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
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
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.
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
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
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
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
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
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
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
