Respiratory drugs

Question 1

Tx anaphylaxis?

Answer 1

ABC + 100% O2 (+/- intubate)
remove cause, raise feet
IM adrenaline 500mcg of 1:1000 (which is 0.5ml
IV chlorphenamine 10mg
IV hydrocortisone 200mg
IVT stat
if wheeze, sally B

monitor serum tryptase 1-6 hours later
amend allergies chart

Question 2

Tx of asthma attack?

“O SHIT ME”

Answer 2

• Oxygen
• Salbutamol 5mg neb
• Hydrocortisone IV* 100mg (or pred PO 40mg)
• Ipratropium* 500mcg neb
• (Theophylline)*
• (Magnesium sulphate 2g IV)*
• (Escalate, reassess every 15 min, repeat nebs)

() indicate senior input
* indicates if life threatening

Question 3

Tx acute COPD exacerbation?

“O SHI-… Ah”

Answer 3

• Oxygen (28%, aim 88-92%, unless peri-arrest)
• Salbutamol 5mg neb
• Hmm…oral pred 30mg ( in 5 mg!! tablets
  daily for 5 days) other oral steroids not appropriate
• Ipratropium 500 mcg neb
• Abx if evidence of infection (amox, clarithromycin, doxycycline)

Question 4

when to consider NIPPV in acute COPD?

Answer 4

RR > 30
pH <7.35
O2 ↑ despite Tx

Question 5

Tx CAP?

Answer 5

CURB-65 (Confusion (AMTS ≤ 8/10), Urea >7.5 mmol/L, RR >30/min, BP (systolic) <90 mmHg and age ≥65 years)

if >1:

ABC, O2, paracetamol, IVT
Abx: amoxicillin, clarithromycin, doxycycline, or erythromycin, co-amoxiclav etc

Question 6

Tx PE?

Answer 6

ABC, O2
morphine 10mg IV, metoclopramide 10mg IV
LMWH - tinzaparin 175 units/kg once daily S/C (or enoxaparin or dalteparin)
IVT stat if ↓ BP
+ if continued ↓ BP - vasopressors (noradrenaline)
+ if haemodynamically unstable thrombolysis (alteplase 10 mg, then 90mg)

Question 7

basic Tx asthma?

Answer 7

1) sally b
2) ICS
3) LABA +/- ↑ ICS +/- LTRA or theophylline
4) ↑ ICS +/- LTRA or theophylline
5) steroid tablet + refer

Question 8

Tx COPD? it’s BORING I KNOW

Answer 8

1) SOB/limited exercise - SABA/SAMA
2) exacerbations/persistent SOB:
FEV>50 then LABA or LAMA-stop-SAMA
FEV<50 then LABA + ICS or LAMA-stop-SAMA
3) then LABA + ICS
or LABA + ICS + LAMA

Question 9

Tx - drug that is indicated immediately in the treatment of PE/DVT?

Answer 9

LMWH - eg dalteparin S/C 200 units/kg daily (max. per dose 18 000 units)

LMW heparin is needed to prevent the clot enlarging while the body breaks it down; it does not thrombolyse the clot itself - it should be continued until warfarin has achieved a therapeutic INR (i.e >2)

Warfarin is oral anticoagulant of choice (inhibits vit K synthesis) - anticoagulant effects occur after 48–72h, so concomitant heparin must be given

Question 10

COPD patient comes in with exacerbation - wheeze, SOB, cyanosed. ↑RR, sats at 90, write a prescription for ONE drug that is most appropriate to provide rapid relief of her bronchospasm?

Answer 10

• high-dose nebulised β2 agonists as 1st line agents ASAP:
• terbutaline sulfate 2.5 mg/mL neb, 5-10 mg
  OR
• salbutamol 2 mg/mL nebuliser liquid, 2.5-5 mg

(why not ipratropium bromide 500 micrograms/salbutamol 2.5 mg/2.5 mL nebuliser liquid ???
- for those with a poor initial response to salbutamol alone)