Respiratory Qs Flashcards
When can you prescribe an ICS in COPD?
- Eosinophil > 300
- Concomitant asthma
- Hospitalisation due to exacerbations
- 6 exacerbations in the last yr, 4 of which were mod
When can’t you prescribe an ICS in COPD?
- 4 pneumonia infections in the last month
- CI in repeat pneumonia
If LABA/ICS is ineffective in COPD
triple therapy LABA/ICS/LAMA
Cystic fibrosis
Those who have evidence of lung disease and inadequare reponse to dornase alfa =
o Add hypotonic sodium chloride inhaler as mucolytic therapy
What must you rule out before prescribing infliximab?
TB
- T spot test or Mantoux test
Which LAMA can be used BD
Aclinidium
Which LAMA is taken OD?
- Tiotropium
- Glycopyrronium
- Umelicinium
Acute angle glaucoma medical emergency
- Cloudiness
- N+V + headache
- AM: ipratropium can trigger or worsen
What is the dose of Montelukast in asthma?
15 years and older: 10 mg OD
6yrs - 14yrs: 5mg OD
6 months - 5yrs: 4mg OD
Bronchiestasis
- lung’s bronchi become permanently damaged and widened
- more common in women than in men.
- Coughing up yellow or green mucus daily -
- SOB that gets worse during flare-ups.
When should montelukast be taken?
Evening
what is the treatment for acute exacerbation that shows a peak flow of <33%, sats <92% with altered consciousness, exhaustion, and cardiac arrhythmia? →
life-threatening:
- oxygen to maintain sats between 94-98%
- nebulized salbutamol 5mg (oxygen driven) + consideration for nebulized ipratropium 500mcg
- prednisolone 40-50mg for at least 5 days
- patients should be followed up within 48 hours of discharge or presentation if not admitted!
Life-threatening exacerbation
PF <33%
Sats < 92%
Altered consciusness
Exhaustion
Cardiac arrythmias
What is the treatment for acute exacerbation of asthma where peak flow is 33-50% and oxygen saturation is at least 92% where pulse is at least 110/min and respiratory rate is at least 25/min? →
SEVERE
- oxygen to maintain sats between 94-98%
- nebulized salbutamol 5mg (oxygen driven)
- prednisolone 40-50mg for at least 5 days
- patients should be followed up within 48 hours of discharge or presentation if not admitted!
Severe asthma exacerbation
- PF 33-50%
- Sat at least 92%
- Pulse at least 110/min
- RR at least 25/min
What is the treatment for acute exacerbation of asthma where peak flow (best of predicted) is 50-75% and pulse is <110 min →
MODERATE
- salbutamol pMDI + spacer up to 10 puffs
- prednisolone 40-50mg for at least 5 days
- patients should be followed up within 48 hours of discharge or presentation if not admitted!
Moderate asthma exacerbation
- PF 50-75%
- pulse is <110/min
Pt develops a stutter
Montelukast
Current smoking and theophylline
Smoking reduces theophylline levels by increasing the clearance
What if pt starts smoking during theophylline treatment
Dose increase to max DD of 2.5mg tds may be reuqired in pt who are smoking or start smoking during treatment
Stopping smoking during theophylline treatment
- Increases theophylline levels
- May need dose decrease
Which condition may increase the risk of a patient developing TB disease? Depression, diabetes, hyperthyroidism, obesity, smoking? →
diabetes - people living with diabetes who are also infected with TB are more likely to develop TB disease and become sick with TB (even if they have latent TB)
CURB
Confusion (mental test score of 8 or less)
Urea > 7mmol/L
RR >30
BP < 90/60
Age > 65
CURB score of 5 = high severity
Treatment
Amoxicillin 1g TDS IV + azithro 500mg OD IV for 5 days
How often do you need to replace the spacer
1 yr
How often do you need to wash spacer?
1m
