Respiratory Flashcards

1
Q

Asthma long term management

A
Steps:
1.
-SABA as needed 
2.
-SABA
-plus low dose ICS B.D.
3. 
-SABA
-plus low dose ICS/LABA B.D. 
or
-low dose ICS/LABA maintenance and reliever 
->budesonide + eformoterol 
4.
-SABA
-plus high dose ICS/LABA B.D.
or
-medium dose ICS/LABA maintenance and reliever 
->budesonide + eformoterol 
5. specialist referral 

Stepping up/down

  • trial for 1-3 months then step up if poor control
  • maintain good control for 3 months before stepping down
  • before stepping up
  • > adherence
  • > inhaler technique
  • > comorbid conditions /alternate diagnosis

Add ons

  • chromones
  • > prophylaxis for exercise
  • > 50% effective (less than SABA)
  • montelukast
  • > add on for under 14yrs with exercise induced (alternative to step 2)
  • Anti-IgE
  • > omalizumab
  • > allergen immunotherapy
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2
Q

non pharm asthma

A

Education/therapeutic alliance

  • regular reviews
  • education about asthma
  • rationale and SE of treatment
  • importance of adherence
  • inhalar technique

Triggers

  • identify
  • avoid (other than exercise)

Asthma action plan

  • personalised and written
  • how to recognise symptoms of flare up
  • how to adjust medications
  • > increase reliever
  • > increase ICS/budesonide+eformoterol
  • > consider oral prednisone
  • when to seek medical attention

MONITORING

Self monitoring

  • symptoms
  • PEF
  • > poor recognition of symptoms
  • > monitor effect of treatment
  • > identify triggers

Primary care monitoring
Timing
-following flare ups and hospital admissions
-6 monthly
-opportunistically for non-asthma appointment
Assess
-symptom control
->Primary care Asthma Control Screening tool
->frequency reliever medication
->spirometry annually
-treatment issues
->inhaler technique (6 monthly)
->adherence
->understanding/review of asthma action plan (annually)
->comorbidities

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3
Q

long term management COPD

A

PRN bronchodilator

  • SABA initially
  • > salbutamol
  • > terbutaline
  • SAMA
  • > ipratropium

Long acting bronchodilatory

  • moderate to severe
  • improves quality of life
  • improve exercise tolerance
  • reduce exacerbations
  • LABA B.D.
  • > eformoterol
  • LAMA once daily
  • > tioptropium
  • monotherapy or combined

ICS

  • severe COPD (FEV1 <50% predicted)
  • frequent exacerbations
  • best evidence for combined with LABA
  • > budesonide + eformoterol B.D.
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4
Q

beta2 agonist

A

SABA: salbutamol, terbutaline
LABA: salmeterol, eformoterol

MOA:

  • Beta 2 receptor is G protein coupled receptor
  • activation leads to activation of adenylyl cyclase
  • > cAMP
  • > smooth muscle relaxation ->bronchodilation
  • difference in duration of action due to susceptibility to COMT and MOA
  • may also
  • > inhibit mast cell release
  • > inhibit neutrophil, eosinophil and lymphocyte response

SE

  • tremor/agitation
  • palpitations/tachycardia
  • headache
  • insomnia
  • hypokalaemia (high doses)

Precautions

  • HTN/post MI/HF/arrhythmias
  • > exacerbate disease
  • hyperthyroid
  • > cardiovascular effects
  • diabetes
  • > hyperglycaemia with high doses
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5
Q

theophylline

A

IV version = aminophylline

MOA

  • inhibition of phosphodiesterase 3
  • > bronchodilation
  • inhibition of phosphodiesterase 4
  • > anti-inflammatory
  • activation of histone deacetylases
  • > down regulate inflammatory genes

SE

  • monitor levels
  • interaction with CYP450 inhibitors
  • antagonism of adenosine
  • > tachycardia + arrhthymias
  • tremor
  • headache
  • GI distress

Aminophylline

  • vomitting
  • arrhythmias
  • convulsions
  • sudden death
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6
Q

ICS

A

Fluticasone, beclamethasone, budesonide

SE:

  • cough
  • dysphonia
  • > laryngeal myopathy
  • oropharyngeal candidiasis
  • allergic contact dermatitis (mouth and nares)
  • systemic effects much less than oral
  • > adrenal crisis
  • > LRTI
  • > glaucoma + cataracts
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7
Q

chromones

A

chromolyn, nedocromil

MOA

  • prevents degranulation of pulmonary mast cells
  • > decrease histamine release

SE

  • throat irritation
  • cough
  • rarely
  • > anaphylactoid reaction
  • > bronchospasm
  • overall favourable side effect profile
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8
Q

montelukast

A

MOA:

  • Selective leukotriene receptor antagonist
  • > inhibits the cysteinyl leukotriene receptor

SE

  • generally well tolerated
  • rarely
  • > anaphylaxis
  • > angioedema
  • > dizziness
  • > dyspepsia
  • > muscle weakness
  • > transaminitis
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9
Q

tiotropium

A

LAMA:

  • half life = 36 hours
  • bronchodilation = 24 hrs

MOA:

  • structural analogue of ipratropium
  • antagonises M3 receptor

SE

  • dry mouth
  • URTI
  • pharyngitis
  • sinusitis
  • headache
  • cardiovascular effects (angina/palpitations) rare
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10
Q

ipratropium

A

MOA

  • blocks muscurinic receptor non specifically
  • > increases cGMP
  • > smooth muscle relaxation

SE

  • headache
  • nausea
  • taste disturbance
  • dry mouth/throat irritation
  • rarely
  • > dizziness
  • > blurred vision
  • > constipation/urinary retention
  • > palpitations

Precautions

  • CVD
  • > may increase adverse events
  • Urinary retention
  • > will worsen symptoms
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