Respiratory: Pharmaceutical Care for Respiratory Patients 2 Flashcards
What should you watch out for in drug to drug interactions in patients with respiratory diseases?
Theophylline:
- Watch out for aminophylline infusions
- Interactions lithium and macrolides
- Drugs that lower potassium
What diseases be affected by drugs that are used for respiratory diseases?
- Diabetes: steroids increase the plasma glucose levels
- Cardiovascular disease (watch out for potassium)
- Hypertension
- Prostatic hyperplasia
- Glaucoma
- Liver disease, pneumonia and heart failure reduces theophylline clearance
What are the severe acute asthma symptoms?
- Cyanosis: turning blue
- Silent breathing: breathing stops for a while, sign of an asthma attack
- Tachycardia
- Tachypnea: increase rate of breathing
- Severe breathlessness
- Decreased O2 saturations
- Accessory muscle use (hunch over to breathe a bit)
How do we treat severe acute asthma symptoms with oxygen and beta 2 adrenergic agonists?
- We give them 94 to 98% of oxygen
- Beta two adrenergic agonists
- Can use salbutamol 2.5mg and 5mg back to back if asthma is bad
- Doesn’t really help much
- Nebulised route can be used (oxygen driven)
- 15 to 30 minute interval of them
- Can be given in IV but may lead to more side effects
How do we treat severe acute asthma symptoms with steroid treatment?
- Give a 5 day course of prednisolone of 40 to 50mg
- Reduces the mortality rate, the need for beta 2 agonists and the amount of hospital admissions
- Oral route is just as effective as the IV route, similar effect and side effects
- When someone suffering an asthma attack, better to give them IV route as they cannot swallow 8 tablets
How do we treat severe acute asthma symptoms with Ipratropium bromide and magnesium sulphate?
- Ipratropium bromide is more potent than the beta 2 agonist and causes more of a bronchodilation effect but shorter duration (500mg QDS every 4 to 6 hours)
- Magnesium sulphate is an effective bronchodilator when administered via IV or nebuliser
How do we treat severe acute asthma symptoms with aminophylline or leukotriene receptor antagonists?
- Aminophylline can be administered through IV when the initial treatment has failed- must check level of theophylline
- Leukotriene receptor antagonists- not indicated in acute asthma
What should you monitor when you’re monitoring a patient with severe asthma?
- Peak expiratory flow rate
- Serum Theophylline
- Blood glucose levels: due to side effects of drugs
- Heart rate: due to side effects of drugs
- Oxygen Saturation
- Potassium levels: too low potassium can cardiac arrest, muscle weakness and respiratory failure
How do you promote healthcare for a patient with asthma?
- You should tell them that they should monitor their symptoms more frequently and follow up with a respiratory nurse in their surgery
- Asthma action plan
- Vaccination as patients will be more prone to disease
How do you counsel a patient that has asthma?
- Access the exacerbation and the trigger factors that cause it
- Review inhaler technique and ensure compliance with the inhaler
- Consider stepping up the treatment
What are the side effects of inhaled corticosteroids?
- Oral candidiasis
- Dysphonia: affects the voice
- Higher doses means more severe side effects
What are the side effects of long acting beta 2 agonists?
- Cardiovascular stimulation
- Anxiety
- Tremor
What are the side effects of Leukotriene receptor antagonists?
- Abdominal pain
- Thirst
- Sleep disturbances
- Headaches
If someone is on a high dose of steroids for a long period of time, what do you have to provide them?
- Steroid treatment card
- Higher risk of side effects
- Show healthcare professional if you feel ill
- Visit the GP if you feel symptoms worsening such as fatigue, muscle weakness, lost of appetite
- You should gradually lower the dose
What are some counselling points you can provide asthmatic patients?
- Know the difference between an preventer and a reliever
- Ensure they know that they must take their preventer regularly
- Know when their inhaler needs to be changed, with salbutamol they should shake the canister
- Prompt them not to waste medication with unnecessary test sprays
- Using a spacer and mouth rinser will reduce the effects of a corticosteroid (must ensure you clean the spacer)
- Aware of any asthma triggers such as dust mites and pet hair
- Carry steroid card as appropriate
What is a spacer?
Device that attaches to the end of an inhaler in order to prevent the side effects of it
How do you optimise medication for a patient with asthma?
- Ensure that their spacer is compatible with their device
- Flag excessive use of reliever medication
- Ensure patient understands personal asthma action plan
- Ensure that patient can go to their respiratory nurse or GP at the last dose of steroid to explain whether or not they’ve seen improvements
- If no improvements, then prescriber may have to adjust the dose accordingly
What is the only way to slow lung decline in COPD?
Smoking cessation
What do mucolytics do and how does it help patients with COPD? Give an example of one and when you should discontinue use of it?
- Breaks down the mucus that’s in the throat and increases the viscosity of the mucus
- Allows mucus to be coughed up more easily
- Carbacistine capsulses
- After 4 weeks of use
What are the new treatments available for COPD when the inhaled corticosteroid and the long acting beta agonist fail?
- Combination of long acting muscarinic agonist and long acting beta 2 agonist
- Examples:
- Umeclidnium and Vilanterol
- Aclidinium Formoterol
What is Roflumilast?
- Anti-cholinesterase
- Works on the phosphodiesterase type 4 inhibitor
- Anti-inflammatory
What are the ways you can monitor COPD?
- Breathlessness
- Exercise tolerance: shows how bad their COPD is
- Frequent Exacerbations: means you’re not managing COPD well
- Oxygen levels
- FEV1
How do you counsel patients with COPD?
- Ensure that they know how to use their inhaler correctly and appropriately
- Long term steroid treatment may need bone protection
- Stress the importance of using correct medication
- Vaccinations
- Ensure patients respond appropriately after first exacerbation
How do you manage COPD exacerbation?
- Inhaled therapy
2. Increase dose of short acting bronchodilators
What are the physical signs of severe exacerbations of COPD?
- Severe breathlessness
- Can be confused
- Unable to do normal living activities
How do you do medicines optimisation for COPD?
- Spacer is compatible for the device
- Flag excessive use of medication
- Monitor and adjust treatments to optimise therapy
- Check all efficacious as per guidelines
What is pneumonia?
Acute respiratory illness that affects the distal airways of the respiratory tract and the lung parenchyma (lower respiratory tract)
How do you treat moderate severity community acquired pneumonia, and what is the duration of the treatment?
- Macrolide and Amoxicillin
2. 7 to 10 days
How do you treat high severity community acquired pneumonia, and what is the duration of the treatment?
- Beta lactamase stable, beta lactam, and macrolide
2. 7 to 10 days
How do you treat highly acquired pneumonia?
- Hospital policy
2. 5 to 10 days
How do you monitor in pneumonia?
- Check body’s response to anti-biotics: temperature, respiratory rate
- Keep co-existing conditions stable
- Monitor renal function
- Avoid respiratory depressants
- Watch out for interactions such as macrolides
- Oxygen saturation 94 to 98%
How do you counsel a patient that pneumonia?
- Week 1: Fever resolved
- Week 4: Chest pain and sputum production (reduced)
- Week 6: Cough and breathlessness reduced
- 3 months: Most symptoms resolved but fatigue present
- 6 months: People feel back to normal
