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Module 5 > Treatments W1-4 > Flashcards

Treatments W1-4 Flashcards

1
Q

Asthma first line

A

Short acting b2 agonists (PRN) and inhaled corticosteroids (BDS)

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2
Q

Examples of SABAS

A

Salbutamol and terbutaline

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3
Q

Examples of ICS

A

Beclometasone, budesonide, fluticasone propionate, fluticasone furoate

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4
Q

Second line treatment asthma

A

SABA, ICS and LABA - fixed dose or MART

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5
Q

Examples of LABAS

A

Salmeterol and formoterol

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6
Q

Third line asthma

A

Consider increasing ICS to medium dose or adding a LTRA. If no response to LABA consider stopping

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7
Q

Monoclonal antibodies in asthma MOA

A

Eg, omalizumab. Binds to IgE inhibiting it’s action

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8
Q

When monoclonal antibodies are used

A

When high dose ICS and LABA don’t work. Used by specialists.

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9
Q

When are oral steroids used in asthma

A

To control exacerbations of asthma

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10
Q

Examples of leukotriene receptor antagonists

A

Montelukast and zafirlukast

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11
Q

Bronchitis

A

Adequate analgesia and hydration. ABx not usually required, if necessary, amoxicillin or doxycycline

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12
Q

Bronchiolitis

A

helping baby to sleep - raising head with pillow, hydration. Supplementary oxygen and fluids if hospitalised

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13
Q

SABA MOA

A

Activate beta2-adrenergic receptors on airway smooth muscle - increases cAMP. cAMP activates protein kinase A - inhibits phosphorylation of myosin and lowers calcium concentrations. Relaxing smooth muscle.

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14
Q

LABA MOA

A

Stimulates intracellular adenyl cyclase - catalyses production of ATP –> cAMP. Increased cAMP relaxes smooth muscle and inhibits release of histamine and leukotrines.

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15
Q

Ultra-long B2 agonists

A

Antagonist of muscarinic receptors M1, M3 and M5. Inhibition of M3 receptor in smooth muscle of the lungs leads to relaxation and bronchodilation

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16
Q

Corticosteroids MOA in asthma: beclometasone, budesonide, fluticasone, propionate..

A

Inhibit leukocyte infiltration at site of inflammation and suppress humeral responses. Increase anti-inflammatory mediators. Reduce eosinophils, macrophages, lympophocytes.

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17
Q

Corticosteroids MOA in asthma: umeclidinium bromide and vilanterol

A

Stimulates adenyl cyclase - increases cAMP. Causes relaxation of smooth muscle and inhibits release of inflammatory mediators - histamine and leukotrienes

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18
Q

Anti-leukotrienes - Montelukast MOA

A

Leukotriene receptor antagonists – prevents release of inflammatory mediators and pro-inflammatory cells

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19
Q

Anti-leukotrienes - Zileuton MOA

A

Lipoxygenase inhibitors - Inhibits augmentation of neutrophil and eosinophil migration, neutrophil and monocyte aggregation, leukocyte adhesion, increased capillary permeability, and smooth muscle contraction by blocking synthesis of leukotrienes.

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20
Q

Monoclonal antibodies MOA

A

Inhibits the binding of IgE to the high-affinity IgE receptor on the surface of mast cells and basophils. The reduction in surface-bound IgE reduces release of mediators - histamine. Reduces availability of circulating IgE for binding.

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21
Q

What is a MART - maintenance and reliever therapy

A

A combined LABA and corticosteroid - way of ensuring that the improved symptom control brought about by use of LABA does not result in the neglect of inhaled corticosteroid.

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22
Q

Example of MART

A

Symbicort - formoterol LABA and Budesonide ICS

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23
Q

Fostair MART components

A

beclometasone (ICS) and formoterol (LABA)

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24
Q

Relvar MART components

A

fluticasone duroate (ICS) and vilanterol (LABA)

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25
Q

Management of associated problems with asthma - gastroesophageal reflux disease

A

PPI - omeprazole

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26
Q

Management of associated problems with asthma - allergic rhinitis

A

Nasal corticosteroids

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27
Q

COPD ongoing treatment

A

SMOKING CESSATION. Patient education and vaccination. Try and manage symptoms with bronchodilators - short or long acting, corticosteroid, anticholinergics, pulmonary rehabilitation, LTOT

28
Q

Surgical interventions for COPD

A

bullectomy (removal of large air sacs from destroyed alveoli), lung volume reduction surgery (remove diseased portions of lung so healthier parts can function better), endobronchial valves, transplantation

29
Q

What is an endobronchial valve

A

One-way valve inserted into a bronchiole - air can flow out of valve during exhalation, but not in during inhalation. Aids expiration in areas of lung where there is hyperinflation due to lack of elasticity - emphysema. When an emphysematous area of lung delates and collapses, there is more room for healthier lung to expand.

30
Q

Mild chest wall abnormality management

A

physical therapy - exercises can improve posture and ability of chest to expand

31
Q

Severe chest wall abnormality management

A

Cosmetic surgery to rebuild chest

32
Q

Acute exacerbation of IPF

A

High-dose cotricosteroid (prednisolone) + or - cytotoxic therapy

33
Q

Ongoing treatment of IPF

A

antifibrotics, smoking cessation, oxygen therapy, + pulmonary rehabilitation, those with GORF PPI, lung transplant

34
Q

Anti-fibrotic examples

A

pirfenidone or nintedanib

35
Q

Non-specific interstitial pneumonia

A

Many respond to corticosteroids with or without immunosuppressants

36
Q

Cryptogenic organising pneumonia - rare and not associated with smoking

A

Corticosteroids - relapse may occur if dose lowered

37
Q

Desquamative interstitial pneumonia - vast majority heavy smokers

A

Cessation of smoking and corticosteroids

38
Q

Occupational asthma

A

Identify and remove cause. Protective devices. Standard management of asthma to reduce symptoms

39
Q

Berylliosis - beryllium - causes non ceasating granulomas

A

Prednisolone. Oxygen therapy, pul rehabilitation

40
Q

Chronic silicosis (silicon dioxide dust inhalation)

A

smoking C, removal of exposure. Cough medicine, bronchodilators, and oxygen therapy if needed

41
Q

Siderosis (iron and oxides inhalation)

A

removal of exposure, manage symptoms

42
Q

Acute silicosis

A

Lung lavage

43
Q

Coal workers lung

A

remove exposure. manage symptoms - oxygen therapy, bronchodilators..

44
Q

Asbestosis

A

supportive care, pulmonary rehabilitation, +/- oxygen therapy. End stage - transplants

45
Q

What does pulmonary rehabilitation include

A

Exercise training for endurance and muscle strength, nutritional counselling (loosing weight), education about disease and management, techniques to save energy, breathing strategies (maximising oxygen intake), counselling

46
Q

Acute sarcoidosis

A

Prednisolone, for low o2 sats <88% ventilatory support and oxygen

47
Q

Chronic sarcoidosis

A
  1. Prednisolone 2.+cytotoxics (methotrexate) and oxygen (low sats) 3. lung transplant
48
Q

Hypersensitivity pneumonitis

A

identification and avoidance of antigen, acute - corticosteroids, chronic - ongoing low dose corticosteroids

49
Q

Type 1 respiratory failure

A

High flow O2 (35-60%) via facemask, if PO2 remains 60% consider assisted ventilation. Target 94-100%. Manage underlying condition

50
Q

Type 2 respiratory failure

A

O2 therapy - start at 24%, check PaCo2 if stable increase oxygen, non-invasive (positive pressure) ventilation. Target 88-94%. Manage underlying condition

51
Q

When long-term oxygen therapy is introduced

A

COPD with PaO2 <7.3 when breathing in state of clinical stability. COPD with PaO2 7.3-8 with presence of secondary diseases (peripheral oedema, polycythaemia..). Severe chronic asthma PaO2<7.3. Interstitial lung disease PaO2<8. Pts with PaO2 8 disabling dyspnoea.

52
Q

Spontaneous pneumothorax bilateral with perfusion failure (haemodynamically unstable)

A

Chest drain

53
Q

PrimaryPTX - 2cm and/or breathless

A

Aspirate. Unsuccessful - chest drain.

54
Q

PrimaryPTX - less than 2cm and not breathless

A

Discharge - review in two-four weeks

55
Q

SecondaryPTX - >2cm or breathless

A

Chest drain

56
Q

SPTX - size 1-2cm

A

Aspirate. Unsuccessful - chest drain

57
Q

SPTX - size <1cm and not breathless

A

Admit. High slow oxygen observe for 24 hours

58
Q

Pulmonary embolism

A

Begin LMWheparin. Once diagnosis confirmed, begin warfarin (takes 48 hours to have anticoag effect so continue heparin for this time). INR is measured - dose adjusted to keep it within 2-3. Warfarin treatment continued 3-6months after 1st episode

59
Q

Drugs that enhance the action of warfarin

A

NSAIDS - aspirin. Erythromycin

60
Q

Drugs that reduce the action of warfarin

A

carbamazepine (anti-convulsant) and barbituates

61
Q

Acute massive PE in haemodynamic collapse

A

Thrombolytic therapy -

62
Q

DVT

A

Elasticated compression stockings, leg exercises. Prophylactic low dose heparin.

63
Q

Malignancy related pleural effusions

A

Management of underlying tumour, drainage will solve dyspnoea, pleurodesis

64
Q

Infection related pleural effusion

A

early chest drain - ABx for infection - beware risk of empyema

65
Q

Empyema

A

culture results pending - empirical ABx cefuroxime or ceftriaxone AND metronidazole or clindamycin
Specific ABx when known chest drain

66
Q

Severe empyema doesn’t respond to ABx or chest drain

A

video-assisted thoracoscopic surgery. ~30% require surgery.

Module 5 (6 decks)

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