Tx of LRTI

Question 1

How long does acute bronchitis take to resolve?

Answer 1

1-3 weeks. Symptoms are self-limited

Question 2

Non-pharmacological Tx of acute bronchitis

Answer 2

Nonpharmacologic options for cough relief such as throat lozenges,
hot tea, honey, steam inhalation, adequate hydration and/or smoking
cessation or avoidance of second-hand smoke is a reasonable first
step.

Question 3

3 types of cough preparations

Answer 3

Antitussives
Mucolytics
Expectorants

Question 4

What should you exclude in a pt with acute bronchitis?

Answer 4

Exclude underlying bronchiectasis or acute exacerbation of chronic bronchitis

Question 5

What are the signs and symptoms of acute on chronic bronchitis? (5)

Answer 5

wheeze
* breathlessness
* tightness of the chest
* respiratory distress
* cough

Question 6

T/F bronchospasm is fully reversible with COPD

Answer 6

F. It is partially reversible

Question 7

Explain the Mx of acute exacerbations of chronic bronchitis

Answer 7

1. Regular doses of short acting bronchodilators (SABA, SAMA)
   -short acting muscarinic agonist
2. Supplemental Oxygen (24-28%)
3. Oral corticosteroids: Prednisone, PO, 30mg daily for 5 days

Question 8

What is the management of acute INFECTIVE exacerbation of chronic bronchitis?

Answer 8

Amoxicillin, oral, 8 hourly for 5 days.
Doxycycline PO for 5 days if severe pen allergy.
(Pt must take full glass of water when taking Doxycyclin)

Question 9

Name two structures of Influenza found that are important in influenza

Answer 9

It is has neuraminidase and haemagglutinin

Question 10

Name 2 drugs that act as Neuraminidase inhibitors?

Answer 10

Oseltamivir
Zanamivir (Inhalor formulation)

Question 11

When should Oseltamivir Tx be initiated?

Answer 11

Initiate tx within 24-48 hours of onset of symptoms reduce duration by less than 1 day

Question 12

List pt groups that are high risk for influenza

Answer 12

Pregnant women
Immunocompromised children <2

Question 13

Who is eligible for influenza PEP?

Answer 13

PEP only for high-risk close contacts (within 48 hours of exposure)

Question 14

Adverse effects of Oseltamivir

Answer 14

N&V (report of fatal neuropsychiatric AEs)

Question 15

How is the influenza vaccine formulated?

Answer 15

2 strains from influenza A and 1 or 2 strains from Influenza B

Question 16

Who is eligible for the influenza vaccine? (6)

Answer 16

-Pregnant women
-HCWs
-HIV+ pts
-Elderly (>65yrs)
-Residents of Old age homes
-Chronic care facilities

Question 17

How long does the vaccine take to become effective?

Answer 17

Takes 2-3 weeks

Question 18

AEs of influenza vaccine

Answer 18

uncommon, myalgia, fever, headache and nausea

Question 19

Contraindications of influenza vaccine

Answer 19

known hypersensitivity to egg protein

Question 20

In the treatment of Covid-19, Which drug is recommended for pts requiring supplemental O2 or on mechanical ventilation

Answer 20

Dexamethasone

Question 21

Which drug is recommended for venous thromboembolism prophylaxis dosing is
recommended for all hospitalised patients?

Answer 21

Heparin

Question 22

Which drug is recommended for pts requiring only supplemental oxygen+

Answer 22

Baricitinib

Question 23

What is the vital signs criteria for mild covid-19 infection?

Answer 23

SpO2≥95% on room air
* Respiratory rate <25
* Heart rate <120
* Temp 36-39°C
* Mental status normal

Question 24

What is the vital signs criteria for severe covid-19 infection?

Answer 24

• Breathless at rest or while talking
• Respiratory rate ≥ 25
• BP < 90/60
• Pulse rate > 120
• Confused or agitated
• Unable to walk without help
• Oxygen saturation < 95%
• Coughs ≥ 1 tablespoon fresh blood

Question 25

What are the signs of tension pneumothorax?

Answer 25

• Sudden breathlessness, more resonant/decreased breath sounds/pain on 1
  side, deviated trachea, BP < 90/60: tension
  pneumothorax likely

Question 26

What medications need to be given to COVID patients?

Answer 26

Analgesics & Antipyretics
Thromboprophylaxis
Corticosteroids

Question 27

What analgesic medication should you give to a patient with covid-19?

Answer 27

Paracetamol is more recommended than NSAIDs

Question 28

List corticosteroids options recommended for pt with covid and are on supplemental O2. Give dosage instructions and duration of use as well. (5)

Answer 28

Dexamethasone 6mg daily for 10 days
* OR
* Betamethasone 6mg (po/iv) for 10 days
* OR
* Prednisone 40mg PO daily for 10 days
* WHO recommended equivalents
* OR
* Hydrocortisone 50 mg IV TDS
* OR
* Methylprednisolone 8 mg QID or 16 mg BD PO or IV

Question 29

List medications that can can be used for thromboprophylaxis in pts with COVID-19

Answer 29

Unfractionated heparin
Low molecular weight heparin (Dalteparin and enoxaparin)

Question 30

Give 2 side effects of heparins

Answer 30

Bleeding, heparin induced thrombocytopenia (HIT)

Question 31

What is the MOA of heparins?

Answer 31

Inactivates thrombin & factor Xa through antithrombin III activation

Question 32

Dosage of enoxaparin for hospitalized pts?

Answer 32

40mg SC daily

Question 33

What is the dosage of unfractionated heparin in hospitalized patients?

Answer 33

5000 units SC 12 hourly