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pre-reg-thuri > RESP SYSTEM- ASTHMA + COPD > Flashcards

RESP SYSTEM- ASTHMA + COPD Flashcards

1
Q

What are the 3 types of acute asthma?

A

Moderate

Severe

Life-threatening

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2
Q

What are 4 moderate acute asthma characteristics?

A

Peak flow more than 50%

Able to say full sentence

O2 level > 92%

Resp rate is less than 30 in children above 5

Resp rate < 40 between 1-5 years

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3
Q

What are 4 severe acute asthma characteristics?

A

Peak flow 33-50%

Unable to complete full sentence

Resp rate is >25 in adults, >30 children 5+, >40 children 1-5 years

HR >125bpm (5+)

HR >140 bpm (1-5 years)

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4
Q

What are 4 life-threatening acute asthma characteristics?

A

peak flow <33%

O2 <92%

cyanosis

silent chest

exhausted

hypotension

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5
Q

What is 1st line moderate acute asthma tx?

A

High dose SABA (salbutamol) via PMI + spacer

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6
Q

What is severe/ life threatening acute asthma treatment?

A

Hospital ASAP

High dose SABA via O2 nebuliser

+

Nebulised ipratropium (if poor response to above)

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7
Q

What IV drug is given in near FATAL acute asthma with poor response to initial therapy?

A

IV aminophylline

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8
Q

What is given to all patients after acute asthma attack?

A

Oral prednisolone

If contra- IV HC or IM methylpred

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9
Q

What to give if oral pred contra after acute asthma attack?

A

IV HC

or

IM methylpred

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10
Q

What to give hypoxic patients?

A

Supplementary oxygen (to keep O2 between 94-98)

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11
Q

1st line moderate acute asthma tx in people 2 + over?

A

SABA -salbutamol with PMI + pacer

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12
Q

1st line severe acute asthma tx in people 2 + over?

A

SABA with oxygen driver nebs

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13
Q

What is max salbutamol dose in acute asthma attack?

A

maximum of 10 puffs of salbutamol via a spacer

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14
Q

What 3 steps to do if children under 2 with acute asthma attack?

A

Hospital ASAP

Mod + severe = immediate o2 + maybe SABA

Combin Nebulised ipratropium if needed

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15
Q

What to give patients 2 and over after acute asthma attack?

A

3 days oral Prednisolone

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16
Q

What to add if poor initial response to SABA in acute asthma?

A

nebulised ipratropium

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17
Q

What to give if poor response to 1st line tx?

A

IV MGSO4

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18
Q

What 3 lifestyle changes can help asthmatic patients?

A

Weight loss

Smoking cessation

Breathing exercise programmes

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19
Q

What is chronic asthma tx in adults?

A

Step 1 : SABA

Step 2 : SABA + low dose ICS

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20
Q

What 4 reasons to start ICS in asthma?

A

If uncontrolled by SABA alone - 3x a week

symptoms 3 x week

1 night time waking

More than 1 inhaler a month

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21
Q

What is step 3 of asthma treatment for adults?(NICE + BTS)

A

NICE = LTRA

sign/BTS - LABA fixed dose or MART

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22
Q

What is step 4 of NICE guidance for asthma tx in adults?

A

Add in LABA with/ or without LTRA

Can also add an ICS into MART

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23
Q

What is STEP 5 of asthma tx in adults?

A

Specialist - high dose ICS

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24
Q

What is tx for asthma in children over 5 compared to adults?

A

Same up to step 3

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25
Q

What age can LABA (e.g formeterol) be given in?

A

5 + years

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26
Q

What is tx of chronic asthma in children over 5?

A

Step 1: SABA

Step 2: SABA + very Low dose ICS

Step 3: SABA + ICS + LABA (sign)/LTRA (nice)

STEP 4: REPLACE LTRA WITH LABA

STEP 5: Increase ICS or specialist (steroids, MAB, tiotropium)

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27
Q

What is difference in asthma tx between adults and children over 5 ?

A

STEP 4: REPLACE LTRA WITH LABA

in children whereas adults can have both.

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28
Q

What age is tiotropium allowed in?

A

12+ years

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29
Q

What is asthma tx in children under 5?

A

Step 1 : SABA

Step 2: ICS paed moderate strength for 8 week trial

step 3: SABA + ICS + LTRA (if not working stop LTRA + refer)

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30
Q

What happens if children under 5 using more than 1 inhaler per month?

A

Urgent referral

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31
Q

How long is trial of ICS for asthma in children under 5?

A

8 week trial

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32
Q

When can asthma tx be dropped down?

A

If controlled for at least 3 months

review regularly

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33
Q

When are reductions of ICS considered?

A

Every 3 months - 25 to 50% reduction each time.

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34
Q

What are 7 signs of complete control?

A

No daytime symptoms

No night-time awaking

No attacks

No need for rescue meds

No exercise limitations

Normal lung function PEF >80%

Low SE from tx

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35
Q

What are 4 asthma symptoms?

A

Dyspnoea

wheezing

cough

chest tightness

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36
Q

What 2 drugs can trigger asthma?

A

BB

NSAIDs

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37
Q

What are 3 SEs of SABAs?

A

Hypokalaemia

CVS SE

tremors of hand

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38
Q

What is typical SABA dose?

A

1-2 puff QDS PRN

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39
Q

List 3 LABAs?

A

Fometerol

Salmeterol

Vilanterol

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40
Q

List 5 ICS?

A

Beclomethasone

Budesonide

Fluticasone

ciclesonide (OD)

mometasone (OD/BD)

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41
Q

What is LABA frequency?

A

BD

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42
Q

Where is fostair kept?

A

Fridge

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43
Q

What is more potent: Qvar or clenil?

A

Qvar 2x potent

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44
Q

What is more potent: fostair or CFC free inhaler?

A

Fostair

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45
Q

What is MHRA alert about ICS?

A

Prescribe beclomethasone CFC by brand

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46
Q

What are 3 main SEs of ICS?

A

Oral thrush

hoarse voice/sore throat

bronchospasm

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47
Q

what to do if bronchospasm with ICS inhaler?

A

Stop

If mild- SABA before use or use DPI

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48
Q

When is LTRA given in the day?

A

at night

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49
Q

What are 2 SEs for montelukast? (CN)

A

Neuropsychic reaction

Churg-strauss syndrome?

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50
Q

4 Symptoms of
Churg-strauss syndrome?

A

eosinophilia

cardiac issue

pulmonary issues

peripheral neuropathy

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51
Q

What is an MHRA warning regarding montelukast?

A

OCD symptoms + speech impairment

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52
Q

What is theophylline?

A

Xanthine Bronchodillator

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53
Q

What is dose frequency of theophylline?

A

every 12 hrs

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54
Q

What is therapeutic index of
theophylline?

A

10-20 mg/L

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55
Q

When is monitoring done for theophylline?

A

5 days after starting oral treatment + at least 3 days after any dose adjustment.

Sample taken 4–6 hours after an oral MR dose.

56
Q

What decreases theophylline levels?

A

Smoking

57
Q

What are 5 SEs of theophylline toxicity? CHAT V

A

Convulsions, CNS stimulation

Hypokalaemia , hyperglycaemia

Arrhythmias

Tachycardia

Vomiting - blood too

58
Q

What 2 drugs increase theophylline levels?

A

Macrolides

Cimetidine

59
Q

What drug class and theophylline cause bronchospasms?

A

BB

60
Q

What 3 drug classes reduce theophylline levels?

A

Carbamazepine
Phenytoin

St johns wort

Rifampicin

61
Q

What antibiotic + theophylline can increase seizures?

A

Cipro

62
Q

What 3 drugs + theophylline can cause hypokalaemia?

A

Salbutamol

diuretics

Steroids

63
Q

What 5 drug classes + theophylline interact to increase risk of torsades?

A

Anti- arrhythmic drugs, SSRIs, macrolides, lithium, methadone, 5HT3 antagonists

64
Q

What is an MHRA advice about pMDI inhalers?

A

Loose parts can make you choke- remove cap

65
Q

How to breathe in using dry powder inhaler?

A

Fast + deep

66
Q

What 3 points on using spacers?

A

Inhale ASAP after actuating, tidal breathing

not interchangeable - + replace 6-12 months

wash monthly

67
Q

What to do if PEF <80%?

A

Quadruple ICS dose

68
Q

What to do if PEF <60%?

A

start oral steroids + medical advice

69
Q

What to do if PEF <50%?

A

urgent medical help

70
Q

What is prednisolone dose for after acute asthma in people over 12 years?

A

40–50 mg once a day for 5 days.

71
Q

What is prednisolone dose for after acute asthma in people under 12 years?

A

30–40 mg once a day for 3 days.

72
Q

What is difference between chronic asthma management in adults and children over 5?

A

Step 4 is changed - in adults can give LTRA + LABA

With children- LTRA is replaced with LABA.

73
Q

What is different in chronic asthma management in children under 5?

A

STEP 2- trial dosing of ICS.

Step 3 - given LTRA with SABA + ICS

If does not work- specialist after

74
Q

What are the 4 symptoms of COPD?

A

Dyspneoea, wheeze, chronic coug

regular sputum production

75
Q

What is COPD?

A

Not fully reversible

Persistant rep symptoms

Bronchiolitis + emphysema

76
Q

What is 1 main risk factor of COPD?

A

Smoking

77
Q

What is Chronic COPD treatment?

A
  1. SABA OR SAMA
  2. depends is asthmatic or non-asthmatic.
78
Q

List the 5 complications of COPD?

A

Cor pulmonale (heart enlargement)

depression

anxiety

type 2 respiratory failure

secondary polycythaemia.

79
Q

What are non drug treatments for COPD?

A

smoking cessation

Pulmonary rehabilitation

80
Q

What should patients be taught if they have too much sputum production?

A

active cycle of breathing techniques

+
how to use positive expiratory pressure devices

81
Q

What 2 vaccines should COPD patients be offered?

A

pneumococcal + annual influenza.

82
Q

What 2 drugs are used for initial management of COPD?

A

SAMA or SABA

(ipratropium or salbutamol)

83
Q

Before stepping up COPD treatment, what 3 things should be done?

A

confirm COPD spirometrically

relevant vaccinations are given

non-drug treatment options

84
Q

What step-up treatment to give COPD patients WITHOUT asthmatic features?

A
  1. SABA OR SAMA
  2. add in LAMA + LABA

(STOP the SAMA if LAMA is given.)

85
Q

What step-up treatment to give COPD patients WITH asthmatic features?

A
  1. SAMA OR SABA
  2. LABA + ICS (Stop the SAMA)
86
Q

What to add for non-asthmatic + asthmatic COPD patients if patient has severe exacerbation or 2+ moderate ones in 1 year?

A

STEP 3

LAMA + LABA + ICS(consider)

87
Q

After step 3 if non asthmatic COPD patients feels no change after 3 months what to do?

A

Go back to step 3 - LAMA + LABA

so stop the ICS.

88
Q

What cannot be given with SAMA?

A

LAMA

89
Q

When are patients given step 3 treatment for COPD?

A

If patient has severe exacerbation or 2+ moderate ones in 1 year.

90
Q

If triple therapy for COPD has not worked what 3 options to try?

A

Give theophylline,

oxygen therapy

mucolytics

91
Q

What drug class should be continued in all stages of COPD treatment?

A

SABA - salbutamol

92
Q

What antibiotic is used for COPD prophylaxis of exacerbations?

A

Azithromycin - review after 3 months

93
Q

What 5 tests to do before giving prophylactic abx for COPD?

A

sputum culture + sensitivity testing

CT scan of the thorax

Baseline ECG (rule out QT prolongation)

LFTs

94
Q

What 2 drug are given as rescue pack for COPD exacerbation?

A

Oral steroid + ABx (amoxicillin or dox or clarithro)

95
Q

What abx is used as rescue pack for COPD exacerbation?

A

Amoxicillin

96
Q

What abx to not give if patient taking prophylactic azithromycin for COPD?

A

Clarithromycin

97
Q

What to give if COPD exacerbation has them hospitalised?

A

Short course prednisolone + other therapies

98
Q

What to give if COPD exacerbation in community with significant breathlessness?

A

Short course pred

99
Q

When to give aminophylline in COPD exacerbation?

A

If not good response to nebs

100
Q

How long does SABA last?

A

4 hrs

101
Q

How long does LABA last?

A

12 hrs

102
Q

What is usual dose of SABA or LABA?

A

1-2 puffs up to 4 times a day

8 puffs max daily

103
Q

What is max SABA/LABA puff a day?

A

8 puffs

104
Q

What condition are SABA/LABA cautioned in?

A

Diabetes - can cause DKA after IV

105
Q

What electrolyte balance is caused by SABA/LABA?

A

Hypokalaemia - QT prolongation

106
Q

What heart related SE can happen with SABA/LABA?

A

Arrhythmias

107
Q

What are 5 SEs with SABA/LABA?

A

Tremor

palpitations

headache

seizure

anxiety

108
Q

What 3 drug classes can cause qt prolongation when given with SABA/LAMA?

A

Diuretics

theophylline

steroids

109
Q

What drug can react with salbutamol to cause toxicity due to hypkalaemia?

A

Digoxin

110
Q

What is example of SAMA?

A

Ipratropium

111
Q

What is example of LAMA?

A

Tiotropium

glcopyrronium

umeclidinium

112
Q

What is 1 main SE of LAMA/ SAMAs?

A

Antimuscarinic side effects

e.g. constipation, dry mouth, increase ocular pressure (halo or blurred vision)

113
Q

What antimuscarinic drugs can interact with SAMA + LAMA?

A

Hycosine
TCAs
Solefenacin

114
Q

5 Examples of inhaled corticosteroids?

A

Beclometasone

Budesonide

Ciclesonide

Fluticasone

Mometasone

115
Q

What inhaled corticosteroid is given OD only compared to others?

A

Ciclesonide

116
Q

What inhaled corticosteroid should be prescribed by brand?

A

Beclometasone

117
Q

What 2 steroid inhalers have small particles + are 2x stronger than clenil?

A

QVAR + KELHALE

118
Q

What to monitor in children when giving long term inhaled steroids?

A

Height + weight

119
Q

What are 3 SEs linked to inhaled Corticosteroids?

A

Taste + voice alteration

Sore mouth

120
Q

What is given for mild paradoxical bronchospasm?

A

SABA use before the steroid
Change to dry powder inhaler.

121
Q

What are 2 SE of montelukast (LRTA)?

A

Risk of neuropsychiatric reactions - seek medical attention if speech problems

Churg strauss syndrome

122
Q

What are some symtpoms of Churg strauss syndrome?

A

eosinophilia, rash, pulmonary + cardiac symptoms

123
Q

What type of drugs can LTRAs interact with

A

Inhibitors + inducers

124
Q

What is theophylline therapeutic level ?

A

10-20mg/L

125
Q

When are theophylline drug levels checked?

A

4-6 hrs after dose

5 days after tx

3 days after dose change

126
Q

How to prescribe theophylline?

A

Brand - different bioavailability

127
Q

4 SEs of theophylline? (SICK + FAST)

A

Vomiting, tremor, palpitations, arrhythmias

Overdose = agitation, restlessness, dilated pupils, sinus tachycardia, and hyperglycaemia. haematemesis, convulsions, and supraventricular and ventricular arrhythmias. Severe hypokalaemia may develop rapidly.

128
Q

What does smoking do to theophylline?

A

Causes it to leave body more

129
Q

What condition reduces theophylline clearance?

A

Fevers

130
Q

What habit increases theophylline clearance?

A

Smoking -so stopping it can be bad, build up

131
Q

What electrolyte imbalance does theophylline cause?

A

hypokalaemia

132
Q

What to give patients before exercise if experiencing exercise induced asthma?

A

SABA

133
Q

What to add if exercise is a particular problem and triggers asthma on patients well controlled on ICS?

A

consider adding either:

LTRA, a long-acting beta2 agonist, sodium cromoglicate or nedocromil sodium, or theophylline

134
Q

What asthma medication is known for dry mouth?

A

Tiotropium (LAMA)

135
Q

What 3 conditions increase theophyline levels?

A

HF , viral infections, elderly, hepatic impairment

pre-reg-thuri (44 decks)

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