Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

reg exam > Respiratory > Flashcards

Respiratory Flashcards

(70 cards)

Start Studying
1
Q

Intensity of acute asthma

A

Moderate:
* Peak flow >50 %
* Normal speech

Severe:
* Peak flow 33-50%
* Unable to complete full sentence
* SpO2 92%+
* RR 25+ (13y+), >30 (5-12y), >40 (1-5y)
* HR >110 (13y+), >125 (5-12y), >140 (1-5y)

Life-threatening:
* Peak flow <33%
* SpO2 <92%
* Hypotension
* Altered consciousness and exhaustion
* Cyanosis
* Cardiac arrythmias and silent chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Management of moderate acute asthma in adults

A

SABA as required via spacer: 4 puffs initially, 2 mins, 2 puffs, 2 mins 2 puffs (upto max 10).
Prednisolone 40-50mg /day for 5 days.
Hospital admission if:
* Inadequate treatment response
* Previous severe attack
* Pregnant
* Disabled
* If occurs after midday

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Management of moderate acute asthma in children

A

SABA as required via spacer: 1 puff every 30-60 seconds (max 10).
Admit to hospital.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Management of severe/life-threatening acute asthma in adults

A
  1. 5mg (high-dose) salbutamol via oxygen-driven nebuliser + 40-50mg prednisolone for 5 days.
  2. Nebulised ipratropium
  3. IV magnesium or aminophylline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Management of severe/life-threatening acute asthma in children >5y

A
  1. 5mg (high-dose) salbutamol via oxygen-driven nebuliser + 30-40mg prednisolone for 3 days.
  2. Nebulised ipratropium
  3. IV magnesium or aminophylline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Management of severe/life-threatening acute asthma in children aged 2-5

A
  1. 2.5mg (high-dose) salbutamol via oxygen-driven nebuliser + 20mg prednisolone for 3 days.
  2. Nebulised ipratropium
  3. IV magnesium or aminophylline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Prednisolone dose for children <2 years for acute severe/life-threatening asthma

A

10mg for 3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Alternative if oral prednisolone can’t be used in acute asthma

A

Equivalent doses of IM methylprednisolone or IV hydrocorisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Lifestyle advice in chronic asthma

A

Weight loss
Smoking cessation
Breathing exercise
Identify and avoid triggers
Keep warm and dry in cold weather

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of asthma in adults and children >12

A
  1. AIR therapy: low-dose inhaled corticosteroid (budesonide) and formoterol PRN.
    If initial symptoms severe enough to bypass step 1, or if step 1 insufficient (reliever required 3/7 OR 1/7 nighttime waking due to symptoms)
  2. Low-dose MART therapy: low-dose ICS and formoterol.
    If step 2 insufficient:
  3. Moderate-dose MART therapy: moderate-dose ICS and formoterol.
    If step 3 insufficient:
  4. Check fractional exhaled nitric oxide (FeNO) level and blood eosinophil count.
    If raised, refer to specialist. If not:
  5. Trial adding LTRA (Montelukast) or LAMA for 12 weeks
    If controlled, continue. If no improvement at all, try the other one. If improved a bit but inadequate:
  6. Trial adding both LTRA (Montelukast) and LAMA for 12 weeks.
  7. Response still inadequate, refer to specialist.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How should patients >12 on SABA alone (old asthma guidelines) be switched?

A

Controlled: leave it.
Uncontrolled: switch to AIR PRN.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How should patients >12 on low-dose ICS + SABA/LABA/LTRA (old asthma guidelines) be switched?

A

Controlled: leave it.
Uncontrolled: switch to low-dose MART.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How should patients >12 on moderate-dose ICS + SABA/LABA/LTRA (old asthma guidelines) be switched?

A

Controlled: leave it.
Uncontrolled: switch to moderate-dose MART.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How should patients >12 on high-dose ICS (old asthma guidelines) be switched?

A

Controlled: leave it.
Uncontrolled: specialist referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why have asthma guidelines changed recently?

A

MHRA UPDATE: risk of severe asthma attacks and increased mortality associated with overuse of SABA with or without anti-inflammatory maintenance therapy in patients with asthma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Management of asthma in children aged 5-11

A
  1. ICS BD + SABA prn
  2. Switch to low-dose MART (formoterol + ICS)
  3. Switch to moderate-dose MART
    • LRTA for 8-12 weels and assess effectiveness

If low/moderate dose MART not manageable, use ICS/LBA BD + SABA prn.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Management of asthma in children aged <5

A
  1. low-dose ICS BD + SABA prn for 8-12 weeks

If symptoms do not resolve: Check inhaler technique, adherence, alternative diagnosis, and environmental factors and then fix them. If not, refer to specialist.

If symptoms resolve: consider stopping treatment and reviewing after 3 months (may be childhood asthma only). If symptoms reoccur:
2. Restart low-dose ICS BD + SABA prn AND THEN increase to moderate-dose ICS BD + SABA prn
3. Trial of + LRTA for 8-12 weeks.
If improves, continue. If no improvement, refer to specialist.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Complete control of asthma symptoms

Signs (7) and action

A
  • No daytime symptoms
  • No night-time awakening
  • No asthma attacks
  • No relievers
  • No exercise limitation
  • FEV1 and or PEF >80% predicted/best
  • Minimal side effects from treatment

When controlled for at least 3 months, maintain patients on lowest possible dose of ICS (reduce by 25-50% every 3 months). Review regularly.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is COPD?

A

Chronic obstructive pulmonary disorder - progressive and irreversible condition which limits airflow due to obstructive bronchiolitis (inflammed bronchioles) and emphysema (damaged, ill-defined alveoli), resulting in symptoms such as dyspnoea, wheeze, chronic cough, sand sputum production.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

COPD management in patients with asthmatic features

A
  1. SABA or SAMA prn
    • LABA + ICS
      If pt has day-to-day symptoms affecting QOL, or has 1 severe or 2 moderate exacerbations within a year:
    • LAMA (if using SAMA discontinue)
  4. +Theophylline, oxygen therapy, and/or mucolytics

Ensure COPD patients are offered pneumococcal and influenza vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

COPD management in patients with non-asthmatic features

A
  1. SABA or SAMA prn
    • LABA + LAMA (if using SAMA discontinue)
      If pt has day-to-day symptoms affecting QOL, or has 1 severe or 2 moderate exacerbations within a year:
    • ICS
      If no improvement after 3 months, refer to LABA + LAMA and:
  4. +Theophylline, oxygen therapy, and/or mucolytics

Ensure COPD patients are offered pneumococcal and influenza vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is “asthmatic features” in COPD

A

Asthmatic features and/or features suggesting steroid responsiveness in this context include:
* any previous secure diagnosis of asthma or atopy
* a higher blood eosinophil count
* substantial variation in FEV1 over time (at least 400 ml)
* substantial diurnal variation in peak expiratory flow (at least 20%).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is given following a COPD exacerbation?

A

A rescue pack of prednisolone (or another oral corticosteroid) plus one of:
* Amoxicillin
* Doxycyline
* Clarithromycin (avoid if taking prophylactic azithromycin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Treatment of acute COPD exacerbation

A
  1. SABA/SAMA + Prednisolone
    • Aminophylline
  3. Oxygen if required
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Name 2 SABAs
Salbutamol Terbutaline
26
Name 3 LABAs
Salmeterol Formoterol Vilanterol
27
Cautions for beta agonists
* Risk of hypokalaemia - QT prolongation and arrythmias * Risk of DKA in diabetics, especially when given IV
28
Side effects of beta agonists
Fine tremor Palpitations Headache Seizure Anxiety
29
Beta agonists interactions
* Hypokalaemia - diuretics, cortucosteroids, theophylline. (increased QT prolongation risk). * Digoxin - risk of digoxin toxicity due to hypokalaemia * Beta-blockers - risk of beta-agonists not working when used concurrently with beta-blockers.
30
Name a SAMA
Ipratropium
31
Name 4 LAMAs
Tiotropium Aclidinium Glycopyrronium Umeclidinium
32
Muscarinic antagonist adverse effects
Usual antimuscarinic effects such as consstipation, dry mouth, cognitive effects.
33
Name 5 ICS
Beclometasone Budesonide Ciclesonide (OD, rest BD) Fluticasone Mometasone
34
Which brands of beclometasone contaihn extra fine particles?
Qvar Kelhale
35
Adverse effects of ICS
* Growth retardation in children in long term therapy (monitor and refer if occurs) * Taste and voice alteration * Candidiasis/oral thrush - causes sore mouth. Use spacer and rinse mouth out after use. * Paradoxical bronchospasm - prevent by using SABA beforehand, and change from aerosol to DPI.
36
Therapeutic range for theophylline plasma levels
10-20mg/l | Same as PHenYtoin (theoPHYlline)
37
Montelukast MHRA warnings
* Neuropsychiatric reactions - report changes in speech and behaviour * Churg-Strauss syndrome - causes eosinophilia, vasculitic rash, pulmonary symptoms, cardiac complicatinos, and peripheral neuropathy
38
When should theophylline levels be taken?
4-6 hours post dose, 5 days after starting treatment and 3 days after a dose adjustment.
39
How should theophylline be prescribed and why?
Prescribe by brand and maintain same brand due to differing bioavailability.
40
Symptoms of theophylline toxicity
Vomiting Tremor Palpitations Arrythmias | Sick and fast
41
What can increase the risk of theophylline toxicity?
* CYP inhibitors * Smoking cessation (or stopping other CYP inducers) * Fever - reduced clearance * Hypokalaemia - avoid concurrent use of diuretics, corticosteroids, beta-agonists etc.
42
Treatment of croup
Mild: Dexamethasone single oral dose Moderate/severe (hospital admission): * Dexamethasone or prednisolone single oral dose (given while awaiting admission). * If can't take oral: IM dexamethasone or nebulised budesonide. * If uncontrolled by steroids: nebulised adrenaline.
43
Symptoms of croup
Initally runny nose and fever Barking cough Hoarse voice Rasping/wheezing (stridor) Difficulty breathing
44
Which antihistamines are more sedating?
1st generation: * Most sedating: Alimemazine + Promethazine * Chlorphenamine * Cyclizine
45
Which antihistamines are less sedating?
2nd generation: * Acrivastine * Cetirizine * Desloratidine * Loratidine * Fexofenadine
46
Which antihistamines are used in treatment of nausea and vomiting?
Cinnarizine Cyclizine Promethazine
47
Which antihistamine is used in migraine treatment?
Buclizine (Migraleve)
48
What is used for allergen immunotherapy?
* Allergen vaccines to reduce symptoms of asthma and allergic rhinoconjunctivitis containing house dust mites, animal dander, pollen extract etc. * Vaccines containing bee/wasp venom extract to reduce risk of severe anaphylaxis. * Omalizumab - MaB which binds to IgE for use in proven IgE-mediate sensitivity when persistent severe allergic asthma cannot be controlled adequaltely with ICS + LABA. Can cause Churg-Strauss syndrome and hypersensitivity.
49
Response to anaphylaxis
* Use epipen immediately then call 999 stating "anaphylaxis". * Administer CPR if necessary * Raise patients legs (encourages blood flow to important organs) * Remove trigger if there is one (e.g., latex gloves, nuts etc) * Repeat adrenaline after 5 minutes if necessary
50
What strength of epipen is used in adults (or children >30kg)?
1:1000 0.3mg in 0.3ml ## Footnote 1 pen = 2ml of 1mg/ml concentration. After administration of 0.3ml (0.3mg), 1.7ml remains in the pen.
51
What strength of epipen is used in children (15-30kg)?
1:2000 0.15mg in 0.3ml ## Footnote 1 pen = 2ml of 0.5mg/ml concentration. After administration of 0.3ml (0.15mg), 1.7ml remains in the pen.
52
Emergency treatment of anaphylaxis (by HCPs)
* ASAP: High-flow oxygen (and IV fluids if patient with hypotensive shock) * Following stabilisation: non-sedating oral antihistamine e.g., cetirizine. If oral route not available, IM or IV chlorphenamine. * May also use SABA or SAMA who have persisting respiratory issues.
53
Dose of adrenaline under 6 months
100-150mcg
54
Dose of anaphylaxis for children 6 months - 5 years
150mcg
55
Dose of adrenaline in children aged 6-11
300mcg
56
Dose of adrenaline in children 12+ and adults?
500mcg
57
What is cystic fibrosis?
Genetic disorder affecting lungs, pancreas, liver, intestines, and reproductive organs which causes production of viscous sputum leading to chest infections and malabsorption.
58
Treatment in cystic fibrosis
Prevention of lung infections and maintenance of lung function: * Dornase alpha - mucloytic which aids clearance of sputum from lungs. * Consider long-term antibacterial therapy to suppress chronic S. aureus Nutrition and exocrine insufficiency treated with Pancreatin/Creon. Monitor patients for liver disease, diabetes, and osteoporosis.
59
Fostair Nexthaler
* ICS + LABA * DPI
60
Luforbec
* ICS + LABA * MDI
61
Fostair
* ICS+LABA * MDI
62
QVAR
ICS MDI
63
Clenil Modulite
ICS MDI
64
Easyhaler
ICS +/- LABA DPI (shaped like normal MDI)
65
Turbohaler Symbicort / Pulmicort
ICSD +/- LABA DPI Tall cylinder shape with lid
66
Ellipta
ICS + LABA DPI Oval/egg shaped
67
Accuhaler
ICS +/- LABA DPI Circular
68
Breezhaler
Various DPI (with capsules) Oval/rectangular with coloured buttons on the side.
69
Respimat
LABA Multi-dose solution for inhalation cartridge
70
Handihaler
LAMA DPI Egg shaped with green button

reg exam (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions