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Pre-reg revision > Respiratory System > Flashcards

Respiratory System Flashcards

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1
Q

What side effects are associated with older antihistamines?

A

More sedation

More anti-muscarinic side effects

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2
Q

What are some older (sedating) anthistamines?

A
  • Promethazine
  • Chlorphenamine
  • Cyclizine
  • Hydroxyzine
  • Alimemazine
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3
Q

Which antihistamines are MOST sedating?

A

Promethazine + alimemazine

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4
Q

What are some newer antihistamines (less sedating)?

A
  • Cetirizine
  • Loratidine
  • Fexofenadine
  • Acrivastine
  • Desloratidine
  • Mizolastine
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5
Q

Why do the newer antihistamines have less sedation + psychomotor impairment?

A

Less penetration of the BBB

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6
Q

Which antihistamines are used to treat N+V?

A

Cyclizine, promethazine, cinnarizine

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7
Q

Which antihistamines are used to treat insomnia?

A

Promethazine, diphenhydramine

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8
Q

In what conditions are antihistamines cautioned?

A
  • Benign prostatic hyperplasia (BPH) - risk of urinary retention
  • Glaucoma - raised intraocular pressure
  • Liver impairment - sedation can precipitate hepatic coma
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9
Q

What are the risks associated with hydroxyzine?

A

Risk of QT prolongation and torsades de pointes

  • contra-indicated in patients with risk of QT prolongation
  • Short term use only
  • Max dose 100mg/day
  • Avoid in the elderly, max dose 50mg/day
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10
Q

How should anaphylaxis be treated in the community (medical emergency)?

A
  1. Secure the airway and maintain the BP
    (lay flat and raise legs or recovery position if vomiting)
  2. Administer adrenaline by IM injection
  3. Repeat adrenaline every 5 mins if necessary
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11
Q

Doses of adrenaline for anaphylaxis?

A

Adult - 500mcg
Child 6-12 - 300mcg
Child <6 - 150mcg

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12
Q

Risk for patients on beta blockers with anaphylaxis?

A

Patients on B-blockers may not respond to adrenaline

Consider treatment with a bronchodilator eg, IV salbutamol

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13
Q

How is adrenaline administered?

A

IM inj
Middle of the thigh
Can be given through clothes inc. jeans

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14
Q

When are mucolytics (eg, carbocisteine) contra-indicated?

A

In peptic ulcers

Mucolytics disrupt gastric mucosa

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15
Q

What do MHRA advise should NOT be given OTC to children under 6 with cough?

A

Antihistamines - chlorphenamine, promethazine, diphenhydramine, doxylamine, triprolidine, brompheniramine
Cough suppressants - pholcodeine, dextromethorphan
Expectorants - guaifenesin, ipecacuanha
Decongestants - psuedoephedrine, ephedrine, oxymetazoline, xylometazoline

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16
Q

What advice should be given to patients about care of spacers?

A
  • Clean once a month with mild detergent and allow to air dry
  • Frequent cleaning should be avoided as electrostatic charge can affect drug delivery
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17
Q

Which patients should be advised to use a spacer?

A
  • All under 15s with inhalers
  • Patients with high dose ICS
  • Children under 5 should have a spacer with face mask
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18
Q

What is a sign of poorly controlled asthma that needs urgent assessment?

A

Use of >1 SABA inhaler per month

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19
Q

Outline the stepwise treatment of asthma in adults?

A

All patients should have a SABA, step up if using >3 times/week
1. Regular preventer - low dose ICS
2. Initial add-on - LABA (with ICS)
3. Additional add-on
If no benefit from LABA - stop + increase ICS
Benefit + poor control - continue LABA + med ICS
Benefit + poor control - continue LABA + ICS + fourth drug
4. High dose therapy - high dose ICS or addition of fourth drug (LTRA, theophylline, oral B2 agonist)
5. Regular oral steroid

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20
Q

How long are the short acting beta agonists duration of action?

A

3-5 hours

salbutamol / terbutaline

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21
Q

How long are the long acting beta agonists duration of action?

A

12 hours, used BD

salmeterol, formoterol, vilanterol

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22
Q

‘LABAs should not be initiated in rapidly deteriorating asthma’
True or false?

A

True

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23
Q

Which is NOT a side effect of beta agonists?

  • Hypokalaemia
  • Hypotension
  • Hand tremors
  • Bradycardia
  • Arrythmias
A

Bradycardia - they may cause tachycardia

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24
Q

Which inhaled corticosteroid is not taken BD?

A

Ciclesonide - OD

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25
Which ICS inhalers are NOT interchangeable as potency differs between brands?
Beclometasone | QVAR is twice as potent as Clenil - half dose should be used
26
What is in a Fostair inhaler?
Beclometasone + formoterol | Extra fine particles - more potent
27
What ages is QVAR licensed in?
12+
28
What ages is beclometasone easyhaler licensed in?
18+
29
What are the side effects of ICS?
- Hoarse voice/sore throat | - Oral candidiasis
30
'Smoking can effect inhaled corticosteroids' | True or false?
True - reduces the effectiveness so higher doses may be needed
31
'ICS are associated with the risk of paradoxical bronchospasm' True or false?
True - can be offset by giving SABA before a dose
32
Low dose of clenil is 100mcg 2 puffs BD, what is the equivalent dose of QVAR?
Beclometasone | 50mcg 2 puffs BD
33
What drugs are in Flutiform inhalers and what do they look like?
Fluticasone + formoterol | MDI - orange
34
What drugs are in Fostair inhalers and what do they look like?
Beclometasone + formoterol Pink MDI or nexthaler = DPI
35
What drugs are in a Symbicort inhaler and what do they look like?
Budesonide + formoterol | Turbohaler (cyclinders) - DPI
36
What drugs are in a Duoresp inhaler and what do they look like?
Budesonide + formoterol | Green or Blue DPI
37
What drugs are in a Seretide inhaler and what do they look like?
Fluticasone + salmeterol Evohaler - purple MDI Accuhaler - purple, round DPI
38
What drugs are in a Relvar inhaler and what do they look like?
Fluticasone + vilanterol | Yellow 'egg shape' DPI
39
Which is ciclesonide not used first line?
More expensive but fewer oropharangeal side effects
40
Outline the treatment of asthma in children
All patients should have SABA 1. Regular preventer- Very low ICS (paed dose) or if UNDER 5 - LTRA 2. Initial add-on therapy - very low dose ICS + LTRA (under 5) OR LABA (over 5) 3. Additional add-on therapy No response to LABA - stop + incr ICS to low dose Benefit + poor control - continue LABA + ICS to low dose Benefit + poor control - LTRA + ICS + LABA 4. High dose therapy - ICS to medium dose or add theophylline 5. Oral steroid tablets
41
Which is the only LAMA licensed in asthma?
Spiriva respimat
42
What are the leukotriene receptor antagonists and how do they work?
Montelukast + Zafirlukast | Reduce bronchoconstriction and inflammation
43
When should montelukast be taken?
In the evening | 3-4 hours to peak plasma conc, worse symptoms at night
44
Which asthma oral drugs are associated with Churg-Strauss syndrome?
LTRA - montelukast + zafirlukast | Associated esp after withdrawal of oral steroids
45
What are the signs of Churg-Strauss syndrome?
Eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, peripheral neuropathy
46
What is a major side effect/caution of Zafirlukast?
Risk of liver toxicity | Patients should report signs of liver toxicity such as N+V, jaundice, abdo pain, itching
47
What are the xanthines?
Theophylline + aminophylline
48
What is the target plasma concentration of theophylline?
10-20 mg/L
49
When should theophylline levels be taken?
Sample taken 4-6 hours post dose | Take levels 5 days after initiation or 3 days after dose changes
50
What may increase the concentrations of theophylline/aminophylline?
``` Liver impairment - metabolised by liver Heart failure Viral infections Elderly Enzyme inhibitors ```
51
What may decrease the concentrations of theophylline/aminophylline?
Smoking Alcohol Enzyme inducers
52
'Theophylline and aminophylline should always be prescribed by brand' True or false?
True
53
What are the signs of theophylline toxicity?
FAST + SICK - Nausea, vomiting, GI disturbance - Tachycardia, CNS stimulation (agitation, restlessness, mydriasis) - Arrythmias, convulsions - HYPOkalaemia - Hyperglycaemia, heamatemesis
54
Can theophylline be used in pregnancy?
Yes- xanthines can be used in pregnancy/breastfeeding but may cause neonatal irritability
55
Can aminophylline be given IM?
No - too irritant
56
Do patients who take oral theophylline need a loading dose with IV aminophylline?
No
57
How should weight-based doses for aminophylline be calculated?
Using IBW if appropriate
58
Which medicines interact with theophylline + aminophylline?
- Risk of hypokalaemia - loop/thiazide diuretics, B2 antagonists, corticosteroids - Risk of convulsions - quinolones - Enzyme inhibitors (conc incr) - macrolides, CCBs, phenytoin, fluconazole - Enzyme inducers (conc dec) - Rifampicin, St johns wort
59
How should an acute asthma attack be treated in the community?
- Give a salbutamol inhaler via large vol. spacer, 2-10 puffs every 10-20 mins PRN - Give O2 driven SABA nebs every 20-30mins if possible - If symptoms persist over 15-30 mins call 999
60
Are steroids always needed post-asthma attack?
Yes - prednisolone or IV hydrocortisone Children - 3 days Adults - min 5 days (40-50 mg)
61
What is the NICE (in the BNF) stepwise treatment for COPD?
1. SABA (at all stages) or SAMA 2. If FEV >50% - LABA or LAMA If FEV <50% - LAMA or LABA + ICS 3. Triple - LABA + LAMA + ICS
62
What drug is a short-acting muscarinic antagonist?
Ipratropium
63
How regularly are SAMAs usually used?
3-4 times per day
64
Name some long-acting antimuscarinics?
- Tiotropium - Glycopyrronium - Aclidinium - Umeclidinium
65
How long do SAMAs take to work?
Onset 30-60 mins | Duration of action 3-6 hours
66
In which conditions should inhaled antimuscarinics be used with caution?
Benign prostatic hyperplasia - risk of urinary retention | Glaucoma - increased intraocular pressure
67
What are the side effects of inhaled antimuscarinics?
- Dry mouth | - Paradoxical bronchospasm
68
When can LABAs be used ALONE?
For treatment of COPD | In asthma only licensed with ICS
69
Which LABAs can be used in COPD?
- Formoterol - Salmeterol - Vilanterol - Olodaterol
70
What drug is in a Seebri inhaler?
Glycopyrronium 55mcg | Orange + white DPI
71
What drug is in an incruse ellipta inhaler?
Umeclinidium 55mcg | Grey egg w. green lid
72
What drug is in an Anoro ellipta inhaler?
Umeclinidium with vilanterol | Grey egg w. pink lid
73
What drug is in an Ultibro breezhaler inhaler?
Glycopyrronium with indacterol | Yellow + white DPI

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