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Medicine block (Y3) > Week 3: Respiratory medicine (1) (medication, acute respiratory presentationsand history taking) > Flashcards

Week 3: Respiratory medicine (1) (medication, acute respiratory presentationsand history taking) Flashcards

1
Q

name some sympathomimetics

A

short acting: salbutamol, terbutaline

SABA

long acting: foremeterol, salmeterol

LABA

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2
Q

main indication for sympathomimetics (salbutamol, formeterol)

A

bronchospasm

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3
Q

action of sympathomimetics

A

B2-selective adrenergic agonistst

  • increases cAMP in SMC resulting in relaxation and thus bronchodliation
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4
Q

side effects of symphathomimetics

A

tremor, headache, GI upset, palpitations, tachycardia, hypokalaemia

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5
Q

name some xanthines

A

aminophylline and theophylline

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6
Q

xanthines indication

A

asthma and COPD

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7
Q

action of xanthines

A

block phosphodiesterase resulting in decreased cAMP breakdown causing bronchodilation

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8
Q

common side effects of xanthines

A

headache, GI upset, reflux, palpitations, dizziness

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9
Q

name some antimuscarinics used in resp medicine

A

short acting: Ipratropium bromide(SAMA)

long acting: tiotropium bromide (LAMA)

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10
Q

action of antimuscarinics

A

muscarinic antagonist

  • decreases cGMP which affects intracellular calcium resulting in decreased SMC contractility
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11
Q

common side effects of antimuscarinics

A

dry mouth, constipation, cough, headache

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12
Q

name some inhaled steroids (glucocorticoids) used in resp medicine)

A

beclomethasone, budesonide, fluticasone

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13
Q

when are inhaled steroids indicated

A

asthma, COPD

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14
Q

action of inhaled steroids

A

increased airway calibre by decreasing bronchial inflammation +- modifying allergic reactions

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15
Q

common side effects of inhaled steroids

A

cough, oral thrust, unpleasant taste, hoarseness

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16
Q

name some corticosteroids

A

Inhaled

beclomethasone, budesonide

Oral

prednisolone (PO), hydrocortione (IV/IM), dexamethasone (PO/IV), triamclinolone (IM)

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17
Q

main indication of corticosteroids

A

suppress inflammation, allergy and immune responses

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18
Q

action of corticosteroids

A

alter gene transcription

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19
Q

side effects of coritcosteroids

A

adrenal suppression , hyperglycaemia, psychosis, insomnia, indigestion, mood swings, diabetes, cushinggoids appearance

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20
Q

general approach to acute resp presentation

A

call for help early + ABCDE

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21
Q

oxygen

A
  • It’s a drug
  • Needs prescribing
  • Aim for target sats
  • General principle – do ABG if sats <92%
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22
Q

types of oxygen masks

A

nasal cannula

venturi masks

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23
Q

when is high flow O2 used

A
  • Cardiac arrest
  • Severe resp failure
    • 76% or less with pneumonia
    • <85% with new resp failure
24
Q

controlled oxygen

A
  • Avoiding over-oxygenation
  • Minimum oxygen conc to achieve correct target sat
  • Evidence that over oxygenation can cause harm
25
Q

Case 1

give differentials and some further tests

A
  • Acute asthma
  • Acute bronchitis
  • Less like- pneumonia, foreign body, cardiac disease, PE

Further tests

  • PEFR (and predicted)
  • Blood pressure
  • RR
  • HR
  • O2 sats
  • ABG
  • CXR
26
Q

classify this asthma

A
  • Severe
    • 50% decrease PEFR
    • RR 28
    • Heart rate 115
    • Not talking in full sentences
  • Only need one of these to be classified as severe
27
Q

Peak expiratory flow rate measurement

A
28
Q

classification of asthma

A

mild/moderate

severe

life threateninf

Near fatal asthma- raise PaCO2- immediate requirement for ventilation

29
Q

Management if acute severe asthma

A
  • Controlled oxygen
  • Nebulised B2- agonist
    • Use O2 driven neb
    • Salbutamol 2.5-5mg
    • Every 15-30 mins depending on responds
  • Nebulised ipratropium bromide (give 0.5mg with salbutamol)
  • Steroids
    • PO prednisolone 40mg OD
    • IV hydrocortisone 200 mg ( if patient cant swallow)

Further management of acute severe

  • IV aminophylline
    • Patient on oral aminophylline/theophylline should never be given the loading dose
    • Other options e.g. IV salbutamol
  • IV magnesium sulphate
30
Q

management of anaphylaxis and angioedema

A

DO NOT DELAY AND GET HELP

  1. remove trigger, maintain airway, controlled oxygen (ABCDE)
  2. IM adrenaline 0.5mg (repeat every 5 mins)
  • Adult IM dose 0.5 mg IM (= 500 micrograms = 0.5 mL of 1:1000) adrenaline (epinephrine).
  1. IV hydrocortisone 200mg (corticosteroid)
  2. IV chlorpheniramine 10mg (antihistamine)
  3. if hypotensive: lie flat and fluid resus
  4. treat bronchospasm: neb salbutamol
  5. laryngeal oedema: neb adrenaline
31
Q

symptoms of anaphylaxis

A

occurs in minutes

pruritus, urticaria and angioedema

hoarseness, progressing to stridor and bronchial obstruction

wheeze and chest tightness from bronchospasm

32
Q

investigations for COPD exacerbation

A

CXR

ABG

blood tests: FBC, U and E, LFTs, blood culture

sputum culture

33
Q

management of acute COPD exacerbation

A
  • Sit the patient up
  • ABCDE approach
  • Controlled O2
    • Aim for 88-92% in COPD
    • If no evidence of Type 2 respiratory failure then aim for 94-98%
  • Nebulised bronchodilators (salbutamol and ipratropium)
  • Steroids
    • Prednisolone (PO)
  • Antibiotics – give if purulent sputum
  • If not improving
    • Consider IV aminophylline
    • Consider non invasive ventilation
    • Consider ITU if pH <7.25
    • Non invasive
34
Q

diagnose

A

pneumonia / lung cancer

35
Q

summarise pneumonia management

A

CURB-65

36
Q

diagnose

A

tension pneumo- haemodynamically unstable

→ X-ray should not have happened→ should be discovered before

37
Q

causes of haemoptysis

A

common: ifnection, brocnhiectasis, TB, lung abscess, aspergilloma, malignancy
rare: PE, systemic vasculitis, A-V malformation, arterial fistulae, cardiac causes (mistral stenosis)

38
Q

management of haemoptysis

A
  • maintain a patent airway, ABCDE
  • oxyegnation
  • place pt slightly head down in the lateral decubitus positon, lying on the side of the suspected lesion
  • determien cause, site and severity of bleeding
  • tranexamic acid
  • definitive therapy will depend on eact aetiology
39
Q

key PE risk factors

A
  • Surgery
  • obstetric: late pregnancy, caesarian section
  • lower limb: fracture, varicose veins
  • malignancy: abdominal/ pelvic, advanced/ metastatic
  • reduced mobility
  • previous proven VTE
  • unprovoked
40
Q

management of PE if haemodynamically stable

A
  • anticoagulation (assuming no contraindications) whilst waiting for CTPA
    • initial recommended treatment is apixaban or rivaroxaban (DOAC)
    • Low molecular weight heparin (LMWH) is an alternative where these are not suitable, or in antiphospholipid syndrome. It should be started immediately before confirming the diagnosis in patients where DVT or PE is suspected and there is a delay in getting the scan. Examples are enoxaparin and dalteparin.
  • ambulatory care
  • consider causes in cases f unprovoked PE
41
Q

management of PE if haemodynamically unstable

A
  • ABCDE approach 0 resus measures if eneded
  • thrombolysis should be cosnidered if a ‘massive PE’-→ consider without imaging if there is substantial clinical suspicion and hypotension +/- cardiac arrest imminent)
  • subsequent anticoagulation when stable
42
Q

classification of PE

A
  • Massive (high risk)
  • Submassive
  • Acute (stable/low risk)
  • Chronic
43
Q

presenting complaints resp

A
  • Dyspnoea
  • Chest Pain
  • Wheeze
  • Cough
  • Sputum
  • Haemoptysis
44
Q

HPC dyspnoea

A
  • MRC score, Exercise Tolerance, triggers, relieving factors, diurnal variation, orthopnoea, PND
  • how many pillows?
  • do you wake up in the night gasping for air?
45
Q

HPC chest pain

A
  • Chest Pain – site, severity, radiation, triggers, relieving factors, associated symptoms
  • cardiac or non-cardiac
46
Q

HOC wheeze

A
  • triggers, relieving factors, diurnal
  • variation, associated cough
47
Q

HPC Cough – dry or productive, triggers, relieving factors, diurnal variation, association with eating or dyspepsia, positional, nasal secretions, associated fever

A

dry or productive, triggers, relieving factors, diurnal variation, association with eating or dyspepsia, positional, nasal secretions, associated fever

48
Q

HPC sputum

A

how much over 24 hours, colour, consistency

49
Q

HPC haemoptysis

A

quantity and frequency, fever / night sweats, appetite, weight loss

50
Q

MRC dyspnoea score

A
51
Q

PMH resp

A

Past Medical and Surgical History (PMH)

  • All relevant
  • Asthma (previous hospitalisation / ITU)
  • COPD
  • DVT / PE
  • Nasal Polyps
  • Previous lung infections, including TB
  • Childhood lung infections
  • Surgery
  • Cardiovascular illness
  • Cancer
52
Q

DH resp

A
  • What drug
  • Dose
  • Frequency
  • Route
  • Patient Adherence
  • Also ask about over the counter drugs / herbal medicines
53
Q

Allergies history resp

A
  • If allergic to something – when and what reaction
  • Distinguish between allergy and side effects
54
Q

FH resp

A
  • Respiratory Disease
  • Cardiac disease
  • Cancer
  • Thrombophilia (if DVT / PE)
  • Cystic Fibrosis (if young and chest infections)
55
Q

Social History (SH) resp

A
  • Smoking – current (pack years), ex (pack years, when stopped), never or passive; also vaping
  • Occupational History – specifically asbestos
  • Pets – specifically cats, birds (budgies, parrots, pigeons) – also friends / neighbours
  • Recent Foreign Travel
  • Immobility – flights / long car or bus journeys Activities of daily living – self care, cooking, cleaning, shopping, type of accommodation, helpers / carers
  • Alcohol
  • Performance Status (Cancer)
56
Q

systems review

A
  • Bowels ok? Appetite / weight loss
  • Any problems with your water works?
  • Joint pains? Rashes?
  • Neuro / Cardio

Medicine block (Y3) (38 decks)

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