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GPhC Exam > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Acute asthma (asthma attack) moderate details

A
  • peak flow > 50%
  • can complete full sentences
  • SpO2 > >92%
  • RR > > 30 (5+ years)
  • RR > > 40 (1-5 years)
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2
Q

Acute asthma severe details

A
  • peak flow 33-50%
  • cant complete full sentences
  • RR > > 25 (adult)
  • RR > 30 (5+ years)
  • RR > 40 (1-5 years)
  • HR > 125 bpm (5+ years)
  • HR > 140 bpm (1-5 years)
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3
Q

Acute asthma life - threatening details

A
  • peak flow < 33%
  • SpO2 < 92%
  • cyanosis
  • silent chest
  • altered consciousness
  • hypotension
  • exhaustion
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4
Q

Acute asthma moderate adults management

A
  • home or primary care - hospital if inadequate response
  • tx = high dose SABA (10 puffs) via PMI and spacer
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5
Q

Acute asthma severe/life threatening adults management

A
  • hospital immediately
  • tx = high dose SABA via oxygen driven nebuliser +/- nebulised ipratopium
  • life threatening with poor response to initial therapy = IV aminophyllin
  • all patient = oral prednisone (40mg 5 days) - if inappropriate = IV hydrocortisone or IM methylpred
  • Hypoxaemic = supplementary O2 (maintain between 94-98%)
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6
Q

Acute asthma children 2 years and older severe/life threatening management

A
  • hospital ASAP (O2 in life threatening of SpO2 <94%)
  • 1st line = SABA via oxygen driven nebuliser
  • 3 days oral pred
  • poor initial response to B2 agonist = add nebulised ipratropium
  • poor response to 1st line = IV magnesium sulfate
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7
Q

Acute asthma children 2 years and older mild-moderate management

A
  • 1st line = SABA via PMI and spacer - medical attention if not controlled after 10 puffs
  • 3 days oral pred
  • poor initial response to B2 agonist = add nebulised ipratropium
  • poor response to 1st line tx = IV magnesium sulfate
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8
Q

Acute asthma management under 2 years old

A
  • all under 2s admitted to hospital
  • mod-severe = immediate oxygen and trial SABA
  • if needed combine nebulised ipratropium bromide
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9
Q

Chronic asthma lifestyle advice

A

weight loss, smoking cessation, breathing exercise programmes

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10
Q

Chronic asthma treatment adults

A
  1. SABA (salbutamol)
  2. SABA + low dose ICS (beclamethasone 200mcg BD)
  3. SABA + ICS + LTRA (montelukast) (NICE)

3.1 SABA + ICS + LABA (fixed or MART e.g. fostair/symbicort) (BTS/SIGN)
4. LABA with/w/o LTRA - can convert LABA and mod ICS to MART
5. increase ICS to high strength OR specialist = theophylline, tiotropium (12+), coral corticosteroids, monoclonal antibodies

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11
Q

Chronic asthma treatment children over 5

A
  1. SABA
  2. SABA + low dose ICS (100mcg BD)
  3. SABA + ICS + LTRA (NICE)/LABA (BTS/SIGN) - if 12 years plus
  4. Replace LTRA with LABA - MART if still no change
  5. increase ICS strength OR specialist = theophylline, tiotropium (12+), oral corticosteroids, monoclonal antibodies
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12
Q

For chronic asthma treatment when should you move to the next step of treatment

A

if using SABA 3x week, symptoms 3x week, night awakening 1x week, > 1 inhaler per month

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13
Q

Chronic asthma treatment children under 5

A
  1. SABA
  2. SABA + low dose ICS - 8 wk trial before continuing
    - if ICS not tolerated= LTRA
  3. SABA + ICS + LTRA
  4. stop LTRA and refer to specialist
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14
Q

Chronic asthma treatment dropping down criteria

A
  • when asthma controlled for at least 3 months
  • regularly r/v patients when decreasing tx
  • maintain lowest effective use of ICS - consider reducing every 3 months by 25-50%
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15
Q

What is complete control of asthma

A
  • no day time symptoms
  • no night-time awakening due to asthma
  • no asthma attacks
  • no need for rescue medication
  • no limitations on activity including exercise
  • normal lung function (FEV and/or PEF > 80% predicted or best)
  • minimal side effects from tx
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16
Q

COPD non-asthmatic features treatment

A
  1. SABA or SAMA (SABA continued throughout)
  2. LAMA + LABA - stop SAMA
  3. LAMA + LABA + ICS - if 1 sev exacerbation or 2+ mod exacerbation per year - if no change after 3 months = back to LAMA + LABA
  4. theophylline, oxygen therapy, mucolytics
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17
Q

COPD asthmatic features treatment

A
  1. SABA or SAMA (SABA continued throughout)
  2. LABA + ICS - stop SAMA
  3. LAMA + LABA + ICS - if 1 sev exacerbation or 2+ mod exacerbation per year
  4. theophylline, oxygen therapy, mucolytics
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18
Q

COPD exacerbation prophylactic treatment

A
  • azithromycin 250mg 3x week
  • offer pneumococcal and influenza vaccine
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19
Q

COPD condition description

A
  • progressive and not fully reversible
  • persistent respiratory symptoms
  • airflow limitation due to a combination of obstructive bronchiolitis and emphysema
  • symptoms = dyspnoea, wheeze, chronic cough, regular sputum production
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20
Q

COPD risk factors

A
  • smoking
  • pollution & occupational exposures
  • genetic factors
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21
Q

COPD rescue pack information

A
  • exacerbation in last year = give rescue pack:
  • Oral corticosteroid (usually pred) + Oral Abx (usually amox) - can be amox, doxy or clarithro
  • avoid clarithro if pt on prophylactic azithro
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22
Q

Non drug treatment of COPD exacerbation

A

positive expiratory pressure helps sputum clearance

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23
Q

COPD exacerbation drug treatment

A
  • SAMA/SABA - hold LAMA if SAMA given (increased muscarinic side effects)
  • hospital = short course pred (30mg 5 days) and other therapies
  • community = short course pred (30mg 5 days) if significant breathlessness
  • aminophylline added if inadequate response to nebulised bronchodilators
  • oxygen if needed to keep O2 saturation of arterial blood levels in range
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24
Q

Name SABAs

A
  • salbutamol, terbutaline (4 hours)
  • 1-2 QDS, 8 puffs max daily, 10 max in acute asthma attack
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25
Q

Name LABAs

A
  • salmeterol, formeterol, vilanterol (12 hours)
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26
Q

SABA/LABA cautions

A
  • diabetes - DKA after IV administration
  • can increase risk of arrhythmias
  • causes hypokalaemia - increase risk of QT prolongation
  • risk of digoxin toxicity due to hypokalaemia
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27
Q

SABA/LABA side effects

A
  • fine tremor
  • palpitations
  • headache
  • seizure
  • anxiety
  • QT interval prolongation with corticosteroids, diuretics, theophylline
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28
Q

Name SAMAs

A

Ipratropium

29
Q

Name LAMAs

A

Tiotrpium, Aclidinium, Glycopyrronium, umeclidinium

30
Q

SAMA/LAMA side effects

A
  • antimuscarinic complications (acts on parasympathetic pathway)
  • constipation
  • dry mouth
  • increase ocular pressure - report halos/blurred vision
31
Q

SAMA/LAMA interactions

A
  • other antimuscarinics e.g. hyoscine, TCAs, solifenacin, tamsulosin
32
Q

Name Inhaled CorticoSteroids (ICS)

A
  • Beclamethasone, budesonide, ciclesdnide, fluticasone, mometasone
  • all BD except ciclesonide (OD)
33
Q

Beclomethasone (ICS) brands

A

prescribed by brand because QVAR and kelhale are 2x stronger than the others

34
Q

ICS precautions

A
  • steroid cards - carry if long term tx with high doses of ICS
  • monitor height and weight in children in prolonged tx annually, slow growth = paediatrician referral
35
Q

ICS side effects

A
  • taste and voice alteration (hoarse voice)
  • sore throat/oral thrush (candidiasis) - use spacer and rinse mouth
  • paradoxical bronchospasms (mild = prevented by inhalation of SABA, change from aerosol to DPI)
36
Q

Name LTRAs

A

montelukast (zafirlukast discontinued)

37
Q

LTRA side effects and MHRA alert

A
  • Charge-strauss syndrome (eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, peripheral neuropathy)
  • MHRA: risk of neuropsychiatric reactions - medical attention if speech and behavioural changes occur
38
Q

LTRA interactions

A
  • CYP450 inducers = reduces conc of LTRA
  • CYP450 inhibitors = increases conc of LTRA
39
Q

Theophylline narrow therapeutic index

A
  • 10 - 20 mg/L
    Check levels:
  • 4-6 hours after dose
  • 5 days after starting tx
  • at least 3 days after dose adjustments
40
Q

Theophylline brands

A
  • DON’T have same bioavailability
  • maintain same brand
  • prescribe by brand
41
Q

Theophylline side effects

A
  • vomiting
  • tremor
  • palpitations
  • arrhythmias
  • fever reduce clearance
  • convulsions
  • diarrhoea
  • gastric irritation
  • insomnia
    CNS stimulation
42
Q

Theophylline and smoking

A

smoking reduces clearance - if want to stop, adjust dose

43
Q

Theophylline interactions

A
  • CYP inducers - reduce concentration
  • CYP inhibitors - increase concentration
  • corticosteroid, SABA/LABA, diuretics = hypokalaemia
44
Q

What is croup

A

a viral infection causing a barking cough, a hoarse voice and breathing difficulties

45
Q

Mild croup treatment

A

single dexamethasone dose

46
Q

Moderate to severe croup treatment

A
  • hospital admission
  • single dose of dexamethasone or prednisolone orally whilst waiting admission
  • if can’t take oral: IM dexamethasone or nebulised budesonide
  • severe not controlled by steroids = nebulised adrenaline/epinephrine
47
Q

What is cystic fibrosis

A

genetic disorder affecting the lungs, pancreas, liver, intestine and reproductive organs - viscous sputum, chest infections and malabsorption

48
Q

Cystic fibrosis treatment

A
  • prevent lung infections and maintain lung function
  • mucolytic = dornase alfa - aids in clearance of mucus or sputum from lungs
  • long-term antibacterial considered to suppress chronic staph. aureus
  • nutrition and exocrine pancreatic insufficiency: pancreatin
  • monitor patients for liver disease, diabetes and bone density
49
Q

1st generation antihistamines

A
  • more sedating
  • alimemazine, promethazine, chlorphenamine, cyclizine
  • alimemazine and promethazine more sedating than chlorphenamine and cyclizine
50
Q

2nd generation antihistamines

A
  • less sedating
  • acrivastine, cetirizine, desloratidine, loratidine, fexofenadine (120mg now OTC)
51
Q

Antihistamines for nausea and vomitting

A
  • cinnarazine, cyclizine, promethazine
52
Q

Antihistamines for migraine

A

buclizine

53
Q

Antihistamines for occasional insomnia

A

1st generation, promethazine OTC

54
Q

Allergy immunotherapy

A
  • allergen vaccines = reduced asthma symptoms and allergic rhino conjunctivitis
  • can contain house dust mite, animal dander or pollen extract
  • vaccines with bee/wasp venom = reduced risk of severe anaphylaxis
  • omalizumab (monoclonal antibody) binds to IgE - when sever persistent allergic asthma not controlled with ICS + LABA. Side effects = churg-strauss syndrome + hypersensitivity reactions
55
Q

What is anaphylaxis

A

severe, life-threatening hypersensitivity reaction - immediate hypotension, rapidly developing airway/circulation problems - from allergen

56
Q

Steps to take with anaphylaxis

A
  1. Autoinjector immediately (IM adrenaline/epinephrine)
  2. call 999 - state anaphylaxis - administer CPR if needed
  3. Lie down - raise legs - helps blood back into system
  4. remove trigger if possible
  5. repeat after 5 minutes if no improvement
  6. High flow O2, IV fluids if hypotension/shock
  7. after stabilisation - non sedating oral antihistamine e.g. certirazine, IM or IV chlorphenamine if oral not possible
  8. Inhaled bronchodilator therapy with salbutamol and/or ipratropium bromide for persisting respiratory problems
57
Q

Doses of adrenaline injector

A
  • child up to 6 months = 100 - 150 mcg
  • child 6 months to 5 years = 150 mcg
  • child 6 to 11 years = 300 mcg
  • over 12 years = 500mcg
58
Q

Adrenaline autoinjector MHRA Alert

A
  • 2 autoinjectors prescribed and carried at all times
59
Q

Which drug should not be stopped abruptly

A

baclofen

60
Q

which drug causes narrow-angle glaucoma

A

tiotropium

61
Q

Which drug causes acute angle-closure glaucoma

A

ipratropium

62
Q

From what age is salmetorol licensed

A
  • 5
  • not licensed under 5 years old
63
Q

Severe asthma vs life-threatening asthma initial management

A

both SABA (salbutamol) but severe = via pMDi and spacer, life-threatening = via nebuliser

64
Q

What is the severity of asthma attack if confusion is present

A

life-threatening

65
Q

What is hydroxyzine

A

a sedating antihistamine that is contraindicated in QT prolongation (caution in heart problems)

66
Q

Which drugs can be used as normal during pregnancy

A
  • SABAs
  • LABAs
  • oral and inhaled corticosteroids
  • sodium cromoglicate
  • nedocromil sodium
  • oral and IV theophylline
67
Q

QVAR in comparison to clenil

A
  • QVAR is 2 times more potent than clenil
  • QVAR has extra fine particles compared to clenil
68
Q

Signs of liver toxicity

A
  • Nausea and vomiting
  • jaundice
  • itching
  • abdominal pain
69
Q

When is azithromycin contraindicated

A

severe hepatic impairment

GPhC Exam (22 decks)

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