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PPT > Wk 4: cardioresp > Flashcards

Wk 4: cardioresp Flashcards

1
Q

peak flow meter measures

A

maximum speed of expiration

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2
Q

variants that can affect peak flow

A

sex
age
height

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3
Q

complete control of asthma =

A 
no daytime symptoms 
no night-time awakening 
no asthma attacks 
no need for rescue medications 
no limitations on activities 
normal lung function
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4
Q

first line treatment of asthma =

A

short acting beta 2 agonist

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5
Q

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

A
  • inhaled SABA more than 3x per week
  • symptomatic 3x per week
  • night waking 1x/ week
  • asthma attack in last 2 years
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6
Q

role of spacer

A

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

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7
Q

what receptor do beta agonists work on

A

beta adrenergic coupled to stimulatory G protein of adenylyl cyclase

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8
Q

2nd line asthma treatment

A

inhaled corticosteroids

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9
Q

SE of inhaled corticosteroids

A

thrush

hoarseness

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10
Q

initial add on therapy to SABA and ICS in asthma

A

Leukotriene receptor antagonist or LABA

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11
Q

e.g of leukptriene receptor antagonist

A

motelukast

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12
Q

2 LABAs

A

salmetrol

formoterol

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13
Q

which LABA is a partial agonist and slower bronchodilator

A

salmeterol

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14
Q

formoterol=

A

LABA full agonist -rapid onset

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15
Q

how is a LABA usually added in asthma

A

combined steroid LABA inhaler

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16
Q

moderate asthma=

A

PEFR > 50-75% predicted

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17
Q

acute severe asthma=

A

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

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18
Q

life threatening asthma=

A
  • change in consciousness
  • exhaustion
  • arrhythmia
  • hypotension
  • cyanosis
  • silent chest
  • PEF <33%
  • SpO2 <92%
  • PaO2 <8
  • normal PaCO2
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19
Q

near fatal asthma=

A

raised PaCO2 and or requiring mechanical ventilation

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20
Q

acute asthma treatment

A

non-rebreather mask with 12-15L/min

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21
Q

when is a non-rebreather mask indicated

A

critically ill patients

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22
Q

what FiO2 can non-rebreather deliver

A

80%

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23
Q

life-threatening asthma treatment

A 
SABA -nebuliser 
ipratropium bromide 
hydrocortisone 
magnesium sulfate 
aminophylline IV 
IV fluids
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24
Q

SE of beta 2 agonists (7)

A 
tremor 
tachycardia 
arrhythmia 
ketoacidosis 
hypokalaemia 
hyperglycaemia 
headache
25
Q

ipratropium=

A

antimuscarinic bronchodilator

26
Q

when is magnesium sulfate used in acute asthma

A

when peak flow <50%

27
Q

aminophylline=

A

theophylline and ethylenediamine

methylxantine bronchodilator

28
Q

SE of theophylline

A

tachycardia
arrhythmia
N and V

29
Q

O2 therapy aim in acute asthma

A

92-95%

30
Q

first line COPD

A

SAMA or SABA as required

31
Q

COPD >50% FEV treatment

A

LABA or/

LAMA (stop SAMA)

32
Q

COPD <50% FEV 1

A

LABA + ICS or/

LAMA (stop SAMA)

33
Q

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

A

LAMA + LABA +ICS combo

34
Q

roflumilast=

A

selective long-acting inhibitor of phosphodiesterase 4

35
Q

use of roflumilast

A

adjunct to bronchodialtors in severe COPD associated with chronic bronchitis

36
Q

non pharma steps for COPD

A

stop smoking

vaccination

37
Q

spO2 target in COPD with hypoxic drive

A

88-92%

38
Q

haldane effect=

A

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

39
Q

in the alveoli what happens when oxygen tensions decrease

A

pulmonary capillary vasoconstriction (hypoxic pulmonary vasoconstriction)

40
Q

treatment for patients with an episode of hypercapnic respiratory failure

A

24 –> 28% venturi

41
Q

in most acutely ill patients what is aim o2 sats

A

94-98%

42
Q

Carbon monoxide poisoning aim =

A

100%

43
Q

patients at increased risk of hypercapnic resp failure

A

88-92%

44
Q

in acute severe asthma what is CO2 usually

A

subnormal

45
Q

in deteriorating acute severe asthma what can happen in CO2

A

may rise steeply

46
Q

what is the treatment for deteriorating asthma with rising CO2 levels

A

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

47
Q

hypercapnic respiratory failure more common in

A 
COPD 
advanced CF 
Severe kyphoscoliosis 
Severe lung scarring 
MSK disorder 
opioid/ drug overdose
48
Q

how to control oxygen in hypercapnic RF

A

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

49
Q

hypercapnic RF SpO2 <85% –>

A

non-rebreather mask

50
Q

range of venturi masks

A

24-60%

51
Q

nasal cannula used when

A

small amounts of oxygen are required without rigid control of respiration

52
Q

flow rate of nasal cannula

A

up to 5L/min

53
Q

O2 conc of nasal cannula

A

28-44%

54
Q

rates above 5L in a nasal cannula cause

A

discomfort
drying nasal passage
nose bleeds

55
Q

does long term oxygen therapy (LTOT) prolong survival

A

yes if used 15/day at least

56
Q

LTOT used when

A

chronic COPD with chronic Hypoxemia

57
Q

acute severe COPD exacerbation treatment

A
  • bag valve mask 85% flow rate 12-15L
  • non-invasive ventilation
  • nebulisers
  • consider IV steroids, IV theophylline and antibiotics
58
Q

what is non-invasive ventilation

A

ventilatory support without using invasive artificial airway

PPT (8 decks)

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