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PM2D Spring Amy L > Pharmaceutical Care of Respiratory Patients II (Role of Pharmacist in Hospital) > Flashcards

Pharmaceutical Care of Respiratory Patients II (Role of Pharmacist in Hospital) Flashcards

1
Q

List 3 drug-drug interactions in asthma/COPD

A
  1. Patients already on theophylline - careful with aminophylline infusions
  2. Drugs that lower potassium
  3. Theophylline interactions - e.g. lithium, macrolides
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2
Q

What are drug-disease interactions?

A
  • Diseases that may be affected by drugs used in asthma/COPD
  • Or disease that may affect the drugs
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3
Q

List 3 drug-disease interactions in asthma/COPD

A
  1. Diabetes
  2. Cardiovascular disease (watch potassium)
  3. Hypertension
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4
Q

List 8 symptoms of acute asthma

A
  1. Severe breathlessness
  2. Tachypnea - abnormally rapid breathing
  3. Tachycardia - abnormally rapid heart rate
  4. Silent chest - lungs tighten so much during attack that there is not enough air movement for wheezing
  5. Cyanosis - blue-ish skin due to poor circulation/inadequate oxygenation of the blood
  6. Accessory muscle use - muscles that assist but do not play primary role in breathing
  7. Altered consciousness
  8. Decreased oxygen saturations
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5
Q

How does oxygen relieve the symptoms of a severe asthma attack?

A

Cells have been starved of oxygen during attack = hypoxia and possibly cyanosis

SpO2 level of 94-98%

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6
Q

How do B2 agonist bronchodilators relieve the symptoms of a severe asthma attack?

A
  • Relieve bronchospasm
  • Repeat at 15-30 minute intervals
  • Can be given via nebuliser or IV
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7
Q

How do steroids relieve the symptoms of a severe asthma attack?

A
  • Prednisolone 40-50mg for at least 5 days
  • Reduces mortality, relapses, subsequent admission and requirement for B2 agonist therapy
  • Can be given orally or parenterally
  • Earlier the steroids are given, the better the outcome
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8
Q

How does ipratropium bromide (Atrovent) relieve the symptoms of a severe asthma attack?

A
  • Greater bronchodilation than a B2 agonist alone
  • Leads to faster recovery and shorter duration of admission
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9
Q

How does magnesium sulphate relieve the symptoms of a severe asthma attack?

A
  • Bronchodilator
  • IV or nebuliser 1.2g-2g
  • IV infusion over 20 minutes
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10
Q

How does aminophylline relieve the symptoms of a severe asthma attack?

A
  • For patients with near-fatal/life-threatening asthma who have poor response to initial therapy
  • Given via IV
  • Check levels if taking oral theophylline
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11
Q

List 6 things that should be monitored in an asthma patient

A
  1. PEFR - peak expiratory flow rate - tests lung function
  2. Oxygen saturation
  3. Heart rate
  4. Potassium
  5. Blood glucose
  6. Serum theophylline
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12
Q

What should occur post-hospital admission following an asthma attack?

A
  • Patient should be followed-up and reviewed as soon as possible by their asthma nurse
  • Asthma action plan (PAAP) written/reviewed
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13
Q

What 3 things should occur during counselling of asthma patients?

A
  1. Assess the exacerbation = trigger factors
  2. Optimise treatment - compliance, review inhaler technique, consider stepping-up treatment
  3. Review understanding - of how to recognise exacerbation and what to do
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14
Q

List the 3 steps of the controlling of symptoms of asthma

A
  • Step 1: Inhaled short-acting B2 agonists e.g. salbutamol, terbutaline
  • Step 2: ICS e.g. beclometasone, fluticasone
  • Step 3: LABA, leukotriene receptor antagonist or theophylline and using a daily corticosteroid tablet
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15
Q

List 2 side effects of ICSs

A
  1. Oral candidiasis
  2. Dysphonia - difficulty in speaking

Higher doses = more severe side effects

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16
Q

List 3 side effects of LABAs

A
  1. Cardiovascular stimulation
  2. Anxiety
  3. Tremor
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17
Q

List 4 side effects of leukotriene receptor antagonists

A
  1. Abdominal pain
  2. Thirst
  3. Sleep disturbances
  4. Headache
18
Q

What advice should be given to patients taking ICSs

A
  • Prolonged high-dose ICS use = risk of systematic side effects
  • Visit GP if experience: worsening fatigue, muscle weakness, loss of appetite
  • Reduce dose gradually
  • Carry steroid card as appropriate
19
Q

List 5 counselling points for asthmatics

A
  1. Know the difference between a preventer and a reliever
  2. Understand the importance of using their preventer inhaler regularly, even when they are well
  3. Know when their inhaler needs to be changed and how to replace it
  4. Don’t waste their medicines through inappropriate usage e.g. test pressing
  5. Clean their spacer correctly and often
20
Q

List 3 ways to improve medicines optimisation

A
  1. Spacer compatible with device
  2. Ensure patient understands the “relapsing remitting” nature of asthma
  3. Make sure patient understands their PAAP
21
Q

What does COPD stand for?

A

Chronic obstructive pulmonary disease

22
Q

What is the purpose of most treatments for COPD?

A

To control or reduce the rate of exacerbation (worsening)

23
Q

What lifestyle change has been the only factor to have slowed the decline in lung function from COPD?

A

Smoking cessation

24
Q

How do mucolytics work?

A
  • Increase expectoration (coughing) of sputum by decreasing its viscosity
  • Discontinue if no improvement after 4 weeks
25
Q

Give an example of a mucolytic and its dose

A
  • Carbocisteine
  • 1.5g-2.25g daily in divided doses
26
Q

List 2 new treatments in COPD

A
  1. Combination of long-acting muscarinic antagonist and long-acting B2 agonist
  2. Roflumilast
27
Q

Describe the use of LAMA and LABA combined to treat COPD

A
  • Used if ICS/LABA is not tolerated
  • Once or twice daily administration, depending on product
  • Convenience and less expensive as one inhaler
28
Q

Describe the use of Roflumilast

A
  • Phosphodiesterase type-4 inhaler
  • Anti-inflammatory
  • Adjunct to bronchodilators for maintenance treatment
  • Causes weight loss - patients should monitor body weight
29
Q

List 5 things that should be monitored in COPD

A
  1. Breathlessness
  2. Oxygen saturations
  3. FEV1 = volume of air that can be expelled from maximum inspiration in the 1st second
  4. Exercise tolerance
  5. Frequency of exacerbations (episodes)
30
Q

List 3 ways to improve medicines optimisation in COPD treatment

A
  1. Spacer compatible with device
  2. Ensure patient understands importance of exacerbation
  3. Monitor and adjust treatments to optimise therapy
31
Q

List 3 counselling points for patients with COPD

A
  1. Explain when and how to use inhalers
  2. Instruct patient to respond appropriately to first sign of an exacerbation
  3. May need bone protection with long-term steroids
32
Q

What is pneumonia?

A
  • Acute respiratory illness
  • Affects distal airways of the respiratory tract and lung parenchyma (i.e. the lower respiratory tract)
  • Differs from bronchitis - has consolidation (air space) on x-ray
33
Q

What does CAP stand for?

A

Community-acquired pneumonia

34
Q

What is the treatment for moderate severity CAP?

A
  • 7-10 days of antibiotic therapy
  • Macrolide and amoxicillin
35
Q

What is the treatment for high severity CAP?

A
  • 7-10 days of antibiotic therapy
  • Beta-lactam and a macrolide
36
Q

What does HAP stand for?

A

Hospital-acquired pneumonia

37
Q

How is HAP treated?

A

According to hospital policy

38
Q

List 6 things that should be monitored in pneumonia

A
  1. Response to antibiotics - CRP, temperature, respiratory rate
  2. Keep co-existing conditions stable
  3. Monitor renal function - adjust doses if necessary
  4. Avoid respiratory depressants
  5. Watch interactions e.g. macrolides
  6. Oxygen saturations - should be between 94-98%
39
Q

What should happen, with regards to symptoms of pneumonia, between 1 to 6 weeks of treatment commencing?

A
  • 1 week - fever should have resolved
  • 4 weeks - chest pain and sputum production should have substantially reduced
  • 6 weeks - cough and breathlessness should have substantially reduced
40
Q

What should happen, with regards to symptoms of pneumonia, between 3-6 months of treatment commencing?

A
  • 3 months - most symptoms should have resolved but fatigue may still be present
  • 6 months - most people will feel back to normal

PM2D Spring Amy L (9 decks)

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