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Respiratory Flashcards

1
Q

How often should a spacer be issued by a prescriber and how should patients clean their spacers?

A

A spacer should be issued every 6 months to a year.

A spacer should be cleaned using a mild detergent and should be allowed to drip dry to reduce static

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2
Q

When are nebulisers used?

A

Nebulisers are used in severe acute asthma for around 5-10 minutes.

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3
Q

What factors are commonly associated with asthma?

A

History of atopic diseases

Family history of asthma

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4
Q

At what threshold is obstructive airway disease is defined?

A

A FEV1/FVC below 80%

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5
Q

What is the treatment regime for asthma in adults?

A

1) SAMA
2) Low dose ICS (If symptomatic at least 3 times/ week, night time symptoms at least once/ week and using SABA atleast 3 times/ week)
3) LABA
4a) If LABA not aiding, stop LABA and increase ICS to medium
4b) If LABA is helping slightly, increase ICS to medium
4c) If LABA is helping slightly, consider LTRA or SR theophylline or LAMA
5a) Consider high dose ICS
5b) Consider LTRA, Beta agonist tablet or SR/Theophylline or LAMA
6) Oral Steroids

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6
Q

What is the treatment regime for asthma in 5-12 year olds?

A

1) SAMA
2) Paediatric dose ICS (If symptomatic at least 3 times/ week, night time symptoms at least once/ week and using SABA atleast 3 times/ week)
3) LABA
4a) If LABA not aiding, stop LABA and increase ICS to low
4b) If LABA is helping slightly, increase ICS to low
4c) If LABA is helping slightly, consider LTRA
5a) Consider medium dose ICS
5b) Consider LTRA, Beta agonist tablet or SR/Theophylline
6) Oral Steroids

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7
Q

What is the treatment regime for asthma under 5 years old?

A

1) SAMA
2) LTRA
3) Paediatric dose ICS
3) Combine LTRA and ICS

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8
Q

Give two examples of SABAs and how often they should be used in a day

A

Salbutamol, Terbutaline, 2 puffs QDS PRN`

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9
Q

Give three examples of ICS and how often they should be used daily

A

Fluticasone, Beclomethasone, Budesonide - BD

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10
Q

If a patient is taking Clenil, and they request to have QVAR, should you give it?

A

NO because the particles size in QVAR have extra fine particles, meaning that the doses in QVAR are double that in Clenil.

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11
Q

What are some of the SEs of ICS? What counselling should you give to patients?

A

Hoarse voice
Sore Throat
Oral Candidiasis - patients need to rinse their mouths throughly after administering inhalers or using a spacer.

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12
Q

Name two examples of LTRAa

A

Montelukast and Zafirlukast

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13
Q

What are SEs assoicated with LTRAs?

A

Churg Strauss Syndrome associated with vasculitis

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14
Q

What monitoring is required for Zafirlukast?

A

Liver function monitoring is required

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15
Q

What is theophylline ?

A

Theophylline is a Xanthine Bronchodilator

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16
Q

What is the target plasma range for theophylline?

A

10-20mg/L

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17
Q

What are the SEs of theophylline?

A 
Nausea and Vomiting
Hypokalaemia
Arrhythmias
Tachycardia
Seizures
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18
Q

What drugs does theophylline interact with?

A

Quinolones- Lowering seizure threshold
Steroids, Loop and Thiazides diuretics and Beta-agonists - Hypokalaemia
Enzyme Inducers - Rifampicin, St’ John’s Wort
Enzyme Inhibitors - Cimetidine, Phenytoin, CCBs, Macrolides

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19
Q

Name two LABAs and list their SEs

A

Salmeterol and Formoterol

Hypokalaemia, Arrhythmias and Tachycardia

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20
Q

What are the signs and symptoms in adults of a:

Moderate asthma attack

A 
Moderate asthma attack:
BP <110bpm
Respiratory Rate <25/min
Communication: Good
Peak flow: 50-75%
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21
Q

What are the signs and symptoms in adults of a: Severe asthma attack

A 
Severe asthma attack
BP >10bpm
Respiratory Rate >25/min
Communication: Limited
Peak flow: 50%<
22
Q

What are the signs and symptoms in adults of a:

Life-threatening asthma attack

A

Cyanosis
Peak flow: 33%<
SpO2 <92%
Silent Chest

23
Q

What are the signs and symptoms in children of a:

Moderate asthma attack

A 
Moderate asthma attack:
BP <125bpm (5-12 years old)
BP <140bpm (5 years old)
Respiratory Rate <30/min (5-12 years old)
Respiratory Rate <40/min (5 years old)
Communication: Good
Peak flow: 50+%
24
Q

What are the signs and symptoms in children of a:

Severe asthma attack

A 
Severe asthma attack:
BP >125bpm (5-12 years old)
BP >140bpm (5 years old)
Respiratory Rate >30/min (5-12 years old)
Respiratory Rate >40/min (5 years old)
Communication: Limited
Peak flow: 33-50%
25
Q

What are the signs and symptoms in children of a:

Life-threatening asthma attack

A

Cyanosis
Peak flow: 33%<
SpO2 <92%
Silent Chest

26
Q

What is the treatment in the case of an asthma attack?

A

SABA 2-10 puffs every 10-20 minutes or PRN
SAMA nebuliser every 20-30 mins or PRN

If not helping, add Ipratropium bromide nebuliser and call 999

Patients should be treated with prednisolone - Max 3 days under 12 or at least 5 days if over

27
Q

What anatomical changes occur in a patient who has COPD?

A

Alveoli are destroyed

Bronchioles lose their shape and are clogged with mucus

28
Q

What are the GOLD standard limits for COPD?

A 
FEV1/FVC <0.7 implies obstruction
1- Mild - FEV1 >/80%
2-Moderate - FEV1 80%
3- Severe - 30%  FEV1 50% 
4- VerySevere - FEV1 30%
29
Q

What are the treatment guidelines for COPD?

A

1) SABA or SAMA
2) If:
FEV1 >/ 50% then LABA or LAMA or LAMA+ICS if no better
FEV1 50% then LABA + ICS or LAMA
3)LAMA+ICS+LABA

30
Q

What could a patient use if they are unable to use an inhaler for COPD and symptoms still persist?

A

MR theophylline or Aminophylline

31
Q

What can patients use for a productive cough?

A

Mucolytics such as carbocisteine

32
Q

When are mucolytics contraindicated?

A

Mucolytics are contraindicated in patients who have active peptic ulcer disease

33
Q

How often should SAMAs be administered?

A

TDS

34
Q

How often should LAMAs be administered?

A

OD

35
Q

What are cautions for patients taking muscarinic antagonists?

A

Glaucoma (Increased risk when nebulised salbutamol + nebulised ipratropium)
Prostatic Hyperplasia

36
Q

What are some of the SEs associated with muscarinic antagonists?

A

Dry mouth

Paradoxical Bronchospasm

37
Q

What addiitional treatments can be added on for acute COPD exacerbations?

A

Oxygen (+Bronchodilator)
Aminophylline IV if poor response to nebulised bronchodilator
Steroids
Anitbiotics

38
Q

What are the two types of anti-histamines and give examples?

A

Sedating - Promethazine (BD/TDS) , Chlorphenamine (QDS), Hydroxyzine (QT prolongation)
Non-Sedating - Acrivastine (TDS), Loratidine (OD), Cetirizine(OD), Fexofenadine (OD)

39
Q

Where are anti-histamines indicated?

A

Hayfever, Urticaria- Allergies

40
Q

What are some of the SEs associated with anti-histamines ?

A

Benign prostatic hyperplasia
Glalucoma
Liver Impairment

41
Q

Which anti-histamine causes QT prolongation?

A

Hydroxyzine

42
Q

What is Olizumumab?

A

An immunoglobulin for chronic spontaneous urticaria (hives) when all other treatments have failed

43
Q

What is a SE of Olizumumab?

A

Churg Strauss syndrome

44
Q

What strength of adrenaline is used in anaphylaxis/?

A

1 in 1000

45
Q

What strength of adrenaline is used in :

a) 6<
b) 6-12
c) Adults

A

a) 150mcg
b) 300mcg
c) 500mcg

46
Q

What should be done during anaphylaxis?

A

Recovery position if sick or unconscious, flat on back, legs elevated, support airways, maintain BP

47
Q

What can be used as adjuncts in anaphylaxis?

A

Oxygen
IV Hydrocortisone
IV Anti-histamine

48
Q

What advice do you give to patients taking epipens?

A

Always carry 2
Administer IM in the mid-point of the outer thigh
Call 999 even if symptoms appear better

49
Q

What are the different types of cough preparations available and give examples.

A

Cough suppressant - Dextrometorphan, Pholcodeine, Codeine linctus
Cough soother - Glycerol, simple linctus
Cough expectorant- Guaifenesin

50
Q

What is croup?

A

The inflammation of the airways in children, resulting in breathing difficulties.

51
Q

What is used to treat croup?

A

Dexamethasone oral solution

Errors (6 decks)

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