Pharmaceutical Care of Respiratory Patients II (Role of Pharmacist in Hospital) Flashcards
(40 cards)
1
Q
List 3 drug-drug interactions in asthma/COPD
A
- Patients already on theophylline - careful with aminophylline infusions
- Drugs that lower potassium
- Theophylline interactions - e.g. lithium, macrolides
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
3
Q
List 3 drug-disease interactions in asthma/COPD
A
- Diabetes
- Cardiovascular disease (watch potassium)
- Hypertension
4
Q
List 8 symptoms of acute asthma
A
- Severe breathlessness
- Tachypnea - abnormally rapid breathing
- Tachycardia - abnormally rapid heart rate
- Silent chest - lungs tighten so much during attack that there is not enough air movement for wheezing
- Cyanosis - blue-ish skin due to poor circulation/inadequate oxygenation of the blood
- Accessory muscle use - muscles that assist but do not play primary role in breathing
- Altered consciousness
- Decreased oxygen saturations
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%
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
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
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
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
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
11
Q
List 6 things that should be monitored in an asthma patient
A
- PEFR - peak expiratory flow rate - tests lung function
- Oxygen saturation
- Heart rate
- Potassium
- Blood glucose
- Serum theophylline
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
13
Q
What 3 things should occur during counselling of asthma patients?
A
- Assess the exacerbation = trigger factors
- Optimise treatment - compliance, review inhaler technique, consider stepping-up treatment
- Review understanding - of how to recognise exacerbation and what to do
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
15
Q
List 2 side effects of ICSs
A
- Oral candidiasis
- Dysphonia - difficulty in speaking
Higher doses = more severe side effects
16
Q
List 3 side effects of LABAs
A
- Cardiovascular stimulation
- Anxiety
- Tremor
17
Q
List 4 side effects of leukotriene receptor antagonists
A
- Abdominal pain
- Thirst
- Sleep disturbances
- 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
- Know the difference between a preventer and a reliever
- Understand the importance of using their preventer inhaler regularly, even when they are well
- Know when their inhaler needs to be changed and how to replace it
- Don’t waste their medicines through inappropriate usage e.g. test pressing
- Clean their spacer correctly and often
20
Q
List 3 ways to improve medicines optimisation
A
- Spacer compatible with device
- Ensure patient understands the “relapsing remitting” nature of asthma
- 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
Give an **example** of a **mucolytic and its dose**
* **Carbocisteine**
* **1.5g-2.25g** daily in **divided doses**
26
List **2 new treatments in COPD**
1. Combination of **long-acting muscarinic antagonist** and **long-acting B2 agonist**
2. **Roflumilast**
27
Describe the use of **LAMA and LABA** combined to **treat COPD**
* Used if **ICS/LABA** is **not tolerated**
* **Once or twice daily** administration, depending on product
* **Convenience** and **less expensive** as one inhaler
28
Describe the use of **Roflumilast**
* **Phosphodiesterase type-4 inhaler**
* **Anti-inflammatory**
* Adjunct to **bronchodilators** for **maintenance treatment**
* Causes **weight loss** - patients should monitor body weight
29
List **5 things** that should be **monitored in COPD**
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. F**requency of exacerbations** (episodes)
30
List **3 ways** to **improve medicines optimisation** in **COPD** treatment
1. **Spacer compatible** with device
2. Ensure patient **understands importance** of **exacerbation**
3. **Monitor** and **adjust treatments** to optimise therapy
31
List **3 counselling points** for patients with **COPD**
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
What is **pneumonia**?
* **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
What does **CAP** stand for?
**Community-acquired pneumonia**
34
What is the **treatment** for **moderate severity CAP**?
* **7-10** days of **antibiotic therapy**
* **Macrolide and amoxicillin**
35
What is the **treatment** for **high severity CAP**?
* **7-10** days of **antibiotic therapy**
* **Beta-lactam and a macrolide**
36
What does **HAP** stand for?
**Hospital-acquired pneumonia**
37
How is **HAP treated**?
**According to hospital policy**
38
List **6 things** that should be **monitored in pneumonia**
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
What should happen, with regards to **symptoms** of **pneumonia**, between **1 to 6 weeks** of **treatment commencing**?
* 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
What should happen, with regards to **symptoms** of **pneumonia**, between **3-6 months** of **treatment commencing**?
* 3 months - most symptoms should have resolved but **fatigue may still be present**
* 6 months - most people will feel back to **normal**
