TAHO - Respiratory Cycle

- Peak flow respiratory - Counselling about peak flow respiratory - Spirometer - Sit upright - Put mouthpiece in - Asthma treatments - Shoet acting bronchodilators - Long acting bronchodilators - Corticosteroids - LTRA's - Over use of short acting bronchodilators - Can lead to lung collapse - Monteleukast - Atopic - Monoclonal Antibodies - Know the criteria - Escelation - Community Pharmacy notes- Upper respiratory tract - Nasal cavity, Larynx, Pharynx - Lower respiratory tract - Trachea and bronchi and lungs - Acute, subacute and chronic cough - Acute= when cough is present for less than 3 weeks - Subacute= when cough is present for 3-8 weeks - Chronic= more than 8 weeks - 90% of URTI's are caused by - viruses - How do coughs occur ? - Receptors in the pharynx, larynx, trachea and bronchi are stimulated by irritant, thermal and mechanical mechanisms. Neural impulses are then carried along afferant pathways of the vagal and superior laryngeal nerves which terminate at the cough centre in the medulla - Efferent fibres of the vagus and spinal nerve carry neural activity to the muscles of the diaphragm, chest wall and abdomen 1/6 - The muscles contract and the glottis opens suddenly to create a cough - What is a cough ? - It's the body's mechanism of removing irritants from the airways - It's usually self limiting (3-4 weeks) - It's classified by duration - Cause of acute cough - Viral - Usually self limiting (7-10 days) - Commonly in the winter - What does a prolonged cough indicate - A secondary bacterial infection or post viral infection - OTC meds for Cough - Expectorants - Antitussives - Antihistamines - Effects of Anticholinergics - Produces dryness, dryness in eyes etc - Cough causes - Most likely= Viral infection - Likely= Upper airways cough syndrome and acute bronchitis - Acute cough treatment - Rest - Fluids - Avoid contact with others - Paracetamol or Ibuprofen - Hot lemon and honey (older than 1) - No Antibiotics unless it's indicated that it's bacterial - If systemically unwell antibiotics are given, if not systemically unwell then antibiotics aren't given - Flu is more severe - Common cold= Has a viral cause - Self limiting - Children are more susceptible to - Transmission via direct contact - Most contagious during day 1-2 - Difference between common cold and flu 2/6 - Cold viruses remain viable on surfaces for several hours - The - More abrupt onset of symptoms - Occurs within hours rather than - - Assessment of cold - Cold treatment Flu - RNA viruses (A, B, C) - Types A and B are the most virulent - Annual vaccinations - More severe than a cold - Flu season is between Dec- March - Pneumonia - Is inflammation of the lungs - At risk groups= Elderly and very young ( heart, lung) - Symptom onset can be gradual or sudden - Refer= Chronic cough, haemoptysis, SOB/ chest pain, confusion - Investigate= CXR, FBC, obs, blood gas, clinical examination, sputum sample, covid swab - Management= IVI, O2, Abx, nebs - Research - Chest x ray interpretation - Why is CAP treated differently in com- - Because the bacteria in hospitals= munity versus hospital environments higher likelihood of resistance to occur - Antibiotics - - Conditions to eliminate - - Upper airways cough syndrome - Acute bronchitis - Croup - COPD - Asthma - Pneumonia - Medicine induced cough or wheeze - HF - Bronchiectasis 3/6 - TB - Carcinoma of the lung - Upper airways cough syndrome - Chronic cough - Patients should be asked if they are swallowing mucus or notice they're clearing their throat more than usual - Can be caused by allergies - UACS - Sinus/ nasal discharge flows behind nose and into throat - Treated using antihistamines or decongestants - Productive cough - Chesty cough - Producing sputum - Non productive cough - Dry, tight, tickly cough - Acute Bronchitis - Most cases are seen in autumn or winter - Similar to URTI but dyspnoea and wheeze is present - The cough lasts for 7-10 days but can persist for 3 weeks - Croup - Triggered by recent infection with parainfluenza virus - Affects infants between 3 months and 6 years - Symptoms occur in the late evening and night - The cough can be severe and violent - If a child's symptoms persist for longer than 48 hours, medical intervention is required - Standard treatment= Oral or intramuscular Dexamethasone or nebulised Budesonide 4/6 - TB - Breathlessness and chest pain - more than 3 week cough with mucus - Tired, exhausted, generally unwell - Pyrexia, rigors (shaking) and night sweats - Loss of appetite - Weight loss - Infection can spread to other body parts (extrapulmonary) - Swollen glands, tummy or pelvic pain - Body aches and pains - Constipation, dark or cloudy urine - Headache - Rashes - Stiff neck - Rash on legs, face or other body parts - Visual disturbances -Different lung sounds - Fine crackles -Coarse crackles - Active TB - start treatment without 6 months of Isoniazide, with Pyrixodine and Rifampicin supplemented with Pyrazinimide and Ethanbutomol - Isoniazide mechanism of action ? - Inhibits bacterial cell wall synthesis and then activates by that KatG in - Isoniazide monitoring - - Counselling of Isoniazide - signs of liver disorder= yellowing of the whites of the eyes, malaise, fever, itchiness - Stop treatment if this occurs, Rifampicin mechanism of action - Inhibits RNA polymerase - Monitoring of Rifampicin - Renal tests - Hepatic function - FBC - Blood function when pt's during prolonged therapy 5/6 - Rifampicin counselling - Dyes all bodily fluids orange-red - Recommend glasses instead of contact lenses - Caution in contraceptive pill - Pyrizinamide mechanism of action - Disrupts cell membrane, not fully understood mechanism - Prizinamide monitoring - Prizinamide counselling - Ethambutol mechanism of action - Ethambutol monitoring - Occular toxicity-> Visual acuity, can damage eyesight so check vision before treatment - Therapeutic drug monitoring, plasma conc needs monitoring - Ethambutol - Why should Isoniazide be given with Pyridoxine - B6 deficiency 6/6