Pharmaceutical Care of Respiratory Patients II (Role of Pharmacist in Hospital) Flashcards Preview

PM2D Spring Amy L > Pharmaceutical Care of Respiratory Patients II (Role of Pharmacist in Hospital) > Flashcards

Flashcards in Pharmaceutical Care of Respiratory Patients II (Role of Pharmacist in Hospital) Deck (40)
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List 3 drug-drug interactions in asthma/COPD

  1. Patients already on theophylline - careful with aminophylline infusions
  2. Drugs that lower potassium
  3. Theophylline interactions - e.g. lithium, macrolides


What are drug-disease interactions?

  • Diseases that may be affected by drugs used in asthma/COPD
  • Or disease that may affect the drugs


List 3 drug-disease interactions in asthma/COPD

  1. Diabetes
  2. Cardiovascular disease (watch potassium)
  3. Hypertension


List 8 symptoms of acute asthma

  1. Severe breathlessness
  2. Tachypnea - abnormally rapid breathing
  3. Tachycardia - abnormally rapid heart rate
  4. Silent chest - lungs tighten so much during attack that there is not enough air movement for wheezing
  5. Cyanosis - blue-ish skin due to poor circulation/inadequate oxygenation of the blood
  6. Accessory muscle use - muscles that assist but do not play primary role in breathing
  7. Altered consciousness
  8. Decreased oxygen saturations


How does oxygen relieve the symptoms of a severe asthma attack?

Cells have been starved of oxygen during attack = hypoxia and possibly cyanosis

SpO2 level of 94-98%


How do B2 agonist bronchodilators relieve the symptoms of a severe asthma attack?

  • Relieve bronchospasm
  • Repeat at 15-30 minute intervals
  • Can be given via nebuliser or IV


How do steroids relieve the symptoms of a severe asthma attack?

  • Prednisolone 40-50mg for at least 5 days
  • Reduces mortality, relapses, subsequent admission and requirement for B2 agonist therapy
  • Can be given orally or parenterally
  • Earlier the steroids are given, the better the outcome


How does ipratropium bromide (Atrovent) relieve the symptoms of a severe asthma attack?

  • Greater bronchodilation than a B2 agonist alone
  • Leads to faster recovery and shorter duration of admission


How does magnesium sulphate relieve the symptoms of a severe asthma attack?

  • Bronchodilator
  • IV or nebuliser 1.2g-2g
  • IV infusion over 20 minutes


How does aminophylline relieve the symptoms of a severe asthma attack?

  • For patients with near-fatal/life-threatening asthma who have poor response to initial therapy
  • Given via IV
  • Check levels if taking oral theophylline


List 6 things that should be monitored in an asthma patient

  1. PEFR - peak expiratory flow rate - tests lung function
  2. Oxygen saturation
  3. Heart rate
  4. Potassium
  5. Blood glucose
  6. Serum theophylline


What should occur post-hospital admission following an asthma attack?

  • Patient should be followed-up and reviewed as soon as possible by their asthma nurse
  • Asthma action plan (PAAP) written/reviewed


What 3 things should occur during counselling of asthma patients?

  1. Assess the exacerbation = trigger factors
  2. Optimise treatment - compliance, review inhaler technique, consider stepping-up treatment
  3. Review understanding - of how to recognise exacerbation and what to do


List the 3 steps of the controlling of symptoms of asthma

  • Step 1: Inhaled short-acting B2 agonists e.g. salbutamol, terbutaline
  • Step 2: ICS e.g. beclometasone, fluticasone
  • Step 3: LABA, leukotriene receptor antagonist or theophylline and using a daily corticosteroid tablet


List 2 side effects of ICSs

  1. Oral candidiasis
  2. Dysphonia - difficulty in speaking

Higher doses = more severe side effects


List 3 side effects of LABAs

  1. Cardiovascular stimulation
  2. Anxiety
  3. Tremor


List 4 side effects of leukotriene receptor antagonists

  1. Abdominal pain
  2. Thirst
  3. Sleep disturbances
  4. Headache


What advice should be given to patients taking ICSs

  • Prolonged high-dose ICS use = risk of systematic side effects
  • Visit GP if experience: worsening fatigue, muscle weakness, loss of appetite
  • Reduce dose gradually
  • Carry steroid card as appropriate


List 5 counselling points for asthmatics

  1. Know the difference between a preventer and a reliever
  2. Understand the importance of using their preventer inhaler regularly, even when they are well
  3. Know when their inhaler needs to be changed and how to replace it
  4. Don't waste their medicines through inappropriate usage e.g. test pressing
  5. Clean their spacer correctly and often


List 3 ways to improve medicines optimisation

  1. Spacer compatible with device
  2. Ensure patient understands the "relapsing remitting" nature of asthma
  3. Make sure patient understands their PAAP


What does COPD stand for?

Chronic obstructive pulmonary disease


What is the purpose of most treatments for COPD?

To control or reduce the rate of exacerbation (worsening)


What lifestyle change has been the only factor to have slowed the decline in lung function from COPD?

Smoking cessation


How do mucolytics work?

  • Increase expectoration (coughing) of sputum by decreasing its viscosity
  • Discontinue if no improvement after 4 weeks


Give an example of a mucolytic and its dose

  • Carbocisteine
  • 1.5g-2.25g daily in divided doses


List 2 new treatments in COPD

  1. Combination of long-acting muscarinic antagonist and long-acting B2 agonist
  2. Roflumilast


Describe the use of LAMA and LABA combined to treat COPD

  • Used if ICS/LABA is not tolerated
  • Once or twice daily administration, depending on product
  • Convenience and less expensive as one inhaler


Describe the use of Roflumilast

  • Phosphodiesterase type-4 inhaler
  • Anti-inflammatory
  • Adjunct to bronchodilators for maintenance treatment
  • Causes weight loss - patients should monitor body weight


List 5 things that should be monitored in COPD

  1. Breathlessness
  2. Oxygen saturations
  3. FEV1 = volume of air that can be expelled from maximum inspiration in the 1st second
  4. Exercise tolerance
  5. Frequency of exacerbations (episodes)


List 3 ways to improve medicines optimisation in COPD treatment

  1. Spacer compatible with device
  2. Ensure patient understands importance of exacerbation
  3. Monitor and adjust treatments to optimise therapy