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Pre-reg > Respiratory > Flashcards

Respiratory Flashcards

1
Q

in asthma when would you add in an ICS?

A
  1. using reliever or symptomatic at least 3 times a week
  2. night time symptoms at elast once a week
  3. asthma attack requiring steroids in last 2 years
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2
Q

in ashtma should you refer someone using more than one inhaler every 2 months?

A

no - refer when using more than one inhaler a month as shows uncontrolled asthma

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3
Q

when starting a preventer how many times a day should the pt use it?

A

BD then step down to OD if well controlled

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4
Q

what’s the next step when someone is already on SABA + ICS?
name 2 of these drugs

A

LABA + low dose ICS
formoterol, salmeterol

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5
Q

after adding LABA with ICS what’s the next step in therapy? (3 parts)

A

Step 3 part 1 - no repsonse: stop LABA - increase ICS dose
Step 3 part 2 - if benefit but control still inadeqaute continue LABA and increase ICS
Step 3 part 3 - if benefit but control still inadequate continue LABA - trial LTRA, LAMA, or SR theophylline

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6
Q

what does step 4 of asthma pathway look like?
what are the options the additonal drug be?

A

add forth drug + high dose ICS
1. SR Theophylline
2. LAMA
3. LTRA - montelukast
4. oral B2 agonist tablet - bambuterol

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7
Q

what do you add in at step 5 of the asthma pathway?

A

oral pred - single dose am then gradually step down

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8
Q

how do you know if vilanterol is being used for COPD or asthma? (combination inhalers)

A

if used with umeclidinium = COPD
if with fluticasone = asthma

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9
Q

out of the 2 LABA for asthma, which one can be use as a releiver and why can’t the other one be used in this way?

A

formoterol = short onset + long action
salmeterol = long onset + long action so not for acute releif

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10
Q

what are the main 5 SE of beta agonists?

A
  1. tremours
  2. tachycardia
  3. hyperglycaemia
  4. hypOkalaemia
  5. CV effectd (prolonged QT) - caution in hypothyroidism
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11
Q

what ICS has OD dosing? (the rest are usually BD)

A

ciclesonide = OD

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12
Q

how many weeks must a pt take ICS before seeing effect on asthma control?

A

3 - 4 weeks

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13
Q

what do you need to remember about the bioequivalance of Qvar and Clenil?

A

they are not interchangable
Qvar is twice as potent as Clenil as has extra fine particles

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14
Q

what ICS is the more potent than traditional CFC-free inhalers?

A

Fostair

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15
Q

what are the 3 main SE with ICS?

A
  1. hoarse voice
  2. sore throat
  3. oral thrush
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16
Q

when dose NICE recommend a spacer should be used?

A

with high dose ICS and pt under 15yrs

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17
Q

what should you do if pt expereicnes paradoxical bronchospasam and what if mild bronchospasam?

A

paradoxical - stop and give alternative
mild - use SABA beforehand or transfer from pMDI to DPI

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18
Q

what do leukotriene receptor antagonists do?

A

by blocking the action of leukotriene on the cysteinyl leukotriene receptors in the lungs and bronchi - reduces bronchocontriction and inflammation

19
Q

what are the 2 SE to look out for with leukotrine receptor antagonists, what are the symptoms?

A
  1. Churg strauss syndrome - occurs on withdrawal or reduciton of oral corticosteroid
    signs = eosinohillia, rash, peipheral neuropathy, worsening pulmonary symptoms
  2. Zafirlukast (liver toxicty) - pt to report signs of liver toxicty (N&V, jaundice, itching, abdo pain)
20
Q

what class of drug is theophylline?

A

Xanthina bronchodilator

21
Q

why is aminophylline give IV and not IM?

A

becuase it’s 20x mroe soluble and too irritant to give IM

22
Q

theophylline has a narrow therapeutic index - what levels do we look for and when do we take the sample?

A

10 - 2-mg/l
sample 4 -6 hrs after dose

23
Q

what factors can increase and decrease the concentration of theophylline?

A

increase = heart failure, hepatic impairment, viral infections, elderly, enzyme inhibitor

decrease = smokers, alcohol, enzyme inducers

24
Q

is theophylline bioequivalent?

A

no - prescribe by brand!

25
Q

what are the signs of theophylline toxicity (fast and sick)?

A

vomitting and GI effects
tachycardia, agitation
arrhythmias, hypOkalaemia

26
Q

what are the 4 types of interactions with theophylline you need to be aware of?

A
  1. increased risk of hypOkalaemia (loop/thiazide diuretics, corticosteorids, B2 agonists)
  2. increased risk of convulsions with ciprofloxacin (quinolones) as they lower seizure threshold
  3. increased plasma conc and risk of toxicity with CCB, fluconazole, phenytoin, macrolides (enzyme inhibitors)
  4. reduced plasma conc is subtherapeutic - st/ johns wort, rifampicin
27
Q

what is given via nebuliser in acute emergencies of asthma?

A

salbulatmol/terbulatine
can add ipratropium bromide if needed
NB PO pred or IV hydrocortisone given for at least 5 days in adults

28
Q

outline the COPD treatmetn pathway (step 1, step 2 with FEV >50% and <50%, and step 3 persistent exacerbation/breathlessness)

A

step 1 = SABA or SAMA
step 2 = if exacerbation or persistent breathlessness = FEV >50% add LABA, then LABA/ICS or LAMA. If FEV <50% add LABA/ICS or LAMA
step 3 = triple therapy = LABA/ICS + LAMA

29
Q

in COPD if symptoms persistnet of pt unable to use inhaler what therapy could you try?

A

MR theophylline/amiinophylline

30
Q

name 3 LABAs used in COPD

A
  1. olodaterol
  2. indacterol
  3. vilanterol
31
Q

name a short acting muscarinic used TDS in COPD ipratropium

A
32
Q

name 3 LAMAs used OD in COPD

A

glycopyronium
umeclidinium
tiotropium

33
Q

when are antimuscarinicns cautioned?

A

in prostatic hyperplasia
risk of acute angle closure glaucoma with nebulised ipratropium

34
Q

what are the 3 parts to treating exacerbation of COPD? (could be 4 parts if poor response to bronchodilators)

A
  1. bronchodilator therapy
  2. IV aminophylline if poor response to nedulised bronchdilator
  3. short course PO pred (30mg OD for 7 - 14 days)
  4. antibacterial therapy
35
Q

when are antihistamines cautioned? (3 cases)

A
  1. benign prostatic hyperplasia (urinary retention)
  2. glaucoma (raised intraocular pressure)
  3. severe liver impairment (sedation precipitates hepatic coma)
36
Q

what is hydroxyzine and what are the MHRA warnings associated with it?

A

a unique antihistamine
warnings = QT prolongation + torsade de pointes
short use only

37
Q

what allergies can desensitising vaccines be used in? what must be on stand by?
when must you avoid desensitising vaccines?

A

hay fever unresponsive to other anti-allergy drugs and hypersenstivity to wasp and bee venom
must have CPR immediately avaialble and monitor pt for at least one hour

avoid in:
asthma
pregnancy
children under 5
beta blockers
ACEi

38
Q

what is the MAb used for allergies?
what Ab does it bind to?
What SE do you need to look out for?

A

omalizumab
binds to IgE
Churg-Strassus syndrome

39
Q

how often should you repeat adrenaline if necessary?

A

every 5 mins

40
Q

what class of drug may stop pt from responding to adrenaline?
waht’s the alternative?

A

beta blockers
IV salbutamol

41
Q

in addition to adrenaline, what other 3 drugs can be used in anaphylaxis?

A

high flow oxygen
chloramphenamine
hydrocortisone

42
Q

what’s the MHRA advice regarding epipens?

A
  1. prescribe 2 auto-injectors, carry at all times
  2. pt/carer with allergies trained on how to use
  3. check expiry dates
43
Q

what is used in the medical emergancy of croup?

A

dexamethasone oral solution

Pre-reg (47 decks)

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