respiratory system Flashcards
symptoms of COPD
breathlessness
cough
wheezing
sputum production
frequent LRTI
what is a low FEV1/FVC
lower than 0.7
forced expiratory vol in 1 second
forced vital capacity
what is CURB-65
score to assess severity of CAP
What does CURB-65 stand for
Confusion
Urea (greater than 7mmol/L)
Respiratory rate (greater than 30)
Blood pressure : 90/60 or lower
65 yrs or older
first choice antibiotic for CAP low severity
First choice: if severity is low (CURB 65 of 0 or 1)
Amoxicillin 500mg x3 a day for 5 days
if amoxicillin not suitable then or allergic to penicillin then alternatives are:
1) doxycycline 200mg first day, 100 mg once a day for 4 days (5 day course)
2) clarithromycin 500mg x2 a day for 5 days
3) Erythromycin (in pregnancy): 500mg x4 a day for 5 days.
first choice antibiotic for CAP moderate severity
1) Amoxicillin: 500mg x3 a day for 5 days
2) clarithromycin: 500mg x2 a day for 5 days
3) erythromycin: 500mg x4 a day for 5 days
CURB-65: 1 or 2
First choice antibiotic for high severity CAP
CURB-65: 3/4 or higher
1) Co-amoxiclav: 500/125mg x 3 day orally or 1.2g x3 a day IV for 5 days.
first choice antibiotic treatment for HAP
low severity
Co-amoxiclav: 500/125mg x 3 a day for 5 days
doxycycline if allergic
or
co-trimoxazole: 960mg x 2 a day for 5 days.
first choice IV antibiotic if severity is high for HAP
1) piracillin with tazobactam: 4.5 g x 3 a day
2) Ceftazidime: 2g x 3 day
3) ceftriaxone: 2 g once a day
4) cefuroxime: 750mg x 3 a day
cough suppressant example
Dextromethorphan
expectorant
example
Guaifenesin
helps treat dry cough with mucus
Decongestants
example
pseudoephedrine
phenylephrine
example of a SABA bronchodilator to treat asthma in kids ?
albuterol
pair with inhaled corticosteroid
e.g. fluticasone
to reduce inflammation.
Examples of non sedating antihistamines and advantages/disadvantages and side effects
1) Loratadine
2) Cetirizine
3) Fexofenadine
Advantages: less likely to cross BBB = less drowsy
- longer duration of action
- reduced cognitive impairment.
Disadvantages: mild sedation in high dose of cetirizine.
side effects: headache, dry mouth, dizziness, fatigue, GI irritation.
sedating antihistamines (examples, advantages, disadvantages, side effects)
1) Diphenhydramine
2) chlorpheniramine
3) promethazine
advantages:
- Effective for treating allergy symptoms
disadvantages: - drowsiness
- not ideal for day time use due to sedative effects
side effects: drowsiness, dizziness, headache, dry mouth, blurred vision, constipation, urinary retention.
- long term use in elderly = cognitive impairment.
nasal corticosteroids (examples, advantages, disadvantages, side effects)
1) Fluticasone
2) Mometasone
3) Budesonide
Advantages:
- reducing inflammation, nasal congestion, sneezing
- minimal systemic absorption
Disadvantages:
- requires frequent usage for greater effect
- not immediate effect
side effects: nasal irritation/dryness/burning, nose bleeds, sore throat, increased intraocular pressure.
nasal antihistamines (examples, advantages, disadvantages, side effects)
examples: Azelastine, olopatadine
Advantages:
- fast acting, directly targets symptoms
- fewer systemic side effects
disadvantages:
- nasal irritation or bitter taste
- requires proper administration technique (spray)
side effects: nasal dryness, headache, drowsiness, mild irritation.
mast cell stabilisers (examples, advantages, disadvantages, side effects)
Cromolyn sodium, nedocromil
advantages:
- prevents allergic reaction by stabilising mast cells
- non drowsy
disadvantages:
- must be used regularly
- less effective for short term symptoms
side effects: nasal irritation, throat dryness, coughing, sneezing.
ocular antihistamines (examples, advantages, disadvantages, side effects)
olopatadine, ketotifen
advantages:
- targets eye symptoms directly
- fast acting and effective for seasonal allergies
disadvantages:
- requires proper administration
side effects: eye irritation, eye dryness, headache, bitter taste.
3 types of allergy tests
1) skin prick test
2) blood test (Specifically IgE test)
3) patch test
3 drug groups that trigger asthma
1) NSAIDs
2) B-blocker
3) ACE inhibitor
How do NSAIDs trigger asthma
moves arachidonic acid pathway towards increased production of leukotrienes, causing bronchoconstriction and air way inflammation.
How do beta blockers trigger asthma
blocks B2 adrenergic receptors on smooth muscle of airways, causing bronchoconstriction and airway inflammation.
How do ACE inhibitors trigger asthma
increased levels of bradykinin, may lead to airway irritation, coughing, exacerbating asthma.
how can smoking cause asthma
damage cilia
causing airways to become blocked
increasing breathing difficulty
what is formoterol
LABA
what is an example of MART
ICS/formoterol combo inhaleres
general asthma symptoms
wheezing
tight chest
shortness of breath
coughing
advantages of using a spacer
- reduces risk of side effects
e.g. voice change, oral thrush. - improved medication delivery
- portable
what is a “rescue pack”
short course of antibiotic and oral steroid.
what is status asthmaticus
severe prolonged asthma attack, doesn’t respond to bronchodilators
involves treatment with
- systemic corticosteroids
- intensive monitoring
- ventilation support
question about asthma
look at page 22 in resp study pack
copd treatment
1) saba/sama
2) LABA + ICS if asthmatic symptoms persist
or laba +lama if if no symptoms or refuse ics
3) LABA +LAMA + ICS
when lama is started..
sama stopped
example of labas
salmeterol
formoterol
indacaterol
olodaterol
example of lamas
tiotropium
aclidinium
umeclidinium
glycopyrronium
example of LABA + ICS
formoterol + beclomethasone (fostair)
salmeterol + fluticasone (Seretide)
formoterol + budesonide (Symbicort)
vilanterol + fluticasone furoate (relvar)
example of LABA + LAMA
Olodaterol + tiotropium (spiolto respimat
formoterol + aclidinium (duakliar genuair)
vilanterol + umeclidinium (anoro ellipta)
example of triple therapy (LAMA + LABA + ICS)
Glycopyrronium + formoterol + beclomethasone (trimbow)
umeclidinium + vilanterol + fluticasone furoate
( Trelegy)
example of sabas
albuterol
levalbuterol
terbutaline
example of samas
ipratropium bromide
oxitropium bromide
example of drug given for severe copd
roflumilast: PDE type 4 inhibitor
- recommended for FEV lower than 50%
can antibiotic be given to copd patients
yes if they do not smoke and if they have frequent sputum production
then azithromycin 250 mg x3 a week
what is treatment for respiratory failure associated with COPD exacerbation
NIV
non invasive ventilation
what to monitor for copd patients
ABG
pulse ox
big question page 50 on copd
page 50 copd question
co amoxiclav dose and directions to treat community CAP
625 mg tds for 5 days
if allergic then give tetracycline like doxycycline or macrolide like azithromycin
chain of events when TB bacteria is inhaled (mycobacterium tuberculosis)
1) bacilli inhaled into lungs
2) immune system stimulated and bacteria binds to macrophages.
3) activated t helper cells release interferon gamma, and the bacilli are ingested by alveolar macrophages
4) cytokines and inflammatory cells form granuloma containing macrophages
5) in 80% of cases, immune system kills bacteria.
however if not then: Granuloma breaks open, and dormant bacteria inside multiply leading to active TB.
symptoms of TB
cough
fever
weight loss
night sweats
fatigue
Shortness of breath
chest pain
haemoptysis (coughing up blood from lungs)
what test is done for pulmonary TB
chest x ray
sputum sample
latent TB test diagnosis
Either tuberculin skin test (TST) or interferon gamma release assay (IGRA)
what is TST
protein from Mycobacterium tuberculosis is injected into skin
if patient is infected, hypersensitivity reaction occurs
Disadvantages: patient ahs to return to have result checked
- previous vaccination against TB could lead to false positive result.
what is IGRA
blood test that uses mycobacterium tuberculosis antigens. Reduces chance of false positive result.
- test measures immune reactivity to tuberculosis.
ACTIVE TB TREATMENT
INTIAL PHASE: lasts 2 months combo of 4 drugs
- Rifamapicin
- Isoniazid
- Pyrazinamide
- Ethambutol
CONTINUATION PHASE:
- Rifampicin
- Isoniazid
- also pyridoxine is given to prevent isoniazid induced neuropathy.
Rifampicin
moa: Inhibits bacterial RNA polymerase, preventing bacterial DNA transcription.
Side effects:
- hepatoxicity
- rash
- orange red discolouration of urine
Isoniazid
moa: inhibits synthesis of mycolic acids, impairing growth of mycobacterium tuberculosis cell walls
Side effects:
- hepatoxicity
- peripheral neuropathy
- rash
Ethambutol
moa: inhibits arabinosyl transferase, impairing production of cell wall
Side effects: Optic neuritis, neuropathy, GI irritation
pyrazinamide
moa: converts into pyrazinoic acid, causing damage to cell wall
Side effects:
- Hepatoxicity
- hyperuricemia
- rash
- joint pain
page 71
TB question
what drugs used to treat covid
corticosteroids:
dexamethasone
6mg for 7-10 days
antiviral drugs:
Remdesivir, sotrovimab, paxlovid, molnupivarvir
