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Respiratory System Flashcards

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1
Q

Who are dry powder inhalers suitable for?

A

Adults and children over 5 who are unwilling/unable to use a pmdi

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2
Q

When should a spacer be used?

A

Always if the patient is prescribed a high dose steroid

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3
Q

How are spacer devices cleaned?

A

Once a month by washing with mild detergent and then allowed to air dry without rinsing, mouth piece should be cleaned of detergent before use.

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4
Q

How often should spacer devices be replaced?

A

Every 6 to 12 months

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5
Q

Define asthma?

A

Asthma is a common chronic inflammatory condition of the airways, associated with airway hyperresponsiveness and variable airflow obstruction

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6
Q

What should be done before initiating a new drug/changing tx for asthma?

A

Consider whether the diagnosis is correct, check adherence and inhaler technique and eliminate trigger factors for acute attacks

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7
Q

What are the stages of asthma – NICE adults 17+:

A

1) SABA (salbutamol/terbutaline)
2) SABA + Low dose ICS
3) SABA + ICS + Leutrokine receptor antagonist (montelukast)
4) Add in LABA
5) Switch to MART regimen: (Inhaled corticosteroid + fast acting LABA, such as formoterol) +
Low dose ICS
6) Trial of LAMA (tiotropium) or m/r theophylline

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8
Q

State the two SABAs:

A

Salbutamol / terbutaline

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9
Q

State the two-long active SABAs:

A

Salmeterol / formoterol

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10
Q

Which other LABAs are used for COPD:

A

Indacaterol, olodaterol
Vilanterol is only available as a combination with fluticasone or/and umeclidinium

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11
Q

Which oral LABA can potentially be of use in nocturnal asthma:

A

Bambuterol

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12
Q

Which other antimuscarinic medication can be used to relieve symptoms in chronic asthma:

A

Ipratropium bromide

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13
Q

Who should have their asthma urgently assessed?

A

Patients using more than one saba device a month

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14
Q

What is the tx of asthma in children under 5?

A

1) saba prn
2) paediatric low dose ics maintenance
3) LTRA eg montelukast reviewed after 4-8 weeks
BTS/SIGn Recommend a LABA first
4) MART regimen
5) increase ICS dose or add theophylline M/R

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15
Q

What is the tx of asthma in children under 5?

A

1) SABA
2) 8 week trial of paed low dose ICS, after 8 weeks stop and monitor symptoms. If no improvement, consider alternative diagnosis, if symptoms recur after 4 weeks then can use as maintenace, if symtpoms recur beyond 4 weeks of stopping then restart trial
3) LTRA - if no improvement refer to specialist

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16
Q

When should you consider stopping/stepping down asthma tx

A

When asthma has been controlled on current therapy for at least 3 months

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17
Q

How is asthma managed in pregnancy?

A

Close monitoring. Asthma should be well controlled throughout. Advise on the importance of taking their asthma medication to maintiain good control

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18
Q

What is moderate acute asthma?

A

Increasing symptoms, Peak flow <50-75% of best, no features of acute sever

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19
Q

What is severe acute asthma?

A

Peak flow 33-50% of best, resp rate >25 bpm, heart rate >110bpm and cannot complete sentences in one breath

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20
Q

What is the tx of life threatening acute asthma?

A

Peak flow <33%, o2 sats <92%, pao2 < 8, silent chest, cyanosis, poor resp effort, arrythmia, altered conscious level, hypotension

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21
Q

What is moderate acute asthma in children?

A
  • able to talk in sentences
  • spo2 >92%
  • peak flow >50% of best
    -heart rate below 140 in children aged 1-5, less than 125 in 5+
  • resp rate less than 40 in 1-5 and less than 30 in 5+
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22
Q

What are the symptoms of severe acute asthma in children

A

Cannot complete sentences in one breath/talk/feed
spo2 less than 92%
peak flow 33-50% of best
hr >140 in 1-5 y/o, and >125 in 5+
resp rate >40 in children 1-5, >30 in 5+

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23
Q

What is life threatening asthma in children

A

Spo2 <92%, peak flow <33, silent chest, cyanosis, poor resp effort, hypotension, exhaustion, confusion

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24
Q

How is acute asthma managed in adults?

A

Patients with severe or life threatening asthma should be treated asap and referred to hospital
moderate asthma treated at hime and response to treatment assessed.
supplementary oxygen to all patients 94-98% o2
high dose SABA. If mild/moderate then pmdi and spcer, if severe then via nebuliser
oral prednisolone (40mg-50mg)

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25
How is acute asthma managed in children over 2 years old
Severe/life threatening should be treated asap or referred to hospital supp ox to severe or spo2 <94% SABA asap oral pred (30-40mg) for up to 3 days
26
When should parents/carer seek urgent medical attention?
If initial symptoms are not controlled with up to 10 puffs of salbutamol via a spacer
27
How is asthma managed in children under 2 years old?
Acute asthma management of all children in this age group should be in the hospital setting. immediate oxygen, saba or add ipatropium bromide. Oral pred (30-40mg) for 3 days
28
What is the follow up of an acute asthma exacerbation?
take a history, check inhaler technique and review regular therapy, give a written asthma action plan. Inform GP 24 hours from discharge and patient should be reviewed within 2 days.
29
Which four drugs are licensed for COPD:
Aclidinium bromide, glycopyronium bromide, umeclidinium, tiotropium
30
What is Theophlline used for?
Xanthine used in asthma and stable COPD Combination with beta agonists may increase risk of side effects such as hypokalaemia
31
What are the symptoms of COPD:
Breathlessness, cough, sputum and airflow obstruction
32
What can relieve symptoms of COPD?
SABA or short acting antimuscarinic bronchodilator
33
If the FEV1 is 50% or higher what would you advise:
LAMA or LABA
34
If the FEV1 is less than 50%:
LABA or LAMA + corticosteroid in combination inhaler. If symptoms persist or if patient is unable to use an Inhaler oral m/r aminophylline or theophylline can be use A mucolytic may be given to those with a productive cough During an exacerbation of chronic COPD, bronchodilator therapy can be given through a nebuliser and oxygen can be given Short course of prednisolone is recommended if affecting daily activities
35
If there is persistent exacerbations or breathlessness, then you can give this for COPD:
LAMA + LABA + inhaled corticosteroid in combination inhaler (such as trimbow)
36
What is the main risk factor for COPD
Tobacco smoking
37
Which vaccinations should patients with COPD recieve?
Influenza annually and pneumococcal once
38
What is the initial management of COPD for all patients?
SABA or SAMA
39
What is the initial step up in COPD without asthmatic features?
LABA and a LAMA. Discontinue SAMA if LAMA given With LABA and a LAMA and had at least 2 moderate exacerbations or one in hospital then consider adding ICS
40
What is the initial step up in COPD with asthmatic features
LABA and ICS. severe exacerbation or 2 moderate then consider adding a LAMA and discontinue SAMA
41
Which prophylactic abx are given in COPD
Azithromycin to reduce exacerbations in non smokers, how have prolonged or frequent exacerbations. Rule out QT prolongation and LFTS. Review after 3 months then every 6 and only continue if the benefit outweighs the risk
42
How is an acute copd exacerbation managed
SAVA at higher dose than maintenance. Short course of prednisolone (30mg for five days)
43
What are the symptoms of croup?
Barking cough that sounds like a seal Hoarse voice Difficulty breathing Feverish symptoms Often worse at night
44
How to treat croup?
Single dose of dexamethasone
45
What are the side effects of antimuscarinics?
Cough, dizziness, dry mouth, nausea, headache, constipation, arrythmias, vision blurred, urinary disorders
46
What is the caution warning for patients taking ipratropium bromide:
Acute angle-closure glaucoma has been reported with nebulised ipratropium
47
What is beta agonists contraindicated in:
Severe eclampsia, pulmonary hypertension, cardiac disease
48
State some cautions for beta agonists:
Diabetes, risk of hyperglycaemia and diabetic ketoacidosis, hypertension, hyperthyroidism, hypokalaemia
49
State the side effects of beta agonists:
Headache, tremor, vomiting, palpitations, dizziness, hypokalaemia
50
What is the duration of action for salbutamol?
3 to 5 hours
51
How are corticosteroids effective in asthma?
They reduce airway inflammation and hence reduce oedema and secretion of mucus into the airway Regular use of inhaled corticosteroids reduces the risk of exacerbation of asthma They must be used regularly for maximum benefit
52
State the 4 inhaled corticosteroids:
Fluticasone, mometasone, beclometasone, budesonide
53
Which 3 brands can be used as relievers, in addition to their regular use for prophylaxis of asthma:
Budesonide + formoterol (Symbicort, Duoresp spiromax) Beclomethasone + formoterol (fostair)
54
State the treatment for acute asthma attack:
High course of prednisolone – corticosteroids
55
Why should oral corticosteroids best have taken as a single dose in morning:
Reduce the disturbance of circadian cortisol secretion
56
Which parenteral corticosteroid has a role in emergency treatment of acute severe asthma:
Which parenteral corticosteroid has a role in emergency treatment of acute severe asthma: Hydrocortisone injection
57
What is the use of inhaled corticosteroids in COPD:
When given with LABA it can reduce exacerbations
58
What is the use of oral corticosteroids in COPD:
Prednisolone oral can be given during an attack
59
What is the MHRA warning for corticosteroids:
Central serous chorioretinopathy – fluid accumulating under the retina Patients should be advised to report any blurred vision and visual disturbances
60
What are the common side effects for corticosteroids:
Headache, oral candiasis, pneumonia with those with COPD, taster altered, glaucoma, adrenal suppression, sleep disorder, paradoxical bronchospasm
61
How can you advised a patient to reduce the risk of oral candiasis:
To use a spacer device and/or rinsing mouth with water after inhalation
62
Which clenil strength can dentists prescribe?
Clenil 50 mcg
63
Which inhalers should be prescribed by brand name:
Clenil and Qvar Qvar has extra fine particles and is more potent than traditional beclometasone and is twice more potent than Clenil
64
How do leutrokine receptor antagonist’s work:
Blocks the effect of cysteinyl leutrokeines in airways
65
When should patients the montelukast:
In the evening
66
State some common side effects of monetelukast:
Diarrhoea, fever, depression, drowsiness, suicidal thoughts, tremor, hallucination
67
State one major side effect of monetelukast:
Eosinophilic granulomatosis with polyangiitis
68
Which drug is churg-strauss syndrome associated with:
Montelukast
69
What should you advise patients on to report whilst taking montelukast:
Vasculitis rash, worsening pulmonary symptoms, cardiac issues, peripheral neuropathy
70
State the advise you would give to a patient who’s child has been recently prescribed montelukast granules:
Granules may be swallowed, or mixed with cold soft food (not liquid), and taken immediately
71
Patients taking this tablet for severe copd + chronic bronchitis and is displaying low mood and suicidal thoughts, what do you do? Bonus point can you name the drug?
Refer to gp Roflumilast
72
What is aminophylline and theophylline:
Narrow therapeutic medicines
73
State the side effects of aminophylline:
Headache, nausea, palpitations
74
Which electrolyte deficiency can aminophylline cause:
Loss in k+ - hypokalaemia
75
State the symptoms of aminophylline overdose/toxicity:
Vomiting, restlessness, agitation, dilated pupils, hyperglycaemia and sinus tachycardia More serious side effects are haematosis, convulsions, hypokalaemia, arrythmias
76
State the monitoring requirements for theophylline:
Plasma-theophylline concentrations 10-20mg (55-110 micromol/litre) is required for satisfactory dilation Adverse effects can occur within 10-20mg but severe side effects can occur 20mg+
77
If aminophylline is given intravenously, when should blood sample be taken:
4-6 hours after starting treatment
78
If aminophylline is given orally:
Plasma-theophylline concertation should be measured after 5 days and at-least 3 days after any dose adjustment
79
State the dose adjustment for theophylline:
May be necessary to increase dose if smoking is started or decrease if stopped during treatment
80
What are the 3 conditions in which plasma-theophylline concentration is increased in:
Heart failure, viral infections and hepatic impairment
81
What are the 2 conditions in which plasma-theophylline concentration is decreased:
Smoking and alcohol consumption
82
What are the signs of theophylline toxicity/overdose
Vomiting, agitation, restlessness, hyperglycaemia, hypertension, dilated pupils, tachycardia. More serious effects: convulsions, hypokalaemia, haematosis
83
Which antihistamines can be used in nausea and vomiting:
Cyclizine, promethazine, cinnarizine
84
Which older antihistamines may be more sedating than others:
Promethazine, alimemazine
85
Which antihistamines are non-sedating and why:
Cetirizine, loratadine, desloratadine, acrivistine, bilastine, mizolastine, levocetrizine, fexofenadine, All of the above cause less sedation and psychomotor symptoms as they can cross the blood- brain barrier only to a slight extent
86
State the dose and ages for IM injection of adrenaline/epinephrine/epipen:
Child 1 month – 5 years = 150 mcg 6 years – 11 years = 300 mcg 12-17 years = 500 mcg Adult = 500 mcg The above dose may be repeated at 5-minute intervals if needed
87
State the MHRA warning with hydroxyzine:
Hydroxyzine is contraindicated in patients with prolonged QT interval or those who have risk factors for prolonged QT interval In kids the maximum dose is 2mg/kg In adults the maximum dose is 100 mg In elderly the maximum dose is 50 mg The lowest effective dose for shortest period of time should be prescribed
88
What is the non-drug treatment for cystic fibrosis?
Regular exercise improves lung function and overall fitness
89
What is the drug treatment of choice for cystic fibrosis:
Dornase-alfa
90
A patient complains of dark urine, pruitis and jaundice. Which drug is responsible?
Zafirlukast
91
Which one is a LABA used in COPD patients only:
Vilanterol
92
Which drug causes rebound nasal congestion when used for more than 7 days:
Xylometazoline
93
Which group of patients should avoid carboceistine:
Patient with active gastrointestinal ulcers
94
Which antihistamine causes QT prolongation:
Hydroxyzine

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