Respiratory Flashcards
what is the aim of treatment for asthma?
no daytime symptoms
no nigh time waking due to symptoms
no asthma attacks
no need for rescue medication
no limitations of activity
normal lung function (PEF >80%)
what are the treatment steps for asthma for adults as per NICE?
SABA
add on low dose ICS
add on LTRA
SABA and ICS+LABA (with/ without LTRA)
switch ICS+LABA to MART therapy (low dose ICS)
increase to moderate dose ICS (as MART or separate)
SPECIALIST
What are the treatment steps for asthma for adults as per BTS/ SIGN?
SABA
add on low dose ICS
add on LABA (MART or separate)
increase to medium dose ICS OR add on LTRA
SPECIALIST
what are the treatment steps for asthma for children as per NICE?
SABA
add on paediatric low dose ICS
add on LTRA
Switch LTRA to LABA (MART or separate)
Increase to moderate dose ICS
SPECIALIST
what are the treatment steps for asthma for children as per BTS/ SIGN?
SABA
add on very low/ low dose ICS
if > 12 add on LABA (MART or separate) THEN add LTRA
if between 5 -12 add on LABA or LTRA
increase to medium dose ICS
SPECIALIST
define moderate acute asthma?
peak flow > 50-75% best/predicted
increasing symptoms
define severe acute asthma?
Any one of the following:
peak flow 33-50% best/predicted
resp rate > 25
HR > 110
inability to complete sentences in one breath
define life threatening acute asthma?
Any one of the following:
peak flow < 33% best/predicted
SpO2 < 92%
cyanosis
silent chest
poor respiratory effort
arrhythmia
exhaustion
altered conscious level
hypotension
how do you manage acute asthma?
SABA
oral prednisolone 40mg 5-7 days
what is the treatment steps for COPD?
SABA/ SAMA
add on LABA & LAMA (discontinue SAMA if LAMA given)
add on ICS (triple therapy)
which antibiotic can be used prophylactically to prevent COPD exacerbations?
azithromycin
how do you manage an exacerbation of COPD?
abx
SABA
oral prednisolone 30mg 5 days
what are the oxygen targets for a healthy patient?
94-98%
what are the oxygen targets for a CO2 retainer?
88-92%
what patients are at risk of hypercapnia and will therefore require reduced oxygen targets?
CF
COPD
how do you treat mild croup?
single dose of oral dexamethasone
Name the SABAs?
Salbutamol
Terbutaline
Name the LABAs?
Formoterol (short onset , long acting) - licensed for MART
Salmeterol
(ROLS)
what are the side effects of b2 agonists?
tremor
tachycardia
hyperglycaemia
hypokalaemia
CV effects
name the ICS’?
BD DOSING:
beclometasone
budesonide
fluticasone
OD DOSING:
ciclesonide
which ICS must be brand prescribed?
beclometasone
Qvar twice as potent as clenil - has extra fine particles
Fostair - has extra fine particles and is more potent than clenil and Qvar
which beclometasone inhaler is licensed in over 12s?
Qvar
name a LTRA?
motelukast
what are the side effects of LTRAs?
churg strauss syndrome
neuropsychotic reactions
Liver toxicity with zafirlukast
what is the therapeutic range of theophylline?
10-20 mg/L
when should a level be taken for theophylline?
4-6 hours post dose
5 days after starting
3 days after dose change
what are the symptoms of theophylline toxicity?
vomiting and GI
tachycardia
arrhythmia
convulsions
hypokalaemia
name the SAMA?
ipratropium
name the LAMAs?
tiotropium
glycopyronnium
(IUM)
name the first generation antihistamines?
promethazine, chlorphenamine, hydroxyzine
what are the side effects to the first generation antihistamines?
sedation and anti-muscarinic
name the second generation antihistamines?
cetirizine, loratadine, fexofenadine, acrivastine
what are the uses of antihistamines besides hayfever?
N&V:
cinnarizine, cyclizine, promethazine
Migraine:
buclizine
Insomnia:
first generation
what is the MHRA alert for hydroxyzine?
QT prolongation and torsade de pointes
what is the dosing for hydorxyzine?
for short term only
100mg max daily dose
how do you manage anaphylaxis?
use adrenaline before calling 999
raise legs
repeat after 5 mins
oxygen
IV fluids (hypotension/ shock)
oral antihistamine when stable
SABA if respiratory problems
what is the dose of adrenaline for a child under 6 months?
100-150mcg
what is the dose of adrenaline for a child between 6 months to 5 years?
150mcg
what is the dose of adrenaline for a child between 6 years to 11 years?
300mcg
