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Respiratory system (Den 305) > Respiratory disorders and their management > Flashcards

Respiratory disorders and their management Flashcards

Gain knowledge about the symptoms, signs and management of COPD Asthma Lung Cancer Fibrotic Lung Disease Obstructive Sleep Apnea Appreciate the action of different drugs used to manage patients with Asthma or COPD

1
Q

Estimated prevalence of COPD UK

A

3M
Majority in 50s
Will rise by 30% over 10 next years

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2
Q

Prevalence of diagnosed/ undiagnosed COPD

A

0.9M diagnosed

2M undiagnosed

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3
Q

Survival rates of COPD

A

5 year survival in individuals with O2 or neb utilisation <30%
2005: 5% of all deaths globally

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4
Q

Diagnosis of COPD

A

Traditionally defined as emphysema (pathological diagnosis) or chronic bronchitis (clinical diagnosis with 3/12 of productive cough for >2 consecutive years)

  • bronchial wall thickening
  • airflow obstruction due to combination of airway and parenchymal damage
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5
Q

Diagnosis of COPD - spirometry CHART

A

FEV1/ FVC less than 70%

Suboptimal predictor of disability and QOL

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6
Q

Symptoms of chronic COPD

A

Shortness of breath on exertion
Wheeze
Cough
Weight loss

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7
Q

Symptoms of acute/ exacerbation of COPD

A 
*worsening of the following*
Acute sob/ wheeze
Worsening sputum production
Fever
Drowsiness/ CO2 narcosis
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8
Q

Signs of COPD - general inspection

A 
Cachexia - low body weight (severe disease)
Use of accessory muscles
Pursed lips
Cyanosis (late disease)
CO2 flap (severe disease)
Drowsiness in CO2 narcosis
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9
Q

Signs of COPD - chest

A 
Hyper-expanded chest (gross disease)
Hyperesonant
Reduced breath sounds
Wheeze (acute disease)
Elevated jugular venous pressure and peripheral oedema in late disease
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10
Q

Disease severity COPD - different clinical parameters

TABLE and CAT SCORE

A

Lung function
Symptoms (e.g. COPD assessment test)
Exacerbation frequency
BODE index

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11
Q

The MCR breathlessness scale

A

1 - not troubled by breathlessness except on strenuous exercise
2 - short of breath when hurrying on level or walking up slight hill
3 - walks slower than most people on level, stops after a mile or so, or stops after 15 minutes walking at own pace
4 - stops for breath after walking about 100 yds or after a few mins on level ground
5 - too breathless to leave the house, or breathless when undressing
less subjective than CAT scale

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12
Q

Disease severity comparisons COPD

- bringing all scores together

A 
A - low risk, less symptoms (you want to be here)
-risk 1-2
-mMRC 0-1
CAT< 10
B - low risk, more symptoms
-risk 0-1
-mMRC >/2
-CAT>/10
C - high risk, less symptoms
-risk 3-4
-mMRC 0-1
-CAT <10
D - high risk, more symptoms
-risk >/2
-mMRC >/2
-CAT >/10
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13
Q

Inhaled treatment of COPD (FLOW CHART)

A

Aims are directed as trials to improve symptoms and < exacerbations
-not stepwise algorithm in contrast to asthma

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14
Q

S/LABA

A

Short/ long acting beta agonist

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15
Q

S/ LAMA

A

Short/ long acting muscarinic agonist

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16
Q

ICS

A

Inhaled corticosteroid

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17
Q

Management of stable COPD

A 
Smoking cessation
Oral Theophylline
Oral mucolytic therapy
Vaccination therapy
Pulmonary rehabilitation
Nutritional support
Surgery
Oxygen therapy
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18
Q

Management of stable COPD - smoking cessation

A

NRT
Bupropion
Varenicline

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19
Q

Management of stable COPD - Oral theophylline

A

Trial of therapy

Risk of side effects

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20
Q

Management of stable COPD - oral mucolytic therapy

A

Carbocisteine

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21
Q

Management of stable COPD - vaccination therapy

A

Annual influenza and 5 yearly pneumococcal vaccination

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22
Q

Management of stable COPD - pulomary rehabilitation

A

Addresses muscle deconditioning
Improves QoL, exercise tolerance
May have some impact on exacerbation
Non-pharmacological intervention

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23
Q

Management of stable COPD - nutritional support

A

BMI of 20-25

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24
Q

Management of stable COPD - surgery (very severe disease)

A 
Transplant
Lung volume reduction surgery
Bullectomy
-surgical removal of a bulla, which is a dilated air space in the lung parenchyma measuring more than 1 cm
Placement of endobronchial valves
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25
Q

Management of stable COPD - oxygen therapy

A

Long term oxygen therapy
Ambulatory
Short burst oxygen therapy (SBOT)

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26
Q

Management of stable COPD - LTOT

A 
Pts with persistant respiratory failure
Min 14 hours per day of continuous O2 therapy delivered by concentrator
-has prognostic benefit
PO2 <7.3kPa persistently
PO2 7.3-8kPa and secondary polycythaemia
-+ nocte sPO2 <90% for >30% of night
-+ peripheral oedema
-+ pulmonary hypertension
Not for symptomatic relief
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27
Q

Management of stable COPD - ambulatory oxygen

A

Desaturation on exercise
> in exercise with supplemental O2
Delivered by cylinder

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28
Q

Management of stable COPD - SBOT

A

Short burst oxygen therapy
-not really advised for COPD
Palliative care

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29
Q

Prevention of exacerbation

A

Seasonal influenza vaccination (one-off pneumococcal vaccination)
Inhaled steroids (in conjunction with long acting bronchodilator)
Other agents
-anticholinergics - ipratropium/ tiotropium
-mucolytics (carbocysteine)
Pulmonary rehabilitation (used for symptom control as well)

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30
Q

Regulation of ventilation

A

GRAPHS

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31
Q

Respiratory failure type I

  • PaO2
  • PaCO2
  • common causes
  • O2
A 
PaO2 <8KPa
Low or normal PaCo2
Common causes
-acute: pneumonia, asthma
-chronic: fibrosing lung disease
O2: yes, give them oxygen
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32
Q

Respiratory failure type II

  • PaO2
  • PaCO2
  • common causes
  • O2
A 
PaO2 <8KPa
PaCO2 >6.0KPa
Common causes
-acute: overdose, trauma
-chronic: COPD, neuromuscular
O2: yes but care in chronic
-too much oxygen switches off hypoxic drive
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33
Q

Treatment for respiratory failure

A

Non-Invasive Ventilation (NIV)

  • employed after optimum medical Rx
  • cyclical non-invasive positive p delivered by face/ nasal mask
  • supplemental O2 supply
  • acute use for respiratory acidosis
  • usually pt trigger with back-up respiratory rate
  • delivered by trained nursing/ physio staff
  • requires ABG/ transcutaneous CO2 monitoring
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34
Q

Contraindications to noninvasive positive pressure ventilation (relative not absolute)

A 
Cardiac/ respiratory arrest
Nonrespiratory organ failure
Facial or neurological surgery, trauma, or deformity
Upper airway obstruction
Inability to cooperate/ protect airway
Inability to clear secretions
High risk for aspiration
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35
Q

Nonrespiratory organ failure as contraindications to NIV

A

Severe encepalopathy (e.g. GCS <10)
Supper upper GI bleeding
Haemodynamic instability or unstable cardiac arrhythmia

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36
Q

Prevalence of asthma in UK

A

5.4 million
1 adult in 12
1 child in 11

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37
Q

Airway during an asthma attack (DIAGRAM)

A 
Narrowed
Swollen submucosa
Excess mucous
Thickened smooth muscle layer
Tightened bands of smooth muscle
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38
Q

Respiratory symptoms of asthma

A 
Wheeze
Cough 
Dyspnea (shortness of breath)
Chest tightness
Nocturnal duration
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39
Q

Structured clinical assessment for asthma (FLOW CHART and DIAGRAMS)

A

Recurrent episodes of symptoms
Symptom variability
Absence of symptoms of alternative diagnosis
Recorded observation of wheeze
Personal history of atopy (genetic tendency to develop allergy)
Historical record of variable PEF or FEV1

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40
Q

Possible triggers of asthma

A 
Exertion
Dust
Change in T
Emotional situations e.g. anxiety
Occupation
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41
Q

Signs of asthma

A 
Eczema 
Nasal polyps
Cushingoid (excess cortisol)
Wheeze
Peripheral/ central cyanosis
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42
Q

Signs of asthma upon exacerbation

A 
Elevated respiratory rate
Elevated heart rate
SpO2
Inability to complete sentences
Audible wheeze
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43
Q

Treatment of asthma

A

Short acting beta2 agonists as required - consider moving up if using 3 doses a week or more
-refer pt for specialist care if using high dose therapies

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44
Q

Method of delivery of inhaled drugs - asthma

A

Metered dose inhaler
MDI via spacer
Breath actuated

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45
Q

Metered dose inhaler

A

(SABA/ LABA/ ipatropium/ ICS)

-inhale with simultaneous depression of canister with breath hold for 10s

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46
Q

MDI via spacer

A

10 puffs of salbutamol via spacer equivalent to nebuliser
Give 4 puffs initially then 2 puffs every 2 mins up to max of 10 puffs
-if not good with inhaler

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47
Q

Pts at risk of developing near-fatal or fatal asthma

A

A combination of severe asthma and adverse behavioural or psychosocial features

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48
Q

Severe asthma is recognised by one or more of:

A

Previous near-fatal asthma
-e.g. previous ventilation/ respiratory acidosis
Previous admission for asthma (especially if in last year)
Requiring 3 or more classes of asthma med
Heavy use of beta2 agonist
Repeated attendances at ED for asthma care (especially in last year)
“Brittle” asthma

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49
Q

Adverse behavioural or psychosocial features recognised by one or more of:

A 
Non-compliance with treatment/ monitoring
Failure to attend
Fewer GP contacts
Frequent home visits
Self discharge from hospital
Psychosis, depression, other psychiatric illness or deliberate self harm
Current or recent major tranquiliser use
Denial
Alcohol/ drug abuse
Obesity
Learning difficulties
Employment problems
Income problems
Social isolation
Childhood abuse
Severe domestic, marital or legal stress
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50
Q

Acute asthma severity (KNOW THIS)

A 
Mild (routine):
-75% PEF % best
-pt should bewell
Moderate (semi urgent):
-50-75% PEF % best
Severe (urgent):
-33-49% best PEF
-RR > 25/min
-HR > 110/min
-not talking
LT (urgent):
-<33% best PEF
-bradycardia
-SaO2 <92, silent chest
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51
Q

Acute asthma management

A

O2 40-60%: drive nebulisers with O2
B2 agonists are mainstay
Oral steroids should be given within an hour (asap)
B2 agonists and anticholinergics in those who fail to progress
IV beta2 agonists (very rare) reserved for those where inhaled route cannot be relied upon

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52
Q

Lung cancer epidemiology

A 
Main cause of cancer related death in UK
2nd most common cancer in UK
2nd most common cancer in males (14%) and females (12%)
69 new cases for every 100,000 persons
85% NSCLC/ 15% SCLC
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53
Q

Lung cancer % operable at diagnosis

A

10%

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54
Q

Risk of spread lung cancer

A

From primary tumours to nodes and distal organs

-bone, liver, lung pleura cavity

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55
Q

What predicts survival of lung cancer

A

T N M1A/1B
Symptoms can be dependent upon stage of disease
-some pts can present late with widespread metastatic disease (and still be feeling well)

56
Q

Major subtypes of NSCLC (non-small-cell)

A

Squamous cell
Adenocarcinoma
Adenocarcinoma in situ (aka bronchoalveolar carcinoma)

57
Q

Lung cancer - chest symptoms

A

Sob - lobar collapse, effusion, lymphangitis
Chest pain - rib involvement, chest wall invasion
Cough
Haemoptysis - usually due to endobronchial involvement

58
Q

Lung cancer - constitutional symptoms

A

Weight loss
Low appetite
Low energy levels

59
Q

Lung cancer - paraneoplastic syndromes (uncommon)

A

High Ca (PTH release or bone involvement)
SIADH
Hypertrophic pulmonary osteoarthropathy
Lambert Eaton Syndrome

60
Q

High calcium syndrome

A 
PTH release (hold on to water) or bone involvement 
Nausea, confusion, abdominal pain and constipation
61
Q

SIADH

A

Confusion, fits, lethargy

62
Q

Lambert Eaton Syndrome

A

Neuromuscular weakness

63
Q

Lung cancer - metastatic disease

A

SVC obstruction (SVCO) due to mediastinal disease
Brain metastasis - confusion, nausea, headache
Bone metastasis - pathological fracture, pain
Liver metastasis - abdominal pain

64
Q

Signs of lung cancer

A 
Finger nail clubbing
Cachexia
Horner's syndrome (tumour in apex of lung, chomps through brachial plexus --> drooping eyelid and miosis)
Neck nodes
Chest signs
Palpable liver
SVCO
65
Q

Diagnosis of lung cancer

A

Chest X-ray
CT
PET scan for radical treatable disease
Tissue biopsy

66
Q

Diagnosis of lung cancer - tissue biopsy

A

Bronchoscopy
Thoracoscopy for pleural disease
Surgical

67
Q

Diagnosis of lung cancer - Chest x-ray

A 
Cheap
Good screening tool
Won't detect mediastinal disease necessarily
Won't detect small nodules
Not a staging tool
68
Q

Diagnosis of lung cancer - CT

A

Staging tool
Detailed info
Requires IV contrast
Contrast not allowed in pts with chronic kidney disease
Cannot detect microscopic disease e.g. in med nodes

69
Q

Diagnosis of lung cancer - PET scan for radical treatable disease

A 
Infusion of FD glucose
Detects cancer, infection and vasculitis
Very sensitive
Expensive
False positive rate
Care needed in DM
70
Q

WHO performance status

A

0: able to carry out all normal activity w/o restriction
1: restricted in strenuous activity but ambulatory and able to carry out light work
2: ambulatory and capable of self-care but unable to carry out any work activities; up and about >50% of waking hours
3: symptomatic and in chair/ bed for >50% of day but not bedridden
4: completely disabled; cannot carry out any self-care; totally confined to bed/ chair

71
Q

Treatment of lung cancer for NSCLC

A

Dependent upon stage and WHO performance status
Radiation therapy/ surgery for limited disease WHO PSo-1/2
Chemo (platinum + 3rd gen drug) for extensive disease
Immunotherapy
Oral EGFR mAb for EGFR +ve disease WHO PS 0-3
BSC for pts not fit for active treatment

72
Q

Immunotherapy

A

Inhibition of PDL suppression by tumours on T-cells

  • allows them to fight malignancy
  • pts must have sufficient PDL1
73
Q

Treatment of lung cancer for SCLC

A

Systemic Cisplatin based Chemotherapy
-disease extensive at presentation
Treat within 7/7 of diagnosis to due speed of deterioration
If localised disease - f/u radiation therapy

74
Q

Interstitial lung disease names (FLOW CHART)

A

Interstitial lung disease
Diffuse parenchymal lung disease
Lung fibrosis

75
Q

Classification of interstitial lung disease

A

Idiopathic
Drug reaction
Extrinsic allergic alveolitis/ hypersensitivity pneumonitis
Associated with rheumatological disease

76
Q

Symptoms of intersititial lung disease

A

Dysnpea
Cough
Consitutional symptoms
Onset of symptoms may identify aetiology
Extrinsic allergic alveolitis - post exposure
Idiopathic pulmonary fibrosis - chronic
Acute intersitial pneumonia - rapid onset

77
Q

Signs of intersitial lung disease

A

Signs associated with CT diseases/ rheumatoid arthritis
Nail clubbing
Sclerodactyly (associated with systemic sclerosis)
Signs of steroid use
Chest - audible crackles; distribution may influence diagnosis
Chest - squeaks - suggest small airways disease

78
Q

Idiopathic pulmonary fibrosis aka cryptogenic fibrosis

A 
Male
Older population
Median survival 3yrs
Associated with clubbing
Mainly lower zone preponderance
Classically restrictive spirometry and < transfer factor
Diagnosis can be made from CT
FEV1/FVC ratio >70%
79
Q

Idiopathic pulmonary fibrosis treatment

A 
Supportive
Pulm rehab
Pirenidone (anti-fibroblast activity with effect on survival and lung function) when FVC<80%
Nintenadib (anti-fibroblast FVC 50-80%)
Opiates/ palliative care in later stages
Role of steroids controversial
80
Q

Extrinsic allergic alveolitis

A

Trigger may not identifiable
Classical triggers occupation- baker, farmer, moulds
Disease has predominant upper zone predominance

81
Q

Treatment for extrinsic allergic alveolitis

A

Antigen avoidance
Trial of corticosteroid therapy
Calcium and vitamin D supplementation
Possible bisphosphonate

82
Q

Sleep apnea

A

Excessive daytime sleepiness with disordered nocturnal irregular breathing
0.5-4% population prevalence cf Type 1 DM
Severity defined by Apnea-Hypopnea Index

83
Q

Apnea-Hypopnea Index

A

Mild: AHI 5-14/hr
Moderate: AHI 15-30/hr
Severe: AHI >30/hr

84
Q

Apnea definition

A

Cessation of flow for 10s

85
Q

Hypopnea definition

A

< of flow for 10s by >30%

86
Q

Types of sleep apnea

A

3

  • obstructive sleep apnea (OSA)
  • central sleep apnea
  • mixed apnea
87
Q

Risk factors for OSA

A 
Obesity
>17 inch collar
Men x2-3 likely
Age
Cranio-facial and upper airway abnormalities e.g. short mandible, tonsillar/ adenoid hypertrophy, wide craniofacial base
88
Q

CAT score

A

Number of different symptoms and pt subjectively scores themselves 0-5
Ranked out of 40

89
Q

BODE index

A

Number of different parameters

  • BMI
  • dyspnea scale score
  • distance walked in 6 mins
90
Q

Sleep apnea symptoms

A 
Excessive daytime sleepiness
Impaired concentration
Snoring
Unrefreshing sleep
Choking episodes during sleep
Witnessed apnoeas
Restless sleep
Irritability/ personality change
Nucturia (waking up to urinate at night)
< libido
91
Q

Obstructive sleep apnea

A

Snoring and apnoeas observed when upper airway collapses

92
Q

Epworth sleepiness scale

A 
Questionnaire with 0-24 scale
11-14 mild sleepiness
15-18 moderate sleepiness
>18 severe sleepiness
-screening tool when assessing daytime somnolence
93
Q

Other tests for sleepiness

A

Sleep latency test and maintenance of wakefulness

94
Q

Some potential causes of excessive daytime sleepiness in adults

A 
Fragmented sleep (quality of sleep)
Sleep deprivation (quantity of sleep)
Shift work
Depression
Narcolepsy
Hypothyroidism
Restless leg syndrome/ periodic limb movement disorder
Drugs
-sedatives
-stimulants (caffeine, theophyllines, amphetamines)
-beta-blockers
-selective serotonin reuptake inhibitors (SSRIs)
Idiopathic hypersomnolence
Excess alcohol
Neurological conditions
95
Q

Neurological conditions as potential causes of excessive daytime sleepiness in adults

A

Dystrophica myotonica
Previous encephalitis
Previous head injury
Parkinsonism

96
Q

Diagnosis of sleeping disorders??

A

Polysomnography

Pulse oximetry

97
Q

Pulse oximetry pros

A

Cheap
Easy to use
Can be used at home

98
Q

Pulse oximetry cons

A

Can show false negative

Less sensitive in thin pts/ issues with tissue perfusion

99
Q

How does pulse oximetry work

A

Measure 4% desaturation rate (ODI)

- >10 events per hour suspicious

100
Q

Pursed lips meaning

A

Pt coping strategy to allow symptomatic improvement
Lips brought together
Working hard to breath out
Creates “auto-PEEP” to allow prolonged opening of distal airways to allow emptying of lungs
> p within windpipes/ bronchioles which splits them open

101
Q

Taking history of COPD

A

Duration of onset of symptoms
Change in vol and character of sputum
Severity of chronic illness - use of supplemental oxygen
Smoking occupational (e.g. coal mining) history
PYH = (cigs consumption/day) x no. of years smoked divided by 20
>10 PYH - significant

102
Q

Treatment for COPD

A 
Visit GP for assessment of infective exacerbation of COPD
Antibiotics given if 2 of
-increasing dyspnoea
-sputum vol
-sputum purulence
Oral prednisolone
-7-10 days (0.6mg/kg/day) = 30-40mg/day
-more rapid improvement in physiology
-shortens hospital discharge
-must weigh severity against side effects
103
Q

How NIV works

A

Pushes in pressure to expand the lungs, helping them inflate/ deflate
Lowers CO2 level?
Tight fitting mask

104
Q

Diagnosis of asthma

A 
PEF A%M (peak flow) 
-fluctuation of 20% indicates asthma 
-poorly sensitive, around 20% would be diagnosed
Bronchodilatory response
-salbutamol via spacer
-20-50% increase indicates asthma
-only diagnoses about 50%
FEV1/FVC ratio
-around 80% of pts would be diagnosed
105
Q

Taking history of asthma

A

Duration of onset of symptom
Any infective features/triggers-dust/pets/exercise/anxiety
Severity of illness – previous hospital/ED/ITU admissions
Other medications

106
Q

Bedside test for asthma

A

Peak flow meter

107
Q

Treatment of suspected asthma

A

Consider monitored initiation of treatment with low dose ICS

-if they get better through this they have asthma

108
Q

5 step ladder of asthma treatment (DIAGRAM)

A

Regular preventer - low dose ICS
Initial add-on therapy - add inhaled LABA to low-dose ICS (normally as combination inhaler)
Additional add-on therapies
High dose therapies
Continuous or frequent use of oral steroids

109
Q

Polysomnography pros

A

Limited vs full

-full considered gold standard

110
Q

Polysomnography cons

A

Full PSG requires hospital admission

111
Q

How polysomnography works

A

Measurement of EEG, eye and limb movements, nasal flow, thoraco-abdo movement, ECG and oxygen saturation

112
Q

Morbidity associated with OSA

A

Untreated x2-3 risk of RTA (DVLA)
Associated with CHD, CCF, PAH & Hypertension & CVD
Insulin resistance (Metabolic syndrome) & T2 DM
Concurrent obesity is a confounding factor in studies
> risk of post-operative complications

113
Q

Treatment of sleep apnea

A

FUNDAMENTAL TREATMENT: Weight loss/lifestyle change
Continuous Positive Airway Pressure (CPAP)
Mandibular Advancement Device (MAD)
Pharmocotherapy & surgery?

114
Q

CPAP

A

(Continuous positive airway pressure)
Delivery of constant pressure by face/nasal mask
Abolition of apneas/hypopneas with improvement in oxygen saturation
Very effective
Adherence variable
Essential to maintain licence validity

115
Q

Mandibular advancement device role

A

Role when CPAP not tolerated
Mild-Moderate OSA
Adherence is key to success

116
Q

Manndibular advancement device mechanism

A 
Anterior displacement of the mandible 
-variable results of trials 
MAD better than no-MAD 
-CPAP better than MAD for 
-< of AHI/ODI 
-sleep fragmentation 
MAD better than CPAP for patient preference 
MAD better than UPPP for AHI/ODI but snoring same for both.
117
Q

Pharmacotherapy in obstructive airways disease

A 
Short acting bronchodilators
-salbutamol (ventolin), terbutaline (bricanyl turbohaler)
Long acting bronchodilators
-salmeterol (severent)
-formoterol (oxis turbohaler)
-formoterol (atimos MDI)
Anticholinergic agents
-ipatropium (Atrovent)
-tiotropium (Spiriva)
-glycoporronium (Seebri)
-aclidinium (Elkira)
Inhaled steroids
-beclometasone (Clenil, Qvar)
-budesonide (Pulmicort)
-fluticasone (Flixotide)
-ciclesonide (Alvesco)
Oral steroids 
-prednisolone
-deflazacort
Theophyllines
-nuelin SA
-slophyllin
Antileukotrienes
-montelukast
-zafilukast
118
Q

Short acting bronchodilators

A 
Relief of symptoms
For PRN use
Use in COPD &amp; Asthma
Immediate bronchodilation
4-6hour duration
Increase in cAMP with reduction in cell Ca2+ leading to relaxation of smooth muscle
119
Q

Short acting bronchodilators side effects

A 
Increased HR &amp; palpitations
Tremor
Hypokalaemia
Headache
Nervousness
120
Q

Long acting bronchodilators

A

Alternative to increasing dose of steroids
Given by inhaled route
Not to be used in monotherapy in Asthma
High selectivity for B2 adenoceptor in pulmonary tissue
Can increase glucocorticord receptor availability

121
Q

Long acting bronchodilators side effects

A

Concern of sudden cardiac death when used in monotherapy

122
Q

Anticholinergic agents (block action of ACh)

A

Relief of symptoms
Primarily for COPD
Reduction in exacerbation frequency in COPD
Improvement in FEV1
Mode of action Blockade of muscarinic receptors M1-3
Systemic absorption low

123
Q

Side effects of anticholinergic agents

A

Possible effect on urinary retention
Dry mouth
Possible adverse cardiovascular effects (seen in severe cardiac disease)

124
Q

Inhaled steroids

A

Mainstay of asthma medication
Prevent symptoms
< risk of exacerbations and death
Usually 2x daily medication
Not useful in acute attack
Binds to cytosolic GR with reduction in cytokines
< bronchoconstriction and airway inflammation

125
Q

Side effects of inhaled steroids

A

Oral candida
Voice change
Risk of skin bruising, bone mineral density change and cataracts with high dose

126
Q

Oral steroids

A

Given in acute asthma or chronically in severe asthma
Avoid if possible as long term therapy but essential if asthma worsens
Clearer role in eosinophilic asthma
Time to efficacy 4hours for IV & PO routes

127
Q

Side effects of oral steroids

A 
Weight gain
Hyperglycaemia
Skin change
Hypertension
Eye change (cataracts)
Mood change
< bone mineral density
128
Q

Theophyllines (help to relieve breathlessness by relaxing muscles in your airways so they open up, and the air can flow through them more easily)

A 
Tablets and intravenous
Useful in acute and chronic asthma
Method of action unclear
Possibly acting upon cAMP via PDE inhibition
Possibly acting upon HDAC pathway
Requires serum level monitoring
Drug interactions
129
Q

Side effects of theophyllines

A 
Nausea
Vomiting
Palpitations
Headaches
Dyspepsia
Arrhythmias
Confusion
130
Q

Antileukotrienes

A

Oral
Useful in chronic asthma
Not useful in acute asthma and not used in COPD
Role in exercise induced asthma & patients with aspirin hypersensitivity
Leukotrienes within phospholipid cell membranes and derived from inflammatory cells
Can promote smooth muscle contraction and inflammatory changes in airway wall

131
Q

Side effects of antileukotrienes

A 
Headache 
N&amp;V
Sleep disturbance
Sore throat
GI disturbance
132
Q

1st line pharmacotherapy for Obstructive Airways (FOR REST SEE TABLE)

A

Asthma and COPD: short-acting B2 agonists PRN

133
Q

Oxygen therapy

A 
O2 is potentially dangerous drug
Delivered by mask, nasal cannulae or ET tube
Controlled i.e. concentration known
-venturi systems, e.g. 24,28,35,60…%
Uncontrolled i.e. concentration guessed
-full face masks
-cannulae – highly dependent on RR
134
Q

Aim for acutely unwell pts on oxygen therapy

A

In majority of acutely unwell pts aim for SpO294-98% unless concern of hypercapnea

135
Q

Aim for COPD and oxygen therapy

A

In COPD (or other conditions prone to type 2 RF e.g. OSA) – aim for SpO2>88-92% until ABG taken

136
Q

Combination treatments

A

Used for COPD not asthma

137
Q

Hypoxic drive

A

Form of respiratory drive in which the body uses oxygen chemoreceptors instead of carbon dioxide receptors to regulate the respiratory cycle
-typical of COPD

Respiratory system (Den 305) (5 decks)

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