol for pain and fever
What are the different types of cough preparations?
- Antitussives
- Mucolytics
- Expectorants
What types of cough are they used for?
for Dry cough - for antitussives
wet cough for- mucolytics and expectorants
Mechanism of action and examples
* Antitussives
* Mucolytics
* Expectorants
- Antitussives : codeine phosphate, methadone and dihydrocodeine
- Mucolytics: N-acetylcysteine and Bromhexine.
- Expectorants: Guaifenesin (Mucinex, Robitussin Chest Congestion
Cautions for cough preparations.
Mucolytics: bronchospasm
GIT irritation
rash
fever
Headache
Antitussives (Cough Suppressants):
drowsiness, headache
constipation, confusion, excitement and sedative
Expectorants: drowsiness, headache
constipation.
Part of COPD, and sometimes with emphysema are characterized by:
chronic cough with or without sputum
shortness of breath
wheezing
if the symptoms suggest TB it will be ?
weight loss, night sweats and fever
what is partially reversible with COPD
bronchospasm.
Management of acute exacerbations of chronic bronchitis: an emergency recognition.
wheeze
breathlessness
tightness of chest
respiratory distress
cough.
Management of acute exacerbations
short-acting bronchodilators (SABA, SAMA
Supplemental oxygen (24-28%)
* Oral corticosteroids: Prednisone, oral, 3
Acute infective exacerbation of chronic bronchitis: drugs used?
Amoxicillin, oral, 8 hourly for 5 days.
Severe penicillin allergy: * Doxycycline, oral, 12 hourly for 5 days
Viral structures of pharmacological
importance: of the influenza virus
neuraminidase
hemagglutinin
Neuraminidase inhibitor
- Oseltamivir * Zanamivir
they all available as inhalers
what is the action of neuraminidase inhibitors?
disrupt the release of influenza virus from the host cell.
what does neuraminidase inhibitors mimic?
These
neuraminidase inhibitors mimic neuraminidase’s sialic acid binding site. When
introduced, they bind neuraminidase on the budding viruses, blocking its enzymatic
activity
Neuraminidase drug that is taken as an initiative within 24-48 hours of onset symptoms reduce duration by less than 1 day ?
oseltamivir
High risk influenza patients:
pregnant, immunosuppressed and children are at risk of influenza.
pep for influenza infected people
is given to high risk close contact patient within 48 hours.
Oseltamivir MOA and class
is an neuraminidase
is a prodrug
used as PEP
oral Adm.
neuraminidase - powder for inhalation
Zanamivir
drug treatment key recommendations for COVID
heparin.
baricitinib.
dexamethasone.
drug for patients requiring supplemental
oxygen or mechanical ventilation
dexamethasone and baricitinib
heparin drug
for venous thromboembolism prophylaxis
sign of severe covid -19
dyspnea
high RR
Bp less than 90/60
confused
unable to walk
oxygen saturation less than 95%
Coughs ≥ 1 tablespoon fresh blood
Mild disease management
- Home management * Separate bedroom available for patient to self-isolate in
- Able to maintain physical distancing at home
- Able to maintain hand hygiene
- Patient able to contact, and return to, healthcare facility in case of
deterioratio
Hospital Level Care for severe disease
Isolate and employ appropriate IPC
Supplemental oxygen / ventilator
support
Respiratory Support
Analgesics & Antipyretics
Thromboprophylaxis
Corticosteroids
Analgesic and antipyretics fr pain and fever
paracetamol
Corticosteroids given to treat covid -19
- Dexamethasone 6mg daily for 10 days
- OR
- Betamethasone 6mg (po/iv) for 10 days
- OR * Prednisone 40mg PO daily for 10 days
- WHO recommended equivalents * OR
- Hydrocortisone 50 mg IV TDS
- OR
- Methylprednisolone 8 mg QID or 16 mg BD PO or I
Thromboprophylaxis drug
heparins
enoxaparin
dalteparin
Inactivates thrombin & factor Xa through antithrombin III activation
side effects of using thromboprophylaxis
bleeding
HIT
Janus kinase inhibitor that has anti-inflammatory
properties
Baricitinib
baricitinib is registered as a drug that treat ?
several dermatological conditions and rheumatoid arthritis.
Vaccine: common side-effects
headache
muscle sore
nausea
fatigue
fever
Vaccine: Caution!!
Thrombocytopenia
* Bleeding disorders
* On coagulation therapy
