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Random Pre Reg Questions > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Adult management of asthma

A

SABA

  • Step 1: low dose ICS - preventer therapy
  • Step 2: Add LABA - normally as a combination inhaler
  • Step 3: Add LTRA - leukotriene receptor antagonist
  • Step 4: High dose ICS, add fourth drug; SR theophylline / LTRA
  • Step 5: Oral steroid
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2
Q

Examples of LTRA

A

Montelukast
Zafirlukast

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3
Q

How often should asthma treatment be reviewed?

A

Every 3 months

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4
Q

What is in a MART?

A

A single inhaler containing;
- low maintenance ICS
- fast acting LABA

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5
Q

Main side effect of SABA

A

Hypokalaemia

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6
Q

When to step up SABA

A
  • if using inhaler at least 3 times a week
  • night time symptoms
  • asthma attack requiring systemic steroids in last 2 years
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7
Q

Main side effect of ICS

A

Oral thrush

rinse mouth with water after dose

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8
Q

What ICS brands are not interchangeable

A

Beclomethasone

Qvar and Clenil Modulite

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9
Q

Main side effect of theophylline

A

Hypokalaemia

Maintain same brand

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10
Q

What are the three parts in step 3 treatment of asthma

A
  • Part 1 (no response): STOP LABA - increase ICS
  • Part 2 (inadequate control) : CONTINUE LABA - increase to medium dose ICS
  • Part 3 (inadequate control): CONTINUE LABA - trial LTRA, LAMA or SR theophylline
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11
Q

How should oral prednisolone be given?

A

Single dose in the morning to prevent insomnia

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12
Q

What LABAs are used in asthma

A

Formoterol - BD
Salmeterol - BD

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13
Q

When wouldn’t LABA be initiated?

A

Rapidly deteriorating asthma

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14
Q

What LABA can be used as relievers in addition to regular use as preventer in asthma

A

Formoterol

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15
Q

Inhaler brands containing LABA
And which type

A
  • Fostair - beclomethasone + Formoterol
  • Symbicort - Budesonide + Formoterol
  • Duoresp spiromax - budesonide + Formoterol
  • Seretide - Fluticasone + Salmeterol
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16
Q

Side effects of LABA

A
  • hand tremors, tachycardia, hypERGlycaemia
  • hypOKalaemia
  • serious cardiovascular events (QT prolongation)
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17
Q

Dose frequency of ICS
exception?

A

Twice daily

Except Ciclesonide - OD
Mometasone - OD/BD

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18
Q

Age restriction of ICS inhalers

A

Easyhaler - 18+
QVAR - 12+

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19
Q

Side effects of ICS

A

Hoarse voice
Sore throat
Oral thrush - use daktarin gel (miconazole)

Paradixical bronchospasm - STOP and give alternative
In mild bronchospasm; use SABA beforehand or transfer from pMDI to dry powder inhaler

20
Q

What inhaler must be kept refrigerated

A

Fostair

21
Q

Side effects of LRA

A
  • Churg Strauss syndrome (vasculitic rash, worsening pulmonary symptoms, cardiac complications)
  • Liver toxicity
22
Q

Target plasma conc of theophylline

A

10-20 mg/L
take sample after 4-6 hours

23
Q

Signs of theophylline toxicity

A

’FAST and SICK
- vomiting and GI effects initially
- tachycardia, CNS stimulation
- arrhythmias, convulsions and hypOKalaemia

24
Q

Theophylline interactions

A
  • HypOKalaemia - diuretics, corticosteroids, B2 agonists
  • Convulsions - Ciprofloxacin, quinolones
  • CCB, cimetidine, phenytoin, fluconazole, Macrolides - Enzyme inhibitors
  • St John’s Wort, Rifampicin
25
Q

General inhaler technique

A
  1. Breathe out, fully and gently
  2. Place inhaler mouthpiece in the mouth and seal the lips around the mouthpiece
  3. Breathe in (pMDIs: slow and steady, DPIs: quick and deep)
  4. Remove inhaler from the mouth and hold breath for up to 10 seconds
  5. Wait for a few seconds then repeat as necessary
26
Q

How is acute asthma treated

A

Oxygen if required (pO2 94-98%)
Prednisolone 40-50mg OD min 5 days - child under 12 up to 3 days
SABA via nebuliser

if symptoms persist, repeat and add nebulised ipratropium

27
Q

Treatment pathway of COPD

A
  1. SABA or SAMA (salbutamol or ipratropium)

If no asthma features,
2. LABA + LAMA
3. LABA + LAMA + ICS (3 months if impact on quality of life)

If asthma features,
2. LABA + ICS
3. LABA + LAMA + ICS

28
Q

Acute exacerbation of COPD tx

A
  1. nebuliser - SAMA, SABA or theophylline
  2. IV aminophylline
  3. Prednisolone 30mg OD 7-14 days
  4. Antibacterial therapy - amoxicillin, tetracycline or clarithromycin
29
Q

Tx of asthma in children (<5 years)

A
  1. SABA
  2. Add LTRA
30
Q

What is the most sedating antihistamine

A

Promethazine (BD/TDS)

Others,
Chorphenmine
Hydroxyzine

31
Q

What antihistamine causes QT prolongation

A

Hydroxyzine

32
Q

What are the non sedating antihistamines

A

‘FLAC’

Acrivastine (TDS)
Cetirizine (OD)
Loratidine (OD)
Fexofenadine (OD)

33
Q

What antihistamines are sold OTC

A

Promethazine (insomnia, nause)
Diphenhydramine (insomnia)
Buclizine (migraine only)

34
Q

Dose of adrenaline 1 in 1000

A

Child under 6: 150 mcg
Child 6-12: 300 mcg
12+ : 500mcg

35
Q

When should second adrenaline injection be given

A

5-15 minutes after first injection

36
Q

Treatment of anaphylaxis

A
  • Adrenaline and oxygen
  • Antihistamine
  • Corticosteroid
37
Q

What is used to treat croup

A

Dexamethasone oral solution

38
Q

MHRA warning with Hydroxyzine

A

QT prolongation
Torsade de pointes

39
Q

Maximum daily dose of Hydroxyzine

A

100mg

In elderly = 50mg

40
Q

What is used to treat lung disease in cystic fibrosis

A

Mucolytics

  1. Dornase alpha
  2. Dornase alfa+ hypertonic sodium chloride
    or
    hypertonic sodium chloride alone.
41
Q

Inhaler technique; pMDI (evohaler)

A

• Start to breathe in slowly and steadily and at the same time press the canister.
• keep your mouth closed and hold your breath for 10 seconds or as long as comfortable.
• If second dose is required, wait 30 seconds,

42
Q

Inhaler technique: accuhaler

A
  • Breathe out gently and slowly and put your lips around moth piece.
  • Breathe in quickly and deeply.
  • Remove inhaler from your mouth and hold your breath for 10 seconds or as long as comfortable.
    Breathe out gently
43
Q

Inhaler technique: turbohaler

A
  1. Twist off cover and uphold upright
  2. Turn coloured base as far as it goes it will go in one direction and then back again. You should hear a click.
  3. Repeat once more.
  4. Twist off top cover
  5. Check mouthpiece and dose counter
  6. Hold upright and twist base to the right and to the left until you hear a click.
  7. Breathe out slowly and gently.
  8. Hold inhaler horizontally.
  9. Put your lips around the mouthpiece
  10. Breathe in quickly and deeply.
  11. Remove the inhaler from your mouth, hold your breath for 10 seconds or as long as comfortable.
  12. Breathe out gently
  13. If second dose is required, repeat the steps
  14. Twist cover back on when finished.
44
Q

Inhaler technique; handihaler

A

1.Press down on the green button to release cap.
2.Check there’s nothing in the mouthpiece.
3.Open the mouthpiece, take a capsule from the blister pack and place inside the inhaler.
4.Close the mouthpiece until you hear a click.
5.Sit or stand up straight
6. Breathe out gently and slowly
7. Hold inhaler horizontally
8. put your lips around the mouthpiece
9, Put your lips around the mouthpiece
10.breathe in quickly and deeply, you should hear a vibrating noise
11.Remove the inhaler from your mouth, hold your breath for 10 seconds or as long as you’re comfortable.
12.Repeat steps again to make sure you empty the capsule.
13.Open the mouthpiece, tip out the empty capsule into bin and close.

45
Q

Inhaler technique; ellipta

A
  1. Slide cover open until you hear a click.
  2. Check the mouthpiece
  3. Hold the inhaler horizontally.
  4. Sit or stand up straight.
  5. Breath out gently and slowly
  6. Put your lips around the mouthpiece
  7. Breathe in quickly and deeply
  8. Remove the inhaler from your mouth.
  9. Breathe out gently
  10. If second dose is required, close cover to reset and repeat
  11. Close cover when finished.
46
Q

Warning with montelukast

A

Suicidal thoughts

Random Pre Reg Questions (12 decks)

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