Respiratory facts Flashcards
Describe the step up plan for patients aged 12+ with Asthma
STEP 1 = Reliever therapy: SABA as needed
STEP 2= Regular preventer therapy
ICS at a low dose, continue SABA as needed for relief
STEP 3=
Add on LABA
Only continue if good response
Otherwise add LEUKOTRIENE RECEPTOR ANTAGONIST
STEP 4= If persistent poor control: increase ICS or a LAMA
SABA > ICS+SABA > ICS+SABA+LABA (Consider Montelukast) > SABA + LABA + LAMA
What are SABA’s
Short acting beta agonists
Salbutamol and Terbutaline
Side effects of SABA use
Arrhythmias
Dizziness
Headache
Nausea
Palpitations
Tremor
SABA interactions
DIGOXIN = Increased risk of digoxin toxicity
ERYTHROMYCIN, ESCITALOPRAM AND FLUCONAZOLE = Increased hypokalaemia risk
What are the side effects of inhaled corticosteroids
-Headache
- Oral candidiasis: use a spacer, rinse mouth out after using
- Taste and voice altered
- Mild bronchospasm
What needs to be monitored if corticosteroids are using in children
Annual monitoring of height and weight
What are the corticosteroid interactions?
Amiodarone and Erythromycin = increased hypokalemia risk
Naproxen= increased risk of gastrointestinal bleeding
Which is more potent Fostair inhaler or traditional beclometasone inhalers?
Fostair has extra fine particles and is more potent than traditional beclometasone inhalers. Therefore, the dose of fostair should be lower.
What are LABAs
Long acting beta agonists
Salmeterol, Formoterol
Should only be added when ICS is not controlling asthma
Leukotriene receptor agonist?
Montelukast
Should be taken at night
What are antimuscarinics used in asthma
Tiotropium, Ipratropium
Theophylline indications
- Chronic asthma
- Reversible airways obstruction
- Severe acute asthma
Signs of overdose of theophylline?
Vomiting
Agitation
Dilated pupils
Restlessness
Sinus tachycardia
Hyperglycaemia
Treatment for theophylline overdose
Repeated doses of activated charcoal
Ondansetron for severe vomiting
IV KCl for hypokalaemia
IV Lorazepam / Diazepam for convulsions
Theophylline interactions
Amiodarone= increased risk of hypokalemia
Digoxin= increased risk of digoxin toxicity
What are the types of inhalers
Pressurised Metered dose inhalers
Breath actuated inhalers= require slow and steady breathing
Dry powder inhalers= require quick and deep breathing
What is croup and what is the treatment
Common infection in children
Upper airway infection - barking cough
Mild croup= self-limiting
Severe croup= Dexamethasone/Prednisolone before hospital transfer
COPD treatment plan?
SABA / SAMA to use as needed
NEXT STAGE:
If no asthmatic features then offer LABA AND LAMA
If asthmatic features then consider LABA AND ICS
NEXT STAGE:
Consider LABA + LAMA + ICS
What is the non-drug treatment for COPD
Smoking cessation
Breathing techniques and devices for those with excessive sputum
Pulmonary rehabilitation
Prophylactic antibiotics for COPD?
Azithromycin can be considered for prophylaxis for non-smokers with frequent or severe exacerbations AFTER optimising other treatments
COPD management in adults?
COPD management in children?
What are the doses of IM adrenaline for anaphylaxis
1month - 5 years = 150mcg
6-11 years= 300mcg
12 years+ = 500mcg
What is a cough suppressant
Work by suppressing the cough
Dextromethorphan
Pholcodine
For 12+
