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Victor BNF Notes > Respiratory System > Flashcards

Respiratory System Flashcards

1
Q

What is chronic asthma

A

reversible obstructive airways

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2
Q

What are Chronic Asthma symptoms

A
  • coughing (usually at night)
  • shortness of breath
  • chest tightness
  • wheezing
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3
Q

Chronic Asthma 1st line

A

Short Acting Bronchodilators (SABA)
- Salbutamol
- Terbutaline

alternative…
- ipratropium bromeide (SAMA)
- Theophylline (if 12 or above)

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4
Q

Why move to second line in chronic asthma management

A
  • if using inhaler/symptomatic at least 3 times a week
  • getting night time symptoms at least once a week
  • asthma attack requiring steroids within 2 years
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5
Q

Chronic Asthma 2nd Line

A
  • Low dose inhaled corticosteroids (BD, reduce to OD if well controlled)

(mometasone, fluticasone, beclometasone, budesonide)

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6
Q

What are alternative 2nd Line treatments for chronic asthma

A
  • inhaled sodium cromogliate
  • leukotriene receptor antagonist (montelukast)
  • Theophylline
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7
Q

Chronic Asthma 3rd Line treatment

A

Long acting Bronchodilators + Inhaled corticosteroid

LABA
- serevent
- foradil (formoterol)

Combination Inhalers with both
- Fostair
- DuoResp
- Seretide
- Symbicort

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8
Q

Chronic Asthma 4th Line treatment:
Part 1

A

If no response for 3rd Line:

Stop LABA
and…
Increase ICS dose

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9
Q

Chronic Asthma 4th Line treatment:
Part 2

A

If benefiting, but still inadequate;
continue LABA

Increase ICS dose
or…
trial LAMA (tiotropium bromide), LTRA or Theophylline

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10
Q

Chronic Asthma 5th Line treatment

A

High dose ICS + fourth drug…

  • Theophylline
  • LAMA (tiotropium bromide)
  • LTRA
  • Oral B2 agonist tablet (bambuterol)
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11
Q

Chronic Asthma 6th Line treatment

A

short dose oral corticosteroid (5 days for adult and 3 days or child 6 to 12)

for potent asthma events

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12
Q

What is a selective B2 agonist (SABA and LABA)

A

drug that causes bronchodilation of the bronchi

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13
Q

Inhaled Short-Acting B2 Agonist examples

A

Salbutamol

Terbutaline

(both QDS PRN)

3-5 hour onset

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14
Q

Inhaled Long-Acting B2 Agonist examples

A

Formoterol

Salmeterol

(both BD)

12 hour onset

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15
Q

Other Long Acting B2 Agonist examples and what are they for

A
  • Olodaterol (COPD)
  • Indacterol (COPD)
  • Vilanterol (Anoro Elipta)
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16
Q

Example of an Oral B2 agonist oral tablet

A

Bambuterol

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17
Q

When should you not initiate a LABA

A

in a patient with rapidly deteriorating asthma

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18
Q

What type of onset is Salmeterol (LABA) and what is it not for

A

Long onset + Long action

not for…
- acute asthma relief
- prevention of exercise induced asthma

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19
Q

What type of onset is Formeterol (LABA) and what is it used for

A

Short Onset + Long Action

Used as a reliever in addition as a preventer

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20
Q

Examples of Combined Inhalers and what LABA do they contain

A

Fostair, DuoResp, Symbicort, Luforbec, Trimbow

Formeterol

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21
Q

Examples of LABA inhalers

A
  • Serevent (salmeterol)
  • Foradil (formoterol), - - Striverdi (olodaterol)
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22
Q

Examples of SABA inhalers

A
  • Salamol
  • Ventolin
  • Bricanyl (terbtaline)
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23
Q

Examples of Inhaled Corticosteroid Inhalers

A

Beclometasone Inhaler brands
- QVAR
- Beconase
- Clenil Modulite
- Kelhale
- Soprobec

Mometasone Inhaler Brands
- Nasonex
- Elocon

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24
Q

Short-Acting B2 Agonist (SABA) side effects

A
  • hand tremors
  • tachycardia
  • hyperglycaemia
  • hypokalaemia
  • Serious cardiovascular events
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25
Q

When prescribing Inhaler always make sure to…

A

explicitly state dose, frequency and max puffs in 24 hours

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26
Q

What are spacers when used with inhalers

A

Spacers take up the medication and holds it for the patient to inhale easier

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27
Q

More information on SABA Side Effect: Hypokalaemia

A

Hypokalaemia can be increased via…

SABA + corticosteroid / other b2 agonists / theophylline

monitor serum potassium

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28
Q

More information on SABA Side Effect: Cardiovascular Events

A
  • Prolonged QT interval
  • arrhythmias
  • tachycardia
  • arterial hypoxia (not enough oxygen for homeostasis)
  • myocardial infarction
  • hypotension

tale caution in hyperthyroidism

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29
Q

Inhaled Corticosteroid (ICS) mode of action

A

reduces inflammation in the bronchi

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30
Q

Inhaled Corticosteroids examples and how often to take

A

BD dosing…
- beclometasone
- budesonide
- fluticasone

OD dosing…
- ciclesonide

BD an OD dosing…
- mometasone

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31
Q

How to long should someone take Inhaled corticosteroids for prevention of asthma

A

3 - 4 weeks

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32
Q

What does CFC free mean stand for in inhalers

A

free from chlorofluorocarbons

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33
Q

Most potent and fine beclometasone cfc free inhalers

A

Least Potent/Least fine

Clenil Modulite

Qvar

Fostair

Most Potent/Most Fine

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34
Q

Qvar minimum age

A

12+

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35
Q

Any Easyhaler minimum age

A

18+

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36
Q

Inhaled Corticosteroid side effects

A
  • hoarse voice
  • sore throat
  • oral candidiasis
  • paradoxical bronchospasm
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37
Q

Inhaled Corticosteroid Side effect: Oral Candidiasis advice and treatment

A

Counselling
- rinse mouth and brush teeth after use, or use a spacer

Treatment
- Daktarin Gel (miconazole get)

… do not use warfarin

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38
Q

Inhaled Corticosteroid Side effect: paradoxical bronchospasm what to do

A

Stop the ICS and give alternative

if only mild…

  • transfer from pMDI to dry powder inhaler
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39
Q

What are the NICE guide lines on who should use large-volume spacers

A
  • patients with high does ICS
  • patients under 15
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40
Q

What lifestyle activity reduces the effectiveness of ICS

A

Current or previous smoking

may need higher dose

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41
Q

When to consider giving a patient a steroid card

A

if their corticosteroids dose is greater than max licensed dose

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42
Q

Leukotriene Receptor Antagonists mode of action

A

blocks action of leukotriene on the cysteinyl leukotriene receptor in the lungs and bronchi. This reduces bronchoconstriction and inflammation

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43
Q

Examples of Leukotriene Receptor Antagonists

A

Montelukast

Zafirlukast

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44
Q

Leukotriene Receptor Antagonists Side effects

A
  • churg strauss syndrome (blood vessel inflammation) (cardiovascular symptoms)
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45
Q

Leukotriene Receptor Antagonists Side effects: Specifically Zafirlukast

A

Liver toxicity

Patient Counselling:

report symptoms such as:
- nausea
- vomiting
- jaundice
- abdominal pain
- itching

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46
Q

Theophylline (Xanthine Bronchodilator) example

A

IV Aminophylline

(theophylline and ethylenediamine) is 20x more soluble

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47
Q

Signs of Theophylline toxicity

A
  • vomiting with GI effects
  • tachycardia (restlessness, agitation, dilated pupils)
  • Arrhythmias
  • Convulsions
  • HypoKalaemia
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48
Q

What medications interact with Theophylline to increase risk of hypokalaemia

A
  • Loop/Thiazide diuretics
  • Corticosteroids
  • B2 Agonists
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49
Q

What does Ciprofloxacin and quinolones with Theophylline interaction cause

A

Convulsions

Quinolones lower the seizure threshold, therefore making them more likely

50
Q

What medications interact with Theophylline to increase its plasma concentration and chance of toxicity

A
  • Verapamil/CCB
  • Cimetidine
  • Phenytoin
  • Fluconazole
  • Macrolides
51
Q

What medications interact with Theophylline to reduce its concentration in the blood (subtheraputic)

A

-St Johns wort
- Rifampicin

52
Q

What to do if patient has Acute Asthma

A
  • regard all cases as severe
  • if treatment failure, transfer to hospital
53
Q

Acute Asthma initial treatment

A

Salbutamol inhaler via large volume spacer
2-10 puffs every 10 to 20 mins or PRN

or…

Salbutamol/Terbutaline nebuliser ever 20 to 30 mins or PRN

54
Q

What to do if treatment failure for acute asthma

A

if symptoms persist after 15 to 30 mins…
call 999

or…

repeat above and add a nebuliser ipratropium bromide

55
Q

Acute asthma management after initial treatment

A

Prednisolone tabs or Hydrocortisone IV

Children (under 12): up to 3 days
Adult: at least 5 days (40 to 50mg once daily)

use high flow oxygen if available

56
Q

What is Chronic Obstructive Pulmonary Disease (COPD)

A

Irreversible airway obstruction

57
Q

COPD with breathlessness or exercise limitation:
1st Line

A

SABA or SAMA (short-acting muscarinic receptor antagonists)

58
Q

COPD with >= 50% forced expiration rate
2nd Line:

A

LABA

then…

LABA/ICS combined inhaler
or…
LAMA

59
Q

COPD with < 50% forced expiration rate
2nd Line:

A

LABA/ICS combined inhaler

or…

LAMA

60
Q

COPD
3nd Line:

A

Triple therapy

LABA/ICS combination inhaler

and

LAMA

61
Q

COPD 4th Line/ or unable to use inhalers:

A

Modified release theophylline

(Uniphyllin Continus)

62
Q

COPD and chronic productive cough (what is the treatment for cough)

A

Mucolytic (carbocisteine)

63
Q

Severe COPD with Hypoxaemia treatment

A

Oxygen therapy

64
Q

About Oxygen therapy for COPD with Hypoxia

A
  • 15 hours a day increases survival chance
  • Must be 88 to 92% saturation
  • must have O2 alert card
  • If history of hypercapnic respiratory failure, must use venturi mask
65
Q

Inhaled Antimuscarinics mode of action

A

relaxes smooth muscle of bronchi to cause bronchodilation

66
Q

Short-Acting Antimuscarinic (SAMA) example and dose frequency

A

Ipratropium Bromide (TDS)

67
Q

Long-Acting Antimuscarinic (LAMA) examples and dose frequency

A
  • Aclidinium (Eklira)
  • Glycopyronnium (Seebri Breezhaler)
  • Umeclidinium (Incruse Elipta)
  • Tiotropium (Spiriva Handihaler)

Take all OD
Eklira BD

68
Q

Cautions with Inhaled Antimuscarinics

A
  • Prostatic Hyperplasia (enlarged prostate gland)
  • Risk of Angle-closure glaucoma
    (enlarged iris blocks drainage pipe)
69
Q

More Information on Antimuscarinic Angle-closure glaucoma

A
  • Usually reported with nebulised ipratropium bromide (usually when given with salbutamol)
  • must protect eyes
70
Q

Side Effects of Inhaled Antimuscarinics

A
  • Dry mouth
  • Paradoxical bronchospasm
71
Q

Acute COPD exacerbation treatment

A
  • Bronchodilator nebuliser therapy (SABA, SAMA, Theophylline)
  • IV Aminophylline (if poor response to nebulised bronchodilators)
  • Short Course of oral prednisolone (30mg daily for 7 to 14 days)

(if increased breathlessness interferes with daily activity)

  • Antibacterial Therapy
    (if oddly coloured sputum)
72
Q

Antihistamine mode of action

A

Binds to H1 receptor site to block the action of histamine

73
Q

(OLD) Sedating Antihistamines examples

A
  • Promethazine Hydrochloride (BD/TDS)
  • Alimemazine
  • Chlorphenamine (QDS)
  • Hydroxyzine (QT prolongation)
74
Q

(NEW) Non-Sedating Antihistamines examples

A
  • Acrivastine (TDS)
  • Cetirizine (OD)
  • Loratidine (OD)
  • Fexofenadine (OD)
75
Q

Main Antihistamine Indications

A
  • Nasal Allergies (hay fever)
  • Skin Allergies (Urticaria)(Hives)
76
Q

Other Antihistamine Indications

A
  • Nausea and Vomiting
    (Cyclizine and Promethazine Hydrochloride)
  • Insomnia
    (Promethazine an Diphenhydramine)
  • Emergency Anaphylaxis as an adjunct
    (promethazine injection)
77
Q

Antihistamine lifestyle advice

A
  • avoid alcohol
  • avoid driving while on them
78
Q

Antihistamine cautions

A
  • Prostatic Hyperplasia causing urinary retention (enlarged prostate gland)
  • Glaucoma (raised intraocular pressure)
  • Sever Liver Impairment (sedation effect moved to liver causing hepatic coma)
79
Q

Hydroxyzine (Antihistamine) cautions

A
  • QT prolongation
  • Torsade De Pointes
80
Q

What is Torsade De Points

A
  • Unique ventricular tachycardia
  • QRS amplitude varies
  • QRS intervals twist around baseline
81
Q

Hydroxyzine (Antihistamine) use and daily dose

A
  • Short-period use only
  • Max daily dose of 100mg
82
Q

Hydroxyzine (Antihistamine) contra-indications

A
  • taking with drugs that can increase QT interval
  • cardiovascular disease
  • family history of sudden death
  • hypokalaemia
  • hypomagnesaemia
  • bradycadia
83
Q

What is Allergen Immunotherapy (like allergen vaccine) used for

A
  • to reduce allergic asthma symptoms, allergic rhinoconjuctivitis

can be allergen vaccine or oral grass pollen extract.

  • to reduce severe anaphylaxis in hypersensitivity to wasp and bee stings

allergen vaccines containing wasp and bee venom extract.

84
Q

Allergen Immunotherapy safety concerns

A
  • can cause a life threatening hypersensitive reaction
  • needs specialist use, monitor for at least 1 hour
  • Need CPR readily available
85
Q

Avoid Allergen Immunotherapy in…

A
  • Pregnant Women
  • Children under 5
  • Beta-blockers
  • ACE Inhibitors
  • Asthma (use with caution)
86
Q

What is Omalizumab Injection

A

Monoclonal antibody that binds to IgE (Immunoglobulin E)

87
Q

What is Omalizumab Injection used for

A

ADD on treatment

  • severe persistant allergic asthma
    (inadequate response to high dose ICS and LABA)
  • Chronic spontaneous urticaria
    (inadequate response to H1 antihistamines, leukotriene receptor antagonists)
88
Q

What is Chronic spontaneous urticaria

A

distressing skin condition that causes red, raised, itchy and sometimes painful hives or wheals (raised rash or patches) on the skin with no known obvious trigger.

89
Q

Side effects of the Omalizumab Injection

A
  • Churg-struass syndrome

(blood vessel inflammation. This inflammation can restrict blood flow to organs and tissues, sometimes permanently damaging them)

90
Q

What is Anaphylaxis

A

an acute allergic reaction to an antigen to which the body has become hypersensitive.

91
Q

What to do in case of anaphylaxis medical emergency (non-pharmacological)

A
  • secure airways
  • restore blood pressure
  • raise legs and lay flat
  • if sick or unconscious place in recovery position
92
Q

What to do in case of anaphylaxis medical emergency (pharmacological)

A

Adrenaline 1 in 1000 solution
(intramuscular injection)
— INJECT IN ANTEROLATERAL ASPECT OF MIDDLE THIGH

repeat every 5 mins if necessary

give IV if compromised circulation

93
Q

Anaphylaxis medical emergency Adrenaline DOSE

A

Child Under 6: 150mcg
Child 6 to 12: 300mcg
12 plus: 500mcg

(if child above 12 is small/pre-puberty 300mcg)

94
Q

Anaphylaxis medical emergency Adrenaline Alternative

A

Patients on Beta-Blockers may not respond to adrenaline

treat with bronchodilator
e.g salbutamol

95
Q

What is the Adjunct therapies for adrenaline in Anaphylaxis medical emergency

A
  • high flow oxygen and IV fluids
  • chlorphenamine injection
  • Hydrocortisone Injection
96
Q

What does a chlorphenamine injection do

A

counters histamine-mediated vasodilation and bronchospasm

97
Q

What does a hydrocortisone injection do

A

prevents further deterioration in severely affected patients

98
Q

Self Administration of adrenaline auto-injectors

A
  • carry 2 at all times
  • patient must be trained on how to use a particular auto-injector (practice using trainer device)
  • Check expiry dates, get new ones before expiry date
99
Q

What is angioedema

A

swelling of the skin often caused by allergic reactions

100
Q

What is present with Severe angioedema and how to treat

A

laryngeal oedema is present in severe angioedema
- larynx area oedema

Treat with same as anaphylaxis…
- adrenaline
- antihistamine
- corticosteroid

101
Q

Mucolytics mode of action

A

facilitates expectoration by reducing sputum viscosity

expectoration: discharge via throat/lungs via coughing and spitting

102
Q

Examples of Mucolytics

A
  • Carbocisteine
  • Erdosteine
103
Q

Uses of Mucloytics

A

reduces COPD exacerbations in patients with chronic productive cough

104
Q

Mucolytic contra-indications

A

Active peptic ulcers
(mucolyitcs disrupt gastric mucosa)

105
Q

What is cystic fibrosis

A

an inherited condition that causes sticky mucus to build up in the lungs and digestive system.

106
Q

Cystic fibrosis 1st line treatment

A
  • Dornase alfa 2500 units of nebulised inhalation solution once daily
  • Mannitol 400mg inhalation powder twice daily
    (if dornase alfa is unsuitable)
107
Q

What is Dornase alfa

A

a genetically engineered version of a naturally occurring human enzyme which cleaves extracellular deoxyribonucleic acid (DNA).

108
Q

Cystic Fibrosis 2nd Line Treatment

A

Sodium Chloride nebulised solution

109
Q

What is CROUP (medical emergency)

A

Croup is a common childhood infection that causes a barking cough and a rasping sound when breathing. It’s usually mild but may need treatment.

110
Q

CROUP treatment for child 1 month to 2 years

A

Dexamethasone oral solution

111
Q

What is Idiopathic pulmonary fibrosis (IPF)

A

a condition in which the lungs become scarred and breathing becomes increasingly difficult.

112
Q

Pharmacological Treatment of Idiopathic pulmonary fibrosis (IPF)

A
  • Pirfenidone
  • Nintedanib
113
Q

Pirfenidone mode of action

A

slow down the process of scarring in the lungs by reducing the activity of the immune system.

114
Q

Pirfenidone dose in Idiopathic pulmonary fibrosis (IPF)

A

1 capsule 3 times a day

115
Q

Pirfenidone side effects

A
  • feeling sick
  • tiredness
  • diarrhoea
  • indigestion
  • a rash caused by exposure to sunlight
116
Q

Pirfenidone serious side effect

A

Serious liver damage

117
Q

Liver Damage side effects

A
  • yellowing of the eyes or skin
  • loss of appetite
  • itchy skin
  • your pee turns a darker colour
  • feeling tired
  • pain in the upper right side of your stomach
118
Q

Nintedanib mode of action

A

help slow down scarring of the lungs

119
Q

Nintedanib dose in Idiopathic pulmonary fibrosis (IPF)

A

1 capsule twice daily

120
Q

Side effects of Nintedanib

A
  • diarrhoea
  • feeling and being sick
  • tummy (abdominal) pain
  • loss of appetite and weight loss

Victor BNF Notes (25 decks)

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