respiratory system Flashcards

1
Q

symptoms of COPD

A

breathlessness
cough
wheezing
sputum production
frequent LRTI

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2
Q

what is a low FEV1/FVC

A

lower than 0.7

forced expiratory vol in 1 second
forced vital capacity

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3
Q

what is CURB-65

A

score to assess severity of CAP

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4
Q

What does CURB-65 stand for

A

Confusion
Urea (greater than 7mmol/L)
Respiratory rate (greater than 30)
Blood pressure : 90/60 or lower
65 yrs or older

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5
Q

first choice antibiotic for CAP low severity

A

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.

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6
Q

first choice antibiotic for CAP moderate severity

A

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

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7
Q

First choice antibiotic for high severity CAP

A

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.

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8
Q

first choice antibiotic treatment for HAP

low severity

A

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.

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9
Q

first choice IV antibiotic if severity is high for HAP

A

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

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10
Q

cough suppressant example

A

Dextromethorphan

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11
Q

expectorant

example

A

Guaifenesin

helps treat dry cough with mucus

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12
Q

Decongestants
example

A

pseudoephedrine
phenylephrine

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13
Q

example of a SABA bronchodilator to treat asthma in kids ?

A

albuterol

pair with inhaled corticosteroid
e.g. fluticasone
to reduce inflammation.

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14
Q

Examples of non sedating antihistamines and advantages/disadvantages and side effects

A

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.

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15
Q

sedating antihistamines (examples, advantages, disadvantages, side effects)

A

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.
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16
Q

nasal corticosteroids (examples, advantages, disadvantages, side effects)

A

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.

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17
Q

nasal antihistamines (examples, advantages, disadvantages, side effects)

A

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.

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18
Q

mast cell stabilisers (examples, advantages, disadvantages, side effects)

A

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.

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19
Q

ocular antihistamines (examples, advantages, disadvantages, side effects)

A

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.

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20
Q

3 types of allergy tests

A

1) skin prick test
2) blood test (Specifically IgE test)
3) patch test

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21
Q

3 drug groups that trigger asthma

A

1) NSAIDs

2) B-blocker

3) ACE inhibitor

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22
Q

How do NSAIDs trigger asthma

A

moves arachidonic acid pathway towards increased production of leukotrienes, causing bronchoconstriction and air way inflammation.

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23
Q

How do beta blockers trigger asthma

A

blocks B2 adrenergic receptors on smooth muscle of airways, causing bronchoconstriction and airway inflammation.

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24
Q

How do ACE inhibitors trigger asthma

A

increased levels of bradykinin, may lead to airway irritation, coughing, exacerbating asthma.

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25
Q

how can smoking cause asthma

A

damage cilia
causing airways to become blocked
increasing breathing difficulty

26
Q

what is formoterol

27
Q

what is an example of MART

A

ICS/formoterol combo inhaleres

28
Q

general asthma symptoms

A

wheezing
tight chest
shortness of breath
coughing

29
Q

advantages of using a spacer

A
  • reduces risk of side effects
    e.g. voice change, oral thrush.
  • improved medication delivery
  • portable
30
Q

what is a “rescue pack”

A

short course of antibiotic and oral steroid.

31
Q

what is status asthmaticus

A

severe prolonged asthma attack, doesn’t respond to bronchodilators

involves treatment with
- systemic corticosteroids
- intensive monitoring
- ventilation support

32
Q

question about asthma

A

look at page 22 in resp study pack

33
Q

copd treatment

A

1) saba/sama
2) LABA + ICS if asthmatic symptoms persist
or laba +lama if if no symptoms or refuse ics

3) LABA +LAMA + ICS

34
Q

when lama is started..

A

sama stopped

35
Q

example of labas

A

salmeterol
formoterol
indacaterol
olodaterol

36
Q

example of lamas

A

tiotropium
aclidinium
umeclidinium
glycopyrronium

37
Q

example of LABA + ICS

A

formoterol + beclomethasone (fostair)

salmeterol + fluticasone (Seretide)

formoterol + budesonide (Symbicort)

vilanterol + fluticasone furoate (relvar)

38
Q

example of LABA + LAMA

A

Olodaterol + tiotropium (spiolto respimat

formoterol + aclidinium (duakliar genuair)

vilanterol + umeclidinium (anoro ellipta)

39
Q

example of triple therapy (LAMA + LABA + ICS)

A

Glycopyrronium + formoterol + beclomethasone (trimbow)

umeclidinium + vilanterol + fluticasone furoate
( Trelegy)

40
Q

example of sabas

A

albuterol
levalbuterol
terbutaline

41
Q

example of samas

A

ipratropium bromide
oxitropium bromide

42
Q

example of drug given for severe copd

A

roflumilast: PDE type 4 inhibitor

  • recommended for FEV lower than 50%
43
Q

can antibiotic be given to copd patients

A

yes if they do not smoke and if they have frequent sputum production

then azithromycin 250 mg x3 a week

44
Q

what is treatment for respiratory failure associated with COPD exacerbation

A

NIV
non invasive ventilation

45
Q

what to monitor for copd patients

A

ABG
pulse ox

46
Q

big question page 50 on copd

A

page 50 copd question

47
Q

co amoxiclav dose and directions to treat community CAP

A

625 mg 3 times a day for 5 days

if allergic then give tetracycline like doxycycline or macrolide like azithromycin

48
Q

chain of events when TB bacteria is inhaled (mycobacterium tuberculosis)

A

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.

49
Q

symptoms of TB

A

cough
fever
weight loss
night sweats
fatigue
Shortness of breath
chest pain
haemoptysis (coughing up blood from lungs)

50
Q

what test is done for pulmonary TB

A

chest x ray
sputum sample

51
Q

latent TB test diagnosis

A

Either tuberculin skin test (TST) or interferon gamma release assay (IGRA)

52
Q

what is TST

A

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.

53
Q

what is IGRA

A

blood test that uses mycobacterium tuberculosis antigens. Reduces chance of false positive result.

  • test measures immune reactivity to tuberculosis.
54
Q

ACTIVE TB TREATMENT

A

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.
55
Q

Rifampicin

A

moa: Inhibits bacterial RNA polymerase, preventing bacterial DNA transcription.

Side effects:
- hepatoxicity
- rash
- orange red discolouration of urine

56
Q

Isoniazid

A

moa: inhibits synthesis of mycolic acids, impairing growth of mycobacterium tuberculosis cell walls

Side effects:
- hepatoxicity
- peripheral neuropathy
- rash

57
Q

Ethambutol

A

moa: inhibits arabinosyl transferase, impairing production of cell wall

Side effects: Optic neuritis, neuropathy, GI irritation

58
Q

pyrazinamide

A

moa: converts into pyrazinoic acid, causing damage to cell wall

Side effects:
- Hepatoxicity
- hyperuricemia
- rash
- joint pain

59
Q

page 71

A

TB question

60
Q

what drugs used to treat covid

A

corticosteroids:
dexamethasone
6mg for 7-10 days

antiviral drugs:
Remdesivir, sotrovimab, paxlovid, molnupivarvir