Chapter 3: Respiratory System Flashcards Preview

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Flashcards in Chapter 3: Respiratory System Deck (153)
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1

DPIs are recommended in children over what age?

5 years

However, between 3 and 5 years DPI can be considered if existing treatment is ineffective

2

What is the MHRA advice surrounding PMDIs?

Risk of airway obstruction from aspiration of loose objects
Patients should be reminded to remove the mouthpiece cover fully, shake the device and check that both the outside and inside of the mouthpiece are clear and undamaged before inhaling a dose, and to store the inhaler with the mouthpiece cover on.

3

What are the different types of inhalers?

DPI
MDI
Breath actuated

4

How should you clean spacer devices?

The device should be cleaned once a month by washing in mild detergent and then allowed to dry in air without rinsing; the mouthpiece should be wiped clean of detergent before use.

5

How often should spacers be replaced?

Every 6-12 months

6

What are the main nebulised drugs and their associated indications?

- A beta 2 agonist or ipratropium bromide to a patient with an acute exacerbation of asthma or of chronic obstructive pulmonary disease

- A beta 2 agonist, corticosteroid, or ipratropium bromide on a regular basis to a patient with severe asthma or reversible airways obstruction when the patient is unable to use other inhalational devices

- An antibiotic (such as colistimethate sodium) or a mucolytic to a patient with cystic fibrosis

- Budesonide or adrenaline/epinephrine to a child with severe croup

- Pentamidine isetionate for the prophylaxis and treatment of pneumocystis pneumonia.

7

Why would you want to avoid high dose ICS in children?

Associated with adrenal suppression, growth impairment and reduced bone mineral density.

8

According to BTS guidelines, what should be prescribed if a patient has been diagnosed with asthma?

How does this differ in children?

SABA
Consider monitored initiation with low dose ICS

Still use SABA but can start with a VERY low dose of ICS

**If the patient is still getting symptomatic, short-lived wheezes, this ICS should be used as a regular preventer**

9

According to BTS and NICE guidelines, in what situations would a patient need a regular preventor?

- If they are using 3 or more doses of their SABA a week
- Symptomatic three times a week or more,
- Waking at night due to asthma symptoms at least once a week.
- Had asthma attack in the last 2 years

10

BTS asthma guidelines in adults:

If a patient is on a regular low dose ICS and SABA yet symptoms are not being controlled, what would the next step up be?

Add inhaled LABA (normally as a combination inhaler with ICS)

11

BTS asthma guidelines in adults:

Patient's regular meds:
Low dose ICS and LABA combination
SABA

If no response to the LABA, what would the next step be?

Stop LABA and increase dose of ICS

12

BTS asthma guidelines in adults:

Patient's regular meds:
Low dose ICS and LABA combination
SABA

If the patient is benefitting from the LABA yet symptoms are still not being controlled, what would the next step be?

Continue LABA and increase ICS to medium dose

At this point you can also consider trials of:
LTRA
S-R Theophylline
LAMA

13

BTS asthma guidelines in adults:

Patient's regular meds:
Medium dose ICS and LABA combination
SABA
Has had a trial of LAMA/LTRA/SR-Theophylline


If a patient is still symptomatic, what would the next step be?

High dose therapies

Consider trial of:

High dose ICS

Addition of 4th drug e.g. LTRA, SR-Theophylline, beta agonist tablet, LAMA

Refer to specialist care

14

BTS asthma guidelines in adults:

After high dose therapies, what would the next step be?

Continuous or frequent use of oral steroids
Use daily steroid tablet in the lowest dose providing adequate control

Maintain high dose ICS

Refer to specialist care

15

In an asthma attack, if a patient required nebulisers, is this driven by air or oxygen?

Oxygen

16

For asthmatic children under 5 years, what type of inhaler is recommended for bronchodilator therapy?

Pressurised metered-dose inhaler and spacer device, with a facemask if necessary

17

For asthmatic children under 5 years, what type of inhaler is recommended for corticosteroid therapy?

Pressurised metered-dose inhaler and spacer device, with a facemask if necessary

18

For asthmatic children between 5 and 15, what type of inhaler is recommended for corticosteroid therapy?

Pressurised metered-dose inhaler and spacer device

19

For asthmatic children between 5 and 15, what type(s) of inhalers is recommended for bronchodilator therapy?

Consider a wider range of inhalers- not just PMDIs
All down to what suits the patient and compliance

20

What is the target peak expiratory flow in asthma?

>80%

21

1. BTS asthma guidelines recommend that ICS should be initially taken how many times a day?
2 .What steroid is the exception to this?

1. Twice a day

(However, the same total daily dose, taken once a day, can be considered in patients with milder disease if good or complete control of asthma is established)

2. Ciclesonide should be taken only once daily initially (only twice daily in severe asthma)

22

True or false:

BTS recommend that inhalers do not need to be prescribed by brand

False

They should be prescribed by brand

23

How long should be the initial trial of an ICS be in a child under 5?
After this trial, in what situation would you continue the ICS?

8 weeks and then review to see if it has benefitted
If they had another exacerbation within 4 weeks of stopping, then continue

24

When would you consider decreasing maintenance therapy for asthma?

What is the recommended dose reduction for ICS at a time and how often?

When a patient's asthma has been controlled with their current maintenance therapy for at least three months

Reduction of 25-50% ICS dose every 3 months

25

Can inhaled corticosteroids be used during pregnancy for asthma?

Yes

26

Can oral corticosteroids be used during pregnancy for asthma?

Yes

27

What is 1st line for acute asthma in adults?

How does the administration route differ with non-life threatening vs life threatening?

High dose inhaled SABA (salbutamol or terbutaline) and oral prednisolone once daily for at least 5 days or until recovery

Non-life threatening - PMDI recommended

Life-threatening - oxygen driver nebuliser recommended

28

In what situation would you use IV beta 2 agonists for acute asthma in adults?

If inhaled therapy cannot be used reliably

29

In severe acute adult asthma, if the patient has poor response to nebulised SABA, what can be added?

Nebulised ipratropium

30

What kind of drug is ipratropium?

SAMA