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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
Name LABAs
- salmeterol, formeterol, vilanterol (12 hours)
26
SABA/LABA cautions
- diabetes - DKA after IV administration - can increase risk of arrhythmias - causes hypokalaemia - increase risk of QT prolongation - risk of digoxin toxicity due to hypokalaemia
27
SABA/LABA side effects
- fine tremor - palpitations - headache - seizure - anxiety - QT interval prolongation with corticosteroids, diuretics, theophylline
28
Name SAMAs
Ipratropium
29
Name LAMAs
Tiotrpium, Aclidinium, Glycopyrronium, umeclidinium
30
SAMA/LAMA side effects
- antimuscarinic complications (acts on parasympathetic pathway) - constipation - dry mouth - increase ocular pressure - report halos/blurred vision
31
SAMA/LAMA interactions
- other antimuscarinics e.g. hyoscine, TCAs, solifenacin, tamsulosin
32
Name Inhaled CorticoSteroids (ICS)
- Beclamethasone, budesonide, ciclesdnide, fluticasone, mometasone - all BD except ciclesonide (OD)
33
Beclomethasone (ICS) brands
prescribed by brand because QVAR and kelhale are 2x stronger than the others
34
ICS precautions
- 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
ICS side effects
- 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
Name LTRAs
montelukast (zafirlukast discontinued)
37
LTRA side effects and MHRA alert
- 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
LTRA interactions
- CYP450 inducers = reduces conc of LTRA - CYP450 inhibitors = increases conc of LTRA
39
Theophylline narrow therapeutic index
- 10 - 20 mg/L Check levels: - 4-6 hours after dose - 5 days after starting tx - at least 3 days after dose adjustments
40
Theophylline brands
- DON'T have same bioavailability - maintain same brand - prescribe by brand
41
Theophylline side effects
- vomiting - tremor - palpitations - arrhythmias - fever reduce clearance - convulsions - diarrhoea - gastric irritation - insomnia CNS stimulation
42
Theophylline and smoking
smoking reduces clearance - if want to stop, adjust dose
43
Theophylline interactions
- CYP inducers - reduce concentration - CYP inhibitors - increase concentration - corticosteroid, SABA/LABA, diuretics = hypokalaemia
44
What is croup
a viral infection causing a barking cough, a hoarse voice and breathing difficulties
45
Mild croup treatment
single dexamethasone dose
46
Moderate to severe croup treatment
- 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
What is cystic fibrosis
genetic disorder affecting the lungs, pancreas, liver, intestine and reproductive organs - viscous sputum, chest infections and malabsorption
48
Cystic fibrosis treatment
- 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
1st generation antihistamines
- more sedating - alimemazine, promethazine, chlorphenamine, cyclizine - alimemazine and promethazine more sedating than chlorphenamine and cyclizine
50
2nd generation antihistamines
- less sedating - acrivastine, cetirizine, desloratidine, loratidine, fexofenadine (120mg now OTC)
51
Antihistamines for nausea and vomitting
- cinnarazine, cyclizine, promethazine
52
Antihistamines for migraine
buclizine
53
Antihistamines for occasional insomnia
1st generation, promethazine OTC
54
Allergy immunotherapy
- 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
What is anaphylaxis
severe, life-threatening hypersensitivity reaction - immediate hypotension, rapidly developing airway/circulation problems - from allergen
56
Steps to take with anaphylaxis
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
Doses of adrenaline injector
- 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
Adrenaline autoinjector MHRA Alert
- 2 autoinjectors prescribed and carried at all times
59
Which drug should not be stopped abruptly
baclofen
60
which drug causes narrow-angle glaucoma
tiotropium
61
Which drug causes acute angle-closure glaucoma
ipratropium
62
From what age is salmetorol licensed
- 5 - not licensed under 5 years old
63
Severe asthma vs life-threatening asthma initial management
both SABA (salbutamol) but severe = via pMDi and spacer, life-threatening = via nebuliser
64
What is the severity of asthma attack if confusion is present
life-threatening
65
What is hydroxyzine
a sedating antihistamine that is contraindicated in QT prolongation (caution in heart problems)
66
Which drugs can be used as normal during pregnancy
- SABAs - LABAs - oral and inhaled corticosteroids - sodium cromoglicate - nedocromil sodium - oral and IV theophylline
67
QVAR in comparison to clenil
- QVAR is 2 times more potent than clenil - QVAR has extra fine particles compared to clenil
68
Signs of liver toxicity
- Nausea and vomiting - jaundice - itching - abdominal pain
69
When is azithromycin contraindicated
severe hepatic impairment

GPhC Exam (22 decks)

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