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Clinical therapeutics 1 > Respiratory therapeutics 1 > Flashcards

Respiratory therapeutics 1 Flashcards

1
Q

Define asthma

A
  • An inflammatory disease of the airways
  • Recurrent reversible airways obstruction
  • Hyper-secretion of mucus by bronchial epithelial cells
  • Infiltration of mast-cells and eosinophils
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2
Q

What is causing asthma?

A
  • Not clear - genetics? enviroment? both?
  • Factors increase chance to develop condition: family history of asthma, born premature, occupational exposure
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3
Q

How is asthma diagnosed?

A
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4
Q

Non-pharmacological advice to manage chronic asthma

A
  • Avoid asthma triggers: smoking, pollen, dust, foods, clean house
  • Healthy lifestyle: regular exercise, healthy weight, control heartburn
  • Education intervention: personalised action plan
  • Relaxation and breathing exercises
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5
Q

Pharmacological treatment of asthma?

A
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6
Q

Mechanism of action: B2 adrenoreceptors

A
  • They activate b2 adrenergic receptors in airway smooth muscle
  • Cause airway smooth muscle relaxation by dependent mechanisms (or independent)
  • Depending on if its SABA or LABA
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7
Q

Mechanism of action: Difference between SABA LABA

A
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8
Q

Advantages and disadvantages of b2 adrenoreceptor agonists

A

Advantages:
* Allow reduction of corticosteroid dose
* Reduction of symptoms and improvement of lung
function
Disadvantages:
* Increase risk of asthma exacerbation, hospitalization, death

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9
Q

Adverse effects of b2 adrenoreceptor agonists

A
  • ‘off target’ effect - e.g. increase in heart rate, hypokalemia, tremor
  • Ill-defned b2 AR mediated effects - increased mortality, high risk of exacerbation
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10
Q

Mechanism of action: Glucocorticoids

A
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11
Q

Examples of glucocorticoids used in asthma treatment

A
  • Inhaled is an ICS
  • Prednisolone is a steroid treatment
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12
Q

Glucocorticoids; adverse effects

A
  • With long term use theres many AE
  • Weight gain
  • Thinning of skin
  • Changes of mood
  • Limb atrophy
  • Infection
  • Diabetes mellitus
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13
Q

LTRA mechanism of action

A
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14
Q

Mechanism of action: muscarinic acetylcholine receptors

A
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15
Q

Examples of muscarinic acetylcholine receptors

A
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16
Q

Side effects of muscarinic receptor antagonists

A
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17
Q

Muscarinic antagonist-b2-agonist MABA: mechanism of action

A
  • Dual pharmacology molecule combining the mAChR antagonist and β2-AR agonist moieties into a single molecule
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18
Q

Xanthines name some examples

A
  • Aminophyline given under orders of senior staff
  • IV drip
19
Q

Mechanism of action: xanthines

A
20
Q

Xanthines side effects

A
  • Nausea
  • Vomiting
  • Gastric irritation
  • Diarrhoea
  • Palpitations
  • Insomnia
21
Q

Severe presistent allergic asthma treatment
Anti-IgE mechanism of action

A
22
Q

Acute asthma treatment

A
  • High dose inhaled SABA
  • Steroids - oral like prednisolone or iv hydrocortisone
  • Supplementary oxygen to main pO2 94-98%
  • Nebulised ipratromium bromide (muscarinic acetylcholine receptors)
  • Magnesium sulfate or aminophylline
23
Q

Compare clinical features of COPD and asthma

A
24
Q

How to diagnose COPD

A
25
Q

Treatment for COPD - step by step approach

A
  • First offer non pharmacological support e.g. no smoking, vaccines
  • Then start inhaled therapy if these didnt work
26
Q

What are the main aims when providing treatment for COPD

A
  • Prevent and control symptoms
  • Reduce the frequency and severity of exacerbations
  • Improve general health status
  • Improve exercise tolerance
27
Q

Non pharmacological treatment for DOPD

A
  • Stop smoking
  • Self management plan
  • Treatment for comorbidities
  • Vaccinations
28
Q

COPD treatments: brinchodilating vs anti inflammatory

A
29
Q

Define pneumonia

A
  • Inflammation of the lung parenchyma (lower respiratory tract) of infective origin characterised by consolidation (radiographic shadowing)
30
Q

What causes pneumonia

A

bacteria treated with antibiotics

31
Q

How do we classify pneuomonia

A
32
Q

Risk factors for community acquired pneumonia CAP

A
  • Age: under 2s and 65+
  • Living/working in nursing home or children
  • Smoking including passive
  • Preexisting pathological conditions: COPD, stroke, CV disease
  • Influenza
  • Hospitilsation
33
Q

Clinical features of CAP - common symptoms

A
  • Cough*
  • Temperature > 38°C*
  • Sputum production
  • Breathlessness, wheeze or chest discomfort*
  • Feeling generally unwell
    Uncommon:
  • Night sweats
  • Dyspnea
34
Q

Diagnosis of CAP in primary care

A
  • Acute illness ≤21days
  • Cough
  • At least ONE ‘symptom’ of lower respiratory tract infections
35
Q

Severity assessment of CAP

A
36
Q

CAP diagnosis in hospital

A
37
Q

Antibiotic treatment

A
38
Q

Patient with low-severity community-acquired pneumonia (treated at home)

A
  • 5-day course of a SINGLE antibiotic
    Amoxicillin 500 mg 3 times a day for 5 days
  • If allergic or pregnant: deoxycline or clarithromycin
39
Q

Patient with suspected moderate severity CAP (in hospital)

A
  • 5-day course of DUAL ORAL antibiotic
  • Amoxicillin 500 mg/3 times WITH clarithromycin 500 mg/2 times a day
  • If allergic or pregnant: doxycline 200mg on first day then 100mg for four days
  • Or clathromycin 500mg twice a day for 5 days
40
Q

Patient with suspected high-severity CAP (in hospital)

A

5-day course of DUAL ORAL OR IV antibiotic
Co-amoxiclav WITH clarithromycin

41
Q

What is hospital acquired pneuonmnia HAP

A

Defined as pneumonia that occurs 48 hours or more after hospital admission and is not incubating at hospital admission

42
Q

Risk factors of HAP and causes

A
43
Q

How is HAP diagnosed

A

Chest xray

44
Q

Treatment of HAP

A

Clinical therapeutics 1 (25 decks)

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