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resp treatments Flashcards

1
Q

asbestosis

A

symptom management

no treatment known to alter disease but corticosteroids are often prescribed

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2
Q

acute bronchitis

A

over the counter painkillers

antibiotics are often given (amoxicillin)

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3
Q

ARDS

A

admit to ITU, supportive care, treat underlying cause

Respiratory Support: Early ARDS - CPAP with 40-60% oxygen, later mechanical ventilation may be required

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4
Q

asthma

A

Step 1: SABA (salbutamol) as required + low dose ICS (beclometasone)
Step 2: + LABA (salmeterol)
↑ICS
Step 3: + 4th Drug: LTRA (montelukast), Methylxanthines (theophylline), LAMA (tiotropium), Sodium Cromoglicate in children
Step 4: + oral steroid (prednisolone)
Step 5: Consider trials of anti-IgE (Omalizumab)/IL-5 (Mepolizumab)/IL-4 (Dupilumab)

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5
Q

acute asthma

A 
Acute O SHIT Man:
Oxygen
Salbutamol (neb)
Hydrocortisone IV / oral prednisolone
Ipratropium (neb) if PEF <75%
Theophylline
Magnesium Sulphate IV
Anaesthetist
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6
Q

small cell carcinoma

A

chemotherapy and radiotherapy (SABR)

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7
Q

non-small cell carcinoma

A

surgery – lobectomy or pneumonectomy, radical radiotherapy, palliative chemotherapy, adenocarcinoma – EGFR mutations

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8
Q

bronchiectasis

A

Stop smoking, flu vaccine, pneumococcal vaccine
Airway clearance techniques and mucolytics

Antibiotics:
>3 exacerbations/year, preventative treatment:
low dose oral macrolides – clarithromycin 1x daily, azithromycin 3x a week

Persistent bacteria in bronchiectasis: 
oral macrolide (azithromycin), nebulised gentamycin, alternating oral Abs, pulsed IV Abs

Exacerbations
2 weeks of sensitive antibiotics

Bronchodilators
Corticosteroids
Surgery: for localised disease or to control severe haemoptysis

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9
Q

COPD

A

LABA/LAMA + SABA

LABA/LAMA/ICS – for frequent exacerbator with high eosinophilic counts (>300 cells)

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10
Q

acute COPD

A

iSOAP

Ipratropium (SAMA) – nebulised
Salbutamol (SABA) – nebulised
Oxygen 24-28%, keep SaO2 between 88-92% (if CO2 is normal target is 94-98%)
Amoxicillin if infection likely
(or doxycycline or clarithromycin)
Prednisolone – oral / hydrocortisone – IV
Aminophylline – IV (if no response)

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11
Q

cor pulmonale

A

Treat underlying cause
Treat respiratory failure – 24% oxygen in PaO2 <8kPa, monitor and slowly increase
Treat cardiac failure –diuretics (eg. furosemide), monitoring U&E
Consider venesection if haematocrit >55%
Consider heart-lung transplantation in young patients

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12
Q

cystic fibrosis

A

Physiotherapy (autogenic drainage, active cycle of breathing)
Antibiotics
Mucolytics
CREON (for absorbing energy due to exocrine failure)
Dietary input
Gastrograffin/Laxido for distal intestinal obstruction syndrome
Annual glucose monitoring
Out of hospital parenteral admission therapy
New gene therapies which target mutations
Lung Transplantation

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13
Q

empyema

A

Chest drainage
Broad spectrum IV antibiotics: amoxicillin and metronidazole
Targeted oral antibiotics for 5 weeks

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14
Q

epiglottis

A

Secure airway with ET tube and urgent IV antibiotics (vancomycin, clindamycin or ceftriaxone)

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15
Q

Hypersensitivity Pneumonitis

A

Acute: remove allergen and give O2 (35-60%), prednisolone

Chronic: allergen avoidance, long-term steroids (prednisolone)

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16
Q

idiopathic pulmonary fibrosis

A

Supportive Care: oxygen, pulmonary rehabilitation, opiates, palliative care input
Anti-fibrotic drugs (pirfenidone and nintedanib): slow disease progression
Oxygen if hypoxic
Pulmonary rehabilitation
Lung transplant (in young patients)

17
Q

influenza

A

bed rest and paracetamol
Uncomplicated Influenza:
Symptomatic treatment
Antivirals for high risk patients

Complicated Influenza:
Antivirals Oseltamivir /Zanamivir

Antibiotics can also be given, as influenza can result in secondary bacterial infection

18
Q

lung abscess

A

IV antibiotics

19
Q

mesothelioma

A

Pemetrexed + cisplatin chemotherapy

20
Q

obstructive sleep apnoea

A

Weight loss, avoidance of tobacco and alcohol, mandibular advancement device/surgery, CPAP during sleep, surgery

21
Q

pertussis

A

clarithromycin

22
Q

pleural effusion

A

Drainage (slow) for symptomatic effusions
Pleural tap
Long term pleural catheters (malignancy)
Pleurodesis with talc for recurrent effusions
Surgery for persistent collections and increasing pleural thickness
Palliative care including chemotherapy (pemetrexed/cisplatin combo) and radiotherapy
INR> 1.3 is a contraindicator for chest drain insertion (high INR means blood takes longer to clot)

Chest drainage is required in patients with a pH <7.2 – raises suspicion of pleural infection

23
Q

pneumonia

A

Antibiotics
Community Acquired: amoxicillin / doxycycline
Hospital Acquired: amoxicillin + gentamycin
Aspiration: amoxicillin + metronidazole
Legionella: levofloxacin

Oxygen – SaO2 94-98% / 88-92%
Fluids
Bed Rest

24
Q

pneumothorax

A

Primary:
<2cm and not SOB: Discharge and outpatient review
>2cm and/or SOB: HF O2, aspirate (16-18G needle)
discharge and review

Secondary:
>2cm or SOB: Chest Drain
1-2cm: Aspirate (16-18G needle)
admit for 24hour observation and review

25
Q

tension pneumothorax

A

-needle decompression with a cannula through anterior second intercostal space in the mid-clavicular line on the side of the pneumothorax, then insert a chest drain and get a CXR

26
Q

pulmonary embolism

A

Thrombolyse (tenecteplase) for massive PE
If haemolytically stable: LMWH (Fragmin) and warfarin – stop warfarin when INR is 2-3
Or DOAC (dabigatran) or factor X (rivaroxaban / apixaban)
Consider placement of IVC filter for recurrent PE
Prevention: heparin to all immobile patients

vitamin k antagonist should be given within 24 hours of diagnosis

27
Q

respiratory distress syndrome

A

Keep warm, NCPAP to prevent atelectasis, intubation + ventilation to deliver artificial surfactant

28
Q

type 1 respiratory failure

A 
Treat underlying cause
Give oxygen (24-60% by facemask
Assisted ventilation (NIPVV) if PaO2 <8kPa despite 60% O2
29
Q

type 2 respiratory failure

A

Treat underlying cause
Controlled oxygen therapy (start at 24% oxygen)
If this fails, consider intubation and ventilation

30
Q

rhinitis

A 
Glucocorticoids
Anti-histamines
Anti-cholinergic drugs
Sodium Cromoglicate 
Cysteinyl Leukotriene Receptor Antagonists
Vasoconstriction
31
Q

sarcoidosis

A

Acute Sarcoidosis: bed rest, NSAIDs, steroids if a vital organ is affected

Indications for corticosteroids (prednisolone for 4-6 weeks):
parenchymal lung disease, uveitis, hypercalcaemia and neurological or cardiac involvement

32
Q

sinusitis

A

Self-resolving but can require antibiotics Symptom relief: nasal decongestant vasoconstrictor (oxymetazoline), a nasal steroid or pseudo-ephedrine

33
Q

tuberculosis

A

Active TB
Isoniazid & Rifampicin & Pyrazinamide & Ethambutol for 2 months
+ Isoniazid & Rifampicin for a further 4 months
Latent TB
Isoniazid & Rifampicin for 3 months

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