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Respiratory Block: Pharmacology > Practical Respiratory Clinical Therapeutics > Flashcards

Practical Respiratory Clinical Therapeutics Flashcards

1
Q

What is the preferred device for patients younger than 4 years old?

A

PMDI plus spacer with a face mask

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2
Q

What is the preferred device for patients 4-6 years old?

A

PMDI plus spacer with a mouthpiece

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3
Q

What is the preferred device for patients older than 6 years old?

A 
DPI 
OR 
PMDI plus spacer with mouthpiece 
OR 
Autohaler
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4
Q

By definition, what makes a week an uncontrolled week?

A

By definition, any exacerbation in any week makes that an uncontrolled week.
- any exacerbation should prompt a review of maintenance to ensure that it is adequate

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5
Q

Characteristic: Daytime symptoms

What is considered controlled (green)?

A

<2/week

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6
Q

Characteristic: Daytime symptoms

What is considered partly controlled (yellow)?

A

> 2/week

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7
Q

Characteristic: Limitation on activity

What is considered controlled (green)?

A

None

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8
Q

Characteristic: Limitation on activity

What is considered partly controlled (yellow)?

A

Any

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9
Q

Characteristic: Nocturnal symptoms / awakenings

What is considered controlled (green)?

A

None

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10
Q

Characteristic: Nocturnal symptoms / awakenings

What is considered partly controlled (yellow)?

A

Any

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11
Q

Characteristic: Need for reliever / rescue treatment

What is considered controlled (green)?

A

<2/week

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12
Q

Characteristic: Need for reliever / rescue treatment

What is considered partly controlled (yellow)?

A

> 2/week

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13
Q

Characteristic: Lung function (PEF/FEV1)

What is considered controlled (green)?

A

Normal

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14
Q

Characteristic: Lung function (PEF/FEV1)

What is considered partly controlled (yellow)?

A

<80% of predicted or personal best

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15
Q

Characteristic: Exacerbations

What is considered controlled (green)?

A

None

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16
Q

Characteristic: Exacerbations

What is considered partly controlled (yellow)?

A

1 or more per year

17
Q

What is considered uncontrolled (red)?

A
  1. 3 or more features of partly controlled asthma in any 1 week
  2. 1 exacerbation in any 1 week
18
Q

What are symptoms of acute severe asthma?

A
  • anxiousness
  • acute distress
  • severe dyspnoea
  • SOB
  • chest tightness or burning
  • the patient is only able to say a few words
  • symptoms are unresponsive to usual measures
19
Q

What are signs of acute severe asthma?

A
  • expiratory and inspiratory wheezing on auscultation
  • dry hacking cough
  • tachypnoea
  • tachycardia
  • pale or cyanotic skin, hyper-inflated chest
  • PEF less than 40% of normal
  • O2 sats by pule oximetry less than 90%
20
Q

What is the treatment for acute severe asthma?

A
  1. O2 via face mask (40%)
    AND
  2. Beta-2 agonist via nebulizer (must use an O2 driven nebulizer) - Salbutamol or Fenoterol
    OR
    IH beta-2 agonist (large-volume spacer)
    AND
  3. Systemic corticosteroids are essential
    - oral prednisone or IV hydrocortisone or IV methylprednisolone
    - only give IV if not able to swallow
21
Q

When should additional therapy be given following standard therapy in acute severe asthma?

A

Additional therapy when symptoms do not improve & in severe and imminently life-threatening situations

22
Q

What additional therapy can be given following standard therapy in acute severe asthma?

A
  • Ipratropium Bromide / beta-2 agonist
  • Theophylline (aminophylline)
  • IV beta-2 agonist
23
Q

What additional therapy can be given in acute severe asthma only if severe and life-threatening?

A

IV magnesium sulphate

24
Q

What additional therapy can be given in acute severe asthma only prior to respiratory arrest?

A

Intubation and ventilation

25
Q

What additional therapy can be given in acute severe asthma if moribund and ONLY if moribund?

A

Epinephrine

26
Q

For acute severe asthma, what should patients be discharged with once improved?

A
  1. Short course of oral corticosteroids (prednisone for 7-14 days)
  2. Improved asthma plan
  3. Re-inforce inhaler technique
  4. Letter to treating doctor / pulmonologist if present to ER
27
Q

How is exercise induced asthma treated?

A

SABA e.g. Salbutamol - 15 minutes prior to exercise (most preferred)
OR
LABA with ICS - Salmeterol + Fluticasone - 30 minutes prior to exercise
OR
Montelukast once daily at night

28
Q

How should geriatric asthma patients be treated?

A

Insensitive toward beta-2 agonists with age & adverse effects e.g. tachycardia and tremor are common
= Use Ipratropium Bromide as first line “reliever”
(remember it has an onset of action of 30 minutes)

Respiratory Block: Pharmacology (8 decks)

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