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A - Pre Reg COPY > Chapter 3 BNF (Respiratory System) > Flashcards

Chapter 3 BNF (Respiratory System) Flashcards

1
Q

What are the symptoms of asthma?

A

Coughing at night
SOB
Chest tightness
wheezing

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2
Q

What is the difference between BTS/SIGN Guidelines and NICE guidelines?

A

BTS/SIGN - Clinical relevant recommendation

NICE - Health economic

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3
Q

What is the first line preventer in adult asthma?

A

low dose corticosteroid

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4
Q

What is the first line add on therapy in adult asthma?

A

BTS/SIGN - LABA

NICE - LTRA

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5
Q

What is the additional add on therapy in adult asthma?

A

1: If LABA is not working, remove LABA and increase ICS dose
2. If LABA slightly works, keep LABA and increase ICS
3. If LABA works, keep both and consider LTRA, SR Theophylline, LAMA

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6
Q

What the next step after additional add on therapy in adults?

A

High dose ICS

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7
Q

whats the next stage after High dose ics in adults?

A

oral steroid

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8
Q

what is considered low dose of ICS in adults?

A 
Beclometasone 100-400mcg daily
Budesonide 400mcg daily
Fluticasone 200-400mcg daily
momatesone 400mcg 
ciclesonide 160mcg
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9
Q

what are the alternatives to SABA?

A

Ipratropium,

If 12+ SR Theophylline or Oral beta agonist

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10
Q

When should patients step up?

A

using inhaler more than 3 times a week
night time symptoms over 1 times a week
asthma attack requiring steroids in last 2 years

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11
Q

What is the general starting dosing regimen with ICS? Whats the exception?

A

BD then move to OD

except ciclesonide

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12
Q

What are the alternatives to ICS?

A

LTRA, Theophylline, sodium cromoglycate, Nedocromil

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13
Q

What are the options in regular preventer therapy in children?

A

very low dose ICS

Under 5 - LTRA

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14
Q

What are the options in initial add on therapy in children?

A

very low dose ICS

LABA if over 5

LTRA if under 5

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15
Q

What is the next stage after additional add on therapy in children?

A

high dose therapy
medium ics
sr theophylline

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16
Q

what is the next stage after high dose therapy in children?

A

Oral steroid

maintain medium ics

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17
Q

What doses of ics are very low in children?

A

beclometasone 200mcg
budosenide 200mcg
fluticasone 100mcg

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18
Q

what doses of ics are medium in children

A

beclometasone 400mcg-800mcg
budesonide 800mcg
fluticasone 500mcg
ciclosenide 360mcg

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19
Q

Whats the dose for SABA? when should the patient contact their GP?

A

QDS PRN

See GP if no result in 3 hrs

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20
Q

Whats the dosing for LABAs?

A

BD

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21
Q

Which beta agonists are mostly used in COPD?

A

Oladaterol
indacaterol
vilanterol

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22
Q

which beta agonists is used orally?

A

bambuterol

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23
Q

When should LABAs not be used?

A

rapidly deteriorating asthma

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24
Q

which laba has a quick onset?

A

formeterol

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25
Q

Which brands can be used as reliever therapy?

A

symbicort
duoresp
fostair

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26
Q

what are the side effects of LABAs?

A

Tremors, hyperglycaemia, tachycardia
hypokalaemia (esp with ICS or theophylline)
cardiac effects (QT prolongation, arterial)

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27
Q

How long must ICS be taken until effect is seen?

A

3/4 weeks

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28
Q

whats the difference between qvar and clenil and fostair?

A

qvar is twice as potent due to extra fine particles and fostair is most potent

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29
Q

whats the age for easyhaler

A

18

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30
Q

whats the age for qvar

A

12

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31
Q

what are the side effects of ics

A

hoarse voice
sore throat
oral thrush
paradoxical bronchospasms

32
Q

when are large volume spacers used?

A

high doses

u15

33
Q

How can paradoxical bronchospasms be aided?

A

stop and give alternative

if mild: use saba prior or transfer to dry powder

34
Q

how dose smoking affect ics

A

reduce effectiveness

35
Q

What are the side effects of LTRA?

A 
Churg strauss syndrome 
liver toxicity (zafirlukast)
36
Q

what are the symptoms of churg strauss syndrome?

A

eosinophilia, vasculitic rash, worsening symptoms

37
Q

What is the mechanism of action of theophylline?

A

xanthine bronchodilator

38
Q

what is the therapeutic range and when should sample be taken?

A

10mg/L - 20mg/L

4/6 hrs after dose

39
Q

what increases the concentration of theophylline?

A

heart failure, hepatic impairment, viral infections, elderly, enzyme inhibitors

40
Q

what reduces the concentration of theophylline?

A

smokers, alcohol, enzyme inducers

41
Q

should theophylline be prescibed by brand?

A

yes

42
Q

signs of theophylline toxicity?

A

fast and sick
vomiting and gi issues
tachycardia, arrythmia, hypokalaemia

43
Q

what interactions would you expect from theophylline?

A

hypokaelamia; steroids, diuretics, b agonist
convulsions: ciprofloxacin
increase plasma levels: verapamil and ccb
reduced plasma levels: st johns worts, rifampicin

44
Q

How is an asthma attack treated in community

A 
treat as severe 
Salbutamol aerosol with large volume spacer (mask if u3)
2-10 puffs every 10-20 mins or prn 
OR 
salbutamol every 20-30mins or prn

if symptoms persist after 15-30 mins call 999
repeat above then add nebulised ipratropium bromide

45
Q

how are asthma attacks treated when in hospital?

A

prednisole tablets or iv hydrocortisone
u12 - 3 days
at least 5 days for adults (40-50mg daily)

46
Q

whats the reliever therapy in COPD?

A

SABA OR SAMA

47
Q

Whats the next step in COPD if FEV is below 50?

A

LABA/ICS or LAMA

48
Q

Whats the next step in COPD if FEV is above 50?

A

LABA then LABA/ICS or LAMA

49
Q

Whats the final step in COPD?

A

Triple therapy

50
Q

what can be offered if symptoms persist or patient unable to use inhaler in COPD?

A

MR Theophylline or aminophylline

51
Q

what can be used for chronic productive cough in COPD

A

MUCOLYTIC

52
Q

What can be used in severe COPD with hypoxaenimia

A 
oxygen therapy
15 hrs a day 
88-92% saturation 
must carry oxygen alert card 
24-48% venturi mask
53
Q

Whats the dose of ipratropium?

A

TDS

54
Q

Whats the dose of LAMAs?

A

OD except Eklira

55
Q

which LAMA is licenced in asthma with 1 or mre severe excercabations in the last year as adjunct to LABA/ICS?

A

Spiriva

56
Q

what condition are cautioned for LAMAs

A

angle closure glaucoma

prostatic hyperplasia

57
Q

what are the side effects of LAMAs

A

dry mouth

paradoxical bronchospasms

58
Q

What is the treatment for acute exercabation of COPD?

A 
bronchodilator therapy (nebulised with oxygen)
IV Aminophylline 
short course of prednisolone (30mg daily 7-14days)
59
Q

Which antihistamines are most sedating?

A

promethazine

almemazine

60
Q

which antihistamine cause qt prolongation

A

hydroxyzine

61
Q

which antihistamine is indicated for nausea and vomiting associated with migraines?

A

buclizine

62
Q

which antihistamines are used in anaphylaxis/ angioedema?

A

chlorphenamine

promethazine

63
Q

when are antihistamines cautioned?

A

bph
glaucoma
severe liver impairemnt

64
Q

whats the MHRA on hydroxyzine

A

qt prolongation
short periods
max dose 100mg

65
Q

what are the contraindications for hydroxyzine?

A 
qt drugs
cvd 
history of sudden death
hypokalaemia
hypomagnesium 
bradycardia
66
Q

when is allergen immunotherapy indicated?

A

hay fever unresponsive to drugs

hypersensitivity to wasp and venom

67
Q

whats the mechanism of action of omalizumab

A

binds to igE

68
Q

When is omalizumab used?

A

add on therapy: severe persistent allergic asthma, 6+

chronic spontaneous urticaria (hives) 12+

69
Q

what are the side effects of omalizumab

A

chaug strauss

70
Q

what are the goals in anaphylaxis?

A

restore BP, secure airways

71
Q

whats solution of adrenaline is used in anaphylaxis?

A

1 in 1000

72
Q

whats the dose of adrenaline in
under 6
6-12
12-18

A

under 6 150mcg
6-12 300mcg
12-18 500mcg

73
Q

how should beta blocker patients be treated in anaphylaxis

A

consider salbutamol

74
Q

whats the treatment for angioedema?

A

adrenaline
antihistamine
steroid

75
Q

whats the contraindication for mucolytics?

A

peptic ulcers

A - Pre Reg COPY (37 decks)

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