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September lectures yr 3 (2018) > Respiratory therapeutics > Flashcards

Respiratory therapeutics Flashcards

1
Q

What happens in asthmas and what are the symptoms?

A

bronchospasm - rapid onset,

symptoms - SOB, cough, wheeze and chest tightness (>1)

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2
Q

What is a key characteristic in terms of diagnosis of asthma?

A

variation in airflow obstruction throughout the day

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3
Q

What can late onset asthma be mistaken for?

A

HF or COPD

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4
Q

What factors in adults make it more likely to be a diagnose of asthma over HF/COPD?

A 
Symptoms are worst at night or following exercise/cold exposure 
History of atopy
FHx of asthma 
Wheeze on auscultation 
Low FEV1 or PEFR 
Raised eosinophils
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5
Q

What factors in adults makes it less likely to be asthma?

A 
dizziness, light headedness or tingling 
productive cough without wheeze or SOB
Normal examination and PEFR when symptomatic 
voice disturbance 
symptoms with colds only 
smoking history 
cardiac disease
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6
Q

What are triggers for asthma?

A

likely multifactorial

  • allergens - dust mite and pollen
  • drugs - aspirin and beta blockers
  • occupational factors - isocyanates, wood resin, dyes
  • environmental factors - cold air, emotion and exercise
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7
Q

What are the general principles of treating asthma?

A

avoiding triggers
treating inflammation with steroids, blocking inflammatory mediates with leukotriene antagonists and preventing bronchospasm using beta 2 agonists

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8
Q

What is the aim of asthma treatment?

A

no daytime symptoms, no night time awakenings due to symptoms, no need for rescue medication, no exacerbations, no limitations on activities and normal lung function (FEV1/PEFR>0.8)
All controlled with minimal drug side effects

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9
Q

What is the key aim of the stepwise approach to asthma treatment?

A

achieve disease control with minimal intervention

Control is maintained by stepping up treatment when necessary or stepping down when control is good

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10
Q

What are the 4 stages asthma?

A

1) minimal intermittent asthma
2) regular preventer therapy
3) initial add on therapy
4) persistent poor control

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11
Q

How is minimal intermittent asthma treated?

A

short acting beta-2 agonist (salbutamol, terbutaline)- PRN for rapid bronchodilation
Selective B2 agents only used PRN or before anticipated symptoms (before exercise)

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12
Q

What can high doses of beta 2 agonists cause?

A

no specific contraindications with minimal SE

high dose can cause tremor, tachycardia and hypokalemia

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13
Q

What can be done if a patient inhaler technique is poor?

A

teach them proper technique or it can be delivered by nebulizers, IV or orally

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14
Q

What is regular preventer therapy?

A

inhaled corticosteroids - beclometasone, fluticasone or budesonide
taken usually by inhaler twice a day at the lowest dose appropriate to the severity of asthma

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15
Q

When are inhaled corticosteroids prescribed to patients?

A

when they have had exacerbations in the last 2 years, have symptoms requiring short acting beta 2 agonist use >2/week and/or have symptoms at least one night/week

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16
Q

What are the adverse effects of inhaled corticosteroids?

A

osteoporosis at high doses, growth suppression in children, sore throat and oral thrush
thrush =common and can be reduced by using a spacer or brushing teeth after inhaler use - treated using antifungaloral suspensions or lozenges

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17
Q

What are the initial add on therapies?

A

long acting selective beta-2 agonists (salmeterol or formoterol) - long duration of action of around 12 hours- relief of reversible airway obstruction

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18
Q

What should long acting selective beta 2 agonists (LABAs) be taken with?

A

alongside corticosteroids and can sometimes be given as a combination inhaler (seretide = salmeterol+fluticasone)

19
Q

When asthma is persistently poorly controlled what treatments are offered?

A

1st is a leukotriene receptor antagonist = montelukast or zafirlukast (oral - prophylaxis) - given particularly in exercise induced or aspirin induced - can be added to inhaled steroids if not responsive to LABAs

20
Q

What are the adverse effects of leukotriene antagonists?

A

hypersensitivity and GI upset

21
Q

Other than leukotriene antagonists what else can be used for poorly controlled asthma?

A

xanthine derivative e.g. modified release theophylline - limited use due to potential drug interactions and narrow therapeutic index

22
Q

What are the adverse effects of xanthine derivatives?

A

cardiac arrhythmias and seizure

23
Q

What are some of the common reasons people have poor asthma control?

A

poor compliance
- could be due to poor understanding or treatment, complicated regime, psychological or physical stress
May also have poor technique
Presence of triggers e.g. smoking, occupational factors, allergens
diagnosis of asthma may be wrong (GORD, COPD or bronchiectasis)

24
Q

On examination of an acute severe asthma attack what is noted?

A

patient unable to complete sentences
chest will be quiet with high heart rate (>110) and resp rate (>25)
PEFR <0.5 predicted and they will easily tire and become dehydrated

25
Q

What treatment is given for an acute severe asthma attack ?

A

OSHITME

  • high flow oxygen
  • salbutamol or terbutaline (nebulizer)
  • hydrocortisone IV (100mg)/oral predisolone (40-50mg)
  • ipratropium bromide (every 4-6 hours via nebulizer)
  • theophylline
  • magnesium (+ also intravenous b2 agonists)
  • escalate
26
Q

What should be given to a patient following an acute asthma attack?

A

nebulizers and steroids over next few days

Also important to establish reason behind attack (technique, compliance or infection)

27
Q

What happens in asthma FUs?

A

usually at GPs with specialist asthma nurses

- adjust medications and check PEFR and symptom

28
Q

What are the bronchodilators in asthma treatment?

A

b2 agonists
PDE inhibitors (aminophylline)
anticholinergics (ipratropium bromide)

29
Q

What are the anti-inflammatories in asthma treatment?

A

sodium chromoglycate (stabilise mast cells)
inhaled corticosteroids (beclomethasone)
Leukotriene receptor antagonists (montelukast)
anti-igE (omalizumab)

30
Q

What people is COPD diagnosis most common?

A

middle aged and elderly smokers

31
Q

What are the symptoms of COPD?

A

Productive cough, alongside increase dyspnoea

32
Q

What factors are looked at assessments of COPD?

A

How much bronchospasm, infection and emphysema the patient has as well as checking for signs of R HF

33
Q

What are the 3 main groups of drug treatments for COPD?

A

1) Inhaled bronchodilators
2) inhaled corticosteroids
3) oral bronchodilators (theophylline)

34
Q

What inhaled bronchodilators are used in COPD?

A

Short or long acting B2 agonists or short or long acting antimuscarincs

35
Q

What is tiotropium?

A

long acting antimuscarinc - not used in preference of regular short acting antimuscarinics (ipratropium)
used alongside short acting B2 agonists in stage 2 treatment or long acting B2 agonists and corticosteroids in stage 3

36
Q

Other than the 3 main treatments for COPD what other medications are commonly used?

A

antibiotics when required

annual flu vaccination and pneumococcal vaccination

37
Q

When are mucolytics used?

A

carbocisteine is used for chronic productive cough

38
Q

When are diuretics used in COPD?

A

Later stages given for HF and oxygen therapy should be given for resp failure

39
Q

What is an essential lifestyle change in COPD?

A

Smoking cessation

40
Q

What is particle proportional to ?

A 
to deposition therefore smaller particles are deposited deeper into the lungs 
>10micrometers = mouth to large airways 
<5 micrometers = small airways
<2micrometers = alveoli
<1micrometers - may be exhaled again
41
Q

What is a common form of inhaler and why?

A

metered dose inhalers - easy to carry around and each actuation contains a measured dose

42
Q

What is the main issue with metered dose inhalers?

A

often people have poor technique as it requires coordination

43
Q

Why are spacer devices used?

A

commonly used with metered dose inhalers because they reduce risk of adverse effects, no longer requires coordination
Less convenient to carry around and reduce amount of medication absorbed

44
Q

How do nebulizers work?

A

use compressed air or ultrasonic energy to produce aerosolized particles of around 1-5 micrometers in size
only 10% of the prescribed dose actually reaches the lungs

September lectures yr 3 (2018) (56 decks)

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