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mpharm year 3 sem 2 > week 9 > Flashcards

week 9 Flashcards

1
Q

how long does a persons asthma need to be well controlled for before it would be appropriate to reduce ICS dose?

A

6 months

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2
Q

which class of asthma would a patient who’s PEFR is 50-75% of their best- what would we do with their treatment?

A

moderate asthma
- increase regular therapy, or step up therapy if required

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3
Q

how is severe asthma classified? (4)

A

one of
- PEFR 33-50% of their best
- unable to talk in sentences due to breathlessness
- respiratory rate 25 or more
- pulse of 110 or more

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4
Q

how would we treat severe asthma (5)

A
  • refer to hospital- may not always need admission
  • oxygen 40-60% via venturi mask
  • oral corticosteroid (prednisolone 40mg/day)
  • nebulised SABA - salbutamol
  • nebulised SAMA if required- ipatropium
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5
Q

how is life threatening asthma classified?

A

severe asthma and one of the following
- altered consciousness
- exhaustion
- arrhythmia
- hypotension
- cyanosis (blue lips etc)
- silent chest (shows no movement of air in the chest)
- poor respiratory effort

PEFR- less than 33% of best
oxygen less than 92%

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6
Q

how would we manage life threatening asthma?

A
  • hospital admission
  • nebulised beta antagonist and ipatropium- driving by oxygen
  • oral corticosteroid (prednisolone)
  • oxygen therapy
  • IV aminophylline, salbutamol or terbutaline
  • IV fluids and electrolytes- especially potassium
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7
Q

treatment for mild COPD exacerbation?

A

short acting bronchodilator (salbutamol)

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8
Q

treatment for moderate COPD exacerbation? (3)

A

salbutamol and antibiotics (normally amoxicillin, but can use doxycycline or clarithromycin if required) and/ or oral corticosteroid

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9
Q

treatment for severe COPD exacerbation?

A

admission to hospital may be required
- possible acute Respiratory failure so need monitoring for this

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10
Q

name 5 signs of a COPD exacerbation

A
  • increased breathlessness
  • increased cough
  • increased sputum volume or purulence- also might be a yellow/ green colour if infection
  • increased wheeze
    -increased tightness in chest
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11
Q

why should nebulisers be driven by air and not oxygen in COPD exacerbations?

A

the patients body may be used to a low level of oxygen- if it suddenly increases very high the patient will stop breathing as their body thinks they have enough- COPD patients tend to breath to get oxygen rather than ‘normal’ people who breath to get rid of CO2

associate with type 2 respiratory failure

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12
Q

why is raising cAMP good?

A

inhibits inflammation- turns on anti inflammatory pathway, turns off pro inflammatory pathways

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13
Q

name 4 cell mediated effects of PDE4 inhibition

A
  • smooth muscle relaxation
  • TNF alpha release
  • T cell proliferation
  • chemotaxis
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14
Q

name 5 positive characteristics of roflumilast

A
  • good bioavailability (~80%)
  • reduced accumulation of neutrophils
  • improved lung function in COPD patients
  • few side effects
  • weight loss associated
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15
Q

what is roflumilast?

A

a PDE4 inhibitor

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16
Q

how many chiral centres are in a steroid backbone structure?

A

6

17
Q

which corticosteroids maintain salt balance and water retention?

A

mineralcorticosteroids

18
Q

what do all biologically active adrenocorticoids require?

A

a 3-keto group and 4,5 unsaturation

19
Q

name 4 reasons why tobacco is addictive

A
  • nicotine changes brain chemistry
  • dopamine reward pathway
  • behaviour- situations linked with tobacco use
  • emotional- becomes coping mechanism
20
Q

social cognitive theory??

A

focuses on the role of observing and learning from others and on positive and negative reinforcement of behaviours

21
Q

name 3 nicotine withdrawal symptoms- why is it important to be aware of these?

A
  • irritability
  • sleepiness
  • anxiety
  • anger
  • sadness
  • restlessness
  • insomnia

so we can make patients aware and help them cope with these symptoms- we can offer help and support of dealing with them

22
Q

what are the 5 Ds of coping with nicotine withdrawal ?

A

delay
distract
drink water
deep breaths
discuss

23
Q

what makes a person suitable for NRT?

A

need to be nicotine dependent meaning
- having their first cigarette within 30 mins or waking
or
- smoke 10 or more cigarettes per day
or
- have craving and/or withdrawal symptoms in previous quit attempts

24
Q

how does theophylline work?

A
  • inhibits phosphodiesterase 3- which relaxes smooth muscle in the airways
  • inhibits phosphodiesterase 4- which reduces mediator release form alveolar macrophages
  • increases apoptosis of inflammatory neutrophils ad T cells
25
Q

name 3 signs of theophylline toxicity

A
  • nausea
  • vomiting
  • headache
  • tachycardia
  • termour
  • diuresis
  • seizures
  • rhabdomyolysis
  • arrhythmias
26
Q

what is the target concentration for theophylline

A

10-20mg/L- for bronchodilator
5-15mg/L for anti- inflammatory and steroid sparing

27
Q

name 4 interactions which can increase clearance of theophylline

A
  • cigarette smoking
  • rifampicin
  • carbamazepine
  • phenytoin
28
Q

name 6 intercations which can reduce clearance of theophylline

A
  • clarithvmycin
  • erythromycin
  • ciprofloxacin
  • diltiazem
  • cardiac failure
  • severe COPD
  • liver cirrhosis
29
Q

what treatment can be given in community for an asthma attack?

A

while waiting on ambulance/ going to hospital
give salbutamol via volumatic spacer

30
Q

ONAP for COPD treatment?

A

Oxygen
- (start with 24%, can be increased to 28% via Venturi mask)
- maintain O2 saturation between 88-92%

Nebuliser
- SABA+/- SAMA- use air not oxygen

Antimicrobials
- amoxicillin - 1st line
- doxycycline or clarithromycin can be used if required

Prednisolone
- 30mg/ day for 7 days - can be increased to 14 days if required

mpharm year 3 sem 2 (11 decks)

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