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M103 T4 > M103 T4 L7 > Flashcards

M103 T4 L7 Flashcards

1
Q

When does asthma most commonly present?

A

in childhood or in middle age

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2
Q

Which three factors cause airflow obstruction?

A

Bronchoconstriction
Bronchial secretions and plugs of mucus
Oedema of the bronchial wall

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3
Q

What causes bronchial secretions and plugs of mucus?

A

inflammation of the bronchial wall

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4
Q

What causes oedema of the bronchial wall?

A

inflammation the lining mucosa of the bronchial wall

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5
Q

How can asthma be identified in patients?

A

skin prick test
measure igE atby levels
often associated hay fever / eczema in the personal family history
blood test (in conjunction with other tests - rarely done by itself for asthma)

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6
Q

What are the symptoms of asthma?

A

Cough
Wheeze
Breathlessness
Chest tightness

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7
Q

Time wise how do asthma symptoms take effect?

A

occurs in episodes with periods of no / minimal symptoms

diurnal variability

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8
Q

What would you look at to better diagnose asthma?

A 
History
Symptom free periods
Past medical history 
family history (of any atopic disease)
social history (occupation, pets) 
alternative diagnosis is unlikely
Physical examination may be normal except during an attack
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9
Q

What are examples of features in a past medical history that could help indicate asthma?

A

previous wheezing illness
hay fever
eczema

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10
Q

What three investigations can be conducted to indicate asthma?

A

Tests done by GP
Tests done by GP/Hospital
Skin prick / blood tests may confirm allergies

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11
Q

Which investigations can be done by the GP alone to help diagnose asthma?

A

Peak flow monitoring

Spirometry may show airflow obstruction, but may be normal between attacks

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12
Q

Which investigations can be done by the GP or the hospital to help diagnose asthma?

A

CXR, eosinophil count, FeNO

CXR often normal, but may show hyperinflation
ec increased

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13
Q

Which investigations can be done by the hospital only to help diagnose asthma?

A

skin prick

blood test

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14
Q

How often is peak flow monitored by the GP?

A

twice day for two weeks

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15
Q

What causes hyperinflated lungs?

A

trapped air - can’t exhale / push out all of the air that’s in the lungs
the air gets trapped and takes up space
can make it harder to get fresh air into the body
the lungs try to fix this by taking in more and more air

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16
Q

How can eosinophilic asthma be identified from other asthmas?

A

patient will have an increased eosinophil count in the blood

count will be greater than 0.3

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17
Q

What value indicates airflow obstruction?

A

when the FEV1 / FVC ratio is greater than 0.7

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18
Q

Reversible airflow obstruction is when the asthma is not present all the time. What test can we do to indicate the presence of asthma in these conditions?

A

patient performs spirometry
measure their FEV1
give them a bronchodilator to see if the value improves

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19
Q

How can salbutamol be administered to an asthma patient?

A

inhaler via a spacer

sometimes nebuliser

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20
Q

In what circumstance can salbutamol be administered as a nebuliser?

A

only if the patient has severe asthma or COPD / acute exacerbation of their asthma

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21
Q

How can salbutamol be administered to an asthma patient?

A

a spacer device containing an inhaler
tablets, capsules or syrup (for people who cannot use an inhaler very well)
nebuliser

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22
Q

How is PEFR monitored independently by the patient?

A

they should take a PEFR three times so that an average value can be calculated
should be standing up at the time

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23
Q

What does a positive FeNO value look like and what does it indicate?

A

a positive test is more than 40ppb - supports diagnosis of asthma

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24
Q

Where is FeNO used?

A

can be done in GP and hospital clinics

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25
Q

How are asthma patients symptoms / QoL improved by non-physiological means?

A

stop smoking

lose weight

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26
Q

What four factors do corticosteroids reduce?

A

ease swelling
itching
redness
allergic reactions

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27
Q

Why are asthma patients never administered a single asthma treatment by itself?

A 
one medication only is associated with increased deaths
a bronchodilator (e.g.) only treats the symptoms - is short term relief
doesn't do anything about the cause - doens't treat the inflammation
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28
Q

What is the function of long acting b2 agonists?

A

to relax smooth muscle and cause bronchodilatation

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29
Q

What are two examples of long acting b2 agonists?

A

salmeterol

formoterol

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30
Q

How long do LABAs last for and how often should they be administered per day?

A 
12 hours (longer lasting than others)
twice a day
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31
Q

What are the two oral treatments of asthma? (LAM Theo)

A

leukotriene antagonist-montelukast

theophyllines

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32
Q

When might an asthma patient be put on low dose long-term oral steroids?

A

chronically poorly controlled asthma

patients who keep having recurrent courses of high doses of steroids

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33
Q

Give an example of a low dose longterm oral steroid

A

prednisolone

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34
Q

Give an example of an oral leukotriene antagonist

A

montelukast

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35
Q

What is the function of short acting beta agonists?

A

relieves symptoms when the patient becomes symptomatic in certain situations e.g. exercise

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36
Q

What are two examples of short acting beta agonists?

A

Salbutamol

Terbutaline

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37
Q

After salbutamol treatment, what would indicate improvement?

A

FEV1 value improves to 15% and 200 ml compared to baseline

38
Q

What is a benefit of Maintenance and reliever therapy?

A

tackles airway inflammation and bronchoconstriction

39
Q

What is the next step of prescription if LABA isn’t that effective (since it’s only short term)?

A

then LABA combined with a specific ICS

40
Q

What is the dosage for specific ICS / LABA combinations taken as additional doses?

A

4/day for 2-3 days

to rapidly treat any worsening asthma symptoms

41
Q

What are the benefits of using certain specific ICS / LABA combinations?

A

can be used as relievers as well as preventers

they aim to address and treat the inflammatory aspect of disease

42
Q

What are the lines of treatment for asthma?

A

1st LoT: low dose ICS
2nd LoT: 1st + inhaled LABA
3rd LoT: 2nd + LTRA or medium dose ICS (if no response to LABA, discontinue)
4th LoT: refer patient for specialist care

43
Q

What are the main two types of inhalers?

A

dry powder inhalers

pressurised metered dose inhalers

44
Q

Which two drugs is MART a combination of?

A

ICS

LABA

45
Q

How do dry powder inhalers work?

A

the powdered drug is dispersed into particles by inspiration

46
Q

How do pressurised metered dose inhalers work?

A

the drug is dissolves in propellant HFCs

a pressure valve system delivers a metered dose

47
Q

When are dry powder inhalers beneficial to use?

A

when the patients know how to use them
when the patient has good dexterity
when the patient has a good enough inspiratory effort - can take a deep enough breath in to trigger activation

48
Q

What should pressurised metered dose inhalers always be used in conjunction with and why?

A

a spacer device

to provide correct co-ordination so that enough gets in the lungs

49
Q

What is a disadv of pressurised metered dose inhalers?

A

contain HCFs - bad for the environment

50
Q

What are the side effects of some asthma-treating drugs from inhalers?

A

thrush (caused by ICS),
tremor (caused by SABA / LABA)
tachycardia (caused by SABA / LABA)

51
Q

What are the three key questions to ask asthma patients?

A

Have you had difficulty sleeping because of your asthma symptoms (including cough)?
Have you had your usual asthma symptoms during the day?
Has your asthma interfered with your usual activities?

52
Q

When are specialised treatments used for asthma patients (4th LoT)?

A

used for a very small number of patients with difficult asthma at a hospital

53
Q

What are specialised treatments for asthma?

A

using monoclonal antibodies

bronchial thermoplasty

54
Q

What are the two types of monoclonal antibody specialist treatments for asthma?

A

anti-IgE injections

anti IL-5 treatment

55
Q

Why are monoclonal antibody treatments only reserved for specialist treatment?

A

much more expensive

given as injections

56
Q

What are five factors that may result in unintentional lack of treatment compliance / adherance?

A 
misunderstanding (continuation of previous inhalers in addition to new ones)
poor inhaler technique
language barrier / medical terminology
forgetfulness
stress
57
Q

What are five factors that may result in intentional lack of treatment compliance / adherance?

A

concern about side-effects
denial
cost (have to pay for prescription drugs in inhaler)

58
Q

What are the requirements for a self management and a personal asthma action plan (PAAP) to lower the rate of asthma deaths?

A

List daily medication to take and explain why
List which asthma triggers to avoid and importance of smoke free environment
List what to look for signs of deterioration of asthma/ values for PEFR
List names and doses of medication to be taken to treat worsening asthma
List indicators of how and when to seek medical attention
Easy to understand, 2-3 action points, traffic light colour coded leaflets

59
Q

What is the importance of using personal asthma action plans?

A

Improves asthma control
Reduces emergency contacts with GP
Reduces hospital admissions

60
Q

Why should all patients should see the asthma nurse at the GP practice regularly?

A

it gives an opportunity for a health care professional to actually see what the asthma control is like
review inhaler technique
review asthma education
either step up or step down treatments

61
Q

What is the PEFR, respiration rate and pulse of patients with acute severe asthma?

A

PEFR: 33-50% of best
Respirations: x≥25 breaths/min
Pulse: x≥110 beats/min

62
Q

What are life threatening features of acute severe asthma?

A

PEFR <33% of best or predicted

SpO2 <92% (regardless of air or oxygen)

63
Q

What are the seven symptoms of life threatening acute severe asthma? (All Arrows Can Exhaust Fierce Soldier Hate)

A 
altered consciousness
arrhythmia 
cyanosis
exhaustion
feeble respiratory effort
silent chest
hypotension
64
Q

What is a symptom of acute severe asthma?

A

Can’t complete sentences in one breath

65
Q

What 1LoT drug types are used to treat acute severe asthma?

A

corticosteroids and nebulised bronchodilators

66
Q

What might be required for asthma treatment in exceptional circumstances?

A

intubation

ventilation

67
Q

What are the requirements for discharging an asthma patient from hospital?

A

their inhaler technique should be checked and recorded

a written PAAP follow up

68
Q

After discharging an asthma patient from the hospital, what follow up meetings should they attend?

A

GP / nurse within 2 working days

respiratory clinic within 4 weeks

69
Q

When are IgE antibodies produced?

A

allergic reaction

70
Q

Is there a large number of eosinophils in circulation in a normal healthy patient?

A

no

71
Q

What device is used to measure the peak expiratory flow rate?

A

peak flow meter

72
Q

What are two oral long term treatments for asthma?

A

theophyllines

leukotriene receptor antagonists

73
Q

How do leukotriene receptor antagonists treat long term asthma?

A

it prevents exercise induced bronchoconstriction

treats seasonal allergic rhinitis

74
Q

What terms is a leukotriene receptor antagonist otherwise known as?

A

antileukotriene

leukotriene modifier

75
Q

What is a feature of breath-actuated inhalers that might make usage either easier or more difficult to use during an asthma flare?

A

they typically require a quick, forceful inhalation

76
Q

What’s an advantage of dry powder inhalers?

A

they allows medicine to get deep into the lungs

77
Q

What is the FeNO test used to diagnose and how?

A

dx breathing conditions (certain types of asthma) via airway inflammation

78
Q

When are FeNO tests used?

A

to diagnose breathing conditions

to check if any medication being taken is working

79
Q

Are FeNO tests used independently?

A

no, other tests are needed (spirometry and a peak flow test)

80
Q

What quantity of salbutamol is delivered via an inhaler?

A

100 mcg

81
Q

What quantity of salbutamol is delivered via an nebuliser?

A

2.5mg (high dose)

82
Q

What are the aims for acute severe asthma treatment?

A

to correct oxygen levels
to administer medication correctly
normal target saturations

83
Q

What is the 2LoT for acute severe asthma?

A

iv MgSO4 or iv aminophylline

84
Q

What corticosteroid is used to treat acute severe asthma?

A

prednisolone 40-60 mgs (oral)

85
Q

What nebulised bronchodilators are used to treat acute severe asthma?

A

salbutamol + ipratropium bromide

86
Q

What are the medical requirements for discharging an asthma patient from hospital?

A

patient must have been on discharge medication for 24hrs

87
Q

What medication do asthma patients need to have for home administration IOT be discharged from hospital?

A

oral and inhaled steroids

bronchodilators

88
Q

What equipment do asthma patients need to have for home administration IOT be discharged from hospital?

A

PEFR meter

89
Q

What must an asthma patients’ PEFR be to be discharged from hospital?

A

PEFR >75% (of best or predicted)

90
Q

What must an asthma patients’ PEFR diurnal variability be to be discharged from hospital?

A

x<25%

M103 T4 (19 decks)

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