RESP SYSTEM- ASTHMA + COPD Flashcards
1
Q
What are the 3 types of acute asthma?
A
Moderate
Severe
Life-threatening
2
Q
What are 4 moderate acute asthma characteristics?
A
Peak flow more than 50%
Able to say full sentence
O2 level > 92%
Resp rate is less than 30 in children above 5
Resp rate < 40 between 1-5 years
3
Q
What are 4 severe acute asthma characteristics?
A
Peak flow 33-50%
Unable to complete full sentence
Resp rate is >25 in adults, >30 children 5+, >40 children 1-5 years
HR >125bpm (5+)
HR >140 bpm (1-5 years)
4
Q
What are 4 life-threatening acute asthma characteristics?
A
peak flow <33%
O2 <92%
cyanosis
silent chest
exhausted
hypotension
5
Q
What is 1st line moderate acute asthma tx?
A
High dose SABA (salbutamol) via PMI + spacer
6
Q
What is severe/ life threatening acute asthma treatment?
A
Hospital ASAP
High dose SABA via O2 nebuliser
+
Nebulised ipratropium (if poor response to above)
7
Q
What IV drug is given in near FATAL acute asthma with poor response to initial therapy?
A
IV aminophylline
8
Q
What is given to all patients after acute asthma attack?
A
Oral prednisolone
If contra- IV HC or IM methylpred
9
Q
What to give if oral pred contra after acute asthma attack?
A
IV HC
or
IM methylpred
10
Q
What to give hypoxic patients?
A
Supplementary oxygen (to keep O2 between 94-98)
11
Q
1st line moderate acute asthma tx in people 2 + over?
A
SABA -salbutamol with PMI + pacer
12
Q
1st line severe acute asthma tx in people 2 + over?
A
SABA with oxygen driver nebs
13
Q
What is max salbutamol dose in acute asthma attack?
A
maximum of 10 puffs of salbutamol via a spacer
14
Q
What 3 steps to do if children under 2 with acute asthma attack?
A
Hospital ASAP
Mod + severe = immediate o2 + maybe SABA
Combin Nebulised ipratropium if needed
15
Q
What to give patients 2 and over after acute asthma attack?
A
3 days oral Prednisolone
16
Q
What to add if poor initial response to SABA in acute asthma?
A
nebulised ipratropium
17
Q
What to give if poor response to 1st line tx in child 2+?
A
IV MGSO4
18
Q
What 3 lifestyle changes can help asthmatic patients?
A
Weight loss
Smoking cessation
Breathing exercise programmes
19
Q
What is chronic asthma tx in adults?
A
Step 1 : SABA
Step 2 : SABA + low dose ICS
20
Q
What 4 reasons to start ICS in asthma?
A
If uncontrolled by SABA alone - 3x a week
symptoms 3 x week
1 night time waking
More than 1 inhaler a month
21
Q
What is step 3 of asthma treatment for adults?(NICE + BTS)
A
NICE = LTRA
sign/BTS - LABA fixed dose or MART
22
Q
What is step 4 of NICE guidance for asthma tx in adults?
A
Add in LABA with/ or without LTRA
Can also add an ICS into MART
23
Q
What is STEP 5 of asthma tx in adults?
A
Specialist - high dose ICS
24
Q
What is tx for asthma in children over 5 compared to adults?
A
Same up to step 3
25
What age can LABA (e.g formeterol) be given in?
5 + years
26
What is tx of chronic asthma in children over 5?
Step 1: SABA
Step 2: SABA + very Low dose ICS
Step 3: SABA + ICS + LABA (sign)/LTRA (nice)
STEP 4: REPLACE LTRA WITH LABA
STEP 5: Increase ICS or specialist (steroids, MAB, tiotropium)
27
What is difference in asthma tx between adults and children over 5 ?
STEP 4: REPLACE LTRA WITH LABA
in children whereas adults can have both.
28
What age is tiotropium allowed in?
12+ years
29
What is asthma tx in children under 5?
Step 1 : SABA
Step 2: ICS paed moderate strength for 8 week trial
step 3: SABA + ICS + LTRA (if not working stop LTRA + refer)
30
What happens if children under 5 using more than 1 inhaler per month?
Urgent referral
31
How long is trial of ICS for asthma in children under 5?
8 week trial
32
When can asthma tx be dropped down?
If controlled for at least 3 months
review regularly
33
When are reductions of ICS considered?
Every 3 months - 25 to 50% reduction each time.
34
What are 7 signs of complete control?
No daytime symptoms
No night-time awaking
No attacks
No need for rescue meds
No exercise limitations
Normal lung function PEF >80%
Low SE from tx
35
What are 4 asthma symptoms?
Dyspnoea
wheezing
cough
chest tightness
36
What 2 drugs can trigger asthma?
BB
NSAIDs
37
What are 3 SEs of SABAs?
Hypokalaemia
CVS SE
tremors of hand
38
What is typical SABA dose?
1-2 puff QDS PRN
39
List 3 LABAs?
Fometerol
Salmeterol
Vilanterol
40
List 5 ICS?
Beclomethasone
Budesonide
Fluticasone
ciclesonide (OD)
mometasone (OD/BD)
41
What is LABA frequency?
BD
42
Where is fostair kept?
Fridge
43
What is more potent: Qvar or clenil?
Qvar 2x potent
44
What is more potent: fostair or CFC free inhaler?
Fostair
45
What is MHRA alert about ICS?
Prescribe beclomethasone CFC by brand
46
What are 3 main SEs of ICS?
Oral thrush
hoarse voice/sore throat
bronchospasm
47
what to do if bronchospasm with ICS inhaler?
Stop
If mild- SABA before use or use DPI
48
When is LTRA given in the day?
at night
49
What are 2 SEs for montelukast? (CN)
Neuropsychic reaction
Churg-strauss syndrome?
50
4 Symptoms of
Churg-strauss syndrome?
eosinophilia
cardiac issue
pulmonary issues
peripheral neuropathy
51
What is an MHRA warning regarding montelukast?
OCD symptoms + speech impairment
52
What is theophylline?
Xanthine Bronchodillator
53
What is dose frequency of theophylline?
every 12 hrs
54
What is therapeutic index of
theophylline?
10-20 mg/L
55
When is monitoring done for theophylline?
5 days after starting oral treatment + at least 3 days after any dose adjustment.
Sample taken 4–6 hours after an oral MR dose.
56
What decreases theophylline levels?
Smoking
57
What are 5 SEs of theophylline toxicity? CHAT V
Convulsions, CNS stimulation
Hypokalaemia , hyperglycaemia
Arrhythmias
Tachycardia
Vomiting - blood too
58
What 2 drugs increase theophylline levels?
Macrolides
Cimetidine
59
What drug class and theophylline cause bronchospasms?
BB
60
What 3 drug classes reduce theophylline levels?
Carbamazepine
Phenytoin
St johns wort
Rifampicin
61
What antibiotic + theophylline can increase seizures?
Cipro
62
What 3 drugs + theophylline can cause hypokalaemia?
Salbutamol
diuretics
Steroids
63
What 5 drug classes + theophylline interact to increase risk of torsades?
Anti- arrhythmic drugs, SSRIs, macrolides, lithium, methadone, 5HT3 antagonists
64
What is an MHRA advice about pMDI inhalers?
Loose parts can make you choke- remove cap
65
How to breathe in using dry powder inhaler?
Fast + deep
66
What 3 points on using spacers?
Inhale ASAP after actuating, tidal breathing
not interchangeable - + replace 6-12 months
wash monthly
67
What to do if PEF <80%?
Quadruple ICS dose
68
What to do if PEF <60%?
start oral steroids + medical advice
69
What to do if PEF <50%?
urgent medical help
70
What is prednisolone dose for after acute asthma in people over 12 years?
40–50 mg once a day for 5 days.
71
What is prednisolone dose for after acute asthma in people under 12 years?
30–40 mg once a day for 3 days.
72
What is difference between chronic asthma management in adults and children over 5?
Step 4 is changed - in adults can give LTRA + LABA
With children- LTRA is replaced with LABA.
73
What is different in chronic asthma management in children under 5?
STEP 2- trial dosing of ICS.
Step 3 - given LTRA with SABA + ICS
If does not work- specialist after
74
What are the 4 symptoms of COPD?
Dyspneoea, wheeze, chronic coug
regular sputum production
75
What is COPD?
Not fully reversible
Persistant rep symptoms
Bronchiolitis + emphysema
76
What is 1 main risk factor of COPD?
Smoking
77
What is Chronic COPD treatment?
1. SABA OR SAMA
2. depends is asthmatic or non-asthmatic.
78
List the 5 complications of COPD?
Cor pulmonale (heart enlargement)
depression
anxiety
type 2 respiratory failure
secondary polycythaemia.
79
What are non drug treatments for COPD?
smoking cessation
Pulmonary rehabilitation
80
What should patients be taught if they have too much sputum production?
active cycle of breathing techniques
+
how to use positive expiratory pressure devices
81
What 2 vaccines should COPD patients be offered?
pneumococcal + annual influenza.
82
What 2 drugs are used for initial management of COPD?
SAMA or SABA
(ipratropium or salbutamol)
83
Before stepping up COPD treatment, what 3 things should be done?
confirm COPD spirometrically
relevant vaccinations are given
non-drug treatment options
84
What step-up treatment to give COPD patients WITHOUT asthmatic features?
1. SABA OR SAMA
2. add in LAMA + LABA
(STOP the SAMA if LAMA is given.)
85
What step-up treatment to give COPD patients WITH asthmatic features?
1. SAMA OR SABA
2. LABA + ICS (Stop the SAMA)
86
What to add for non-asthmatic + asthmatic COPD patients if patient has severe exacerbation or 2+ moderate ones in 1 year?
STEP 3
LAMA + LABA + ICS(consider)
87
After step 3 if non asthmatic COPD patients feels no change after 3 months what to do?
Go back to step 3 - LAMA + LABA
so stop the ICS.
88
What cannot be given with SAMA?
LAMA
89
When are patients given step 3 treatment for COPD?
If patient has severe exacerbation or 2+ moderate ones in 1 year.
90
If triple therapy for COPD has not worked what 3 options to try?
Give theophylline,
oxygen therapy
mucolytics
91
What drug class should be continued in all stages of COPD treatment?
SABA - salbutamol
92
What antibiotic is used for COPD prophylaxis of exacerbations?
Azithromycin - review after 3 months
93
What 5 tests to do before giving prophylactic abx for COPD?
sputum culture + sensitivity testing
CT scan of the thorax
Baseline ECG (rule out QT prolongation)
LFTs
94
What 2 drug are given as rescue pack for COPD exacerbation?
Oral steroid + ABx (amoxicillin or dox or clarithro)
95
What abx is used as rescue pack for COPD exacerbation?
Amoxicillin
96
What abx to not give if patient taking prophylactic azithromycin for COPD?
Clarithromycin
97
What to give if COPD exacerbation has them hospitalised?
Short course prednisolone + other therapies
98
What to give if COPD exacerbation in community with significant breathlessness?
Short course pred
99
When to give aminophylline in COPD exacerbation?
If not good response to nebs
100
How long does SABA last?
4 hrs
101
How long does LABA last?
12 hrs
102
What is usual dose of SABA or LABA?
1-2 puffs up to 4 times a day
8 puffs max daily
103
What is max SABA/LABA puff a day?
8 puffs
104
What condition are SABA/LABA cautioned in?
Diabetes - can cause DKA after IV
105
What electrolyte balance is caused by SABA/LABA?
Hypokalaemia - QT prolongation
106
What heart related SE can happen with SABA/LABA?
Arrhythmias
107
What are 5 SEs with SABA/LABA?
Tremor
palpitations
headache
seizure
anxiety
108
What 3 drug classes can cause qt prolongation when given with SABA/LAMA?
Diuretics
theophylline
steroids
109
What drug can react with salbutamol to cause toxicity due to hypokalaemia?
Digoxin
110
What is example of SAMA?
Ipratropium
111
What is example of LAMA?
Tiotropium
glcopyrronium
umeclidinium
112
What is 1 main SE of LAMA/ SAMAs?
Antimuscarinic side effects
e.g. constipation, dry mouth, increase ocular pressure (halo or blurred vision)
113
What antimuscarinic drugs can interact with SAMA + LAMA?
Hycosine
TCAs
Solefenacin
114
5 Examples of inhaled corticosteroids?
Beclometasone
Budesonide
Ciclesonide
Fluticasone
Mometasone
115
What inhaled corticosteroid is given OD only compared to others?
Ciclesonide
116
What inhaled corticosteroid should be prescribed by brand?
Beclometasone
117
What 2 steroid inhalers have small particles + are 2x stronger than clenil?
QVAR + KELHALE
118
What to monitor in children when giving long term inhaled steroids?
Height + weight
119
What are 3 SEs linked to inhaled Corticosteroids?
Taste + voice alteration
Sore mouth
120
What is given for mild paradoxical bronchospasm?
SABA use before the steroid
Change to dry powder inhaler.
121
What are 2 SE of montelukast (LRTA)?
Risk of neuropsychiatric reactions - seek medical attention if speech problems
Churg strauss syndrome
122
What are some symtpoms of Churg strauss syndrome?
eosinophilia, rash, pulmonary + cardiac symptoms
123
What type of drugs can LTRAs interact with
Inhibitors + inducers
124
What is theophylline therapeutic level ?
10-20mg/L
125
When are theophylline drug levels checked?
4-6 hrs after dose
5 days after tx
3 days after dose change
126
How to prescribe theophylline?
Brand - different bioavailability
127
4 SEs of theophylline? (SICK + FAST)
Vomiting, tremor, palpitations, arrhythmias
Overdose = agitation, restlessness, dilated pupils, sinus tachycardia, and hyperglycaemia. haematemesis, convulsions, and supraventricular and ventricular arrhythmias. Severe hypokalaemia may develop rapidly.
128
What does smoking do to theophylline?
Causes it to leave body more
129
What condition reduces theophylline clearance?
Fevers
130
What habit increases theophylline clearance?
Smoking -so stopping it can be bad, build up
131
What electrolyte imbalance does theophylline cause?
hypokalaemia
132
What to give patients before exercise if experiencing exercise induced asthma?
SABA
133
What to add if exercise is a particular problem and triggers asthma on patients well controlled on ICS?
consider adding either:
LTRA, a long-acting beta2 agonist, sodium cromoglicate or nedocromil sodium, or theophylline
134
What asthma medication is known for dry mouth?
Tiotropium (LAMA)
135
What 3 conditions increase theophyline levels?
HF , viral infections, elderly, hepatic impairment
