Asthma Flashcards

Question

How do leukotriene antagonists work? (eg. Zileuton, Monteleukast)

Answer 1

* LTs = inflammatory mediators released by mast cells, cause bronchoconstriction + inc mucus production * LTRAs useful in pts who still have symptoms despite taking high-dose ICS or oral CS and in pts with asthma induced by aspirin 2 main MOAs: 1. **_Inhibition of 5-lipoxygenase pathway:_** drugs such as Zileuton block this pathway, inhibiting the synthethic pathway of leukotriene metabolism 2. **_Antagonism of cysteinyl-leukotriene type 1 receptors:_** agents such as Montelukast block actions of cysteinyl leukotrienes at CysLT1 receptor on target cells such as bronchial sm muscle. Help improve asthma symptoms, reduce asthma exacerbations and limit markers of inflammation eg. eosinophils Side effects: GI disturbances, headache

Answer 2

* inability to **complete** sentences * pulse **\> 110bpm** * RR **\> 25/min** * PEFR **33-50%** predicted value or pt's best

Answer 3

* **silent** chest * **cyanosis** * **feeble** resp rate * exhaustion * bradycardia or hypotension * confusion or coma * **normal** PaCO₂ (should be low due to hyperventilation, normal means pt fatigued) * PEFR **\<33%** predicted value or patient's best * PaO₂ **\<8kpa**, SaO₂ **\<92%**

Answer 4

* assess _severity_ of attack - tachycardia? inability to speak? high RR? * if PEFR \<150L/min -\> call ambulance + warn ITU if severe * sit pt up, give **40-60% O₂**, via non-rebreathe bag * aim to maintain O₂ sats at **94-98%** * nebulised **salbutamol** **5mg** or terbutaline 10mg * plus **ipratropium bromide 0.5mg** nebulised w/ O₂ * **hydrocortisone 200mg** i.v. (4 hourly / 24hrs) * **prednisolone 60mg** orally (continued for 2/52) * Abx if infection (CXR focal shadowing, purulent sputum) * CXR to exclude pneumothorax * monitor peak flow + sats, reassess regularly * ABG -\> if **PaCO₂ \>7kPa** -\> ventilate * give 1 of following infusions if no improvement: * salbutamol 3-20 ug/min, or * terbutaline 1.5-5.0 ug/min, or * magensium sulphate 1.2-2g over 20 mins * if still no improvement -\> transfer to **ITU**

Answer 5

patients before discharge must have: 1. been stable on discharge medication for 24h (given a tapering dose of prednisolone) 2. had inhaler technique checked 3. PEFR must be \>75% predicted or pts best + durnal variability \<25% 4. steroid (inhaled/oral) and bronchodilator therapy 5. own a PEF meter + have mgmt plan 6. GP appointment within 1 week 7. resp clinic appt within 4 weeks

Answer 6

* **simplification** of treatment regimes * **education** (patient + family) * self-management plans (based on monitoring of PEFR and symptoms and written action plan showing patient how to act in exacerbations) * During an attack, pt should be advised to: * sit up * inhaler - 1 puff every minute for 5 mins or until symptoms resolve * if no improvement, call 999, carry on w/ 1 puff/5mins until help arrives

Answer 7

* most people w/ asthma given **reliever** inhaler (blue) (SABA), used to relieve symptoms within few mins * if a patient needs to use a reliever often, they may also need a **preventer** inhaler (steroids) - helps to reduce inflammation and sensitivity of airways, stopping symptoms from occurring, used everyday even without symptoms * **combination** inhalers used if either of above don't work

Answer 8

*“(Name of inhaler) is a preventer – it helps to reduce the swelling in the airways and stops them from being so sensitive. You use this to lower the risk of severe attacks. I would like you to inhale …(x puff(s))…(x time(s) a day)…everyday. It’s really important that you don’t miss doses, as regular use is key to keeping your asthma/COPD under control”* Remind the patient to rinse mouth after use if the inhaler contains a steroid due to risk of oral candidiasis.

Answer 9

*“(Name of inhaler) is a reliever. This is useful to help relieve immediate wheezing/asthma attacks. It works by relaxing the airways so that you can breathe more easily. You shouldn’t need this more than 3 times a week if your asthma is well controlled. Ask your GP for a review if you are using this more frequently. I would like you to inhale (x puff(s)) when you feel short of breath.”*

Answer 10

* **metered dose inhalers** (MDIs) - give medicine in a spray form eg. ventolin, airomir, salamol - here **spacers** can be used to make inhalers more effective and reduce side-effects (eg. oral candidiasis) * **breath actuated inhalers** (BAIs) such as easi-breathe, airmax, and autoinhaler automatically release a spray of medicine when you begin to inhale * **dry powder inhalers** (DPIs), such as accuhaler, give the medicine in a dry powder instead of a spray

Answer 11

1. **prepare** inhaler (shake aerosol inhaler) 2. attach inhaler mouthpiece to the spacer device 3. breathe out **gently** as far as is comfortable 4. **seal lips** around the spacer mouthpiece 5. **release** 1 dose into the spacer device 6. breathe in and out through the spacer mouthpiece **several** times 7. administer second dose if needed + finish ## Footnote *Spacer should be washed w/ detergent once a month and left to air-dry, don't use wipes as drug particles will stick to sides.*

Answer 12

* ask pt to carry out procedure themselves whilst you observe * most pt's techniques will require tweaking * point out the positives, then introduce room for improvement ## Footnote **demonstrate \> observe \> fine tune \> repeat as necessary**

Answer 13

* ensure PEFR meter set to **zero** * sit up straight or stand * **take a deep breath** * place your mouth around the mouthpiece of the PEFR meter, ensuring a **tight seal** w/ your lips * exhale as **forcefully** as you possibly can manage * note the PEFR reading * **repeat** this process a further 2 times * the _highest_ reading of the 3 should be taken as the overall result

Asthma Flashcards

(37 cards)