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Pre-reg revision > Respiratory System > Flashcards

Respiratory System Flashcards

1
Q

What side effects are associated with older antihistamines?

A

More sedation

More anti-muscarinic side effects

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2
Q

What are some older (sedating) anthistamines?

A
  • Promethazine
  • Chlorphenamine
  • Cyclizine
  • Hydroxyzine
  • Alimemazine
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3
Q

Which antihistamines are MOST sedating?

A

Promethazine + alimemazine

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4
Q

What are some newer antihistamines (less sedating)?

A
  • Cetirizine
  • Loratidine
  • Fexofenadine
  • Acrivastine
  • Desloratidine
  • Mizolastine
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5
Q

Why do the newer antihistamines have less sedation + psychomotor impairment?

A

Less penetration of the BBB

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6
Q

Which antihistamines are used to treat N+V?

A

Cyclizine, promethazine, cinnarizine

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7
Q

Which antihistamines are used to treat insomnia?

A

Promethazine, diphenhydramine

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8
Q

In what conditions are antihistamines cautioned?

A
  • Benign prostatic hyperplasia (BPH) - risk of urinary retention
  • Glaucoma - raised intraocular pressure
  • Liver impairment - sedation can precipitate hepatic coma
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9
Q

What are the risks associated with hydroxyzine?

A

Risk of QT prolongation and torsades de pointes

  • contra-indicated in patients with risk of QT prolongation
  • Short term use only
  • Max dose 100mg/day
  • Avoid in the elderly, max dose 50mg/day
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10
Q

How should anaphylaxis be treated in the community (medical emergency)?

A
  1. Secure the airway and maintain the BP
    (lay flat and raise legs or recovery position if vomiting)
  2. Administer adrenaline by IM injection
  3. Repeat adrenaline every 5 mins if necessary
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11
Q

Doses of adrenaline for anaphylaxis?

A

Adult - 500mcg
Child 6-12 - 300mcg
Child <6 - 150mcg

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12
Q

Risk for patients on beta blockers with anaphylaxis?

A

Patients on B-blockers may not respond to adrenaline

Consider treatment with a bronchodilator eg, IV salbutamol

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13
Q

How is adrenaline administered?

A

IM inj
Middle of the thigh
Can be given through clothes inc. jeans

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14
Q

When are mucolytics (eg, carbocisteine) contra-indicated?

A

In peptic ulcers

Mucolytics disrupt gastric mucosa

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15
Q

What do MHRA advise should NOT be given OTC to children under 6 with cough?

A

Antihistamines - chlorphenamine, promethazine, diphenhydramine, doxylamine, triprolidine, brompheniramine
Cough suppressants - pholcodeine, dextromethorphan
Expectorants - guaifenesin, ipecacuanha
Decongestants - psuedoephedrine, ephedrine, oxymetazoline, xylometazoline

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16
Q

What advice should be given to patients about care of spacers?

A
  • Clean once a month with mild detergent and allow to air dry
  • Frequent cleaning should be avoided as electrostatic charge can affect drug delivery
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17
Q

Which patients should be advised to use a spacer?

A
  • All under 15s with inhalers
  • Patients with high dose ICS
  • Children under 5 should have a spacer with face mask
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18
Q

What is a sign of poorly controlled asthma that needs urgent assessment?

A

Use of >1 SABA inhaler per month

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19
Q

Outline the stepwise treatment of asthma in adults?

A

All patients should have a SABA, step up if using >3 times/week
1. Regular preventer - low dose ICS
2. Initial add-on - LABA (with ICS)
3. Additional add-on
If no benefit from LABA - stop + increase ICS
Benefit + poor control - continue LABA + med ICS
Benefit + poor control - continue LABA + ICS + fourth drug
4. High dose therapy - high dose ICS or addition of fourth drug (LTRA, theophylline, oral B2 agonist)
5. Regular oral steroid

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20
Q

How long are the short acting beta agonists duration of action?

A

3-5 hours

salbutamol / terbutaline

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21
Q

How long are the long acting beta agonists duration of action?

A

12 hours, used BD

salmeterol, formoterol, vilanterol

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22
Q

‘LABAs should not be initiated in rapidly deteriorating asthma’
True or false?

A

True

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23
Q

Which is NOT a side effect of beta agonists?

  • Hypokalaemia
  • Hypotension
  • Hand tremors
  • Bradycardia
  • Arrythmias
A

Bradycardia - they may cause tachycardia

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24
Q

Which inhaled corticosteroid is not taken BD?

A

Ciclesonide - OD

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25
Q

Which ICS inhalers are NOT interchangeable as potency differs between brands?

A

Beclometasone

QVAR is twice as potent as Clenil - half dose should be used

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26
Q

What is in a Fostair inhaler?

A

Beclometasone + formoterol

Extra fine particles - more potent

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27
Q

What ages is QVAR licensed in?

A

12+

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28
Q

What ages is beclometasone easyhaler licensed in?

A

18+

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29
Q

What are the side effects of ICS?

A
  • Hoarse voice/sore throat

- Oral candidiasis

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30
Q

‘Smoking can effect inhaled corticosteroids’

True or false?

A

True - reduces the effectiveness so higher doses may be needed

31
Q

‘ICS are associated with the risk of paradoxical bronchospasm’
True or false?

A

True - can be offset by giving SABA before a dose

32
Q

Low dose of clenil is 100mcg 2 puffs BD, what is the equivalent dose of QVAR?

A

Beclometasone

50mcg 2 puffs BD

33
Q

What drugs are in Flutiform inhalers and what do they look like?

A

Fluticasone + formoterol

MDI - orange

34
Q

What drugs are in Fostair inhalers and what do they look like?

A

Beclometasone + formoterol
Pink
MDI or nexthaler = DPI

35
Q

What drugs are in a Symbicort inhaler and what do they look like?

A

Budesonide + formoterol

Turbohaler (cyclinders) - DPI

36
Q

What drugs are in a Duoresp inhaler and what do they look like?

A

Budesonide + formoterol

Green or Blue DPI

37
Q

What drugs are in a Seretide inhaler and what do they look like?

A

Fluticasone + salmeterol
Evohaler - purple MDI
Accuhaler - purple, round DPI

38
Q

What drugs are in a Relvar inhaler and what do they look like?

A

Fluticasone + vilanterol

Yellow ‘egg shape’ DPI

39
Q

Which is ciclesonide not used first line?

A

More expensive but fewer oropharangeal side effects

40
Q

Outline the treatment of asthma in children

A

All patients should have SABA
1. Regular preventer- Very low ICS (paed dose) or if UNDER 5 - LTRA
2. Initial add-on therapy - very low dose ICS + LTRA (under 5) OR LABA (over 5)
3. Additional add-on therapy
No response to LABA - stop + incr ICS to low dose
Benefit + poor control - continue LABA + ICS to low dose
Benefit + poor control - LTRA + ICS + LABA
4. High dose therapy - ICS to medium dose or add theophylline
5. Oral steroid tablets

41
Q

Which is the only LAMA licensed in asthma?

A

Spiriva respimat

42
Q

What are the leukotriene receptor antagonists and how do they work?

A

Montelukast + Zafirlukast

Reduce bronchoconstriction and inflammation

43
Q

When should montelukast be taken?

A

In the evening

3-4 hours to peak plasma conc, worse symptoms at night

44
Q

Which asthma oral drugs are associated with Churg-Strauss syndrome?

A

LTRA - montelukast + zafirlukast

Associated esp after withdrawal of oral steroids

45
Q

What are the signs of Churg-Strauss syndrome?

A

Eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, peripheral neuropathy

46
Q

What is a major side effect/caution of Zafirlukast?

A

Risk of liver toxicity

Patients should report signs of liver toxicity such as N+V, jaundice, abdo pain, itching

47
Q

What are the xanthines?

A

Theophylline + aminophylline

48
Q

What is the target plasma concentration of theophylline?

A

10-20 mg/L

49
Q

When should theophylline levels be taken?

A

Sample taken 4-6 hours post dose

Take levels 5 days after initiation or 3 days after dose changes

50
Q

What may increase the concentrations of theophylline/aminophylline?

A 
Liver impairment - metabolised by liver
Heart failure
Viral infections
Elderly
Enzyme inhibitors
51
Q

What may decrease the concentrations of theophylline/aminophylline?

A

Smoking
Alcohol
Enzyme inducers

52
Q

‘Theophylline and aminophylline should always be prescribed by brand’
True or false?

A

True

53
Q

What are the signs of theophylline toxicity?

A

FAST + SICK

  • Nausea, vomiting, GI disturbance
  • Tachycardia, CNS stimulation (agitation, restlessness, mydriasis)
  • Arrythmias, convulsions
  • HYPOkalaemia
  • Hyperglycaemia, heamatemesis
54
Q

Can theophylline be used in pregnancy?

A

Yes- xanthines can be used in pregnancy/breastfeeding but may cause neonatal irritability

55
Q

Can aminophylline be given IM?

A

No - too irritant

56
Q

Do patients who take oral theophylline need a loading dose with IV aminophylline?

A

No

57
Q

How should weight-based doses for aminophylline be calculated?

A

Using IBW if appropriate

58
Q

Which medicines interact with theophylline + aminophylline?

A
  • Risk of hypokalaemia - loop/thiazide diuretics, B2 antagonists, corticosteroids
  • Risk of convulsions - quinolones
  • Enzyme inhibitors (conc incr) - macrolides, CCBs, phenytoin, fluconazole
  • Enzyme inducers (conc dec) - Rifampicin, St johns wort
59
Q

How should an acute asthma attack be treated in the community?

A
  • Give a salbutamol inhaler via large vol. spacer, 2-10 puffs every 10-20 mins PRN
  • Give O2 driven SABA nebs every 20-30mins if possible
  • If symptoms persist over 15-30 mins call 999
60
Q

Are steroids always needed post-asthma attack?

A

Yes - prednisolone or IV hydrocortisone
Children - 3 days
Adults - min 5 days (40-50 mg)

61
Q

What is the NICE (in the BNF) stepwise treatment for COPD?

A
  1. SABA (at all stages) or SAMA
  2. If FEV >50% - LABA or LAMA
    If FEV <50% - LAMA or LABA + ICS
  3. Triple - LABA + LAMA + ICS
62
Q

What drug is a short-acting muscarinic antagonist?

A

Ipratropium

63
Q

How regularly are SAMAs usually used?

A

3-4 times per day

64
Q

Name some long-acting antimuscarinics?

A
  • Tiotropium
  • Glycopyrronium
  • Aclidinium
  • Umeclidinium
65
Q

How long do SAMAs take to work?

A

Onset 30-60 mins

Duration of action 3-6 hours

66
Q

In which conditions should inhaled antimuscarinics be used with caution?

A

Benign prostatic hyperplasia - risk of urinary retention

Glaucoma - increased intraocular pressure

67
Q

What are the side effects of inhaled antimuscarinics?

A
  • Dry mouth

- Paradoxical bronchospasm

68
Q

When can LABAs be used ALONE?

A

For treatment of COPD

In asthma only licensed with ICS

69
Q

Which LABAs can be used in COPD?

A
  • Formoterol
  • Salmeterol
  • Vilanterol
  • Olodaterol
70
Q

What drug is in a Seebri inhaler?

A

Glycopyrronium 55mcg

Orange + white DPI

71
Q

What drug is in an incruse ellipta inhaler?

A

Umeclinidium 55mcg

Grey egg w. green lid

72
Q

What drug is in an Anoro ellipta inhaler?

A

Umeclinidium with vilanterol

Grey egg w. pink lid

73
Q

What drug is in an Ultibro breezhaler inhaler?

A

Glycopyrronium with indacterol

Yellow + white DPI

Pre-reg revision (14 decks)

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