Respiratory Flashcards
What is the peak expiratory volume for moderate acute asthma, severe acute asthma respectively?
Moderate 50-75%,
Severe 33-50%
What is the management in adults for severe acute asthma when admitted to hospital?
Oxygen,
Nebulised SABA and SAMA,
Steroids (prednisolone 40mg for 5 days),
IV magnesium sulfate,
IV aminophylline
What does MART stand for?
Maintenance and reliever therapy
What do MART inhalers include?
Duoresp spirimax <18 (budesonide and formoterol),
Fostair (beclomethasone, formoterol) <18,
Symbicort <12 (budesonide, formoterol)
What is the steps for adult 12 and over NICE/BTS/SIGN?
AIR therapy then low dose MART, moderate dose MART then add LTRA or LAMA
What is the steps for children 5 to 11 NICE/BTS/SIGN?
BD low dose ICS + SABA then
if able to manage MART: low dose MART then moderate dose MART
if unable to manage MART: add LTRA to BD low dose ICS then BD low dose ICS/LABA then moderate dose ICS/LABA (add on SABA in all steps)
How often do you review preventer therapy/step down for asthma adult?
Every 3 months
What are high doses of ICS?
Beclometasone 500micrograms (fine particles) 2 doses, standard particles 1200 (clenil) micrograms 2 doses,
Fluticasone proprionate 600mcg in 2 doses, fluticasone furoate 200mcg as a single dose,
Mometasone 800mcg in 2 doses,
Budesonide 1000mcg in 2 doses
Childrens NICE/BTS/SIGN guidelines <5?
SABA then very low ICS then add LTRA
What is the name of the oral beta agonist tablet?
Bambuterol
List some side effects of beta agonists
Hand tremors,
Tachycardia,
Hyperglycaemia, Hypokalaemia,
Prolonged QT interval
What are the two brands of beclomethasone and which is more potent?
QVAR, more potent.
Clenil less potent
Side effects of ICS?
Hoarse voice,
Sore throat,
Oral candidiasis,
Paradoxical bronchospasm
What are the side effects of LTRAs?
Churg Strauss syndrome, liver toxicity (with zafirlukast)
MHRA alert for montelukast
Risk of neuropsychiatric reactions,
Discontinue montelukast in patients who develop new or worsening neuropsychiatric symptoms.
What class of drug is theophylline?
Xanthine bronchodilator
What is the therapeutic range of theophylline?
10-20mg/L
When do you take theophylline levels?
Five days after initiation or 3 days after a dose change, take 4-6 hours after an oral MR preparation
What does smoking do to theophylline?
Smoking decreases the concentration of theophylline in the blood, stopping smoking causes an increase of theophylline concentration (monitor for toxicity)
What are the general symptoms of emphysema and chronic bronchitis? (COPD)
Emphysema: Pink puffer- frequent pink complexion, fast RR and pursed lips.
Chronic bronchitis- blue bloaters due to bluish colour of skin and lips, cyanosis and swollen ankles
What is the first treatment for COPD?
SABA or SAMA PRN
What vaccinations do COPD patients need to get?
Annual influenza and pneumococcal vaccine
What do you give for COPD patients without asthmatic features (FEV >50%)?
SAMA/SABA PRN, LABA or LAMA (disc SABA if LAMA given), then add ICS, then triple therapy (LABA, LAMA, ICS)
What do you give patients with asthmatic features (FEV<50%?)
SABA/SAMA PRN, ICS with LABA, then triple therapy
After triple therapy in COPD you can use theophylline. When do you take levels?
5 days after commencing therapy, 3 days after changing the dose and 4-6 hours after oral MR dose taken
You can’t give aminophylline via a) IV b) IM
IM as too irritant (20x more soluble than theophylline)
How often do you take the LAMAs?
Once daily (except for Eklira which is BD- aclidinium)
List some LAMAs and their brands
Glycopyrronium (Seebri breezhaler),
umeclidinium (Incruse Ellipta),
tiotropium (spriva handihaler)
How long are short courses of pred for COPD?
30mg for 5 days
Which antibiotic do you use for prophylaxis in COPD?
Azithromycin (unlicensed) used if 4 or more exacerbations per year resulting in hospital.
NB: never give macrolides with azithromycin
What is CHM advice for chronic asthma regarding formoterol and salmeterol?
Only be added if control with ICS has failed, not be initiated in deteriorating asthma, introduce at a low dose, be discontinued in absence of benefit etc
Oxygen targets for asthmatics?
94-98%,
but 88-92% in chronic respiratory failure ie COPD, CF etc
Croup (seal like barking cough)- treatment?
Self-limiting, paracetamol and ibuprofen to control fever and pain.
If taken into hosp: corticosteroid (Dexamethasone) by mouth
Adrenaline doses?
150 micrograms 1 month – 5 years,
300 micrograms 6-11 years,
500 micrograms 12 years and above
MHRA alerts with adrenaline pens?
Always carry 2, patient and carers with allergies trained on how to use and practice with training device, check expiry dates and obtain replacements before expiry
First line treatment, second and third line for CF?
Dornase alfa, hypertonic saline, mannitol (think about pancreatin, fluids)
Age for otrivine childrens nasal drops?
> 6
Age for xylometazoline (otrivine adult)?
> 12
Age for diphenhydramine?
> 16 (nytol)
Age for pseudoephedrine?
> 12
Age for phenylephrine?
> 6
Age for guaifenesin, diphenhydramine, pholcodeine, dextromethorphan?
> 6
Age for loratadine?
> 6
Age for cetirizine solution and cetirizine zirtek tabs?
solution >2
Tabs >6
Age for nasal corticosteroids OTC?
> 18
