CHAPTER 3: Respiratory: Asthma Flashcards
(98 cards)
1
Q
Which groups of people can find pMDI difficult to use? (2)
A
- Elderly
2. Children
2
Q
What device can children and the elderly be given to help them use pMDIs?
A
Spacer device
3
Q
If they cannot use a pMDI, who can benefit from a dry powder inhaler?
A
Adults and children over 5
4
Q
Provided the can use the device effectively, who are breath actuated devices suitable for?
A
Adults and older children
5
Q
What may occur as a side effect of using a dry powder inhaler?
A
Coughing
6
Q
What do spacer devices remove the need for?
A
Coordination between actuation and inhalation of pMDI
7
Q
What does a space device reduce?
A
- Velocity of particle
2. Impaction on the back of the throat
8
Q
What does a spacer device allow more time for?
A
Inhalation
9
Q
Who are spacer devices particularly useful for? (4)
A
- Poor inhalation technique
- Children
- High dose ICS
- Oral thrush with ICS
10
Q
Which is the most effective spacer device?
A
A one way valve volumatic
11
Q
Are spacer devices interchangeable?
A
No, patients should be advised not to switch between them
12
Q
When using spacer devices, what type of breathing is as effective than single breaths?
A
Tidal breathing
13
Q
How often should a spacer device be cleaned?
A
Once a month
14
Q
When cleaning a spacer device, what must a patient NOT do? (2)
A
- Rinse it
2. Dry it
15
Q
How often should spacers be replaced?
A
Every 6-12 months
16
Q
In which condition are nebulisers used?
A
Severe acute asthma
17
Q
How long are nebulisers administered for?
A
5-10 minutes
18
Q
What are nebulisers driven by?
A
Oxygen
19
Q
Why is it preferable for patients to have oxygen during a severe acute asthma attack instead of a beta2 agonist?
A
Beta2 agonist can increase arterial hypoxaemia
20
Q
What are the main indications for use of a nebuliser? (6)
A
- Beta2 agonist - acute exacerbation of asthma
- Ipatropium - acute exacerbation of COPD
- Beta2 agonist, ICS, Ipatropium - regular administration for severe asthma/reversible obstruction
- Antibiotic - CF
- Budesonide/adrenaline - severe croup
- Pentamidine - prophylaxis and treatment PCP
21
Q
The use of nebulisers in persistent asthma and COPD should be considered in which situations? (4) - Patient should have a 2 week trial
A
- Review of diagnosis
- Review of therapy and inhaler technique
- Increased doses from hand-held devices have been tried for 2 weeks
- Patient remains breathless after trying multiple things
22
Q
What is the proportion of the drug to reach the lungs after administration via nebuliser?
A
10%
23
Q
Give 4 examples of drugs that can be given by mouth
A
- Beta2 agonists
- Corticosteroids
- Leukotriene receptor antagonists
- Theophylline
- Aminophylline
24
Q
Give 3 examples of drugs that can be given IV
A
- Beta2 agonists
- Corticosteroids
- Aminophylline
25
Asthma is characterised by broncoconstriction, what are the most frequent symptoms? (4)
1. Chest tightness
2. Shortness of breath
3. Wheezing
4. Coughing
26
Broncoconstriction in asthma is usually reversible, however it may get worse and which medical emergency can it trigger?
Asthma attack
27
What is complete control of asthma defined as? (5)
1. No daytime symptoms
2. No night-time waking due to asthma
3. No asthma attacks
4. No need for rescue medication
5. Normal lung function
28
Which FEV1/Peak flow i considered to be normal lung function?
Over 80%
29
Which lifestyle advice can be given to people with asthma? (3)
1. Weight loss
2. Smoking cessation
3. Breathing exercises
30
Before stepping up treatment for asthma, what must you first check? (3)
1. Compliance
2. Inhaler technique
3. Triggers
31
What is the first step of treatment for mild or intermittent asthma?
5. What is step 4?
STEP 1: Inhaled SABA PRN
3. + LABA
4. Increase dose ICS / + LRA / + MR Theophylline + MR oral BA
32
Asthma: When should the patient be moved on to step 2? (3)
1. Using the inhaler >3 times a week
2. Any night time symptoms
3. Asthma attack within the last 2 years
33
Asthma: What is step 2?
STEP 2: SABA PRN + Regular ICS
34
Asthma: What is step 3?
STEP 2: SABA PRN + Regular ICS + Regular LABA
35
Asthma: What are the options for step 4? (4)
STEP 4:
1. Increase dose ICS
2. Leukotriene receptor antagonist
3. MR Theophylline
4. MR Oral beta agonist
36
Asthma: What is step 5?
STEP 5:
| Regular oral steroids
37
Which drugs can be used as inhaled SABA? (STEP 1) (2)
1. Salbutamol
| 2. Terbutaline
38
Which drugs can be used as ICS? (STEP 2) (4)
1. Beclometasone
2. Budesonide
3. Mometasone
4. Fluticasone
39
What is the ICS dose for a child 5-12?
200-400mcg/day
40
What is the ICS dose for an adult?
400-800mcg/day
41
Which drugs can be used as inhaled LABA? (STEP 3) (2)
1. Formetarol
| 2. Salmetarol
42
What should be done if a person is going through more then one SABA a month?
Urgent assessment
43
Is a LABA included in the management of asthma for children under 5?
No
44
Asthma >5: What is step 1?
STEP 1: SABA PRN
45
Asthma >5: What is step 2?
STEP 2: Regular ICS
46
Asthma 2-5: What is step 3?
STEP 3: Monteleukast
47
Asthma >5: What is step 4?
STEP 4: Referral to peadiatrician
48
Asthma <2: What is step 3?
STEP 4: Referral to peadiatrician
49
Which side effects are associated with using ICS in children? (3)
1. Adrenal suppression
2. Low BMD
3. Growth failure
50
If asthma treatment is to be stepped down, what do they recommend to continue?
Regular ICS
51
If asthma treatment is to be stepped down, how often should this be done and by how much?
Every 3 months, 25-50% dose reduction each time
52
What is the drug of choice in exercise induced asthma? When should it be used?
SABA
| Immediately before
53
What is the peak flow of moderate acute asthma?
>50-75% of best
54
As well as inability to complete sentences in one breath, What is the peak flow of severe acute asthma?
33-50% of best
55
As well as inability to complete sentences in one breath, What is the respiratory rate of severe acute asthma?
>25/min
56
As well as inability to complete sentences in one breath, What is the heart rate of severe acute asthma?
>110BPM
57
What is the peak flow and oxygen of life-threatening acute asthma?
<33%, <92%
58
What is the characteristic of near fatal acute asthma?
Raised carbon dioxide requiring mechanical ventalation
59
In acute asthma, which patients can be treated at home?
Moderate
60
In acute asthma, which patients need to be admitted to hospital?
Severe or life threatening
61
Which level of oxygen should we try to maintain in patients with acute asthma?
94-98%
62
What is first line treatment for non life threatening acute asthma?
pMDI SABA given through a spacer
63
What is first line treatment for life threatening acute asthma?
SABA given through a nebuliser
64
In acute asthma, how long should a patient be prescribed oral prednisolone?
For 5 days or until recovery
65
In severe acute asthma, which 2 drugs are an option to be used only after recommendation by senior staff?
1. IV Magnesium sulfate
| 2. IV Aminophylline infusion
66
In acute asthma, how long should a child over 2 be prescribed oral prednisolone?
3 days
67
How soon after an asthma attack should the GP be informed? They need to do a review and come up with an action plan
24 hours after discharge
68
Why is ephedrine a less suitable broncodilator compared with salbutamol or terbutaline?
Less selective, associated with arrhythmias
69
What are the indications for adrenaline?
1. Anaphylaxis
2. Severe croup
3. Angiodema
4. Cardiopulmonary ressus
70
With which other drug should LABAs be used?
Only if the patient regularly used an ICS
71
Which LABA should not be used in asthma attacks due to its long onset?
Salmetarol
72
What effect does theophylline have on electrolytes?
Causes hypokalaemia
73
What effect can beta 2 agonists have on electrolytes?
Cause hypokalaemia
74
In people using beta 2 agonists, which concomittant medicines may result in hypokalaemia? (3)
1. Theophylline
2. Diuretics
3. Corticosteroids
75
What should be monitored in patients with severe asthma?
Potassium - risk of hypokalaemia
76
Which asthma broncodilator should be discontinued if there is no benefit?
LABA - formetarol or salmetarol
77
If a previously effective SABA fails to provide relief for at least how long should the patient be advised to contact their doctor?
3 hours
78
A trial of ICS are used for 3-4 weeks to help distinguish asthma from COPD. If there is a clear improvement after 3-4 weeks, what does this suggest?
Asthma
79
How are ICS effective in asthma?
Reduce airway inflammation, reduce oedema and secretion of mucous in the airway
80
What reduces the efficacy of ICS?
Current or previous smoking
81
How long after initiation does it take for symptoms to be alleviated with ICS?
3-7 days
82
Which LABA + ICS combination inhalers can be used as a reliever for patients struggling with SABA alone? (2)
1. Symbicort
| 2. Fostair
83
Does the dose of an oral steroid need to be tapered if high doses are used short-term for an acute asthma attack?
No
84
At what time of day should an oral steroid be taken to reduce effect on normal circadian rhythm?
Morning
85
Is a patient develops oral thrush while using an ICS, what are the options?
1. Counselling on rinsing mouth out after administration
2. Using a spacer device
3. Antifungal oral suspension or gel
86
Is a patient develops oral thrush while using an ICS, does it need to be stopped?
No
87
Which ICS should be prescribed by brand as they are not interchangeable?
QVAR and Clenil Modulite - QVAR is twice as potent
88
What should be issued to patients with high doses of beclometasone?
Steroid card
89
How would you describe the particles in fostair?
Extra fine - if switching from a non-extra-fine inhaler, half the dose
90
Why can toxicity of aminophylline and theophylline be delayed?
Often prescribed as modified release preparations
91
What are the symptoms of aminophylline toxicity? (6)
1. Vomiting
2. Agitation
3. Restlessness
4. Dilated pupils
5. Sinus tachycardia
6. Hyperglycaemia
92
Why is plasma-theophylline monitoring essential?
To avoid loading patients already taking it with more as side effects of convulsions and arrythmias often preced other signs of toxicity
93
What should the level of plasma theophylline be?
10-20mg/L, 5-15mg/L may also be effective
94
At which plasma theophylline level do we start to see severe adverse effects?
>20mg/L
95
How long after starting IV aminophylline treatment should a plasma theophylline level be taken?
4-6 hours
96
If a patient is taking oral theophylline treatment, how long after they start should a plasma level be taken?
5 days after
97
Should patients already taking oral theophylline or aminophylline receive a loading dose of aminophylline?
NO
98
How much theophylline be prescribed?
BY BRAND
