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Clinical therapeutics 1 > Respiratory care - Hospital > Flashcards

Respiratory care - Hospital Flashcards

1
Q

Roles of respiratory hospital pharmacist

A
  • Medicine optimisation eg. Inhaler technique evaluation
  • Ward referrals for complex patients
  • Monitor high risk patients
  • patient telephone support clinic
  • Clinical audits
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2
Q

Drug interactions in asthma/COPD

A
  • Patients already on oral theophylline - careful with aminophylline infusions
  • These are drugs that lower potassium (hypokalaemia)
    [aminophylline is used to prevent wheezing/shortness of breath]
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3
Q

Drug-disease interactions in asthma/COPD

A
  • These are diseases that may be effected by drugs used for COPD
  • Diabetes
  • Cardiovascular disease (watch potassium)
  • Hypertension
  • Glaucoma (optic nerve connected to the brain is damaged)
  • Liver disease
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4
Q

Symptoms of acute severe asthma

A
  • Severe breathlessness
  • Tachypnoea
  • Tachycardia
  • Silent chest
  • Cyanosis
  • Accessory muscle use
  • Altered consciousness
  • Decreased O2 saturations
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5
Q

Name the levels of severity in asthma

A
  • Chronic: long term
  • Severe acute: increasingly worsening
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6
Q

Name five treatments if severe acute asthma symptoms

A
  1. SABA e.g. Salbutamol - B2 agonist bronchodilator
  2. Steroids such as prednisolone
  3. Ipratropium bromide - this relaxes muscle and SABA relaxes bronch, so both occur
  4. Magnesium sulphate - also a bronchodilator
  5. Aminophylline - only given under supervision from senior staff. IV form, if other treatments don’t work
    If the first one doesn’t work then add the second one and so on
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7
Q

What is a b2 agonist drug?

A
  • Agonists mimim natural action , causing activation
  • Beta-2-agonists act directly on beta-2-receptors
  • This causes smooth muscle relaxation and dilated airways
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8
Q

Salbutamol as a treatment for severe acute asthma?

A
  • Its a b2 agonist drug so a bronchodilator
  • Can use a nebuliser
  • Works quickly in higher doses
  • Can be given as IV
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9
Q

Steroids as treatment for severe acute asthma?

A
  • Prednisolone 40-50mg for at least five days
  • Reduce mortality, relapses, subsequent hospital admission and requirement for β2agonist therapy
  • Earlier given the better
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10
Q

Ipratropium bromide treatment for severe acute asthma?

A
  • Greater bronchodilation than a β2agonist alone
  • leading to a faster recovery and shorter duration of
    admission
  • 500 micrograms every 4-6 hours (usually QDS)
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11
Q

Magnesium sulphate for treatment of severe acute asthma?

A
  • Bronchodilator when given IV or nebulised (only IV
    currently recommended)
  • 1.2-2g IV infusion over 20 minutes
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12
Q

What is a nebuliser?

A

 Converts a solution of a drug into a fine spray
 Oxygen, compressed air or ultrasonic power is
used to break up the liquid drug
 Delivered through a face mask

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13
Q

When are nebulisers used?

A
  • Severe asthma attacks when a patient is fatigue or out of breath
  • Young children or elderly with cognitive or physical disabilities
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14
Q

Aminophylline for treatment of severe acute asthma?

A
  • For patients with near fatal asthma or with poor response to initial treatment
  • IV form typically
  • Check plasma levels before aminophylline
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15
Q

Treatment for chronic asthma? The stepwise plan according to BTS/SIGN

A
  • Provide a personalised asthma actions plan PAAP
  • Start with SABA e.g. salbutamol
  • Then add ICS if required e.g.
  • Then ADD long actinig b2 agonists LABA as well as ICS and SABA
  • Then increase the dose of ICS and add LTRA
  • For chronic asthma usually specialist therapy
  • annotate
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16
Q

Specialist therapies for asthma?

A
17
Q

What is maintenance and reliever MART therapy?

A
  • Step three and above in BTS
  • LABA and ICS in combination
  • Maintenance TWICE daily dose
  • Same inhaler can be used as reliever
  • Review treatment plan if use as a reliever regularly
18
Q

Does asthma treatment need to be reviewed?

A
  • Regular review important
  • Take into account:
     Severity of asthma
     Side effects
     Time on current dose
     Beneficial effect achieved
     Patient’s preference
  • Reductions every 3 months,
    reducing by 25-50% each time
19
Q

Side effects of asthma drugs

A
20
Q

ics advice

A
  • Reduce dose gradually
  • Patients on prolonged high dose ICS are at risk of systemic side effects
  • Advise healthcare team if fall ill
  • Visit GP if you feel worsening fatigue, muscle weakness, dizziness or loss of appetite
21
Q

What is the difference between ICS, saba lama and laba and combination therapy

A
  • ICS focuses on controlling inflammation in asthma
  • SABA, LAMA and LABA are bronchodilators. They relax muscle instead of anti inflammation
  • Combination therapy is for chronic asthmatics and offers bronchodilation and anti-inflammation e.g. LABA and ics
22
Q

What is COPD?

A
  • Chronic obstructive pulmonary disease
  • Airway obstruction is caused by chronic
    inflammation, often due to environmental
    exposure to toxic particles or gases, e.g.
    tobacco
  • COPD also includes chronic bronchitis, emphysema, bronchiectasis and cystic fibrosis
23
Q

Risk factors for COPD

A
  • Tobacco smoking
  • Occupational exposure
  • Air pollution
  • Genetics
  • Asthma
24
Q

Potential complications of COPD?

A
  • Reduced QoL, increased morbidity and
    mortality
  • Depression and anxiety – common
    comorbidities
  • Cor pulmonale- right sided HF secondary
    to lung disease, due to pulmonary
    hypertension, caused by chronic hypoxia
  • Frequent chest infections
  • Lung cancer: risk factor
  • Muscle wasting, loss of appetite and
    weight loss: patients have increased
    nutritional requirements
  • General malaise/ fatigue/ lack of
    concentration
25
Q

Describing the treatment plan for COPD

A

SABA – short acting beta agonist
SAMA – short acting muscarinic
antagonist
LABA – long-acting beta agonist
LAMA – long-acting muscarinic
antagonist
ICS – inhaled corticosteroid

26
Q

Other options for COPD treatment excluding the NICE ones

A
27
Q

What are the points to review when reviewing therapy for chronic asthma

A
  • Step up or down in terms of medication?
  • Is MART required?
  • Side effects?
28
Q

COPD exacerbation symptoms

A
  • Pursed lip breathing
  • Acute confusion
  • Marked reduction in activities of daily living
  • Cough
  • Wheeze
  • Fever
29
Q

How to manage COPD exacerbations?

A
  • Inhaled therapy: increase dose of SABA
  • Oral therpy: steroids like prednisolone 30mg
  • Antibiotics
  • IV therapy e.g. theophylline
  • Ventilation therapy
30
Q

Side effects of inhaled therapy

A
31
Q

Counselling for COPD

A

• Explain when and how to use inhalers, demonstrate correct technique for using them
• Preventer vs reliever; importance of using preventer inhaler regularly even when well
• Know when inhaler needs to be changed and how to replace it
• Using a spacer and mouth-rinsing will avoid the most common side effects of ICS
• Provide steroid cards as appropriate and counsel patients on side-effects
• Cleaning their spacer correctly, once a month, non-ionic detergent, air dry, replace once visible deposits on spacer wall
• Aware of any asthma triggers (e.g. dust mites, pet hair), how to avoid/ cope with them
• Discuss personal asthma action plan (PAAP) and how to respond at first sign of an exacerbation
• Lifestyle advice, vaccinations

32
Q

Patient is taking SABA, LAMA, LABA. He COPD is exaberating what would you give?

A

Steroids. Prednisolone 30mg, one a day fer five days.

Clinical therapeutics 1 (3 decks)

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