Resp misc Flashcards
B2 agonist side effects
tremour, trachycardia, hypokalemia, hypoglycemia, LABA: increased mortality by asthma
Anti-cholinergic inhaled side effects
dry mouth, cardiovascular effects?
Inhaled corticosteroids side effects
cataracts, osteoporosis, oropharyngeal thrush, increased risk of pneumonia in COPD patients
Treatments of COPD (medical)
SABA, LABA, Anticholinergics, combination, corticosteroids, phosphodiesterase-4 inhibitor
What do corticosteroids do?
produce anti-inflammatory effects and increase binding of LABA to the B receptor
how do SAMAs and LAMAs work?
M3 receptors stimulated by Ach in the smooth muscle of bronschioles caused to stimulate G protein and then contraction. SABA is an antagonists that blocks ACh
How to SABAs work?
B receptors on smooth muscle in bronchioles. Adrenaline or noradrenaline - adenylate cyclase (converts ATP to cAMP) - increase in cAMP causes muscle relaxation - bronchodilation. agonists promote this
what does PD4 inhibition do? (phospodiesterase 4)
interferes with the breakdown of cAMP. accumulation of cAMP causes the release of protein kinase A which can produce anti-inflammatory effects.
Name a methylxanthine and how does it work?
theophilline and aminophyilline. These inhibit the PD4, this icnreases cAMP and causes bronchodilation
what are methylxanthines metabolised by?
CYP450
Name 3 inhaled corticosteroids (ICS)
beclomethasone, budesonide and fluticasone
WHat would you prescribe if a patient had exacerbations and persistent breathlessness?
FEV1 more than 50% - LABA or LAMA
FEV1 less than 50% - LABA+ ICS or LAMA
if patient has PERSISTENT exacerbations and persistancet breathlessness what would you prescribe?
ICS+ LABA if only LABA taken. if LAMA taken before, give LAMA+LABA+ICS
When would you prescribe LABA+ICS?
FEV1<50% or persistent exacerbations and breathlessness
When would you prescibe antibiotics to manage an exacerbation?
increased dyspnea, increased sputum volume, and increased sputum purulence.
Who require mechanical ventilation.
What is an exacerbation?
worsening of symptoms compared to normal day to day variations.
What can an exacerbation lead to?
increase in economic costs, mortality, decrease in lung function and quality of life.
What can Noninvasive ventilation do?
Improves respiratory acidosis, decreases respiratory rate, severity of dyspnea, complications and length of hospital stay.
Decreases mortality and needs for intubation.
Manage Exacerbations: Indications for Hospital Admission
Marked increase in intensity of symptoms Severe underlying COPD Onset of new physical signs Failure of an exacerbation to respond to initial medical management Presence of serious comorbidities Frequent exacerbations Older age Insufficient home support
How is mild exacerbation treated?
SABA and SAMA only
How is moderate exacerbation treated?3
SABDs plus antibiotics and/or oral corticosteroids
How is severe exacerbations treated
hospitalization (20% of cases) or visits the emergency room. Severe exacerbations may also be associated with acute respiratory failure.
what are the signs of LIFE-THREATENING respiratory failure
Respiratory rate > 30 breaths per minute
Using accessory respiratory muscles
Acute changes in mental status
Persisting hypoxemia / need for high FiO2 (>40%)
Hypercapnia i.e. PaCO2 increased compared with baseline or elevated> 60 mmHg
Acidosis (pH <7.25)
hhow is life threatending resp failure treated?
Mainstay of Rx – SABAs, SAMAs, systemic corticosteroids 7-14 days (prednisolone 30mg OD) +/- osteoporosis prophylaxis , antibiotics 5-7 days and NIV if required.
how do you assess for cor pulmonale?
Peripheral oedema Raised jugular venous pressure (JVP) Systolic parasternal heave A loud pulmonary second heart sound (P2) Widening of the descending pulmonary artery on CXR Right ventricular hypertrophy on ECG
What to spot on CXT of COPD?
> 6 anterior ribs seen above diaphragm in mid-clavicular line (flattened diaphram), hyperexpnsion, air trapping
what to spot on CT of COPD?
areas of gross emphysema (BLACK areas)
When can LVRS (lung volume reduction surgery) be carried out?
Patients who have low exercise capability and predominent emphysema in the upper lobes
ABCD O SHIT ME Athsma emergency treatment?
maintain o2 at 94-98, salbutamol neb, Hydrocortisone IV / oral prednisolone (daily 6 hourly). Ipratropium (4-6 houlry if life threatening), Theophylline (usually in ICU), Magnesium sulphate (one dose before theophilline if liufe threatening), Escalate care (ventilation and incubation)
Causes of Pneumonia?
Legionella’s (recently from spain) - do urinary antigen test
Jirovecci - HIV patiences
strep pneumoniae
Staph aureus
ABx for legionella pneumonia
fluroquinalone and clarithromycin
side effect of ACE i and why?
courgh due to build up of bradykinin
AA of inhaled corticosteroids?
eg. beclomethasone. osteoporosis (take vit D and bisphosphonates)
Adverse effects of B2 agonsists?
hypokalaemia, tremour, palpations, muscle cramps
Lung cancer treatment?
Stage I/II→ surgical excision and radical
deep x-ray therapy
Stage III/IV→ Palliative chemotherapy,
chemotherapy and radiotherapy, palliative
care
investigations for CF?
90% diagnosed before the age of 8.
Sweat (NaCl) test (parents taste salt when kissing baby)
Genetics testing
