Respiratory

Question 1

1. What is the MOA of penicillins?
2. In what group of patients is a dose reduction required?
3. Name 5 examples

Answer 1

1. BETA LACTAM - inhibition of enzymes responsible for cross-linking peptidoglycans in bacterial cell walls
2. renal impairment

3. amoxicillin
    benzylpenicillin
    co-amoxiclav
    flucloxicillin
    pipericillin-tazobactam

Question 2

1. What is the MOA of cephalosporins?
2. In which group of patients is a dose reduction required?
3. in which group of patients should these drugs be avoided?
4. name 4 examples

Answer 2

1. BETA LACTAM - inhibition of enzymes responsible for cross-linking peptidoglycans in bacterial cell walls
2. renal impairment
3. penicillin allergy (due to risk of cross-reactivity)
4. cefaclor
   cefuroxime
   cefotaxime
   ceftriaxone

Question 3

1. What is the MOA of macrolides?
2. In which group of patients is a dose reduction often required?
3. Name 3 examples

Answer 3

1. inhibit 50s ribosome subunit, thus inhibit bacterial protein synthesis
2. renal and hepatic impairment
3. erythromycin
   clarythromycin
   azithromycin

Question 4

1. What is the MOA of aminoglycosides?
2. Name 2 serious complications of aminoglycosides
3. Name 3 examples

Answer 4

1. inhibit 30s ribosome subunit therefore inhibits bacterial protein synthesis
2. nephrotoxicity
   ototoxicity
3. gentamycin
   streptomycin
   tobramycin

Question 5

1. what is the MOA of tetracycilnes?
2. In which group of patients should tetracyclines be avoided (and why?)
3. Name another drug which tetracyclines cross react with
4. Name 4 examples

Answer 5

1. inhibition of 30s ribosomal subunit thus inhibit bacterial protein synthesis
2. children and pregnant/breastfeeding women - discolours teeth and bones
3. warfarin (enhances anticoagulant effect)
4. doxycycline
   tetracycline
   minocycline
   lymecycline

Question 6

1. What is the MOA of quinolones

2. Name 2 examples

Answer 6

1. inhibits bacterial DNA synthesis
2. ciprofloxacin
   mocifloxacin

Question 7

What are the components of the CURB-65 score?

Answer 7

C - confusion
U - urea (raised)
R - RR > 30
B - systolic BP <90
65 - aged >65

Question 8

What are the implications of CURB-65 score for level of care

1. 0-1
2. 2
3. 3
4. 4-5

Answer 8

1. low risk of death; suitable for treatment at home
2. moderate risk of death; short stay hospital treatment or hospital-supervised outpatient care
3. higher risk of death; managed as inpatient
4. high risk of death; may require critical care intervention

Question 9

Name 4 causative organisms of typical pneumonia

Answer 9

• Strep pneumoniae
• H influenzae
• group A strep
• staph aureus

Question 10

What antibiotics are prescribed first and second line to patients who are able to take penicillin with the following CURB-65 scores:

1. 0-1
2. 2
3. 3-5

Answer 10

1. amoxicillin 500mg every 8 hours
2. oral doxycycline 100mg 12 hourly
   oral amoxicillin + clarythromycin
3. IV co-amoxiclav 1.2g 8hrly + IV clarythromycin 500mg 1-2 hrly

Question 11

What antibiotics are prescribed first and second line to patients who are allergic penicillin with the following CURB-65 scores:

1. 0-1
2. 2
3. 3-5

Answer 11

1. oral doxycycline 100mg 12 hrly
2. oral doxycycline 100mg 12hrly
   oral clarythromycin 500mg 8hrly
3. IV cefotaxime 1g 8hrly + IV clarythromycin 500mg 12hrly

Question 12

In terms of antimicrobial stewardhsip, which type of antibiotics, and which route of administration are preferred?

Answer 12

oral, narrow spectrum antibiotics

Question 13

Name 4 aetiological organisms of Atypical pneumonia

Answer 13

• legionella
• mycoplasma pneumoniae
• chlamydiphilla pneumoniae
• c burnettii

Question 14

1. How is atypical pneumonia caused by legionella treated?

2. How is atypical pneumonia caused by other organisms treated?

Answer 14

1. fluroquinolone

2. macrolides

Question 15

Name 4 drugs used to treat tuberculosis

Answer 15

1. rifampicin
2. isoniazid
3. pyrazinamide
4. ethambutol

Question 16

1. Which TB drug is a CYP450 inducer?
2. Which TB drug is associated with hepatotoxicity and gout
3. Which TB drug is associated with optic neuritis
4. which TB drug discolours bodily secretions orange?
5. which TB drug can cause hepatotoxicity and peripheral neuropathy?

Answer 16

1. rifampicin
2. pyrazinamide
3. ethambutol
4. rifampicin
5. isoniazid

Question 17

1. What is the treatment regime for latent TB?

2. What is the treatment regime for active TB?

Answer 17

1. 6 months of isoniazid or 3 months of rifampicin + isoniazid
2. intensive phase - 2 months of 4 drugs
   continuation phase - 4-7 months of 2 drugs

Question 18

When treating acutely ill patients with signs and symptoms of infective endocarditis, when is empirical antibiotic therapy started?

Answer 18

after at least 3 (preferably 3) sets of blood cultures have been obtained from separate venopunctures

Question 19

What is complete control of asthma defined as? (6)

Answer 19

1. no daytime symptoms
2. no night time awakening due to asthma
3. no asthma attacks; no need for rescue medication
4. no limitations on activity, including exercise
5. normal lung function (FEV1 and/or peak flow)
6. minimal side effects from treatment

Question 20

What are the BTS asthma management guidelines?

Answer 20

1. PRN SABA
2. add low dose ICS
3. add LABA
4. increase ICS or add leukotriene receptor antagonist/theophylline
5. add oral steroid

Question 21

1. Name 2 examples of SABAs

2. name 6 side effects from the use of SABAs

Answer 21

1. salbutamol
   terbutaline

2. tachycardia
    tremor
    hypotension
    hyperkalaemia
    hyperglycaemia
    angioedema

Question 22

name 2 examples of inhaled corticosteroids

Answer 22

• beclometasone

- fluticasone

Question 23

1. name 2 examples of LABAs

2. which LABA is suitable for concomittant use with ICS and why?

Answer 23

1. salmeterol; formeterol

2. formeterol (due to fast onset of action)

Question 24

1. What is the MOA of theophylline?
2. Name an example that is commonly used
3. name complications of this?
4. why are there lots of drug interractions?

Answer 24

1. inhibits phosphodiesterase, and blocks adenosine receptors, leading to bronchodilation and a reduced inflammatory response
2. aminophylline
3. cardiac arrythmias, GI disturbance, seizures
4. metabolised by CPY450

Question 25

What is the MOA of montelukast?

Answer 25

leukotriene receptor antagonists

Question 26

How is status asthmaticus managed?

Answer 26

- oxygen (via non-rebreathe mask) - nebulised SABA - oral pred/IV hydrocortisone - nebulised ipratropium - IV Mg (acts as a bronchodilator) - ICU admission if sats <90%

Question 27

What is the stepwise management of COPD?

Answer 27

1. SABA or SAMA 2. LABA + LAMA or LABA + ICS 3. LABA + LAMA + ICS

Question 28

1. What is the MOA of muscarinic receptor antagonists in the treatment of COPD? 2. Name 2 examples

Answer 28

1. promotes bronchodilation 2. ipratropium tiotropium

Question 29

When is oxygen therapy indicated?

Answer 29

In hypoxaemia, to achieve target sats of 94-98%

Question 30

1. How should nebulisers be driven in patients with asthma? | 2. How should nebulisers be driven in patients with hypercapnic acidosis?

Answer 30

1. driven by piped oxugen | 2. driven by compressed air (if necessary, to maintain O2 sats, supplimentary O2 should be delivered via nasal cannulae)

Question 31

1. What does a non-rebreathe O2 mask deliver? | 2. What are the indications for this mask?

Answer 31

1. variable O2 concentrations (depending on patient's respiratory effort) between 60 and 80% 2. critical illness, trauma patients, post arrest

Question 32

1. What are the indications of a simple face mask? 2. In which patients should they be avoided? 3. why should O2 flow be at least 5L/min?

Answer 32

1. type I respiratory failure 2. patients with a hx or at risk of hypercapnic respiratory failure 3. to prevent CO2 build up

Question 33

1. What are the indications of a venturi mask? | 2. What type of oxygen does it deliver?

Answer 33

1. patients requiring controlled/low dose oxygen or patients at risk of type II respiratory failure 2. constant oxygen concentration at different flow rates