Respiratory

Question 1

Which type of nebulisers should you avoid in COPD and why

Answer 1

Oxygen-driven - risk of hypercapnia

Question 2

Management of asthma in steps

Answer 2

Step 1: SABA PRN
Step 2: + ICH low dose
Step 3: + Leukotriene receptor antagonist (Montelukast) - assess effect for 4-8 weeks
Step 4: + LAMA (with or without Montelukast)
***
Step 5: Combine LABA and ICS; optimise doses

Question 3

What changes need to be made to asthma therapy in pregnancy

Answer 3

None. If asthma is well-controlled, reducing/stopping treatment may lead to acute attacks which are more dangerous for the baby than a minimal systemic absorption from inhaled therapy.

Question 4

Management of acute asthma attack

Answer 4

SABA via oxygen-driven nebuliser
Prednisolone oral for 5 days or until recovery (3 days for children)

Can add ipatropium bromide via nebuliser

Question 5

COPD management

Answer 5

If FEV1 >50%:
LABA or LAMA 1st line
Can add ICS if not controlled

If FEV1<50%:
LAMA or LABA + ICS - 1st line
then switch to triple therapy LAMA+LABA+ICS if not controlled

Question 6

Duration of prednisolone oral therapy in COPD exacerbation

Answer 6

7-14 days

Question 7

Risk factors (conditions) for hypercapnia

Answer 7

COPD, Cystic Fybrosis, Lung scarring in TB, opioid/benzos overdose

Question 8

Are Spiriva and Braltus bioequivalent?

Answer 8

Yes

Question 9

Are Qvar and Clenil bioequivalent?

Answer 9

No. Qvar is 2x more potent

Question 10

Main side-effects of b-agonists to look out for

Answer 10

Hypokalaemia, hyperglycaemia and DKA

Question 11

Can Salbutamol be given IV?

Answer 11

Yes

Question 12

What can affect the effectiveness of ICS

Answer 12

Smoking

Question 13

At what dose does Fluitcasone require steroid card?

Answer 13

> 100microgram/dose

Question 14

When are Leutriene receptor antagonists especially effective?

Answer 14

Exercise-induced asthma

Question 15

How is Theophylline/Aminophlline metabolised?

Answer 15

By liver

Question 16

What can affect Theophylline/Aminophlline lvls

Answer 16

Smoking

Question 17

How do we calculate dosage of Theophylline/Aminophlline by weight?

Answer 17

Using IBW

Question 18

Signs of Theophylline/Aminophlline toxicity

Answer 18

Convulsions, arrhythmias, vomiting, dilated pupils, tachycardia

Question 19

What is the target plasma-Theophylline concentration

Answer 19

10-20 mg/L

Question 20

When do you take plasma lvl sample for Theophylline/Aminophlline?

Answer 20

4-6hrs post-dose; 5 days after initiation; 3 days after each dose change

Question 21

Which antihistamine is the most sedative?

Answer 21

Promethazine

Question 22

Anaphylaxis management

Answer 22

Oxygen, Fluids, Adrenaline, IV/IM antihistamines

Question 23

What do you monitor for Ivacaftor and co

Answer 23

LFTs

Question 24

OTC cough & cold advice for children 6-11yo

Answer 24

ONE product at a time, no more than 5 days OTC use