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PharmEducate Notes > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Does asthma symptoms occur more at night or during the day?

A

At night which interrupts sleep

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2
Q

Medications that trigger asthma?

A

NSAIDs and beta-blockers

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3
Q

What is the first step in asthma treatment in children 12+ and adults?

A

SABA PRN

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4
Q

If SABA is not sufficient in treatment of asthma in children 12+ and adults?

A

Add a regular preventer = low dose ICS

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5
Q

Examples of low dose ICS?

A

Beclometasone 200-400mcg
Budesonide 400mcg
Fluticasone 200mcg
Mometasone 400mcg
Ciclesonide 169mcg

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6
Q

When would a patient need to step up their asthma treatment?

A

Use their SABA or have symptoms 3+ times a week
Night time waking once a week
Asthma attack in the last 2 years requiring oral steroids

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7
Q

Initial add on therapy to SABA + ICS in asthma?

A

LABA as fixed dose BD or MART (maintainable and reliever therapy)

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8
Q

What is LABA MART therapy?

A

LABA (E.g. formoterol) + ICS in one inhaler

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9
Q

Do you still give SABA with MART therapy?

A

No. MART therapy is sufficient as a reliever

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10
Q

What is the next step after a LABA in asthma for children 12+ or adults?

A

Consider stopping the LABA if no response.
Increase ICS dose or add a leukotriene receptor antagonist (E.g. montelukast)

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11
Q

What is the next step in asthma management for children 12+ or adults who have not been managed with medium dose ICS or LTRA?

A

Refer - may be be started on oral steroids or theophylline

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12
Q

When should an asthma patient be urgently assessed?

A

> 1 inhaler per month

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13
Q

Is formoterol (LABA) fast acting?

A

Yes which is why it can replace a SABA in MART treatment

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14
Q

How does asthma treatment in children vary?

A

Doses of ICS are lower I.E. stepped up from very low to low if needed
LTRA can be started at any step including as an alternative to LABA

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15
Q

At what age is LABA not licensed for use in asthma?

A

< 5 give LTRA instead

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16
Q

How long do effects of SABAs last?

A

3-5 hours
Refer to doctor if less

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17
Q

Side effects of SABA / LABA?

A

Hypokalaemia
Tremors or headaches
CVS effects including palpitations

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18
Q

SABA dose?

A

1-2 puffs QDS PRN

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19
Q

Can you take a SABA dose before exercise to prevent symptoms?

A

Yes

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20
Q

Which electrolyte disturbance is caused by Prednisolone or theophylline?

A

Hypokalaemia
Caution when taking with SABA / LABA

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21
Q

Relationship between potassium and glucose?

A

Hypokalaemia = hyperglycaemia
And vice versa

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22
Q

Storage for fostair inhalers?

A

Keep in the fridge

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23
Q

Dose of LABA inhalers?

A

BD + reliever doses in MART

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24
Q

Can a LABA be used without an ICS?

A

No

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25
Q

How long does it take for an ICS to work?

A

7-14 days

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26
Q

Dose of ICS?

A

BD
Except Ciclesonide = OD

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27
Q

What colour inhaler is beclometasone?

A

Brown

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28
Q

Should beclometasone CFC free inhalers be prescribed by brand?

A

Yes

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29
Q

Which beclometasone inhaler is more potent, Qvar or Clenil?

A

Qvar is twice as potent as Clenil

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30
Q

Licensing age of beclometasone easyhaler?

A

18+

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31
Q

Licensing age for becolometasone Qvar/Clenil inhaler?

A

12+

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32
Q

Side effects of ICS?

A

Oral thrush - do not need to stop
Hoarse voice and sore throat
Bronchospasm - stop - mild cases can be prevented by using SABA before use

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33
Q

How to avoid oral candidiasis in ICS?

A

Use a spacer
Rinse mouth and brush teeth after use
Ensure proper technique
Can treat with miconazole OTC and no need to stop inhaler

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34
Q

When should LTRAs be taken?

A

At night

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35
Q

Side effects of LTRAs?

A

Neuropsychiatric reactions - report changes in speech or behaviour including speech impairment and obsessive-convulsive symptoms

Church-Strauss syndrome - inflammation of blood vessels reducing blood flow to organs and tissues

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36
Q

How often is theophylline given?

A

Every 12 hours

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37
Q

Theophylline therapeutic index?

A

10-20mg/L

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38
Q

Is theophylline brand specific?

A

Yes

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39
Q

How long after a theophylline dose is blood levels taken?

A

4-6 hours

40
Q

Does theophylline require frequent monitoring?

A

Not once the dose is stable

41
Q

What factors increase theophylline levels?

A

HF, infection, elderly, liver impairment

42
Q

What factors decrease theophylline levels?

A

Smokers and alcohol

43
Q

What should be done if someone quits smoking while on theophylline?

A

The dose should be reduced

44
Q

Signs of theophylline toxicity?

A

“CHAT V”
Convulsions/CNS stimulation (dilated pupils, restless)
Hypokalaemia (potentially leading to QT prolongation) and hyperglycaemia
Arrhythmias
Tachycardia
Vomiting

45
Q

Interactions with theophylline?

A

Beta blockers - bronchospasm Ciprofloxacin - seizures

46
Q

Which inhaler devices should be used slow & steady?

A

pMDI and breath-actuated inhaler

47
Q

Which inhaler should be used fast and deep?

A

DPI

48
Q

How old do you have to be to use a DPI?

A

5 years old

49
Q

Are spacers interchangeable?

A

No

50
Q

How often should a spacer be changed?

A

Every 6-12months

51
Q

How should spacers be cleaned and how often?

A

Once a month with warm water and mild detergent

52
Q

How many times should a peak flow reading be repeated?

A

3

53
Q

What’s does a PEF > 80% mean?

A

Good control

54
Q

What should be done if a patients PEF < 80%?

A

Quadruple the ICS dose

55
Q

What should be done if a patients PEF < 60%?

A

Start oral steroids and seek same day medical advice

56
Q

What should be done if a patients PEF < 50%?

A

Seek urgent medical help

57
Q

How is asthma attacks treated?

A

Salbutamol 2-10 puffs every 10-20mins or PRN using a spacer device

Followed by a short course of Prednisolone 40-50mg OD for at lease 5 days if 12+ or 3 days if under 12

58
Q

When should a patient having an asthma attack go to hospital?

A

Unresponsive, severe or life threatening or if they’re under 2 years old

59
Q

Main symptoms which distinguishes COPD from asthma?

A

Chronic symptoms present throughout the day
Cough that produces mucus

60
Q

Can a patient have asthma and COPD?

A

Yes

61
Q

First line treatment for COPD?

A

SABA or SAMA PRN

62
Q

Example of a SAMA?

A

Ipatropium bromide

63
Q

If patient is still breathless despite reliever therapy or has an acute exacerbation of COPD symptoms?

A

Step up treatment depending on the presence of asthmatic features

64
Q

If patient has asthmatic features in COPD?

A

Add an inhaler containing LABA + ICS

65
Q

If patient has no asthmatic features in COPD?

A

LABA + LAMA
STOP SAMA if given previously

66
Q

When would a COPD patient need triple therapy?

A

Severe exacerbation which requires hospital admission
Or 2+ moderate exacerbations in the last year that required steroids or antibiotics
Patients with asthmatics features that effect QoL

67
Q

What is triple therapy for COPD?

A

LABA + ICS + LAMA (stop SAMA)

68
Q

When can theophylline be used in COPD?

A

Alternative to bronchodilators (SAMA or SABA)

69
Q

Treatment of acute COPD exacerbation?

A

Antibiotic (macrolide or quinolone) + 30mg Prednisolone for 7-14 days

70
Q

Which antibiotics are used in acute COPD exacerbations?

A

Macrolide or quinolone

71
Q

Treatment of severe COPD + chronic bronchitis?

A

Roflumilast + bronchodilators

72
Q

Oxygen targets for COPD patients?

A

88-92%

73
Q

Example of a LAMA?

A

Tiotropium
Common brands include Spriva and Braltus

74
Q

Dose of LAMA?

A

OD
Except Aclidinium which is BD

75
Q

How long does ipratropium last?

A

3-6 hours

76
Q

How many times can ipratropium be taken a day?

A

TDS

77
Q

Important MHRA counselling for tiotropium?

A

Never place a capsule directly into the mouth piece as this can cause you to inhale it

78
Q

How often can chlorphenamine be taken?

A

QDS

79
Q

Which juices must be avoided with fexofenadine?

A

Apple and orange juices reduce exposure

80
Q

Which antihistamines are non-sedative?

A

“LAC”
Loratidine
Acrivastine
Cetirizine

81
Q

Which antihistamine can cause QT prolongation?

A

Hydroxyzine - prescribe lowest effective dose for the shortest effective period and half dose in elderly if unavoidable

82
Q

Do non-sedative antihistamines make you sleepy?

A

Yes but to a lesser extent

83
Q

Cautions for antihistamines?

A

BPH, glaucoma and severe liver impairment (sedative antihistamines)

84
Q

Allergen vaccine interactions?

A

Beta blockers (may deem adrenaline ineffective) and ace inhibitors (severe anaphylactoid reactions)

85
Q

Adrenaline doses?

A

12+ = 500mcg
6-12 = 300mcg
6 months - 6 = 150mcg

86
Q

How many epipens should a patient carry at all times?

A

2

87
Q

How long after the first adrenaline injection should the second one be given?

A

5-15mins

88
Q

Should a patient seek medical advice after injecting with adrenaline if symptoms improve?

A

Yes call ambulance after the first injection

89
Q

How should the patient be sat while waiting for the ambulance following an epidemic injection for anaphylaxis?

A

Lay down with legs raised to restore BP unless having breathing difficulties which requires them to sit up

90
Q

What is angioedema?

A

Swelling of the soft tissue due to allergic reaction. Symptoms include swollen lips, eyes and tongue.

91
Q

Treatment of angioedema?

A

Antihistamine + corticosteroids

IM adrenaline if laryngeal oedema

92
Q

Contraindications of mucolytics such as carbocisteine?

A

Active peptic ulcers as this also decrease stomach mucus making ulcers worse

93
Q

Symptoms of croup?

A

Barking cough
Hoarse voice
Breathing difficulties
Stridor - high pitched sound made when breathing in

94
Q

When is croup a medical emergency?

A

When it effects breathing

95
Q

Treatment of croup?

A

Dexamethasone oral solution

PharmEducate Notes (8 decks)

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