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Respiratory > Asthma > Flashcards

Asthma Flashcards

1
Q

What drugs can worsen asthma? (2)

A

Non-selective beta blockers e.g. propranolol
NSAIDs

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2
Q

What is seen on an ABG during an acute asthma attack? What does it change to if it’s very bad?

A

Resp alkalosis
Resp acidosis is very concerning

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3
Q

What are some concerning signs in an acute asthma attack? (3)

A

Normal pCO2
Low PaO2
Resp acidosis

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4
Q

What Resp disease has diurnal variation?

A

Astham

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5
Q

What are the typical symptoms of asthma? (4)

A

• Shortness of breath
• Chest tightness
• Dry cough
• Wheeze

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6
Q

What is the key finding on examination that indicates asthma?

A

widespread “polyphonic” expiratory wheeze.

Whistling sound with various tones

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7
Q

What indicates a moderate asthma attack?

A

PEFR of 50-70

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8
Q

What indicates a severe asthma attack? (4)

A

Can’t complete sentences
Hr >110
Rr >25
PEFR 33-50

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9
Q

What indicates a life threatening asthma attack? (8)

A

Silent chest
Cyanosis
Exhaustion
Confusion
Poor Resp effort
PaO2 <8
Sats <92
PEFR <33

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10
Q

What is the treatment for an acute asthma exacerbation?

A

O shit me

Oxygen
Salbutamol 2.5-5 g nebs
Hydrocortisone 100mg IV or prednisolone 40mg PO
Ipratropium 500mg nebs
Theophylline (aminophylline infusion)
Magnesium sulphate 2g IV over 20mins
Escalate care - intubation and ventilation

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11
Q

What should be monitored with salbutamol treatment?

A

K+
Salbutamol causes K+ to be absorbed into cells so causes hypokalaemia

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12
Q

What are some side effects of salbutamol? (4)

A

Fine tremor
Tachycardia
Hypokalaemia
Lactic acidosis

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13
Q

What level of reversibility indicates asthma?

A

> 12% increase in fev1

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14
Q

How long should a PEFR diary be kept for asthma diagnosis? What would indicate asthma from this?

A

2-4 weeks
Variability of >20%

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15
Q

What FeNO supports a diagnosis of asthma?

A

> 40 ppb

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16
Q

What can lower FeNO readings and cause discrepancies with asthma testing?

A

Smoking

17
Q

What are the initial investigations of asthma? (2)

A

FeNO
Spirometry with reversibility

18
Q

After first 2 tests for asthma what test is done if they are still u certain?

A

PEFR diary testing for variability

19
Q

What is the last test done if 3 previous tests are uncertain for asthma?

A

Direct bronchial challenge test with histamine or methacholine

20
Q

What is a direct bronchial challenge test?

A

Used in diagnosing asthma
Histamine or methacholine stimulates bronchoconstriction
PC20 <8mg/ml is positive result

21
Q

Give an example of a SABA?

A

Salbutamol

22
Q

What is the action of a SABA?

A

Work quickly but don’t last long
Adrenalin acts on smooth muscle and causes dilatation

23
Q

Give an example of an ICS

A

Beclomethasone

24
Q

What is the action of an ICS?

A

Reduce inflammation of airways

25
Q

What is the action of a LABA?

A

Work in same way as a SABA but last longer

26
Q

Give an example of a laba

A

Salmeterol

27
Q

Give an example of a lama

A

Tiotropium

28
Q

What is the action of a lama (long acting muscarinic antagonist)?

A

Block ACh receptors
ACh receptors are usually stimulated by the parasympathetic nervous system and cause constriction of bronchial smooth muscle
Blocking this results in bronchodilation

29
Q

Give an example of a leukotriene receptor antagonist

A

Montelukast

30
Q

What is the action of leukotriene receptor antagonists?

A

Leukotrienes are produced by the immune system and cause inflammation, bronchoconstriction and mucus secretion
Antagonists block these effects

31
Q

How is theophylline used in asthma?

A

Theophylline. This works by relaxing bronchial smooth muscle and reducing inflammation. Unfortunately it has a narrow therapeutic window and can be toxic in excess so monitoring plasma theophylline levels in the blood is required. This is done 5 days after starting treatment and 3 days after each dose changes.

32
Q

What is maintence and reliever therapy (mart)?

A

This is a combination inhaler containing a low dose inhaled corticosteroid and a fast acting LABA. This replaces all other inhalers and the patient uses this single inhaler both regularly as a “preventer” and also as a “reliever” when they have symptoms.

33
Q

What is the BTS stepwise ladder for asthma? (5)

A
  1. SABA
    • ICS
    • LABA / change to mart
  4. Increase dose of ICS / add in Montelukast
  5. Specialist advice
34
Q

Aside from medications what are the additional managements for asthma? (4)

A

• Each patient should have an individual asthma self-management programme
• Yearly flu jab
• Yearly asthma review
• Advise exercise and avoid smoking

Respiratory (18 decks)

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