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Pre Reg > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What might patients experience when switching from pMDI to a dry powder inhaler?

A

Lack of sensation in the mouth and throat
Coughing

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2
Q

What is the MHRA warning for pMDIs?

A

risk of airway obstruction from aspiration of loose objects

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3
Q

How often should spacer devices be changes?

A

Every 6-12 months

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4
Q

What is the dilution for nebulisers?

A

Sodium Chloride 0.9%

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5
Q

What are the four indications for nebulisers?

A
  1. deliver beta2 agonist or ipratropium bromide to a patient with acute exacerbation of asthma or COPD
  2. deliver beta2 agonist, corticosteroid or ipratropium bromide on a regular basis to a patient with severe asthma or reversible airways obstruction when patient unable to use other devices
  3. deliver antibiotic or mucolytic to a patient with cystic fibrosis
  4. deliver pentamidine isetionate for prophylaxis of pneumocystis pneumonia
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6
Q

What is considered as moderate acute asthma in adults?

A
  • Increasing symptoms
  • Peak flow > 50-75% best or predicted
  • No features of acute severe asthma
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7
Q

What is considered as severe acute asthma in adults?

A

One of the following;
- Peak flow 33-50% best or predicted
- RR ≥ 25/min
- HR ≥110/min
- Inability to complete sentences in one breath

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8
Q

What is considered as life-threatening acute asthma in adults?

A

Any one of the following;
- Peak flow <33% bets or predicted
- SpO2 <92%
- PaO2 <8kPa
- Normal PaCO2 (4.6-6kPa)
- Silent chest
- Cyanosis
- Poor respiratory effort
- Arrhythmia
- Exhaustion
- Altered conscious level
- Hypotensuin

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9
Q

What is considered as moderate acute asthma in children?

A
  • Able to talk in sentences
  • SpO2 ≥92%
  • Peak flow >50% best or predicted
  • HR ≤ 140/min in children between 1-5 years
  • HR ≤ 125/min in children ages over 5
  • RR ≤ 40/min in children 1-5 years
  • RR ≤ 30/min in children over 5 years
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10
Q

What is considered as severe acute asthma in children?

A
  • Cant complete sentences in one breath or too breathless to talk or feed
  • SpO2 <92%
  • Peak flow 33-50% best or predicted
  • HH ≥ 140/min in children aged 1-5 years
  • HH ≥ 125/min in children ages over 5 years
  • RR > 40/min in children 1-5 years
  • RR > 30/min in children ages over 5 years
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11
Q

What is considered as life-threatening acute asthma in children?

A

Any one of the following;
- SpO2 < 92%
- Peak flow <33% best or predicted
- Silent chest
- Cyanosis
- Poor respiratory effort
- Hypotension
- Exhaustion
- Confusion

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12
Q

What SpO2 level should be maintained?

A

94-98%

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13
Q

What is the treatment for acute asthma?

A

Severe/ life-threatening - Refer!!

Moderate:
1st line: high-dose inhaled SABA ASAP (e.g. salbutamol)
- in mild-moderate acute asthma - pMDI inhaler and spacer can be used
- in severe/ life-threatening asthma - oxygen driven nebuliser, if response poor, consider continuous nebulisation

In all cases of acute asthma - pt’s should be prescribed adequate dose of oral prednisolone while continuing usual ICS
- Alternatives: parenteral hydrocortisone or IM methylprednisolone

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14
Q

What is the treatment for acute asthma in children over 2?

A
  • High flow oxygen via tight fitting mask or nose cannula given to all children with life-threatening acute asthma or SpO2 <94% to achieve normal 94-98%

1st line: inhaled SABA ASAP
- mild-moderate - pMDI and spacer

Severe/ life-threatening asthma:
- administration via oxygen driven nebuliser

In all cases:
- prescribe oral dose of prednisolone for 3 days
–> repeat dose in children who vomit or consider IV route in those who cannot retain oral medicatio
–> continue ICS as usual

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15
Q

If a child over 2 is having an episode of acute asthma, when should they seek urgent medical attention?

A

If symptoms not controlled after 10 puffs of salbutamol via spacer or if symptoms return within 3-4 hours

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16
Q

What can be added to nebulised beta agonists to provide greater bronchodilation?

A

nebulised ipratropium bromide

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17
Q

What is given as add-on treatment to bronchodilator therapy in patients with severe COPD with chronic bronchitis?

A

Roflumilast

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18
Q

How do you manage exacerbations of COPD?

A

Breathlessness: high-dose short-acting inhaled bronchodilator

Withhold LAMA if SAMA given

Short course prednisolone
- consider osteoporosis prophylaxis in those who require frequent oral corticosteroids

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19
Q

How is mild croup treated?

A

Single dose of corticosteroids e.g. dexamethasone

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20
Q

How do you treat moderate-severe croup?

A

Single dose oral corticosteroid (dexamethasone or prednisolone) while awaiting hospital admission

If child too unwell to receive oral medication: IM dexamethasone or budesonide by nebulisation

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21
Q

How do you treat severe croup not controlled with corticosteroid treatment?

A

Nebulised adrenaline/epinephrine solution 1 in 1000 (1mg/ml) - clinical effects should last 1 hour but usually subside 2 hours after administration

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22
Q

What are the side effects of antimuscarinics?

A

Arrhythmias
Constipation
Cough
Dizziness
Dry mouth
Headache
Nausea

Inhaled antimuscarinics end in ‘ium’

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23
Q

Name some LABA drugs?

A

Bambuterol hydrochloride
Fomoterol fumarate
Indacaterol
Olodaterol
Salmeterol

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24
Q

What are the cautions for beta2-adrenoceptor agonists, selective?

A

Arrhythmia
Cardiovascular disease
Diabetes - risk of hyperglycaemia and ketoacidosis, especially with IV use
Hypertension
Hyperthyroidism
Susceptibility to QT prolongation

Hypokalaemia - particular caution in severe asthma and COPD because this effect may potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, diuretics and by hypoxia

25
Q

Name some SABA drugs?

A

Salbutamol
Terbutaline

26
Q

What are the common side effects of inhaled corticosteroids?

A

Headache
Oral candidiasis
Pneumonia - in patients with COPD
Taste altered
Voice alteration

27
Q

What is the MHRA warning for inhaled beclometasone?

A

CFC-free pMDIs (Qvar and Clenil) are not interchangeable
- should be prescriibed by brand
- Qvar and Fostair has extra fine particles and is more potent

28
Q

What is the MHRA warning for montelukast?

A

Risk of neuropsychiatric reactions including speech impairment, obsessive-compulsive symptoms
- evaulate risk

29
Q

What are the signs and symptoms of theophylline overdose?

A

Vomiting
Agitation
Restlessness
Dilated pupils
Sinus tachycardia
Hyperglycaemia
Hypokalaemia

Severe symptoms:
Haematemesis
Convulsions
Superventricular and ventricular arrhythmia

30
Q

What is the satisfactory theophylline concentration?

A

10-20mg/L
Although, lower concentrations may be effective 5-15mg/L

31
Q

How do you treat acute attacks of hereditary angioedema?

A

Administer C1-esterase inhibitor, an endogenous complement blocker derived from human plasma
- cinestat alfa
- icatibant

32
Q

What is used for short and long term prophylaxis of hereditary angioedema?

A

Tranexamic acid and Danazol
- danazol avoided in children due to androgenic effect

Short-term: started several days before planned procedure and continued for 2-5 days afterwards

33
Q

What should be offered to patients with cystic fibrosis with evidence of lung disease?

A

Offer mucolytic
1st line: dornase alfa
2nd line: dornase alfa + hypertonic sodium chloride
OR hypertonic sodium chloride alone

If dornase alfa unsuitable and lung function is rapidly declining and other osmotic drugs not considered appropriate:
- recommend mannitol dry powder for inhalation

34
Q

What should be offered to cystic fibrosis patients with deteriorating lung function or repeated pulmonary exacerbations?

A

Long-term treatment with azithromycin at an immunomodulatory dose (usually 500mg three times a week)

2nd line: stop azithromycin and consider oral corticosteroids

35
Q

What is the treatment for distal intestinal obstruction syndrome in cystic fibrosis patients?

A

1st line: meglumine amidotrizoate with sodium amidotrizoate

36
Q

What do you give cystic fibrosis patients with abnormal LFT?

A

Ursodeoxycholic acid until liver function restored

37
Q

What can be given to infants under 3 months for nasal decongestion?

A

Sodium chloride 0.9%

38
Q

What is the age restriction for OTC cough suppressants containing codeine?

A

Avoid in children under 12 and children of any age known to be CYP2D6 ultra-rapid metabolisers

39
Q

Which OTC cough and cold medicines should be avoided in children under 6?

A

Those that contain:
- brompheniramine, chlorphenamine, diphenhydramine, doxylamine, promethazine or triprolidine (antihistamines)
- dexatromethorphan (cough suppressant)
- guaifenesin or ipecacuanha (expectorants)
- phenylephrine, pseudoephedrine, ephedrine, oxymetazoline or xylometazoline (decongestants

40
Q

What is the storage requirements for fostair?

A

Store in fridge until dispensed then can be stored in room temperature

Do not use fostair beyond 3 months or after the expiry date - whichever is sooner

41
Q

What is the contraindication for Carbocisteine?

A

Active peptic ulcer

42
Q

What are the side effects of Carbocisteine?

A

GI haemorrhage
Skin reactions
Stevens-Johnson syndrome
Vomiting

43
Q

When do you take theophylline concentratio?

A

5 days after starting, 4-6 hours after dose

44
Q

Which antihistamines are sedating?

A
  • Promethazine
  • Chlorphenamine
  • Hydroxyzine
  • Cyproheptadine
  • Alimemazine
  • Clemastine
45
Q

Which antihistamines are not sedating?

A
  • Acrivastine (TDS)
  • Cetirizine
  • Loratadine
  • Fexofenadine
46
Q

How do you treat an overdose of theophyline?

A

Activated charcoal - even if more than an hour has elapsed after ingestions and especially if it is a MR formulation

Hypokalaemia - IV potassium chloride

Convulsions - IV lorazepam or diazepam

Tachycardia, hypokalaemia,
and hyperglycaemia - IV short acting beta blocker

47
Q

What is the MHRA warning for hydroxyzine?

A

Risk of QT prolongation and torsade de pointes

Max. daily dose in children with body-wright up to 40kg = 2mg/kg

Max. daily dose in adults = 100mg

Max. daily dose in elderly = 50mg

48
Q

What is the adrenaline dose for cardiopulmonary resuscitation?

A

1 in 10,000 solution IV used for cardiopulmonary resuscitation
- 1mg every 3-5 mins

49
Q

What is Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) an adverse effect of?

A

Montelukast

In many of the reported cases the reaction followed the reduction or withdrawal of oral corticosteroid therapy. Prescribers should be alert
to the development of eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications,
or peripheral neuropathy.

50
Q

What conditions increase theophylline concentration?

A

Heart failure
Hepatic impairment
Viral infections

51
Q

When should sample of aminophylline be taken?

A

Sample should be taken 4-6 hours after starting treatment

52
Q

When would a patient not require a loading dose of aminophylline?

A

If they already take oral theophylline

53
Q

Should actual body weight always be used to calculate aminophylline dose?

A

No - use IBW if patient is obese or in extreme body weights

54
Q

What is the only route of administration for aminophylline?

A

IV

55
Q

Which drug has no drug interactions?

A

Carbocisteine

56
Q

Deficiency of what electrolyte is often seen in asthmatic patients?

A

Deficiency of magnesium

57
Q

Which prophylactic antibiotic treatment should you consider in patients who are non-smokers and have all other treatments optimised?

A

Azithromycin

58
Q

What is the COPD oxygen target?

A

88-92%

Pre Reg (14 decks)

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