2154 Respiratory

Question 1

Codeine & dextromethorphan supply limit + CI

Answer 1

Limit to 240 mL within 4 days
CI: MAOi

Question 2

cough drugs safe to use in pregnancy (2)

Answer 2

Dextromethorphan & Guaifenesin (lowest dose & shortest duration)

Question 3

Oral Decongestant caution (4)

Answer 3

1. uncontrolled BP
2. Glaucoma
3. BPH
4. Hyperthyroidism

Question 4

TOP Decongestant ADR + pregnancy alternative

Answer 4

rebound congestion = do not use > 5 days (pregnancy use saline)

Question 5

Antihistamine caution (3)

Answer 5

1. Avoid in elderly with BPH / glaucoma
2. Avoid alcohol, opioids, antidepressant
3. Pregnancy use chlorpheniramine

Question 6

intranasal corticosteroids sprays caution (2)

Answer 6

worsen
1. Glaucoma
2. Cataract

Question 7

Leukotriene antagonist (Montelukast) ADR (2)

Answer 7

1. Neuropsychiatric SE
2. Behavioural / mood changes

Question 8

SABA (salbutamol) ADR

Answer 8

1. Tremor, muscle cramp
2. Tachycardia / palpitation

Question 9

ICS (steroids) ADR (2)

Answer 9

1. Oral Candidiasis –> rinse & spit out water after
2. throat irritation, hoarseness, cough

Question 10

LAMA (Umeclidinium) ADR

Answer 10

Anticholinergic (dry mouth, tachycardia, urinary retention)

Question 11

COPD Groups & treatment (3)

Answer 11

1. Group E: > 2 exacerbation or hospitalisation = LABA + LAMA +/- ICS
2. Group B: mMRC > 2 = LABA + LAMA
3. Group A: mMRC 0-1 = bronchodilator

Question 12

mMRC score for COPD (5)

Answer 12

0 = least Sx, breathless when exercise
1 = SOB walking up hill
2 = walks slower, stop for breath when walking normally
3 = stops for breath 100m
4 = too breathless to leave house

Question 13

Indication for ICS in COPD (3)

Answer 13

1. Hx of hospitalisation / asthma
2. COPD exacerbations > 2 / year
3. Blood eosinophils > 300

Question 14

Indications for Abx in COPD exacerbation (2)

Answer 14

1. worsening SOB
2. increase sputum purulence & volume

Question 15

Criteria to start NRT (4)

Answer 15

1. Smoke within 1h of waking
2. > 10 cig /day
3. Hx of craving / withdrawal in past quit attempts
4. Nicotine dependence (>3 in score)

Question 16

Cig per day (CPD) to NRT patch dose

Answer 16

< 10 CPD= 7 mg
10-20 CPD = 14 / 21 mg
21-30 CPD = 28 mg
31-40 CPD = 35 mg
> 40 CPD = 42 mg

Question 17

Bupropion SR avoid (3)

Answer 17

1. Psychiatric patients (seizure, schizo, bipolar)
2. Pregnancy & breastfeeding
3. Under 18

Question 18

Varenicline avoid (3)

Answer 18

1. Pregnancy
2. ESCKD
3. Sx of agitation, depression, suicidal thoughts, behavioural changes

Question 19

Cisplastin & Carboplatin ADR (3)

Answer 19

1. CINV
2. Ototoxicity & nephrotoxicity
3. Peripheral neuropathy

Question 20

administration supp with cisplatin (3)

Answer 20

1. Vigorous hydration
2. IV NaCl pre & concurrent
3. KCl & MgSO4 supp (electrolyte)

Question 21

Pemetrexed avoid (2) + supp (3)

Answer 21

avoid NSAIDs & CrCl < 45
Supp: Folic acid + vit B12 + dexamethasone

Question 22

Tyrosine Kinase inhibitor (Osimertinib) instruction & DDI

Answer 22

take on empty stomach
DDI with CYP3A4 (PPI, H2RA, statin, warfarin)

Question 23

Red flag questions for respiratory (4)

Answer 23

1. Unintentional weight loss, night sweat (TB)
2. Dyspnoea / SOB
3. Hemoptysis (vomit blood)
4. Long lasting fever > 7d