Respiratory Flashcards
Which type of nebulisers should you avoid in COPD and why
Oxygen-driven - risk of hypercapnia
Management of asthma in steps
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
What changes need to be made to asthma therapy in pregnancy
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.
Management of acute asthma attack
SABA via oxygen-driven nebuliser
Prednisolone oral for 5 days or until recovery (3 days for children)
Can add ipatropium bromide via nebuliser
COPD management
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
Duration of prednisolone oral therapy in COPD exacerbation
7-14 days
Risk factors (conditions) for hypercapnia
COPD, Cystic Fybrosis, Lung scarring in TB, opioid/benzos overdose
Are Spiriva and Braltus bioequivalent?
Yes
Are Qvar and Clenil bioequivalent?
No. Qvar is 2x more potent
Main side-effects of b-agonists to look out for
Hypokalaemia, hyperglycaemia and DKA
Can Salbutamol be given IV?
Yes
What can affect the effectiveness of ICS
Smoking
At what dose does Fluitcasone require steroid card?
> 100microgram/dose
When are Leutriene receptor antagonists especially effective?
Exercise-induced asthma
How is Theophylline/Aminophlline metabolised?
By liver
