respiratory unit 1 Flashcards
what could asymmetrical obstruction be due to?
the nasal cycle
which drugs contribute to drug induced rhinitis?
ACE inhibitors ▪ beta blockers, especially topical ocular preparations used to treat glaucoma ▪ chlorpromazine ▪ aspirin and NSAIDs ▪ methyldopa ▪ oral contraceptives ▪ alpha blockers
where does the nose receive blood from?
external and internal carotid arteries which form anastamoses with each other
when is intranasal drug delivery suitable?
Drug has low oral bio availability, is potent (volume of less than 1ml), for chronic use or when rapid onset is needed
main symptoms of a URTI
Blocked/running nose, clear discharge which becomes thick and yellow/green after 2-3 days, fever, cough, feeling unwell
when is a follow up needed for a URTI?
After 3-4 days if symptoms are worsening OR after 7-14 days if symptoms are persisting
what is the most common oral decongestant and what age is it licensed for?
pseudo ephedrine for over 6 years
who are decongestants not recommended for?
children, pregnant women, breastfeeding women, people with HTN, pts taking MAOIs
name 2 more potent sympathomimetic drugs and what age are they licensed for?
xylometazoline AND oxymetalozine for over 12 years
when is it illegal to supply pseudoephedrine and ephedrine?
more than 720mg of Pseudoephedrine OR more than 180mg ephedrine without a prescription OR combination exceeding these amounts OR both in one transaction
what is echinacea?
used for prevention of cold symptoms
what is pholcodine and who is it licensed for age?
cough suppressant for over 6 years
what is citric acid formulated as?
simple linctus
what is benzoin tincture?
friars balsam - aromatic inhalation
when does influenza A usually occur?
in epidemics and is more virulent
what are strains of influenza typed and named according to?
Antigen - site and year first identified and haemagglutinin (N) and neuraminidase(N) type
what is the incubation period for influenza?
1-5 days (usually 2-3 days)
which age group usually has shorter and milder symptoms of influenza?
children
how is influenza differentiated from other symptoms?
sudden onset of symptoms, fever over 38 degrees, muscle aches and pains, cough (>90% patients report this)
when should oseltamivir be given and what age is it licensed for?
1 + and when influenza is circulating in the community, for post-exposure prophylaxis for at risk adults, who have been in close contact with someone suffering from influenza AND given within 48hrs
when should zanamivir be given and what age?
5+ and for severly immunocompromised patients, when oseltamivir can not be used or when resistance to oseltamivir is suspected
what are major pandemics of influenza A associated with?
antigenic drifts
unless contraindicated the live influenza vaccine is administered which is called? and for what age?
fluenz tetra in children 2-17 years
what is often the first presenting symptom in a common cold?
sore throat
what is glandular fever caused by and who is it most common in?
epstein-barr virus and common in 15-25 years young adults
what criteria helps predict the likelihood of bacterial throat infection?
feverPAIN and centor criteria
what might sore throat be an early indicator of?
medication-induced blood disorder
what age is strefan licensed for?
flurbiprofen and for 12 +
what age are beechams max strength sore throat relief licensed for?
7+
what age are strepsils licensed from?
6+
how long does a acute URTI-associated cough resolve within?
3 weeks
what symptom associated with a cough should NOT be considered an indication for a referral alone?
coughing up green purulent sputum
What age is simple linctus (citric acid 2.5%) licensed from?
12+
How does hypertrophy of the adenoid contribute to paediatric rhino-sinusitis cases?
blocks airflow to the nose leading to insufficient ventilation of the sinuses
What are risk factors/causes of rhino sinusitis?
colder climates, increases in damp environment, smoking, high levels of pollution, dental infections
What age are 85% of patients diagnosed with rhino-sinusitis?
16-65 years
When does rhino-sinusitis cause headache or facial pain?
when there is an acute bacterial infection with blockage of sinuses
What are the two main classifications of nasal polyps?
ethmoidal and antrochoanal
Where do antrochoanal polyps usually arise from?
maxillary sinus and usually unilateral
Who are nasal polyps more common in?
more common in men than women BUT in asthma where it is equal in males and females
Management for nasal polyps?
Flixonase nasules (400g) for an initial two weeks before changing to Flixonase spray (50g) as a maintenance medication.
What sprays are alternatives to nasal douching?
sterimar spays and products such as NeilMed sinus rinse
Who is AOM more common in?
common in boys, children who attend nursery, those who are formula fed, have craniofacial abnormalities (for example, cleft palate or Down’s syndrome), who are exposed to passive smoking, children under 10
Who may A/B be neccessary for in AOM?
babies under 3 months old, children under 2 years
with bilateral AOM, patients whose symptoms have lasted >72 hours, those with systemic symptoms, if ear drum perforation, for those who are immunocompromised or have CF
otoscopic examination of AOM?
bulging tympanic membrane, red yellow or cloudy tympanic membrane with LOSS of tympanic membrane land marks
what is primarily responsible for nasal blockages in allergic rhinitis?
Leukotrienes and cytokines attract and activate eosinophils to cause allergic inflammation, which is primarily responsible for nasal blockage
what is the role of eosinophils in allergic rhinitis?
Eosinophils contain aggressive proteinaceous mediators that stimulate sensory neurones to increase the production of neuropeptides which act on special venous capacitance vessels causing dilatation and nasal blockage.
why should first generation antihistamines be avoided in allergic rhinitis?
penetrate easily into the CNS where histamine causes arousal and alertness- - so FGAH cause drowsiness and poor attention so use SGAH which penetrate less well into the brain
how do antihistamines work?
do not block H1 receptor but they cause a change in the receptor driving equilibrium to inactive state - INVERSE AGONISTS
what is a disadvantage of mizolastine?
SGAH - can cause QT prolongation
what age is chlorphenamine licensed for?
allergy - >1 years
cough - >6 years
what is cyclizine used for?
motion sickness, nausea and vomiting
how do corticosteroids reduce inflammation?
by interacting with a specific steroid receptor
in the cytoplasm of a cell, and the steroid receptor then moves into the cell nucleus where it influences protein synthesis
what is lipocortin?
corticosteroids synthesise this protein which inhibits breakdown of phospholipids to arachidonic acid which inhibits formation of PGs and LTs
what is the main excipient is sodium cromoglicate?
benzalkonium chloride
how often should sodium cromoglicate be used?
four times a day
what may symptoms of vasomotor rhinitis be triggered by?
stress, hormonal changes, environmental factors, occupational irrtants, hot or spicy foods
who is vasomotor rhinitis common in?
over 20 years
when can hormonal rhinitis occur?
menstruation, puberty, pregnancy and in hypothyroidism
