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afsha Pre- Reg > Respiratory system > Flashcards

Respiratory system Flashcards

1
Q

What defines complete control of asthma? (6)

A
  • No daytime symptoms
  • no night-time awakening due to asthma
  • no asthma attacks
  • no need for rescue medication
  • no limitations on activity including exercise
  • normal lung function
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2
Q

How should severe acute attacks of asthma during pregnancy be managed?

A

should be treated promptly in the hospital with conventional therapy

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3
Q

How should pregnant women with asthma be treated?

A

as normally

but their asthma needs to be closely monitored during pregnancy

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4
Q

What lifestyle changes are recommended for managing chronic asthma? (3)

A
  • Weight loss in overweight patients
  • smoking cessation
  • breathing exercises
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5
Q

What does exercise-induced asthma usually indicate?

A

poorly controlled asthma

treatment may need stepping up.

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6
Q

How should treatment be stepped down once control of asthma is achieved?

A

gradually stepped down every three months (25–50% each time)

to avoid unwanted side effects and unnecessary costs

maintaining patients at the lowest possible dose of inhaled corticosteroid.

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7
Q

What is the initial management for children under 5 years with mild intermittent asthma according to BTS/SIGN Guidelines? (4)

A
  1. Inhaled short-acting beta2 agonist (such as salbutamol or terbutaline)
  2. Regular preventer therapy: a. Add inhaled corticosteroid (ICS), or b. Add leukotriene receptor antagonist (LTRA) if child unable to take ICS (not as effective)
  3. Initial add-on therapy: a. 2–5 years, add LTRA or ICS; b. under 2 years, proceed to step 4
  4. Persistent poor control: refer to respiratory pediatrician.
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8
Q

Why should a steroid card be issued for high doses of steroids, especially in children?

A

High doses of steroids are associated with systemic side-effects

including growth failure, reduced bone mineral density, and adrenal suppression.

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9
Q

What should be monitored in patients receiving high doses of steroids?

A

Eyes should be monitored for cataracts

and weight and height should be monitored for growth.

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10
Q

According to BTS/SIGN Guidelines, what is the initial management for adults and children over 5 years with mild intermittent asthma?

A

Inhaled short-acting beta2 agonist.

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11
Q

What are the options for regular preventer therapy in adults and children over 5 years with mild intermittent asthma according to BTS/SIGN Guidelines?

A

a. Add inhaled corticosteroid (ICS), or
b. Add leukotriene receptor antagonist (LTRA) or theophylline if the child is unable to take ICS (not as effective).

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12
Q

What is the initial add-on therapy for adults and children over 5 years with mild intermittent asthma according to BTS/SIGN Guidelines?

A

Add regular inhaled long-acting beta2 agonist (LABA) (formoterol or salmeterol).

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13
Q

If there is no response to LABA as an initial add-on therapy, what should be done according to BTS/SIGN Guidelines? (adults + children >5)

A

Discontinue LABA and increase the dose of inhaled corticosteroid, and consider a trial of leukotriene receptor antagonist (LTRA) or modified-release theophylline.

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14
Q

What is recommended if there is persistent poor control of asthma according to BTS/SIGN Guidelines?

A

a. Increase inhaled corticosteroid to maximum dose.
b. Consider adding a fourth drug such as leukotriene receptor antagonist (LTRA), modified-release theophylline, or modified-release beta2 agonist.

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15
Q

What should be done if a patient requires continuous use of oral corticosteroids according to BTS/SIGN Guidelines?

A

Refer to specialist care, or initiate regular oral corticosteroid under specialist supervision.

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16
Q

What is the recommended oxygen flow rate to maintain SpO2 levels between 94–98% in acute asthma management?

A

High flow oxygen (40-60%).

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17
Q

What is the preferred method of administering beta2 agonists in acute asthma management, and why?

A

should be administered by an oxygen-driven nebulizer to avoid pulmonary oxygen displacement.

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18
Q

What is the recommended duration for oral prednisolone in acute asthma management?

A

Oral prednisolone should be given once daily for at least 5 days or until recovery.

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19
Q

What additional treatments can be considered if there is no improvement in acute asthma management?

A

a. Nebulized ipratropium bromide
b. Intravenous dose of magnesium sulfate
c. Intravenous aminophylline (with caution if the patient is already on theophylline)

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20
Q

What are the characteristics of moderate acute asthma?

A

Increasing symptoms

peak flow > 50–75% of the best or predicted

no features of acute severe asthma.

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21
Q

What are the criteria for diagnosing severe acute asthma?

A

Any one of the following:

Peak flow 33–50% of the best or predicted
Respiratory rate ≥ 25/min
Heart rate ≥ 110/min
Inability to complete sentences in one breath

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22
Q

What are the signs and symptoms of life-threatening acute asthma?

A

Any of the following, in a patient with severe asthma:

Peak flow < 33% of the best or predicted
Arterial oxygen saturation (SpO2) < 92%
Partial arterial pressure of oxygen (PaO2) < 8 kPa
Normal partial arterial pressure of carbon dioxide (PaCO2) (4.6–6.0 kPa)
Silent chest
Cyanosis (blue discoloration)
Poor respiratory effort
Arrhythmia
Exhaustion
Altered conscious level
Hypotension

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23
Q

What defines near-fatal acute asthma?

A

Raised PaCO2 requiring mechanical ventilation with raised inflation pressures, or both.

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24
Q

What is the recommended treatment for mild croup?

A

A single dose of a corticosteroid, such as dexamethasone, is usually offered

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25
Q

What treatment options are recommended for more severe croup or mild croup that might cause complications?

A

Hospital admission, and dexamethasone or budesonide (by nebulization) are often recommended to reduce symptoms.

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26
Q

What should be done if symptoms persist after initial treatment with corticosteroids for croup?

A

If symptoms persist, the dose of corticosteroids may need to be repeated after 12 hours. If still not controlled, nebulized adrenaline solution is given.

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27
Q

What is the recommended medication for reducing symptoms in more severe cases of croup?

A

Nebulized adrenaline solution is given if symptoms persist after initial treatment with corticosteroids.

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28
Q

How does smoking cessation affect mortality risk and prognosis in COPD?

A

Smoking cessation greatly reduces mortality risk and improves prognosis in COPD.

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29
Q

What should we do in patient with cor pulmonale in COPD?

A

Referral to a specialist is required

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30
Q

How is peripheral edema treated in COPD?

A

with furosemide

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31
Q

When is referral to a dietician necessary in COPD management?

A

for abnormal BMI in COPD

Nutritional supplements are recommended for BMI <18.5

and weight loss is recommended for BMI >25.

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32
Q

What symptom can mucolytic (carbocisteine) provide relief for in COPD?

A

Mucolytic (carbocisteine) may provide relief of chronic productive cough in COPD.

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33
Q

When is long-term oxygen therapy indicated in COPD?

A

Long-term oxygen therapy (15 hours a day) is needed in severe COPD with hypoxemia.

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34
Q

How are exacerbations of COPD treated?

A

Exacerbations of COPD are treated with nebulized bronchodilators (such as salbutamol or ipratropium)

antibiotics if infection is suspected

and a 7 to 14-day course of corticosteroids if breathlessness interferes with daily activity.

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35
Q

What is the primary effect of selective beta2 agonists?

A

produce bronchodilation

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36
Q

When are short-acting beta2 agonists typically used in asthma management?

A

Short-acting beta2 agonists are used for immediate relief of asthma symptoms.

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37
Q

What should be considered if a patient needs a short-acting beta2 agonist

more than three times a week

or experiences night-time symptoms at least once a week?

A

Prophylactic treatment should be considered in such cases.

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38
Q

What are the recommended short-acting beta2 agonists for asthma, according to the text?

A

Salbutamol and terbutaline are considered the safest and most effective short-acting beta2 agonists for asthma.

39
Q

What caution should be taken regarding hypokalaemia in patients using beta2 agonist therapy?

A

Potentially serious hypokalaemia may result from beta2 agonist therapy, especially in severe asthma.

Caution and monitoring are required, particularly in patients using concomitant theophylline, corticosteroids, or diuretics, as well as in cases of hypoxia.

40
Q

What role do long-acting beta2 agonists play in asthma management?

A

Long-acting beta2 agonists, such as formoterol and salmeterol, have a role in the long-term control of chronic asthma, especially in patients who regularly use an inhaled corticosteroid.

41
Q

What is the CHM advice regarding the use of formoterol and salmeterol in chronic asthma?

A

According to CHM advice, formoterol and salmeterol should be added if control with regular inhaled corticosteroids (ICS) has failed.

They should not be initiated in patients with rapidly deteriorating asthma, should be introduced at a low dose with proper monitoring before considering dose increase, and should be discontinued if no benefit is observed.

Additionally, they should not be used for the relief of exercise-induced asthma symptoms unless regular inhaled corticosteroids are also used, and their use should be reviewed as clinically appropriate with consideration for stepping down therapy when good long-term asthma control has been achieved.

42
Q

What is the role of ipratropium in chronic asthma and COPD management?

A

Ipratropium can provide short-term relief in chronic asthma and COPD.

43
Q

Which antimuscarinics are licensed for the maintenance treatment of patients with chronic obstructive pulmonary disease (COPD)?

A

Aclidinium, glycopyrronium, tiotropium, and umeclidinium are licensed for the maintenance treatment of patients with COPD.

44
Q

For what condition is tiotropium (via Respimat® device) licensed as an adjunct treatment?

A

Tiotropium (via Respimat® device) is licensed as an adjunct to inhaled corticosteroids and long-acting beta2 agonists for the maintenance treatment of patients with asthma who have suffered one or more severe exacerbations in the last year.

45
Q

What are the cautions associated with the use of antimuscarinics?

A

Caution should be exercised in patients with prostatic hyperplasia, bladder outflow obstruction, and those susceptible to angle-closure glaucoma. Antimuscarinics may also be associated with paradoxical bronchospasm.

46
Q

What adverse effect has been reported with nebulized ipratropium, particularly when given with nebulized salbutamol?

A

Acute angle-closure glaucoma has been reported with nebulized ipratropium, particularly when given with nebulized salbutamol.

47
Q

What is the role of theophylline in asthma and COPD management?

A

Theophylline is used as a bronchodilator in asthma and stable COPD.

48
Q

What are the warning signs that should be reported immediately to a doctor regarding the use of theophylline?

A

Symptoms of toxicity (such as vomiting, agitation, restlessness, dilated pupils, sinus tachycardia, hyperglycemia, or severe hypokalemia)

Symptoms of uncontrolled asthma (such as cough, wheeze, tight chest)

Frequent courses of antibiotics and/or oral corticosteroids (indicating poor asthma control)

49
Q

What should be monitored in patients with severe asthma due to the potential risk of hypokalemia?

A

Plasma potassium levels should be monitored in patients with severe asthma due to the potential risk of hypokalemia.

50
Q

What interactions should be considered with theophylline therapy? (5)

A

Potential interactions include:

Increased plasma concentration with drugs like diltiazem, cimetidine, ciprofloxacin, erythromycin, estrogens, fluvoxamine, and verapamil.

Increased plasma-theophylline concentration in conditions such as heart failure, hepatic impairment, viral infections, and in the elderly.

Possible increased risk of convulsions when theophylline is given with quinolones.

Reduced plasma concentrations with alcohol, carbamazepine, primidone, phenobarbital, phenytoin, and ritonavir.

Decreased plasma-theophylline concentration in smokers.

51
Q

What advice should be given regarding theophylline therapy in pregnancy and breastfeeding?

A

The risk of asthma exacerbations outweighs the risk of treatment, so theophylline should be continued as normal with monitoring during pregnancy and breastfeeding.

52
Q

Why is it important to maintain the same brand of modified-release theophylline preparations?

A

The rate of absorption from modified-release preparations can vary between brands. If a prescription does not specify a brand name, the pharmacist should contact the prescriber to agree on the brand to be dispensed. Additionally, patients discharged from the hospital should be maintained on the brand on which they were stabilized as an in-patient.

53
Q

What monitoring is recommended for patients on theophylline therapy?

A

Serum potassium levels and plasma theophylline concentration should be monitored.

54
Q

What is the mechanism of action of leukotriene receptor antagonists?

A

Montelukast and zafirlukast block the effects of leukotrienes, which are inflammatory mediators in the airways.

55
Q

In what conditions are leukotriene receptor antagonists effective?

A

Leukotriene receptor antagonists are effective in asthma when used alone or with an inhaled corticosteroid.

56
Q

What disorder is associated with an increased risk when taking zafirlukast?

A

Zafirlukast is associated with an increased risk of hepatic disorders. Patients should seek medical attention if symptoms or signs such as persistent nausea, vomiting, malaise, jaundice, or dark urine develop.

57
Q

What is a rare risk of leukotriene receptor antagonists?

A

Churg-Strauss syndrome

a rare risk reported following the reduction or withdrawal of oral corticosteroid therapy in patients taking leukotriene receptor antagonists. Symptoms may include eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, or peripheral neuropathy.

58
Q

What is the primary effect of corticosteroids in asthma management?

A

effective in asthma as they reduce airway inflammation

which consequently reduces edema and secretion of mucus into the airway.

59
Q

How long does it typically take for symptoms to improve after initiation of corticosteroid inhalers in asthma management?

A

Alleviation of symptoms usually occurs 3 to 7 days after initiation of corticosteroid inhalers in asthma management

60
Q

What is the role of inhaled corticosteroid therapy in COPD management?

A

Inhaled corticosteroid therapy may reduce exacerbations when given in combination with an inhaled long-acting beta2 agonist in COPD management.

61
Q

What should be done if bronchospasm occurs during treatment with corticosteroids?

A

Discontinue treatment and offer alternative therapy. Bronchospasm may be prevented by inhaling a short-acting beta2 agonist beforehand or by using dry powder inhalation instead of aerosol inhalation.

62
Q

How can the risk of oral candidiasis be reduced in patients using corticosteroids?

A

The risk of oral candidiasis can be reduced by using a spacer device, rinsing the mouth with water after inhalation of a dose, and using antifungal oral suspension or oral gel to treat oral candidiasis without discontinuing therapy.

63
Q

What systemic side effects are associated with high doses of corticosteroids, especially in children?

A

High doses of corticosteroids, especially in children, are associated with systemic side effects, including growth failure, reduced bone mineral density, and adrenal suppression.

64
Q

What ocular monitoring is recommended for patients using corticosteroids?

A

Patients using corticosteroids should have their eyes monitored for cataracts, and their weight and height should be monitored for growth.

65
Q

Why should brands of beclometasone inhalers not be interchangeable?

A

Beclometasone inhalers (such as Qvar® and Clenil Modulite®) are not interchangeable because Qvar® has extra-fine particles and is twice as potent as Clenil Modulite®. Fostair®, a combination beclometasone and formoterol inhaler, is also more potent than traditional beclometasone dipropionate CFC-free inhalers.

66
Q

What is the unlicensed use associated with Easyhaler beclometasone?

A

Easyhaler beclometasone is not licensed for children under 18 years. Similarly, Qvar, Clenil 200, and 250 are not licensed for children under 12.

67
Q

What is the primary effect of antihistamines in the treatment of nasal allergies?

A

Antihistamines reduce rhinorrhoea (runny nose) and sneezing in the treatment of nasal allergies, particularly hay fever.

68
Q

For what conditions are oral antihistamines used?

A

Oral antihistamines are used to prevent urticaria and treat urticarial rashes, pruritus, insect bites and stings, as well as drug allergies. Some are also used for nausea and vomiting, such as cinnarizine, cyclizine, and promethazine.

69
Q

What are the side effects associated with sedating antihistamines?

A

Sedating antihistamines, such as promethazine, alimemazine, chlorphenamine, and hydroxyzine, have significant antimuscarinic activity and should be used with caution in prostatic hypertrophy, urinary retention, and susceptibility to angle-closure glaucoma. Rare side effects may include hypotension, palpitation, arrhythmias, extrapyramidal effects, dizziness, and confusion.

70
Q

Name some sedating antihistamines.

A

promethazine, alimemazine, chlorphenamine, and hydroxyzine.

71
Q

What are some examples of non-sedating antihistamines?

A

acrivastine, cetirizine, desloratadine, fexofenadine, levocetirizine, loratadine, and mizolastine.

72
Q

What condition is buclizine included to treat in Migraleve tablets?

A

Buclizine is included as an anti-emetic in Migraleve tablets.

73
Q

What is the primary use of promethazine besides being an antihistamine?

A

Promethazine is also used for occasional insomnia.

74
Q

What are the potential risks associated with hydroxyzine use?

A

Hydroxyzine is associated with a small risk of QT-interval prolongation and Torsade de Pointes. These events are most likely to occur in patients with risk factors such as concomitant use of drugs that prolong the QT interval, cardiovascular disease, family history of sudden cardiac death, significant electrolyte imbalance (low plasma potassium or plasma magnesium concentrations), or significant bradycardia.

75
Q

What dose restrictions and precautions are recommended for hydroxyzine use?

A

To minimize the risk of adverse effects, the following precautions and restrictions are recommended:

Hydroxyzine is contraindicated in patients with prolonged QT-interval or those with risk factors for QT-interval prolongation.
Avoid use in the elderly due to increased susceptibility to side effects.
Consider the risks before prescribing to patients taking drugs that lower heart rate or plasma-potassium concentration.
The maximum daily dose for adults is 100 mg, and for the elderly, it is 50 mg (if use cannot be avoided).
For children with body weight up to 40 kg, the maximum daily dose is 2 mg/kg.
Prescribe the lowest effective dose for the shortest period of time.

76
Q

For which conditions are desensitizing vaccines recommended?

A

Desensitizing vaccines are recommended for seasonal allergic hay fever (caused by pollen) that has not responded to anti-allergic drugs, and for hypersensitivity to wasp and bee venoms.

77
Q

Who should generally avoid or use desensitizing vaccines with particular care?

A

Desensitizing vaccines should generally be avoided or used with particular care in patients with asthma. They should also be avoided in pregnant women, children under five years old, and those taking beta-blockers or ACE inhibitors.

78
Q

What are aromatic inhalations primarily used for?

A

Aromatic inhalations, containing volatile substances like menthol and eucalyptus oil, are used to encourage deliberate inspiration of warm moist air, which is often comforting in bronchitis. They are also used for relieving nasal obstruction in acute rhinitis or sinusitis.

79
Q

Why are aromatic decongestants not advised for infants under 3 months?

A

Aromatic decongestants are not advised for infants under 3 months due to safety concerns. Instead, sodium chloride 0.9% nasal drops are preferred, or suction aspiration can be conducted.

80
Q

What factors should be considered before prescribing cough suppressants?

A

Before prescribing cough suppressants, underlying disorders such as asthma, GORD, or rhinitis should be addressed. Additionally, cough may be a side-effect of another drug, such as an ACE inhibitor, or associated with smoking or environmental pollutants.

81
Q

What are some examples of cough suppressants?

A

dextromethorphan, and pholcodine.

codeine too but now POM

82
Q

What is the purpose of demulcent cough preparations?

A

Demulcent cough preparations contain soothing substances such as syrup or glycerol, which some patients believe relieve a dry, irritating cough. Preparations like simple linctus are harmless and inexpensive.

83
Q

Why should OTC cough and cold medicines containing certain ingredients not be given to children under 6 years old?

A

Children under 6 years should not be given OTC cough and cold medicines containing antihistamines, cough suppressants, expectorants, or decongestants due to safety concerns.

84
Q

What are the restrictions for the use of codeine in children?

A

Codeine is restricted in children under 12 years old, patients known to be CYP2D6 ultrarapid metabolizers, breastfeeding mothers, all children under 18 undergoing surgery of tonsils or adenoids for sleep apnoea, and all children under 18 with respiratory problems.

85
Q

What is anaphylaxis?

A

a severe, life-threatening, generalised or systemic hypersensitivity reaction characterised by rapid respiratory/circulatory problems and associated skin/mucosal changes.

86
Q

What are some common causes of anaphylaxis?

A

Anaphylaxis can be caused by certain foods (such as nuts, eggs, fish), medicinal products (especially after parenteral administration), and additives/excipients in foods.

87
Q

What are the initial steps in treating a patient experiencing anaphylaxis?

A

The initial steps include securing the airway, restoring blood pressure by placing the patient in the recovery position, and administering adrenaline (I.M. dose of 500mcg), with potential repetition after 5-minute intervals based on blood pressure, pulse, and respiratory function.

88
Q

What medications are typically administered after adrenaline in the treatment of anaphylaxis?

A

After adrenaline, antihistamines such as chlorphenamine are administered either intravenously (I.V.) or intramuscularly (I.M.). Additionally, an I.V. corticosteroid is given to prevent further deterioration, particularly in severe cases.

89
Q

In cases of continuing respiratory deterioration, what further treatment options are available?

A

Continuing respiratory deterioration may necessitate treatment with bronchodilators, including inhaled or I.V. Salbutamol, Ipratropium, aminophylline, or magnesium sulphate.

90
Q

Why should branded inhalers like QVAR and Clenil Modulite be prescribed by brand name?

A

Branded inhalers like QVAR and Clenil Modulite are not interchangeable because they have different formulations. QVAR, for example, has extra fine particles and is twice as potent as Clenil Modulite.

91
Q

What is the recommended initial prescription of QVAR when switching a patient with well-controlled asthma from another corticosteroid inhaler?

A

Initially, 100mcg of QVAR should be prescribed for every 200-250mcg of beclomethasone/budesonide in the previous inhaler.

92
Q

What is the recommended initial prescription of QVAR when switching a patient with poorly controlled asthma from another corticosteroid inhaler?

A

Initially, 100mcg of QVAR should be prescribed for every 100mcg of beclomethasone/budesonide in the previous inhaler.

93
Q

What are the age restrictions for the unlicensed use of Easyhaler, Clenil Modulite 200/250, and QVAR?

A

Easyhaler is not recommended for use in individuals under 18 years old, while Clenil Modulite 200/250 and QVAR are not recommended for use in individuals under 12 years old.

afsha Pre- Reg (24 decks)

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