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pre reg Thammis cards > Respiratory (medium) > Flashcards

Respiratory (medium) Flashcards

1
Q

what are the different Peak flow percentages for moderate, severe and life-threatening asthma attacks

A

moderate: 50-75%
severe: 33-50%
life threatening: <33%

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2
Q

what are the oxygen saturations for someone having a moderate acute asthma attack and life threatening asthma attack

A

moderate: >92%

life threatening: <92%

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3
Q

what is the likely respiratory rate for a child 1-5 having moderate asthma attack and anyone over the age of 5

A

child 1-5: <40

5+: <30

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4
Q

what is the treatment management for moderate acute asthma attack?

A

can be treated in primary care or home

high dose SABA (salbutamol usually)
up to 10 puffs at once via PMI or spacer

if inadequate response -> hospital

PLUS
oral prednisolone for 5 days OR
IV hydrocortisone/ IM methylprednisolone if oral pred not appropriate
hypoxaemic patients should be given supplemental oxygen with target spO2 94-98%

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5
Q

what is the likely respiratory rate and HR for someone having an asthma attack in:
adults
children over 5
children 1-5

A

adults: >25, HR >125
5+: >30, HR>125
1-5:>40, HR>140

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6
Q

Treatment of someone having a severe asthma attack

A

hospital immediately

high dose SABA (Salbutamol) via oxygen driven nebuliser

can give with or without nebulised ipratropium (SAMA)

PLUS
oral prednisolone for 5 days OR
IV hydrocortisone/ IM methylprednisolone if oral pred not appropriate
hypoxaemic patients should be given supplemental oxygen with target spO2 94-98%

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7
Q

symptoms of life threatening asthma attack

A 
altered consciousness
hypotension
cyanosis 
silent chest 
exhaustion
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8
Q

management of life threatening asthma attack

A

high dose SABA via oxygen nebuliser
+/- nebulised ipratropium
IV aminophylline

PLUS
oral prednisolone for 5 days OR
IV hydrocortisone/ IM methylprednisolone if oral pred not appropriate
hypoxaemic patients should be given supplemental oxygen with target spO2 94-98%

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9
Q

treatment for children over 2 having an asthma attack

A

1st line: SABA (Salbutamol)

if moderate: via PMI or space -> A+E if not controlled after 10 puffs

if sever: via nebulised oxygen-driven nebuliser

PLUS
oral prednisolone for 3 days
poor response to SABA -> give nebulised ipratropium
poor response to 1st line: IV magnesium sulphate

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10
Q

treatment for children under 2 having an asthma attack

A

always treated in hospital
immediate oxygen + trial a SABA
If needed add: nebulised ipratropium

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11
Q

Step 1 of management of long term Asthma

A

reliever: SABA (salbutamol) PRN

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12
Q

When should step 2 be initiated for long term management of asthma

A

using SABA >3x a week
experience symptoms >3x a week
waking up at night >1 x a week
using >1 inhaler per month

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13
Q

what is step 2 in asthma management

what is the difference in children under 5

A

reliever (SABA) + low dose ICS (preventor)

for children under 5 trial the ICS for 8 weeks - if not effective try montelukast

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14
Q

what is the treatment management step 3 in asthma management

A

SABA + ICS + LABA (BTS/SIGN)
- can be given as fixed dose LABA or MART (maintenance and reliever)

SABA + ICS + LTRA (NICE)
-this is used for children <5 -> if LTRA not effective can be stopped and refer to specialist

LABA only for >12

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15
Q

what is the maintenance treatment management for Step 4 for asthma

A

add LABA if not already added (i.e. if gone down NICE route)

  • this can be with out with LTRA
  • can convert to MART at this stage (if gone down BTS/ sign route)

in children replace LTRA with LABA
Can be given as MART

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16
Q

step 5 of asthma management

A

under a specialist: increase to high strength ICS or initiate the following:

  • theophylline
  • monoclonal antibody
  • oral corticosteroids (e.g., prednisolone)
  • tiotropium (over 12 only) (LAMA)
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17
Q

how is the management of asthma tapered down

A

reviewed every three months
asthma should be well controlled for 3 months
maintain them on the lowest possible effective ICS dose
Reduce dose by 25-50% if appropriate

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18
Q

what is considered as complete control of asthma

A
  • no daytime symptoms
  • no night time awakening from asthma
  • no need to use reliever
  • no asthma attacks
  • no limitations on activity including exercise
  • minimal side effects
  • PEF/ FEV <80% predicted or best
19
Q

what is the initial step 1 treatment for COPD

A

SABA OR SAMA

20
Q

what is the 2nd step treatment for COPD for asthmatic and non-asthmatic symptoms

A

non-asthmatic:
LAMA and LABA (discontinue SAMA if this was initiated in 1st step)

asthmatic:
LABA and ICS (discontinue SAMA)

21
Q

when is step 3 initiated in COPD

A

if patient has a severe exacerbation or more than 2 moderate exacerbations in a year

22
Q

what is step 3 management for COPD

A

LABA + LAMA + ICS

if non asthmatic and no effect with triple therapy - revert back to LABA + LAMA

23
Q

Other management for COPD patients

A

vaccine and immunisation (pneumococcal and influenza)
mucolytics e.g. carbocisteine
theophylline
oxygen therapy
azithromycin prophylaxis in non-smoking patients who have been optimised on all other treatments and have 4 or more exacerbations/ exacerbations requiring hospital

24
Q

when is a rescue plack given for COPD patients and what does it consist of

A

if they have one exacerbation in the past year

rescue pack: oral corticosteroid + antibiotic
doxycycline
amoxicillin
clarithromycin (do not give if on prophylactic azithromycin)

25
Q

what is the drug management for a COPD exacerbation

A

SABA OR SAMA (withhold LAMA if SAMA given)
in community: oral prednisolone short course if very breathless
in hospital: oral prednisolone short course + other therapies
if inadequate response to bronchodilators add aminophylline
oxygen added if needed

26
Q

when should LABA AND SABAS be cautioned

A

diabetes - increased risk of DKA
QT prolongation - due to potential for hypokalemia
may cause arrythmias

27
Q

side effects and risks of SABA and LABAS

A 
palpitations
tremor
headache
seizure and anxiety 
risk of QT prolongation and arrythmia
risk of digoxin toxicity due to hypokalaemia risk
28
Q

what are the side effects of SAMA and LAMA (antimuscaranics) and interactions

A

dry mouth, dry eyes, increased intraocular pressure - report blurred vision/ halos, constipation

interaction with other antimuscarinics

29
Q

which ICS should be prescribed by brand

A

beclomethasone

30
Q

side effects of ICS

A

taste and voice alteration

sore mouth -> thrush
- can be reduced by using spacer and rinsing mouth after use

paradoxical bronchospasms

  • if mild - use SABA before ICS
  • changing formulation from aerosol inhaler to Dry powder inhalation can be effective
31
Q

what are the side effects and MHRA warning of montelukast

A

MHRA: neuropsychiatric effects - seek medical attention if any change in behavior or speech

churg strauss syndrome: eosinophilia, vasculitic rash, pulmonary symptoms, cardiac complications, peripheral neuropathy

32
Q

what are the side effects and MHRA warning of montelukast

A

MHRA: neuropsychiatric effects - seek medical attention if any change in behavior or speech

churg strauss syndrome: eosinophilia, vasculitic rash, pulmonary symptoms, cardiac complications, peripheral neuropathy

33
Q

interactions of montelukast

A

montelukast is a CYP substrate

CYP inducers will reduce concentration of montelukast

CYP inhibitors will increase concentration of CYP inhibitors

34
Q

therapeutic range and monitoring of theophylline

A

range: 10-20mcg/l

monitoring:
6-12 hours after dose 
5 days after initiating 
at least 3 days after dose adjustment
routinely 6-12 monthly

must always be brand specific

35
Q

side effects of theophylline

A

SICK AND FAST

vomiting 
palpitations 
arrythmia 
tremor
hypokalaemia
36
Q

interactions of theophylline

A

CYP substrate
CYP inducers will decrease concentration
CYP inhibitors will increase concentration
drugs that cause hypokalaemia = increase risk of QT prolongation and risk of digoxin toxicity (beta agonists, ICS, diuretics…)
smoking - increase clearances so will require higher dose. if smoking cessation - dose adjustment will be needed
fever decreases clearance - so may need lower dose during fever
lithium - potentiates excretion of lithium

37
Q

management of mild croup

A

single dose of oral dexamethasone - can be treated in community

38
Q

management of moderate to severe croup

A

in hospital

single dose of oral prednisolone or dexamethasone whilst waiting on admission
if unable to take oral - IM dexamethasone OR nebulised budesonide

if severe and not controlled by steroids:
- nebulised adrenaline/ epinephrine

39
Q

symptoms of anaphylaxis

A

difficulty breathing, hypotension, poor circulation,

40
Q

management of anaphylaxis

A
  1. administer autoinjector (IM adrenaline/ epinephrine)
  2. call 999 - administer CPR if needed (not breathing/ heart stops)
  3. lie them down and raise their legs
  4. remove trigger causing anaphylaxis if possible
  5. repeat after 5 mins if no improvement
41
Q

management of anaphylaxis in hospital once acute treatment given

A

high flow oxygen
IV fluids to treat hypotension and shock

once stable - give non-sedating antihistamine such as cetirizine
if unable to have oral - give IV/ IM chlorphenamine

persistent respiratory problem:
salbutamol +/- ipratropium

42
Q

doses of adrenaline for different age groups in anaphylaxis

A

<6 months: 100-150mcg
6 months - 5 years: 150mcg
6-11 years: 300mcg
12 years plus: 500mcg

43
Q

MHRA advice for autoinjectors

A

prescribe and supply 2 at all times

pre reg Thammis cards (8 decks)

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