Respiratory

Question 1

How often should a spacer be issued by a prescriber and how should patients clean their spacers?

Answer 1

A spacer should be issued every 6 months to a year.

A spacer should be cleaned using a mild detergent and should be allowed to drip dry to reduce static

Question 2

When are nebulisers used?

Answer 2

Nebulisers are used in severe acute asthma for around 5-10 minutes.

Question 3

What factors are commonly associated with asthma?

Answer 3

History of atopic diseases

Family history of asthma

Question 4

At what threshold is obstructive airway disease is defined?

Answer 4

A FEV1/FVC below 80%

Question 5

What is the treatment regime for asthma in adults?

Answer 5

1) SAMA
2) Low dose ICS (If symptomatic at least 3 times/ week, night time symptoms at least once/ week and using SABA atleast 3 times/ week)
3) LABA
4a) If LABA not aiding, stop LABA and increase ICS to medium
4b) If LABA is helping slightly, increase ICS to medium
4c) If LABA is helping slightly, consider LTRA or SR theophylline or LAMA
5a) Consider high dose ICS
5b) Consider LTRA, Beta agonist tablet or SR/Theophylline or LAMA
6) Oral Steroids

Question 6

What is the treatment regime for asthma in 5-12 year olds?

Answer 6

1) SAMA
2) Paediatric dose ICS (If symptomatic at least 3 times/ week, night time symptoms at least once/ week and using SABA atleast 3 times/ week)
3) LABA
4a) If LABA not aiding, stop LABA and increase ICS to low
4b) If LABA is helping slightly, increase ICS to low
4c) If LABA is helping slightly, consider LTRA
5a) Consider medium dose ICS
5b) Consider LTRA, Beta agonist tablet or SR/Theophylline
6) Oral Steroids

Question 7

What is the treatment regime for asthma under 5 years old?

Answer 7

1) SAMA
2) LTRA
3) Paediatric dose ICS
3) Combine LTRA and ICS

Question 8

Give two examples of SABAs and how often they should be used in a day

Answer 8

Salbutamol, Terbutaline, 2 puffs QDS PRN`

Question 9

Give three examples of ICS and how often they should be used daily

Answer 9

Fluticasone, Beclomethasone, Budesonide - BD

Question 10

If a patient is taking Clenil, and they request to have QVAR, should you give it?

Answer 10

NO because the particles size in QVAR have extra fine particles, meaning that the doses in QVAR are double that in Clenil.

Question 11

What are some of the SEs of ICS? What counselling should you give to patients?

Answer 11

Hoarse voice
Sore Throat
Oral Candidiasis - patients need to rinse their mouths throughly after administering inhalers or using a spacer.

Question 12

Name two examples of LTRAa

Answer 12

Montelukast and Zafirlukast

Question 13

What are SEs assoicated with LTRAs?

Answer 13

Churg Strauss Syndrome associated with vasculitis

Question 14

What monitoring is required for Zafirlukast?

Answer 14

Liver function monitoring is required

Question 15

What is theophylline ?

Answer 15

Theophylline is a Xanthine Bronchodilator

Question 16

What is the target plasma range for theophylline?

Answer 16

10-20mg/L

Question 17

What are the SEs of theophylline?

Answer 17

Nausea and Vomiting
Hypokalaemia
Arrhythmias
Tachycardia
Seizures

Question 18

What drugs does theophylline interact with?

Answer 18

Quinolones- Lowering seizure threshold
Steroids, Loop and Thiazides diuretics and Beta-agonists - Hypokalaemia
Enzyme Inducers - Rifampicin, St’ John’s Wort
Enzyme Inhibitors - Cimetidine, Phenytoin, CCBs, Macrolides

Question 19

Name two LABAs and list their SEs

Answer 19

Salmeterol and Formoterol

Hypokalaemia, Arrhythmias and Tachycardia

Question 20

What are the signs and symptoms in adults of a:

Moderate asthma attack

Answer 20

Moderate asthma attack:
BP <110bpm
Respiratory Rate <25/min
Communication: Good
Peak flow: 50-75%

Question 21

What are the signs and symptoms in adults of a: Severe asthma attack

Answer 21

Severe asthma attack
BP >10bpm
Respiratory Rate >25/min
Communication: Limited
Peak flow: 50%<

Question 22

What are the signs and symptoms in adults of a:

Life-threatening asthma attack

Answer 22

Cyanosis
Peak flow: 33%<
SpO2 <92%
Silent Chest

Question 23

What are the signs and symptoms in children of a:

Moderate asthma attack

Answer 23

Moderate asthma attack:
BP <125bpm (5-12 years old)
BP <140bpm (5 years old)
Respiratory Rate <30/min (5-12 years old)
Respiratory Rate <40/min (5 years old)
Communication: Good
Peak flow: 50+%

Question 24

What are the signs and symptoms in children of a:

Severe asthma attack

Answer 24

Severe asthma attack:
BP >125bpm (5-12 years old)
BP >140bpm (5 years old)
Respiratory Rate >30/min (5-12 years old)
Respiratory Rate >40/min (5 years old)
Communication: Limited
Peak flow: 33-50%

Question 25

What are the signs and symptoms in children of a: | Life-threatening asthma attack

Answer 25

Cyanosis Peak flow: 33%< SpO2 <92% Silent Chest

Question 26

What is the treatment in the case of an asthma attack?

Answer 26

SABA 2-10 puffs every 10-20 minutes or PRN SAMA nebuliser every 20-30 mins or PRN If not helping, add Ipratropium bromide nebuliser and call 999 Patients should be treated with prednisolone - Max 3 days under 12 or at least 5 days if over

Question 27

What anatomical changes occur in a patient who has COPD?

Answer 27

Alveoli are destroyed | Bronchioles lose their shape and are clogged with mucus

Question 28

What are the GOLD standard limits for COPD?

Answer 28

``` FEV1/FVC <0.7 implies obstruction 1- Mild - FEV1 >/80% 2-Moderate - FEV1 80% 3- Severe - 30% FEV1 50% 4- VerySevere - FEV1 30% ```

Question 29

What are the treatment guidelines for COPD?

Answer 29

1) SABA or SAMA 2) If: FEV1 >/ 50% then LABA or LAMA or LAMA+ICS if no better FEV1 50% then LABA + ICS or LAMA 3)LAMA+ICS+LABA

Question 30

What could a patient use if they are unable to use an inhaler for COPD and symptoms still persist?

Answer 30

MR theophylline or Aminophylline

Question 31

What can patients use for a productive cough?

Answer 31

Mucolytics such as carbocisteine

Question 32

When are mucolytics contraindicated?

Answer 32

Mucolytics are contraindicated in patients who have active peptic ulcer disease

Question 33

How often should SAMAs be administered?

Answer 33

TDS

Question 34

How often should LAMAs be administered?

Answer 34

OD

Question 35

What are cautions for patients taking muscarinic antagonists?

Answer 35

Glaucoma (Increased risk when nebulised salbutamol + nebulised ipratropium) Prostatic Hyperplasia

Question 36

What are some of the SEs associated with muscarinic antagonists?

Answer 36

Dry mouth | Paradoxical Bronchospasm

Question 37

What addiitional treatments can be added on for acute COPD exacerbations?

Answer 37

Oxygen (+Bronchodilator) Aminophylline IV if poor response to nebulised bronchodilator Steroids Anitbiotics

Question 38

What are the two types of anti-histamines and give examples?

Answer 38

Sedating - Promethazine (BD/TDS) , Chlorphenamine (QDS), Hydroxyzine (QT prolongation) Non-Sedating - Acrivastine (TDS), Loratidine (OD), Cetirizine(OD), Fexofenadine (OD)

Question 39

Where are anti-histamines indicated?

Answer 39

Hayfever, Urticaria- Allergies

Question 40

What are some of the SEs associated with anti-histamines ?

Answer 40

Benign prostatic hyperplasia Glalucoma Liver Impairment

Question 41

Which anti-histamine causes QT prolongation?

Answer 41

Hydroxyzine

Question 42

What is Olizumumab?

Answer 42

An immunoglobulin for chronic spontaneous urticaria (hives) when all other treatments have failed

Question 43

What is a SE of Olizumumab?

Answer 43

Churg Strauss syndrome

Question 44

What strength of adrenaline is used in anaphylaxis/?

Answer 44

1 in 1000

Question 45

What strength of adrenaline is used in : a) 6< b) 6-12 c) Adults

Answer 45

a) 150mcg b) 300mcg c) 500mcg

Question 46

What should be done during anaphylaxis?

Answer 46

Recovery position if sick or unconscious, flat on back, legs elevated, support airways, maintain BP

Question 47

What can be used as adjuncts in anaphylaxis?

Answer 47

Oxygen IV Hydrocortisone IV Anti-histamine

Question 48

What advice do you give to patients taking epipens?

Answer 48

Always carry 2 Administer IM in the mid-point of the outer thigh Call 999 even if symptoms appear better

Question 49

What are the different types of cough preparations available and give examples.

Answer 49

Cough suppressant - Dextrometorphan, Pholcodeine, Codeine linctus Cough soother - Glycerol, simple linctus Cough expectorant- Guaifenesin

Question 50

What is croup?

Answer 50

The inflammation of the airways in children, resulting in breathing difficulties.

Question 51

What is used to treat croup?

Answer 51

Dexamethasone oral solution