Respiratory Flashcards
What medications can you use for mild otitis externa
analgesia
topical antimicrobials
How can you prevent otitis externa
keep ears dry after swimming
use acetic acid and isopropyl alcohol ear drops after swimming
what medications can you use for intact eardrums
dexamethasone, framycetin and gramicidn for tds-qid
or framycetin tds
what medications can you use for a perforated eardrum
ciprofloxacin with/without hydrocortisone
If a fungal infection is suspected in your ear, what can you use
flumetasone
clioquinol
traimcinolone
neomycin
nystatin
gramicidin
what medications can you use to treat otitis media
analgesics
not decongestant or antihistamine
Are antibiotics recommended for children over 2yrs old for the treatment of otitis media
only if its persists after 24hrs
How do you diagnose CAP
CURB-65
CRB-65
How would you manage mild CAP
Amoxicillin 1g tds
Doxycycline 100mg bd
Dual therapy of amoxicillin with doxycycline
If penicillin allergies indicated, use moxifloxacin
What medications can you use to treat a moderate CAP
Benzyl penicillin IV then to amoxicillin 1g tds for total of 7days
With doxycycline 100bd for 7days
if hypersensitive to penicillin
Ceftriaxone IV to Cefuroxime PO plus doxycycline 100mg bd
Immediate penicillin hypersensitivity
moxifloxacin as monotherapy
In some tropical regions in Australia
ceftriaxone and genatimicin
When would you need to switch from IV to PO in the treatment of CAP
Clinical improvement
Fever resolved or improving
No unexplained haemodynamic instability
No concerns about malabsorption
Suitable PO with similar spectrum
What would you use to treat severe CAP
Ceftriaxone IV with azithromycin IV for minimum of 7days
Change to PO when patient is stable
Penicillin allergies
Moxifloxacin IV with azithromycin IV
Tropical Australia
Meropenem IV with azithromycin IV
What are your treatment options for low to moderate HAP and high severity HAP
Low to moderate
Amoxicillin/clavulanate 875/125mg bd for 5-7days
Ceftriaxone IV
High severity
Piperacillin/ clavulanate IV
Consider other potential organisms
Treatment of aspiration pneumonia includes
As per CAP or HAP
Consider metronidazole if there’s severe periodontal disease, putrid sputum or if the patient is being treated with cephalosporin
How can you manage mild, mild/moderate and severe croup
Mild croupe
no intervention required, keep child calm and settled
analgesics may be required for fever
Mild/moderate
Dexamethasone single dose
Severe
Dexamethsone single dose OR prednisolone two doses
With nebulised adrenaline
What combination of medications are used to treat pulmonary tuberculosis
Ioniazid, rifampicin, ethambutol and pyrazinamide
How can you treat a pulmonary exacerbation in a patient with cystic fibrosis
Mild
CIprofloxacin PO with inhaled tobramycin/ colistin
Moderate to severe
2 IV antibiotics with PsA cover and differing mode of action
e.g. Tobramycin with norfloxacin
Inhaled antibiotics
What is the only intervention known to reduce the progression of COPD
Smoking cessation
What can you use to treat an acute COPD exacerbation
Oxygen
Antibiotics - amoxicillin 500mg tds for 5days OR doxycycline 100mg bs for 5days
Bronchodilator - SABA (salbutamol or terbutaline) OR SAMA (ipratropium)
Corticosteroids - Prednisolone 30-50mg PO for 5days
Ventilation
How do you manage COPD
Start with a short-acting reliever
SABA - terbutaline or salbutamol
SAMA - ipratropium
Add a long-acting preventer
LABA - Indacaterol, Eformoterol, Salmeterol or Olodaterol
LAMA - tiotropium
Combination - LABA/LAMA
Triple therapy
Add inhaled glucocorticoids - budesonide/ formoterol, fluticasone proprionate/ salmeterol or fluticasone furoate/ vilanterol
How would you diagnose a COPD patient
Spirometry
FEV1/FVC ratio <0.70
FEV1 <80%
Irreversible bronchoconstriction/ narrowing of the airways
How would you diagnose if a person has asthma
Spirometry
FEV1/FVC ratio <0.70
Baseline FEV1 >1.7L and post-bronchodilator FEV1 at least 12% higher than baseline
Baseline FEV1 > 1.7L and post-bronchodilator FEV1 at least 200ml higher than baseline
Peak flow meters
Define what a good, partial and poor control asthmatic patients
Good control
All of
Daytime symptoms <2 days per week
Need for reliever <2 days per week
No limitations of activities
No symptoms during night or on waking
Partial control
one or two of
Day symptoms >2 days per week
Need for reliever >2 days per week
Any limitations of activities
Any symptoms during night or on waking
Poor control
Three or more of
Daytime symptoms >2 days per week
Need for reliever >2 days per week
Any limitations of activities
Any symptoms during night or on waking
How would you manage adults with asthma
SABA alone
Regular maintenance low dose ICS + SABA reliever as needed
OR budesonide/formoterol low dose as needed
Step up to
Regular daily low dose ICS/LABA which is a reliever/preventer
OR regular daily maintenance low dose ICS/LABA with SABA reliever
Step up to
Regular daily medium-high dose ICS/LABA
OR regular daily maintenance medium-high dose ICS/LABA with SABA reliever
When would you need to step up in intervention for asthmatic patients
When the symptoms are only partly controlled despite
low dose ICS
good adherence
correct inhaler technique
Step up to next intervention and review after 4-8weeks
Continue step if required
When would an asthmatic patient step down in their intervention
After 2-3months of good control
No flares in the past 12months
Reduce ICS dose by 25-50% every 3months
Stop LABA if ICS is low
How would you manage children 1-5yrs old with asthma
SABA as reliever only as needed
Step up
Regular preventer + reliever as needed
ICS low dose
Monteleukast
Step up
Low dose ICS + monteleukast
ICS high dose (paediatric dose)
Referal if required
How would you manage children 6-11yrs old with asthma
SABA as reliever
Step up
Regular preventer + reliever
ICS low dose
Montelukast
Step up
ICS high dose
ICS/LABA combination
ICS low dose + monteleukast
