NPS foundation term Flashcards
What is a common cause of COPD exacerbation?
Infection; viral URTI and bacterial LRTI. Non infective causes like air pollution and temperature changes can also exacerbate COPD acute
What is the rationale for drug use in an acute exacerbation of COPD?
symptom relief and to treat exacerbation
How should we treat an acute exacerbation of COPD? (general drugs)
Bronchodilator beta2 agonists and ipratropium bromide (anticholinergic)–> symptom reliefOral corticosteroids shorn recovery and reduce the severity of the acute exacerbationAntibiotic therapy
What should we do immediately with an acute exacerbation of COPD?
Provide oxygen via venturi mask (observe in case the patient is a CO2 retainer)
What is a multidisciplinary pulmonary rehabilitation program?
Graduated increments in exercise to train skeletal and accessory respiratory muscles. Increase exercise tolerance
What medication should we use to treat an acute exacerbation of COPD? (list specific drugs and dose)
salbutamol 100 mg, ipratropium bromide 40mg, doxycycline 100 mg, prednisolone 25 mg, and nicotine if required
What are some recommended non drug treatments for acute pulmonary oedema APO
- restrict salt2. sit the patient upright3. high o2 flow therapy4. restrict fluid 5. CPAP
What are some clinical symptoms of APO?
Dypsnoea, tachycardia, poor peripheral circulation, agitation, restlessness, lung crackles widespread, altered conscious state. due to intraalveolar fluid acculmulation and extreme SNS activation
How would we treat APO (drugs?)
LMNOPL- Lasex Frusemide (IV) Once only 40mgM- morphine IV every 2 hrs 2.5mg (reduces preload)N- GTN sublingually PRN 600 microgramO- oxygenP- sit up position
What do we worry about with APO, and how can we prevent it?
Venous thrombosis embolism–> VTE. VTE prophylaxis= enoxaparin.
What can cause delirium in older patients?
UTI, infections, changes in electrolytes, benzodiazapines, digoxin toxicity, diuretics (can cause hyponatremia)
What can we give a confused older patient (delirium)
Haloperidol PO 1mg
What can cause hyponatremia?
SSRIs, diuretics (indapamide)
What are the most effective LDL lowering agents? How much do they reduce LDL levels by? how many times do you take this drug?
Statins. They reduce LDL by 30-50%. Recommended once daily
What drug would you take if you had elevated triglyceride levels but not LDL levels?
Fibrates. Fenofibrate, gemfibrizol
What are some adverse effects of statins?
Myopathy + elevated liver enzymes
When would combination therapy of statins and other lipid modifying drugs be indicated? what are the usual combinations?
When statin mono therapy does not achieve LDL lowering goals. Instead of increasing the dose (which may increase risk of myopathy), we can add ezetimide or fibrates
What should be monitored subsequent to commencing statin therapy?
Serum lipids ever 4-6 weeks Adverse effectsLFTs for elevated transaminasesCK- should be measured before starting a statin
if we had a patient with an NSAID induced gastric ulcer, but requires NSAID medication for pain relief, then what drug would we prescribe?
Misoprostol 400 mg. However, the best case scenario is getting them off NSAIDs and using another drug class like paracetamol for pain relief
What are the drugs of first choice for NSAID induced ulcers?
Proton pump inhibitors.
What might happen if you prescribe verapamil and digoxin together? (think additive effect)
Both depress the AV node and so may cause heart block
How might diclofenac interfere with the effect of frusemide? What is diclofenac?
Diclofenac may decrease the efficacy of frusemide as NSAIDs cause sodium and water retention and compete for the organic acid secretory pathway of frusemide
How might diclofenac cause renal impairment?
Prostaglandin inhibition may be associated with decreased renal perfusion and a decline in kidney function in patients with renal disease
What Ace inhibitor is best used to treat HT and cardiac failure?
enalapril
For a patient with renal impairment and heart failure, would it be necessary to administer another drug for potassium levels if on loop diuretics?
Potassium supplements are not usually needed in these circumstances. Potassium retention tends to occur in renal impairment and dietary potassium is usually sufficient to replace losses associated with small doses of frusemide. Also, ACE inhibitors used in heart failure are associated with potassium retention because of aldosterone inhibition.
is verapamil indicated in cardiac failure? what other drug would you suggest?
Negative inotropes are best avoided in cardiac failure and may contribute to AV block in patients on digoxin. An ACE inhibitor would be a better choice given her heart failure.
What happens to verapamil’s bioavailability in liver cirrhosis?
It increases bc its primary mode of metabolism is hepatic metabolism
Triple whammy drugs? what do they cause?
Acute renal failure. Ace inhibitor, NSAID and diuretic
how to prevent post operative nausea and vomiting preoperatively?
administer dexamethasone prior to anaesthetic
how to treat post operative pain and vomiting?
morphine and paracetamol (to reduce opioid dose) and 5HT3 antagonists like ondanestron. Do not give oral form of medication because of vomiting
why shouldn’t tramadol be used with pethidine?
risk of serotonin toxicity
