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Respiratory Flashcards

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1
Q

Does asthma symptoms occur more at night or during the day?

A

At night which interrupts sleep

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2
Q

Medications that trigger asthma?

A

NSAIDs and beta-blockers

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3
Q

What is the first step in asthma treatment in children 12+ and adults?

A

SABA PRN

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4
Q

If SABA is not sufficient in treatment of asthma in children 12+ and adults?

A

Add a regular preventer = low dose ICS

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5
Q

Examples of low dose ICS?

A

Beclometasone 200-400mcg
Budesonide 400mcg
Fluticasone 200mcg
Mometasone 400mcg
Ciclesonide 169mcg

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6
Q

When would a patient need to step up their asthma treatment?

A

Use their SABA or have symptoms 3+ times a week
Night time waking once a week
Asthma attack in the last 2 years requiring oral steroids

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7
Q

Initial add on therapy to SABA + ICS in asthma?

A

LABA as fixed dose BD or MART (maintainable and reliever therapy)

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8
Q

What is LABA MART therapy?

A

LABA (E.g. formoterol) + ICS in one inhaler

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9
Q

Do you still give SABA with MART therapy?

A

No. MART therapy is sufficient as a reliever

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10
Q

What is the next step after a LABA in asthma for children 12+ or adults?

A

Consider stopping the LABA if no response.
Increase ICS dose or add a leukotriene receptor antagonist (E.g. montelukast)

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11
Q

What is the next step in asthma management for children 12+ or adults who have not been managed with medium dose ICS or LTRA?

A

Refer - may be be started on oral steroids or theophylline

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12
Q

When should an asthma patient be urgently assessed?

A

> 1 inhaler per month

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13
Q

Is formoterol (LABA) fast acting?

A

Yes which is why it can replace a SABA in MART treatment

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14
Q

How does asthma treatment in children vary?

A

Doses of ICS are lower I.E. stepped up from very low to low if needed
LTRA can be started at any step including as an alternative to LABA

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15
Q

At what age is LABA not licensed for use in asthma?

A

< 5 give LTRA instead

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16
Q

How long do effects of SABAs last?

A

3-5 hours
Refer to doctor if less

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17
Q

Side effects of SABA / LABA?

A

Hypokalaemia
Tremors or headaches
CVS effects including palpitations

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18
Q

SABA dose?

A

1-2 puffs QDS PRN

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19
Q

Can you take a SABA dose before exercise to prevent symptoms?

A

Yes

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20
Q

Which electrolyte disturbance is caused by Prednisolone or theophylline?

A

Hypokalaemia
Caution when taking with SABA / LABA

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21
Q

Relationship between potassium and glucose?

A

Hypokalaemia = hyperglycaemia
And vice versa

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22
Q

Storage for fostair inhalers?

A

Keep in the fridge

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23
Q

Dose of LABA inhalers?

A

BD + reliever doses in MART

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24
Q

Can a LABA be used without an ICS?

A

No

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25
How long does it take for an ICS to work?
7-14 days
26
Dose of ICS?
BD Except Ciclesonide = OD
27
What colour inhaler is beclometasone?
Brown
28
Should beclometasone CFC free inhalers be prescribed by brand?
Yes
29
Which beclometasone inhaler is more potent, Qvar or Clenil?
Qvar is twice as potent as Clenil
30
Licensing age of beclometasone easyhaler?
18+
31
Licensing age for becolometasone Qvar/Clenil inhaler?
12+
32
Side effects of ICS?
Oral thrush - do not need to stop Hoarse voice and sore throat Bronchospasm - stop - mild cases can be prevented by using SABA before use
33
How to avoid oral candidiasis in ICS?
Use a spacer Rinse mouth and brush teeth after use Ensure proper technique Can treat with miconazole OTC and no need to stop inhaler
34
When should LTRAs be taken?
At night
35
Side effects of LTRAs?
Neuropsychiatric reactions - report changes in speech or behaviour including speech impairment and obsessive-convulsive symptoms Church-Strauss syndrome - inflammation of blood vessels reducing blood flow to organs and tissues
36
How often is theophylline given?
Every 12 hours
37
Theophylline therapeutic index?
10-20mg/L
38
Is theophylline brand specific?
Yes
39
How long after a theophylline dose is blood levels taken?
4-6 hours
40
Does theophylline require frequent monitoring?
Not once the dose is stable
41
What factors increase theophylline levels?
HF, infection, elderly, liver impairment
42
What factors decrease theophylline levels?
Smokers and alcohol
43
What should be done if someone quits smoking while on theophylline?
The dose should be reduced
44
Signs of theophylline toxicity?
“CHAT V” Convulsions/CNS stimulation (dilated pupils, restless) Hypokalaemia (potentially leading to QT prolongation) and hyperglycaemia Arrhythmias Tachycardia Vomiting
45
Interactions with theophylline?
Beta blockers - bronchospasm Ciprofloxacin - seizures
46
Which inhaler devices should be used slow & steady?
pMDI and breath-actuated inhaler
47
Which inhaler should be used fast and deep?
DPI
48
How old do you have to be to use a DPI?
5 years old
49
Are spacers interchangeable?
No
50
How often should a spacer be changed?
Every 6-12months
51
How should spacers be cleaned and how often?
Once a month with warm water and mild detergent
52
How many times should a peak flow reading be repeated?
3
53
What’s does a PEF > 80% mean?
Good control
54
What should be done if a patients PEF < 80%?
Quadruple the ICS dose
55
What should be done if a patients PEF < 60%?
Start oral steroids and seek same day medical advice
56
What should be done if a patients PEF < 50%?
Seek urgent medical help
57
How is asthma attacks treated?
Salbutamol 2-10 puffs every 10-20mins or PRN using a spacer device Followed by a short course of Prednisolone 40-50mg OD for at lease 5 days if 12+ or 3 days if under 12
58
When should a patient having an asthma attack go to hospital?
Unresponsive, severe or life threatening or if they’re under 2 years old
59
Main symptoms which distinguishes COPD from asthma?
Chronic symptoms present throughout the day Cough that produces mucus
60
Can a patient have asthma and COPD?
Yes
61
First line treatment for COPD?
SABA or SAMA PRN
62
Example of a SAMA?
Ipatropium bromide
63
If patient is still breathless despite reliever therapy or has an acute exacerbation of COPD symptoms?
Step up treatment depending on the presence of asthmatic features
64
If patient has asthmatic features in COPD?
Add an inhaler containing LABA + ICS
65
If patient has no asthmatic features in COPD?
LABA + LAMA STOP SAMA if given previously
66
When would a COPD patient need triple therapy?
Severe exacerbation which requires hospital admission Or 2+ moderate exacerbations in the last year that required steroids or antibiotics Patients with asthmatics features that effect QoL
67
What is triple therapy for COPD?
LABA + ICS + LAMA (stop SAMA)
68
When can theophylline be used in COPD?
Alternative to bronchodilators (SAMA or SABA)
69
Treatment of acute COPD exacerbation?
Antibiotic (macrolide or quinolone) + 30mg Prednisolone for 7-14 days
70
Which antibiotics are used in acute COPD exacerbations?
Macrolide or quinolone
71
Treatment of severe COPD + chronic bronchitis?
Roflumilast + bronchodilators
72
Oxygen targets for COPD patients?
88-92%
73
Example of a LAMA?
Tiotropium Common brands include Spriva and Braltus
74
Dose of LAMA?
OD Except Aclidinium which is BD
75
How long does ipratropium last?
3-6 hours
76
How many times can ipratropium be taken a day?
TDS
77
Important MHRA counselling for tiotropium?
Never place a capsule directly into the mouth piece as this can cause you to inhale it
78
How often can chlorphenamine be taken?
QDS
79
Which juices must be avoided with fexofenadine?
Apple and orange juices reduce exposure
80
Which antihistamines are non-sedative?
“LAC” Loratidine Acrivastine Cetirizine
81
Which antihistamine can cause QT prolongation?
Hydroxyzine - prescribe lowest effective dose for the shortest effective period and half dose in elderly if unavoidable
82
Do non-sedative antihistamines make you sleepy?
Yes but to a lesser extent
83
Cautions for antihistamines?
BPH, glaucoma and severe liver impairment (sedative antihistamines)
84
Allergen vaccine interactions?
Beta blockers (may deem adrenaline ineffective) and ace inhibitors (severe anaphylactoid reactions)
85
Adrenaline doses?
12+ = 500mcg 6-12 = 300mcg 6 months - 6 = 150mcg
86
How many epipens should a patient carry at all times?
2
87
How long after the first adrenaline injection should the second one be given?
5-15mins
88
Should a patient seek medical advice after injecting with adrenaline if symptoms improve?
Yes call ambulance after the first injection
89
How should the patient be sat while waiting for the ambulance following an epidemic injection for anaphylaxis?
Lay down with legs raised to restore BP unless having breathing difficulties which requires them to sit up
90
What is angioedema?
Swelling of the soft tissue due to allergic reaction. Symptoms include swollen lips, eyes and tongue.
91
Treatment of angioedema?
Antihistamine + corticosteroids IM adrenaline if laryngeal oedema
92
Contraindications of mucolytics such as carbocisteine?
Active peptic ulcers as this also decrease stomach mucus making ulcers worse
93
Symptoms of croup?
Barking cough Hoarse voice Breathing difficulties Stridor - high pitched sound made when breathing in
94
When is croup a medical emergency?
When it effects breathing
95
Treatment of croup?
Dexamethasone oral solution

PharmEducate Notes (8 decks)

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