Respiratory

Question 1

Treatment of acute asthma in Children

Answer 1

Fist line:
O2 - aim 94-98%
SABA - Salbutamol 2-10 puffs - give through spacer and pMDI as less likely to have S/E (tachycardia + Hypoxia) compared to nebs. altho for severe-life threatening choose nebs.
If SABA not working - add Ipratropium bromide 25mcg/dose mixed with SABA.
Early oral steroid treatment - under 2 yrs ( 10 mg), 2-5 yrs (20mg), > 5 yrs (30-40mg) for 3 days or until symptoms resolve. No need to wean down if treatment less than 14 days.
Second line: (if not responding to above)
1. Magnesium sulphate (40mg/kg/day)
2. IV Salbutamol as single bolus (15mcg/kg)
3. IV Aminophylline (severe - life-threatening)

Question 2

Theophylline metabolism

Answer 2

Metabolized in the liver
Conc increased by: 
- elderly
- Hepatic impairment
- Heart failure
- Viral infections
Conc decreased by:
- smocking
- alcohol
M/R brands have different absorption rate - ALWAYS PRESCRIBE BY BRAND - same applies to aminophylline oral M/R.

Question 3

Theophylline S/E

Answer 3

Hypokalaemia (can be severe esp if on concomitant B2 blocker therapy or corticosteroids) - monitor plasma potassium
GI discomfort and GORD
palpitations + tremors
seizures
Urinary disorder

Question 4

Overdose theophylline

Answer 4

Think caffeine overdose:

• Vomiting (can be severe)
• agitation and restlessness
• dilated pupils
• sinus tachycardia
• hyperglycaemia
• haematemesis
• convulsion
• supraventricular and ventricular arrhythmias
• severe hypokalemia

Question 5

Monitoring theophylline

Answer 5

Aim 10-20mg/L
Avoid above 20mg/L as the risk of toxicity
Measure 5 days after starting oral treatment and 3 days after a change in dose
collect sample 4-6 hrs after M/R oral dose taken

Question 6

Aminophylline monitoring

Answer 6

ALWAYS MONITOR PLASMA CONC IF LOADING DOSE GIVEN TO PT ALREADY ON ORAL THEOPHYLLINE (altho those pt should not normally receive a loading dose)
Aim 10-20 mg/L
Same then Theophylline for oral treatment
Take sample 4-6 hrs after start treatment for IV aminophylline
Give IV aminophylline very slowly with close monitoring

Question 7

carbocysteine BNF

Answer 7

X in active peptic ulcer
Disrupt the mucosal barrier of GI - need to be careful of GI ulcer esp in pt with hx of peptic ulcer
S/E: GI ulcer, steven-jonhson syndrome, skin reactions, vomiting

Question 8

Montelukast BNF

Answer 8

CAUTION! risk of neuropsychiatric disorder: speech impairment and obsessive compulsive symptoms.
S/E: Diarrhoea, GI pain, nausea, vomiting, muscle spasms, muscle complaints.
report of eosinophilic granulomatosis with polyangiitis - esp after withdrawal of corticosteroid treatment, care if eosinophilia, vasculitis rash, worsening pulmonary symptoms, cardiac complication or peripheral neuropathy.