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EXAM Y4 > Respiratory > Flashcards

Respiratory Flashcards

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1
Q

What are the symptoms of asthma?

A

– Wheezing (especially on expiration)
– Breathlessness (not enough O2)
– Coughing
– Chest tightness

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2
Q

What is emphysema?

A

The membranes in the alveoli which hold them are broken down which leads to large holes in air spaces
Not efficient gas exchange

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2
Q
A
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3
Q

What are symptoms of chronic bronchitis?

A

– Excess mucus production – bronchospasm – wheezing dyspnea – hypoxia and hypercapnia – productive cough – overweight

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4
Q

What are the symptoms of emphysema?

A

– Increase dyspnoea even at rest – Minimal cough – hyperventilation – thin pursed lips to compensate for lack of elastic recoil

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5
Q

Is it common to have COPD if under 35?

A

No it is rare

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6
Q

Is a chronic productive cough present in asthma symptoms?

A

No more of a dry cough

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7
Q

What does atopic history mean?

A

Strong links with other allergies for example eczema

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8
Q

What can be some triggers of asthma?

A

Allergen exposure, infection, cold air, exercise, some medication (NSAID’s)

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9
Q

What is included in a high diagnosis probability of asthma?

A

Typical symptoms, wheeze, no suggestion of alternative
Record likely asthma, start treatment for six weeks with inhaled corticosteroid reassess symptoms

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10
Q

What is included in a medium diagnosis probability of asthma?

A

Some but not all typical features or do not respond to initial treatment
Carry out reversibility test with Bronco dilator repeat after ICS

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11
Q

What is peak expiratory flow and give the benefits?

A

Measurement of volume of air expelled from lungs
Cheap and easy to use
Can keep a diary
Useful diagnosis and monitoring

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12
Q

Give red flags in asthma diagnosis:

A

– Unexpected clinical features (crackles)
– Persistent breathlessness
– X-ray shows shadows
– Chronic sputum production

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13
Q

If over 35, what other symptoms are likely to be COPD?

A
  • Excertional breathlessness
  • Chronic cough
  • Regular sputum production
  • Freq winter bronchitis
  • Wheeze
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14
Q

What are two red flag symptoms of COPD?

A

Chest pain and haemoptysis- coughing up blood

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15
Q

What is a dyspnoea scale?

A

Scale from grade 1 to 5, one being the least and five being the most

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16
Q

What is spirometry?

A

Monitors lung function and diagnosis respiratory conditions
Measured expelled from lungs by mouth, not nose (sealed)

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17
Q

What is a normal forced expiratory volume compared to one of asthma?

A

Normal 4 litres
Asthma 2 litres

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18
Q

Before changing asthma treatment, what are three things to check?

A
  • Adherence
  • Inhaler techniques
  • Eliminate triggers
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19
Q

What are three nonpharmaceutical treatments for COPD?

A

– Treatment and support to stop smoking
– Pneumonnical and influenza vaccines
– Pulmonary rehabilitation (physiotherapist)

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20
Q

What pharmaceutical treatment should be used for COPD if the patient also has asthma symptoms?

A

LABA+ ICS

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21
Q

What pharmaceutical treatment should be used for COPD if the patient doesn’t have asthma symptoms?

A

LABA+ LAMA

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22
Q

What if there is no improvement on the second stage of treatment for COPD?

A

Use LABA, LAMA and ICS

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23
Q

What are the two brands beclometasone is available in?

A

Qvar
Clenil

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24
Are the two brands of beclometasone interchangeable and why?
No, must be prescribed by brand and not generic name Qvar has extra fine particles and approx twice the potency of Clenil
25
Why are oral corticosteroids used for in asthma and COPD?
Usually a short term rescue therapy to bring symptoms under control e.g. -asthma exacerbation -COPD when patient gets URTI, usually with antibiotics
26
What are local adverse affects of corticosteroids?
Hoarseness Throat irritation Dysphonia- changes in voice Candida- T cells important against fungal infections
27
What are practical considerations in corticosteroids?
Can be given in multiple routes but lead to more systemic SE Effect can be slow so needs to make sure to take regularly Don't stop them abruptly Children can take it, can leads to slow growth COPD, only in combo with LABA or LAMA
28
Give the counselling points for corticosteroids:
Regular use as preventative Morning and evening dose, usually fits in with routine Oral dose first thing in morning with breakfast as decreases GI disturbances and better with natural steroid production
29
How long should you wait between doses of inhalers?
30 seconds
30
Which system do muscarinic receptors work on?
Parasympathetic, apart form sympathetic for sweat glands
31
Give six examples of muscarinic antagonists:
Atropine- no selective, crosses the BBB Tiotropium Hyoscine Tropicamide Pirenzepine- M1 Darifenacin- M3
32
What are the effects of muscarinic antagonists?
Sympathetic effects: fight or flight Tachycardia, increases HR BP unchanged GIT motility inhibited Urinary retention Dilation of pupil
33
What are the clinical uses of antimuscarinics and some examples:
Asthma and COPD: tiotropium, ipratropium Antispasmatics: hyoscine, dicycloverine Motion sickness hyoscine hydrobromide Urinary incontinence: darifenacin Ophthalmology: mydriasis
34
What are the side effects of muscarinic antagonists?
Relate to sympathetic action: Dry mouth, dry skin, reduced bronchial secretions, tachycardia, constipation, urinary retention, blurred vision, drowsiness
35
Name and describe the short acting muscarinic antagonist (SAMA) for COPD:
Ipatropium Lisenced for airway obstruction, bronchospasm and acute life threatening asthma Max effect within 30 mins, effects last 3-6 hours 3-4 times daily
36
Name four long acting muscarninc antagonists:
-Tiotropium, Handihaler for COPD only, Respimat for asthma also - Glycopyrronium- Seebri breezhaler - Umeclidinium- Ellipta Aclidinium- Elikra Genuair
37
What are cautions for prescribing antimuscarinics:
Prostatic hyperplasia Glaucoma Bladder outflow obstruction
38
What are practical considerations when prescribing a LAMA?
Discontinue SAMA if going to use LAMA Duration of action is usually long so OD use is fine
39
What are counselling points for SAMA/ LAMA's?
SAMA as reliever LAMA take regularly Nebulised ipatropium, risk with glaucoma so cover eyes or use a mouth piece nebuliser rather than a face mask
40
How are LTRAs used?
Not for COPD Popular in children, 6 months upwards Additive effect with corticosteroids Are in the additional controller therapy after LABA and low dose ICS
41
Give an example of an LTRA and it's info:
Montelukast, OD evenings Oral (tabs, chewable, granules) Used at earlier stage for children to reduce steroid burden SE: GI disturbances
42
What are two major considerations when using LTRAs?
Neuropsychiatric reactions: - depression, speech impairment, stuttering Churg- strauss syndrome: Inflammation of BV, associated with patients who have been on oral steroids
43
Name the two xanthines used for the treatment in asthma/ COPD:
Theophylline Aminophylline
44
What are the directions for taking xanthines:
BD dose using M/R preps Prescribed as brand as not interchangeable Additive effect when used with B2 agonist but can increase SE
45
What are the side effects of xanthines?
CNS stimulation CV effects -palpitations -tachycardia -vasodilation GI effects -nausea/ vomiting -GI irritation -Diarrhoea Hyperkalemia
46
What could side effects of GI disturbances when using xanthines indicate?
The patient is taking too high dose
47
How do xanthines interact with macrolides?
Xanthines have a very small therapeutic window The antibiotic inhibits the P450 enzyme which breaks down the xanthine So an increase in P450 means an increase in xanthine and due to small therapeutic window it becomes toxic
48
What can the conc of xanthines be increase by?
Heart failure Hepatic impairment Viral infections Elderly
49
What can the conc of xanthines be decreases by?
Smoking Heavy alcohol consumption
50
What are the therapeutic levels of xanthines?
10-12 mg/L optimal range 10-20 mg/L therapeutic range
51
What are the measures put in place to ensure the correct dose of xanthines are being used?
Blood conc measured after 5 days of oral treatment Sample 4-6 hours after IV aminophylline
52
When are xanthines used in treatment for asthma and COPD?
Asthma- reserved for those with severe conditions- specialist COPD- when can't use inhaler therapies Aminophylline used as IV in both when severe exacerbations
53
When are mast cell stablisers used in asthma and COPD?
Asthma- specialist as prophylaxis, rarely used COPD- not used
54
Give two examples of mast cell stabilisers:
Nedocromil sodium Sodium cromoglycate
55
What can some patients experience with mast cell stabilisers and how is this fixed?
Cause paradoxical bronchospasm Withdraw treatment slowly with SABA
56
What three things can be used to manage asthma triggers:
Antihistamines Avoidance Nasal corticosteroids
57
Name and describe a mucolytic agent for COPD:
Carbocisteine Pts with chronic productive cough to reduce sputum viscosity Only in patients with stable COPD and more bronchitis symptoms Stop if no benefit after 4 week trial
58
What is oxygen therapy?
Prolongs survival in some patients with COPD Use for a min of 15 hours per day Ambulatory oxygen
59
How to treat acute asthma?
- Use O2 to maintain SpO2 level at 94-98% - High dose B2 agonist - nebulised, often with ipatropium aswell - Steroids, IV and continue for min of 5 days
60
How to treat acute COPD?
- Increase dose of short acting bronchodilators, often nebulised - Rescue pack - Theophylline if poor response to bronchodilator - Oxygen - In severe cases pt may require ventilation -Physiotherapy
61
Name two Short Acting Beta Agonists (SABA's):
Salbutamol (Ventolin) Terbutaline
62
What is the timescale on when SABAs work?
Max effect within 30 minutes Bronchodilatory effects 4-6 hours
63
Name 3 LABA's for asthma:
Salmeterol, formoterol, bambuterol
64
Which LABA is used as MART and how does this work?
Maintenance And Reliever Therapy Formoterol Dual action as has both long and short acting components
65
How is Bambuterol administered?
Only available as an oral tablet Is a prodrug of terbutaline
66
What are adverse effects of SABAs and LABAs?
Due to systemic adsorption: Tremor, nervous tension, headache, tachycardia/ palpitations, hypokalaemia
67
What is MART therapy?
Famoterol + steroid combination Has both long and short acting components Usually taken BD as a preventer but also be used for rescue When used as a rescue therapy, can increase steroid exposure, which can control exacerbations
68
What is the advice for taking SABAs and LABAs during pregnancy?
The benefits outweigh the risks SABA can also be used to delay premature labour as it causes relaxation of smooth muscle in the uterus
69
When can steroids become ineffective?
In steroid resistance, particularly seen in COPD with smokers
70
Which corticosteroid are less likely to contribute to adrenal suppression and why?
Fluticasone, Mometasone and Ciclesonide Poorly absorbed from the GI tract and undergo almost complete pre-systemic metabolism
71
Which steroids are used at which point in the treatment of airway diseases?
Regular bronchodilator: low dose inhaled beclometasone More severe: high dose inhaled fluticasone Acute exacerbations: IV hydrocortisone and oral prednisolone

EXAM Y4 (19 decks)

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