Wk 4: cardioresp

Question 1

peak flow meter measures

Answer 1

maximum speed of expiration

Question 2

variants that can affect peak flow

Answer 2

sex
age
height

Question 3

complete control of asthma =

Answer 3

no daytime symptoms 
no night-time awakening 
no asthma attacks 
no need for rescue medications 
no limitations on activities 
normal lung function

Question 4

first line treatment of asthma =

Answer 4

short acting beta 2 agonist

Question 5

when do you step up from SABA to ICS (4)

Answer 5

• inhaled SABA more than 3x per week
• symptomatic 3x per week
• night waking 1x/ week
• asthma attack in last 2 years

Question 6

role of spacer

Answer 6

slows down speed of aerosol coming from inhaler so less drug impacts back of mouth

Question 7

what receptor do beta agonists work on

Answer 7

beta adrenergic coupled to stimulatory G protein of adenylyl cyclase

Question 8

2nd line asthma treatment

Answer 8

inhaled corticosteroids

Question 9

SE of inhaled corticosteroids

Answer 9

thrush

hoarseness

Question 10

initial add on therapy to SABA and ICS in asthma

Answer 10

Leukotriene receptor antagonist or LABA

Question 11

e.g of leukptriene receptor antagonist

Answer 11

motelukast

Question 12

2 LABAs

Answer 12

salmetrol

formoterol

Question 13

which LABA is a partial agonist and slower bronchodilator

Answer 13

salmeterol

Question 14

formoterol=

Answer 14

LABA full agonist -rapid onset

Question 15

how is a LABA usually added in asthma

Answer 15

combined steroid LABA inhaler

Question 16

moderate asthma=

Answer 16

PEFR > 50-75% predicted

Question 17

acute severe asthma=

Answer 17

perf 33-50%
RR >25
HR >110
inability to complete sentences

Question 18

life threatening asthma=

Answer 18

• change in consciousness
• exhaustion
• arrhythmia
• hypotension
• cyanosis
• silent chest
• PEF <33%
• SpO2 <92%
• PaO2 <8
• normal PaCO2

Question 19

near fatal asthma=

Answer 19

raised PaCO2 and or requiring mechanical ventilation

Question 20

acute asthma treatment

Answer 20

non-rebreather mask with 12-15L/min

Question 21

when is a non-rebreather mask indicated

Answer 21

critically ill patients

Question 22

what FiO2 can non-rebreather deliver

Answer 22

80%

Question 23

life-threatening asthma treatment

Answer 23

SABA -nebuliser 
ipratropium bromide 
hydrocortisone 
magnesium sulfate 
aminophylline IV 
IV fluids

Question 24

SE of beta 2 agonists (7)

Answer 24

tremor 
tachycardia 
arrhythmia 
ketoacidosis 
hypokalaemia 
hyperglycaemia 
headache

Question 25

ipratropium=

Answer 25

antimuscarinic bronchodilator

Question 26

when is magnesium sulfate used in acute asthma

Answer 26

when peak flow <50%

Question 27

aminophylline=

Answer 27

theophylline and ethylenediamine | methylxantine bronchodilator

Question 28

SE of theophylline

Answer 28

tachycardia arrhythmia N and V

Question 29

O2 therapy aim in acute asthma

Answer 29

92-95%

Question 30

first line COPD

Answer 30

SAMA or SABA as required

Question 31

COPD >50% FEV treatment

Answer 31

LABA or/ | LAMA (stop SAMA)

Question 32

COPD <50% FEV 1

Answer 32

LABA + ICS or/ | LAMA (stop SAMA)

Question 33

COPD with persistent exacerbations after treatment with LABA /LAMA/ ICS

Answer 33

LAMA + LABA +ICS combo

Question 34

roflumilast=

Answer 34

selective long-acting inhibitor of phosphodiesterase 4

Question 35

use of roflumilast

Answer 35

adjunct to bronchodialtors in severe COPD associated with chronic bronchitis

Question 36

non pharma steps for COPD

Answer 36

stop smoking | vaccination

Question 37

spO2 target in COPD with hypoxic drive

Answer 37

88-92%

Question 38

haldane effect=

Answer 38

deoxygenation of blood increased hemoglobins ability to carry CO2 --> increased O2 by supplemental O2 displaces CO2 molecules increasing CO2 in blood

Question 39

in the alveoli what happens when oxygen tensions decrease

Answer 39

pulmonary capillary vasoconstriction (hypoxic pulmonary vasoconstriction)

Question 40

treatment for patients with an episode of hypercapnic respiratory failure

Answer 40

24 --> 28% venturi

Question 41

in most acutely ill patients what is aim o2 sats

Answer 41

94-98%

Question 42

Carbon monoxide poisoning aim =

Answer 42

100%

Question 43

patients at increased risk of hypercapnic resp failure

Answer 43

88-92%

Question 44

in acute severe asthma what is CO2 usually

Answer 44

subnormal

Question 45

in deteriorating acute severe asthma what can happen in CO2

Answer 45

may rise steeply

Question 46

what is the treatment for deteriorating asthma with rising CO2 levels

Answer 46

high conc O2 and intermittent positive pressure ventilation if PaCO2 remains high

Question 47

hypercapnic respiratory failure more common in

Answer 47

``` COPD advanced CF Severe kyphoscoliosis Severe lung scarring MSK disorder opioid/ drug overdose ```

Question 48

how to control oxygen in hypercapnic RF

Answer 48

28% of less venturi titrated up until O2 88-92%

Question 49

hypercapnic RF SpO2 <85% -->

Answer 49

non-rebreather mask

Question 50

range of venturi masks

Answer 50

24-60%

Question 51

nasal cannula used when

Answer 51

small amounts of oxygen are required without rigid control of respiration

Question 52

flow rate of nasal cannula

Answer 52

up to 5L/min

Question 53

O2 conc of nasal cannula

Answer 53

28-44%

Question 54

rates above 5L in a nasal cannula cause

Answer 54

discomfort drying nasal passage nose bleeds

Question 55

does long term oxygen therapy (LTOT) prolong survival

Answer 55

yes if used 15/day at least

Question 56

LTOT used when

Answer 56

chronic COPD with chronic Hypoxemia

Question 57

acute severe COPD exacerbation treatment

Answer 57

- bag valve mask 85% flow rate 12-15L - non-invasive ventilation - nebulisers - consider IV steroids, IV theophylline and antibiotics

Question 58

what is non-invasive ventilation

Answer 58

ventilatory support without using invasive artificial airway