Respiratory

Question 1

what is the aim of treatment for asthma?

Answer 1

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%)

Question 2

what are the treatment steps for asthma for adults as per NICE?

Answer 2

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

Question 3

What are the treatment steps for asthma for adults as per BTS/ SIGN?

Answer 3

SABA
add on low dose ICS
add on LABA (MART or separate)
increase to medium dose ICS OR add on LTRA
SPECIALIST

Question 4

what are the treatment steps for asthma for children as per NICE?

Answer 4

SABA
add on paediatric low dose ICS
add on LTRA
Switch LTRA to LABA (MART or separate)
Increase to moderate dose ICS
SPECIALIST

Question 5

what are the treatment steps for asthma for children as per BTS/ SIGN?

Answer 5

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

Question 6

define moderate acute asthma?

Answer 6

peak flow > 50-75% best/predicted
increasing symptoms

Question 7

define severe acute asthma?

Answer 7

Any one of the following:
peak flow 33-50% best/predicted
resp rate > 25
HR > 110
inability to complete sentences in one breath

Question 8

define life threatening acute asthma?

Answer 8

Any one of the following:
peak flow < 33% best/predicted
SpO2 < 92%
cyanosis
silent chest
poor respiratory effort
arrhythmia
exhaustion
altered conscious level
hypotension

Question 9

how do you manage acute asthma?

Answer 9

SABA
oral prednisolone 40mg 5-7 days

Question 10

what is the treatment steps for COPD?

Answer 10

SABA/ SAMA
add on LABA & LAMA (discontinue SAMA if LAMA given)
add on ICS (triple therapy)

Question 11

which antibiotic can be used prophylactically to prevent COPD exacerbations?

Answer 11

azithromycin

Question 12

how do you manage an exacerbation of COPD?

Answer 12

abx
SABA
oral prednisolone 30mg 5 days

Question 13

what are the oxygen targets for a healthy patient?

Answer 13

94-98%

Question 14

what are the oxygen targets for a CO2 retainer?

Answer 14

88-92%

Question 15

what patients are at risk of hypercapnia and will therefore require reduced oxygen targets?

Answer 15

CF
COPD

Question 16

how do you treat mild croup?

Answer 16

single dose of oral dexamethasone

Question 17

Name the SABAs?

Answer 17

Salbutamol
Terbutaline

Question 18

Name the LABAs?

Answer 18

Formoterol (short onset , long acting) - licensed for MART
Salmeterol

(ROLS)

Question 19

what are the side effects of b2 agonists?

Answer 19

tremor
tachycardia
hyperglycaemia
hypokalaemia
CV effects

Question 20

name the ICS’?

Answer 20

BD DOSING:
beclometasone
budesonide
fluticasone

OD DOSING:
ciclesonide

Question 21

which ICS must be brand prescribed?

Answer 21

beclometasone

Qvar twice as potent as clenil - has extra fine particles
Fostair - has extra fine particles and is more potent than clenil and Qvar

Question 22

which beclometasone inhaler is licensed in over 12s?

Answer 22

Qvar

Question 23

name a LTRA?

Answer 23

motelukast

Question 24

what are the side effects of LTRAs?

Answer 24

churg strauss syndrome
neuropsychotic reactions
Liver toxicity with zafirlukast

Question 25

what is the therapeutic range of theophylline?

Answer 25

10-20 mg/L

Question 26

when should a level be taken for theophylline?

Answer 26

4-6 hours post dose 5 days after starting 3 days after dose change

Question 27

what are the symptoms of theophylline toxicity?

Answer 27

vomiting and GI tachycardia arrhythmia convulsions hypokalaemia

Question 28

name the SAMA?

Answer 28

ipratropium

Question 29

name the LAMAs?

Answer 29

tiotropium glycopyronnium (IUM)

Question 30

name the first generation antihistamines?

Answer 30

promethazine, chlorphenamine, hydroxyzine

Question 31

what are the side effects to the first generation antihistamines?

Answer 31

sedation and anti-muscarinic

Question 32

name the second generation antihistamines?

Answer 32

cetirizine, loratadine, fexofenadine, acrivastine

Question 33

what are the uses of antihistamines besides hayfever?

Answer 33

N&V: cinnarizine, cyclizine, promethazine Migraine: buclizine Insomnia: first generation

Question 34

what is the MHRA alert for hydroxyzine?

Answer 34

QT prolongation and torsade de pointes

Question 35

what is the dosing for hydorxyzine?

Answer 35

for short term only 100mg max daily dose

Question 36

how do you manage anaphylaxis?

Answer 36

use adrenaline before calling 999 raise legs repeat after 5 mins oxygen IV fluids (hypotension/ shock) oral antihistamine when stable SABA if respiratory problems

Question 37

what is the dose of adrenaline for a child under 6 months?

Answer 37

100-150mcg

Question 38

what is the dose of adrenaline for a child between 6 months to 5 years?

Answer 38

150mcg

Question 39

what is the dose of adrenaline for a child between 6 years to 11 years?

Answer 39

300mcg