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Nayla Pharm > 3-COPD > Flashcards

3-COPD Flashcards

1
Q

COPD is inflammation of the small airways due to

A

Narrowing
Fibrosis (chronic bronchitis)
Destruction of parenchyma
Destruction of alveolar walls (Emphysema)

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2
Q

COPD has a predominance of what types of cells

A

Neutrophils
Macrophages
TC1 cells (cytotoxic T)

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3
Q

COPD results in

A

Airway closure on expiration
Air trapping/hyperinflation
SOB and exercise limitation

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4
Q

How does GOLD reach categorization COPD

A

Spirometry confirmed diagnosis (FEV1:FVC <0.7)
Assessment of airflow limitation
Assessment of symptoms and risk of exacerbations

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5
Q

What are the GOLD COPD groups

A

1: FEV1 *)+
2: FEV1 50-79
3. FEV1 30-49
4: FEV1 <30

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6
Q

What are the GOLD COPD ABCD groups

A

A: 0-1 exacerbations, no hospital. mMRC 0-1, CAT <10
B: 0-1 exacerbations, no hospital, mMRC 2+, CAT 10+
C: 2+ exacerbation or 1+ hospital, mMRC 0-1, CAT <10
D: 2+ exacerbation or 1+ hospital, mMRC 2+, CAT 10+

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7
Q

How do you treat the different groups

A

A: Bronchodilator
B: LAMA or LABA- if Sx persist, LAMA+LABA
C: LAMA- if Sx persist, LAMA+LABA
D: LAMA+LABA, if Sx persist LAMA+LABA+ICS (can add Macrolide if ex-smoker)

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8
Q

Are SABA great COPD drugs?

A

not really, only small improvement in FEV1 (per spirometry)
response is usually less than seen in asthma
BUT, can improve respiratory Sx and exercise tolerance

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9
Q

Side Effects of Bronchodilators

A

Tachycardia, Tremors, Rhythm disturbance

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10
Q

Are LABA’s good COPD drugs?

A 
Yes; 
Relieve dyspnea
improve QoL
improve lung function
reduce exacerbation frequency
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11
Q

How do anti-muscarinics work

A

Competitively block cholinergic receptors in bronchial smooth muscle= Bronchodilation

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12
Q

What are the different anticholinergics

A

SAMA: Ipratropium. Slower onset but more prolonged effect vs albuterol
LAMA: Tiotropium, umeclidinium. Improve lung fun significantly, comparable to LABA. Decrease exacerbations, lower mortality risk

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13
Q

Side effects of anticholinergics are

A

Dry mouth
Nausea
Metallic taste

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14
Q

How do corticosteroids affect COPD (anti-inflammatory MOA)

A

Reduce capillary permeability (decrease mucus)
Inhibit LT enzyme release
Inhibit prostaglandins (PLA2, COX2)

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15
Q

When are systemic corticosteroids used

A

In chronic management, to slow disease progression

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16
Q

Side effects of Systemic corticosteroids are

A 
Osteoporosis 
Muscular atrophy
Thinning skin
Cataracts
(Adrenal suppression/insufficiency)
17
Q

How do you treat Alpha Anti-Trypsin deficiency associated Emphysema

A

AAT infusion

Bronchodilators prn

18
Q

What is a LABA+ICS

A

Salmeterol+Fluticasone
Formoterol+Budesonide
-Better at improving FEV1 and decreasing exacerbations

19
Q

What did the FDA approve for COPD therapy in 2017

A

Triple therapy all in one inhaler QD, Trelegy Ellipta (Fluticasone+Umeclidinium+Vilanterol)
ICS+LAMA+LABA

20
Q

Five step strategy for smoking cessation is

A 
Ask
Advise
Assess
Assist
Arrange
21
Q

What agents are first line smoking cessation meds

A

Bupropion SR (oral)
Nicotine gum, inhaler, nasal spray, patch
Varenicline/Chantix (oral)

22
Q

When should you use oxygen therapy

A

Severe resting chronic hypoxemia, to improve survival

23
Q

When shouldn’t you use oxygen therapy

A

Stable COPD and resting or exercise induced moderate desaturation

24
Q

When should you use Non-invasive ventilation

A

Severe chronic hypercapnia

Hx ARF

25
Q

What are the “cardinal symptoms” of COPD

A

Increasing Dyspnea, Sputum volume, Sputum purulence

26
Q

What are the stages of acute COPD exacerbations

A

Mild: 1 cardinal Sx + 1 (URI w/in 5 days, fever, wheezing, cough, HR/RR increase >20% baseline)
Moderate: 2 cardinal Sx
Severe: 3 cardinal Sx

27
Q

What therapies can be used in acute COPD exacerbations

A 
Antibiotics 
Corticosteroids
Bronchodilators 
Oxygen therapy
Non-Invasive mechanical ventilation
28
Q

What therapy is recommended in anyone with moderate or severe exacerbation

A

Antibiotics

29
Q

What is the caveat to corticosteroid use

A

if longer than 14 days, taper down to avoid HPA axis suppression

30
Q

Bronchodilators can be used in what form

A

Moderate dose inhaler or Dry powder inhaler (just as efficacious as nebulizers)

31
Q

What bronchodilators would you use

A 
Beta agonists (also increase mucociliary clearance) 
LAMA and LABA not for acute relief
32
Q

How should oxygen therapy be administered

A

Titrate O2 to >90%

monitor ABG for hypercapnia

33
Q

When should you NOT use Non-invasive mechanical ventilation

A

AMS
Severe acidosis
Respiratory arrest
Cardiovascular instability

34
Q

What vaccines should COPD patients get

A

Flu vaccine yearly

Pneumococcal vaccine

35
Q

Who gets the pneumococcal vaccines

A

PCV13: 65+, 19-64 with low immunity
PPSV23: 65+, 19-64 or <2 y/o smoker, chronic illness, cochlear implant or CSF leak, low immunity

36
Q

What Abx should you use if pt has Uncomplicated exacerbation (<4 exacerbations x year and FEV1 >50%)

A

Azithromycin, Clarithromycin (Macrolide)
2-3 gen Cephalosporin
Doxycycline

37
Q

What abx should you NOT use if pt has uncomplicated exacerbation (<4 exacerbations and FEV1 >50%)

A

Bactrim
Amoxicillin
1 gen cephalosporin
Erythromycin

38
Q

What abx should you use if patient has a complicated exacerbation (65+, >4 exacerbations, FEV1 35-50%)

A

Augmenting

Levo/Moxi/Gemifloxacin (Fluoroquinolone anti-pneumo)

39
Q

What abx should you use if patient has complicated exacerbation with P. Aureginosa RF (nursing home w/ 4+ exacerbations, FEV1 <35%, chronic corticosteroid use, chronic bronchial sepsis)

A

Levofloxacin (anti-pneumo and anti-pseudo Fluoroquinolone)

+/- IV therapy

Nayla Pharm (12 decks)

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