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Pre-reg Exam > Respiratory System > Flashcards

Respiratory System Flashcards

1
Q

How should spacers be cleaned and how often should they be replaced?

A

Once a month in mild detergent then allow to dry WITHOUT rinsing- clean mouthpiece.
Replace every 6-12 months

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2
Q

What are the aims of asthma treatment?

A 
No daytime symptoms
No night time waking
No need for rescue meds
No asthma attacks
No limits on exercise
Minimal side effects from medicines
Normal lung function FEV1 + PEF >80%
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3
Q

How is asthma managed in ADULTS?

Differentiate between NICE and BTS/SIGN guidance.

A

**SABA- salbutamol/ terbutaline throughout.

Step 1: Both say low dose ICS first

Step 2: NICE -add LTRA,
BTS/SIGN - add LABA

Step 3: NICE- increase ICS to med dose or add LABA
BTS/SIGN- increase ICS to medium dose or add LTRA/ SR theophylline/ LAMA

Step 4: NICE- increase ICS to high dose/ add SR theophylline / LAMA
BTS/SIGN- increase ICS to high dose/ add 4th drug.

BTS/SIGN also recommend immunosuppressant (methotrexate) and monoclonal antibodies under specialist for severe asthma in adults and children >6

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4
Q

When should you consider stepping up the asthma management ladder?

A

More than one SABA a month
More than 3 SABA doses a week
Waking at night due to asthma
Asthma attack in the last 2 years

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5
Q

What is the MART regimen?

A

Maintenance and reliever regimen.

That is when you combine an ICS with a LABA such as with fostair- the device is used both regularly and PRN.

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6
Q

Which are the monoclonals used in asthma?

What types of asthma are they licensed in?

A

Omalizumab- for IGE (allergic) asthma

Mepolizumab and reslizumab- for eosinophilic asthma

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7
Q

How is asthma chronic managed in children over 5?

Differentiate between NICE and BTS/SIGN guidance.

A
    • SABA throughout: salbutamol/ terbutaline
    • Child is <16 for NICE but <12 for BTS/SIGN guidelines

Step 1: Both say low dose ICS (BTS/SIGN call it very low)

Step 2: Add LTRA
BTS/SIGN say add LTRA/ LABA

Step 3: Add LABA/ increase ICS to paed mod dose
BTS/SIGN say add LTRA/LABA/MR theophylline/ increase ICS to low dose

Step 4: Add MR theoph/ increase ICS to paed high dose
BTS/SIGN say add LTRA/ MR theoph/ oral steroids/ increase ICS to paed mod dose.

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8
Q

How is asthma chronic managed in children under 5?

Differentiate between NICE and BTS/SIGN guidance.

A

** SABA throughout: salbutamol/ terbutaline

STEP 1:

NICE:
8 week trial of paed mod dose ICS
After 8 weeks:
-If symptoms don’t resolve- wrong diagnosis
-If symptoms recur in 4 weeks, start paed low dose ICS
-If symptoms recur beyond 4 weeks, repeat 8 week trial

BTS/SIGN
Start very low dose ICS (or LTRA if not tolerated)

STEP 2: Both say add LTRA

STEP 3: Both say stop LTRA and refer to specialist.

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9
Q

Can LABA (eterol) inhalers be used alone?

A

NO increased risk of asthma attacks

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10
Q

When should you consider stepping down asthma treatment?

A

Well controlled for at least 3 months

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11
Q

How should ICS inhalers be stopped?

A

Reduce by 25-50% each time- should be the last to be stopped.

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12
Q

What is classed as severe ACUTE asthma in adults?

Where should this be managed?

A

peak flow 33-50%
resp rate ≥ 25
heart rate ≥ 110
Unable to complete sentences

Manage in hospital

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13
Q

What is classed as life-threatening ACUTE asthma in adults?

A

peak fllow ≤ 33%
oxygen sats (SPO2) ≤ 92%
cyanosis, hypotension, arrhythmia, confusion

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14
Q

What is the treatment for acute asthma in adults?

A

oxygen to maintain sats between 94-98%
high dose SABA (nebs driven by oxygen)
oral pred 40-50mg/ IV hydrocortisone at least 5 days

If poor response to SABA: add ipratropium nebs
If life threatening, IV aminophylline/ magnesium

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15
Q

What is classed as severe asthma in children?

A

peak flow 33-50%
oxygen sats (SPO2) ≤ 92%
resp rate ≥ 40 (if 2-5 years) / ≥ 30 (if over 5 years)
heart rate ≥ 140 (if 2-5 years) / ≥ 125 (if over 5 years)

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16
Q

What is classed as life-threatening ACUTE asthma in children?

A

peak flow ≤ 33%

hypotension, confusion, exhaustion

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17
Q

What is the treatment for acute asthma in children over 2?

How does this differ in children under 2?

A

oxygen to maintain sats between 94-98%
high dose SABA (nebs driven by oxygen)
oral pred IV hydrocortisone at least 3 days

If poor response to SABA: add ipratropium nebs
If life threatening, IV aminophylline/ magnesium/ IV salbutamol

Aminophylline and magnesium should not be used in children under 2

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18
Q

What follow up should occur after a patient has had an acute asthma attack?

A

Written asthma action plan
GP informed with 24 hours of discharge

If severe/life threatening, follow up with respiratory specialist for at least a year.

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19
Q

How is chronic COPD managed?

A

Reliever: SABA/ SAMA

If FEV1 ≥ 50%
Step 1: LABA (eterol) /LAMA (ium)
Step 2 (if LABA chosen at step 1): LABA + ICS
Step 3: LAMA + LABA + ICS

If FEV1<50% (more ill)
Step 1: LAMA/ LABA+ICS (or LAMA+LABA)
Step 2: LAMA + LABA + ICS

If symptoms persist, MR theophylline can be trialled
If productive cough, try a mucolytic

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20
Q

How is acute COPD managed?

A 
Nebulised salbutamol/ipratropium
IV aminophylline if nebs dont work
Oral pred 30mg for 7-14 days
If signs of infection: amox/doxy/clarith 5 days
Oxygen
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21
Q

How should oxygen be given in patients at risk of hypercapnic respiratory failure?

What is the target oxygen sats?

A

24% or 28% venturi mask + an oxygen alert card stating what oxygen sats are needed during an exacerbation.

Oxygen must be 28% or less
target- 88-92%

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22
Q

When does long term oxygen therapy prolong survival in severe COPD?

A

If PaCO2 <7.3kPa

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23
Q

Which patient groups are at risk of hypercapnic respiratory failure?

A

COPD, severe CF, severe TB, opioid overdose

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24
Q

What is the main warning for patients on home oxygen?

A

No smoking- risk of fires

25
Q

What is croup? How is it treated?

A

Self-limiting disease
You get ‘barking cough’ that sounds like a seal, difficulty breathing, hoarse voice
Treatment: dex (0.15mg/kg) if child 3 months- 6 years, oxygen, if severe; adrenaline

26
Q

What are the side effects of inhaled LAMAs/ SAMAs?

A

The usual antimuscarinic side effects

Caution in bladder outflow problems and glaucoma.

27
Q

What should you be careful to do when administering ipratropium need?

A

Protect the eyes.

28
Q

What are the side effects of inhaled beta agonists SABA and LABAs?

A

HYPOkalaemia
tachycardia (palpitations)
tremor
HYPERglycaemia

29
Q

Can LABAs be used alone?

A

NO- only use once patient is already on an ICS

30
Q

What can reduce the efficacy of ICS?

A

Smoking (higher doses needed)

31
Q

What are the side effects of inhaled corticosteroids?

A

oral thrush, growth retardation in children, bronchospasm (discontinue drug), altered smell/ taste, vision issues, systemic steroid S/Es (to a lesser extent)

32
Q

What is the MHRA alert regarding ICS?

A

Rare risk of serious chorioretinopathy (eye related)

33
Q

What can the monoclonal antibodies used in asthma treatment increase the risk of?

A 
Helminth infections (such as threadworm and tapeworm) 
Treat before starting treatment.
34
Q

What can happen if theophylline is given too rapidly via IV?

A

arrhythmias

seizures

35
Q

What occurs in theophylline toxicity?

A

severe vommiting
tachycardia
restlessness
dilated pupils (mydriasis)

SEVERE: convulsions, arrhythmia, severe hypokalaemia

36
Q

What is the therapeutic levels for IV theophylline?

When should samples be taken for IV levels?

What about oral?

A

10-20mg/L

4-6 hours post dose

Oral: levels 4-6 hours post dose after 5 days of starting and 3 days after dose adjustments.

37
Q

What is urticaria?

A

hives

38
Q

What is pruritus?

A

itchy skin

39
Q

Which are the sedating antihistamines?

A

Alimemazine
promethazine
hydroxyzine

40
Q

Which are the less sedating (but still sedating) antihistamines?

A

chlorphenamine

cyclizine

41
Q

Which are the non-sedating antihistamines?

A

cetirizine
loratadine
fexofenadine
desloratadine, acrivistine, bizantine, mizolastine

42
Q

What is the treatment of anaphylaxis?

A

IM adrenaline 500 micrograms. Repeatable every 5 minutes.
Oxygen
IV fluids

Adjuncts: IV antihistamines (chlorphenamine)
IV steroids (hydrocortisone)

If respiratory function still bad, bronchodilators (salbutamol, ipratropium, aminophylline, IV magnesium)

43
Q

What are the renal dose adjustments associated with cetirizine?

A

AVOID if egfr <10ml/min

use half dose if egfr 30-50 ml/min

use half dose and on alternate days if egfr 10-30ml/min

44
Q

What are some issues associated with alimemazine use?

A

Lots of contraindications: epilepsy, Parkinson’s, glaucoma, liver and renal problems

Photosensitivity with high doses: avoid sunlight.

45
Q

What is the MHRA alert regarding hydroxyzine?

A

Risk of QT prolongation and torsade de pointes
Contraindicated in patients at risk of QT prolongation
Maximum dose 100mg OD in adults
Not for long term use

46
Q

Which systems of the body does CF affect?

A 
lungs
pancreas
liver
intestines
reproductive organs
47
Q

Is lumacaftor with ivacaftor recommended for use in patients with CF?

A

No

48
Q

How is p.aeruginosa infection managed in patients with CF?

A

oral antibacterials (IV if clinically unwell)
AND
inhaled antibacterials
1st line: nebuliser colistimethate
2nd line: colistimethate DPI
3rd line: nebuliser aztreonam/ tobramycin

49
Q

What type of treatment would be needed for infections of aspergillum?

A

antifungals as its a fungal thing.

50
Q

What should be done if a patient with CF gets recurrent infections?

A

Long term azithromycin.

If it keeps getting worse, switch to a steroid

51
Q

What other conditions can present in patients with CF and should be monitored for?

A

Osteoporosis

Diabetes

52
Q

How should pancreatic insufficiency be managed in CF?

A

Pancreatin (creon)

If signs of malabsorption continue, vitamins, an acid suppressant (PPIs) can all help.

53
Q

What drugs can be used as cough suppressants?

A

Codeine - constipating, lots of s/es, dependence.
Dextromethorphan
pholcodeine
sedating antihistamines

54
Q

What are demulcents? Which type of cough are they used for?

A

Soothing e.g syrup, glycerol, simple linctus

Dry coughs

55
Q

What is the MHRA alert regarding OTC coughs and cold medicines in children under 6?

A

They should not be given medicines containing:

Antihistamines
Cough suppressants
Expectorants
Decongestants- e.g ephedrine, xylometazoline

56
Q

What are expectorants? Which type of cough are they used for?

A

Guianfenesin

ipecacuanha

57
Q

What is recommended when selling cough + cold medicines to children 6-12?

A

Maximum 5 days treatment

Maximum one preparation sold at a time

58
Q

How is respiratory depression managed?

A 
Doxapram (IV only)
Ventilatory support (intubation) has largely replaced doxapram use.
59
Q

What is tiotropium licensed for?

A

COPD only

NOT asthma

Pre-reg Exam (15 decks)

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