Respiratory Flashcards
Indications of Beta 2 agonist
Asthma - SABA uses to relive breathlessness, LABA used to trat chronic asthma when ICS isn’t enough but given in combination with an ICS
COPD - SABA for breathless, LABA second line therapy
Hyperkalaemia — helps to lowers potassium levels
Contraindications for beta 2 agonist
LABA ONLY if on ICS
Caution for CVS patients
Pt ed for beta 2 agonist
Treats symptoms not disease, seek med advice if using inhaler frequently
Make they are clear on how and when to use
Side effects for beta 2 agonist (5)
Tachycardia
Palpitation
anxiety
tremor
LABA-muscle cramps
Monitoring for beta 2 agonist
Peak flow
potassium levels
Key interaction for beta 2 agonist
Beta blockers may reduce effectiveness of B2agonist
Codominant use of b2 agonist with theophylline and corticosteroid can lead to hypokalaemia
MOA for beta 2 agonist
β2-receptors are found in smooth muscle of the bronchi, gut, uterus and blood vessels.
Stimulation of this G protein-coupled receptor activates a signalling cascade that leads to smooth muscle relaxation. This improves airflow in constricted airways, reducing the symptoms of breathlessness.
2 SABA medication name
salbutamol
terbutaline
2 LABA medication name
salmeterol
formoterol
Indication for antimuscarinic
COPD
Asthma
Contraindication for Anti-muscarinic (3)
caution in patients susceptible to angle closure glaucoma, arrythmia or urinary retention
Pt ed for anti-muscarinic
Treats symptoms not the disease
Clear on inhaler technique and side effects and wash mouth after use or advice to chew gum or suck sweet
Side effects for anti-muscarinic
Irritation of respiratory tract
GI disturbance
Blurred vision and headache
Monitoring for anti-muscarinic
check if it helped with symptoms and peak flow, check side effect and check inhaler technique
Key interaction for anti-muscarinic
Not usually a problem due to low systemic absorption
name of a LAMA
tiotropium
name of a SAMA
ipratropium
indication for ICS
COPD
Asthma
Contraindication for ICS (2)
caution in COPD patients with a ▴history of pneumonia and in ▴children, where there is potential for growth suppression
Pt ed for ics
offering to dampen down inflammation in the lung
advice to rinse mouth
check inhaler technique
side effect for ics
oral candidiasis
hoarse voice
increase risk of pneumonia in COPD
Monitoring for ics
check severity through symptoms and peak flow
review after 3-6 months of therapy should be undertaken to alter management
Key interaction for ics
none clinically significant
MOA for ICS
Corticosteroids pass through the plasma membrane and interact with receptors in the cytoplasm. The activated receptor then passes into the nucleus to modify the transcription of a large number of genes.
Pro-inflammatory interleukins, cytokines and chemokines are downregulated, while anti-inflammatory proteins are upregulated.
In the airways, this reduces mucosal inflammation, widens the airways and reduces mucus secretion. This improves symptoms and reduces exacerbations in asthma and COPD.
indication for oxygen
acute hypoxemia
pneumothorax
CO poisoning
Contraindication for oxygen
patients with chronic type 2 respiratory failure e.g COPD
Pt ed in oxygen
Mask and cannula need to be kept
side effect for oxygen
Dry throat
Monitoring for oxygen
Frequent spO2
Arterial blood gas monitoring
indications for antihistamine
First line for allergies
Pruritus and urticaria
adjunctive treatment in anaphylaxis
nausea and vomiting
Contraindications for antihistamine
avoid sedating anti histamine in severe liver disease
Pt ed for antihistamine
cetirizine and loratadine - no side effects
Chlorphenamine - may make you feel sleepy
Side effect for antihistamine
sedation (first gen antihistamine)
Monitoring for antihistamine
clinical assessment for allergic symptoms and enquire about side effects
indication for montelukast
add on therapy for asthma (adults)
allergic rhinitis
Contraindication for montelukast
only prescribed if asthma is incompletely controlled with ics
Pt education for montelukast
advice to report side effects or worsening symptoms
Side effect for montelukast
Headache
abdo pain
hyperactivity
Monitoring for montelukast
efficacy measured by symptom diary and peak flow
indication for mucolytic (acetylcysteine)
paracetamol poisoning
reduce resp secretion
Side effect for mucolytic (acetylcysteine)
bronchospasm
diarrhoea
fever
headache
hypotension
Patient education for mucolytic (acetylcysteine)
explain that the aim of treatment is to loosen secretions and help them
clear their sputum. Advise that treatment is additional to other
measures to improve sputum clearance, such as maintaining hydration
and doing regular chest clearance exercises.
Monitoring for mucolytic (acetylcysteine)
monitor
efficacy of oral carbocisteine or acetylcysteine by enquiry about
frequency of cough and sputum production. Stop treatment if there is
no improvement in symptoms; if unacceptable side effects develop; or
if sputum production is no longer a problem.
Indication for theophylline
Bronchodilator
Contraindication for theophylline
- HF
- Viral infection
- smoking and alcohol
- Fever
Side effects for theophylline
- hyperuricemia
- seizures
- sleep disorders
- Gi upset
- Palpitation
Key interaction for theophylline
- quinolone
- diltiazem
- carbamazepine
