COPD🫁

Question 1

SAMA IPRATROPIUM SHOULD BE AVOIDED IN THESE CASES:

Answer 1

Glaucoma due to get into the eyes and increases intraocular pressure
BPH

Question 2

Patient is grade A COPD , with history of arrhythmia , what is the appropriate drug used ?

Answer 2

Use Ipratropium SAMA not SABA salutamol which causes Arrythmiya, Tachycardia and Tremor

SAMA S.E; Dry mouth and Bitter taste.

Question 3

Using Roflumilast in presence of three reasons;

Answer 3

Chronic bronchitis
Frequency Exacerbation
Severe COPD where FEV1 less than 50% of predicted

Question 4

What do we need to monitor while using Roflumilast?

Answer 4

Liver function test

Question 5

What are the S.E of Roflumilast?

Answer 5

Psychiatric issues

Weight loss

Question 6

When to use Azithromycin?

Answer 6

History of smoking

Not improving even with the combination of LAMA+LABA

Question 7

Why is Azithromycin is superior to Erythromycin:

Answer 7

Because Erythromycin used in more freqency and blocking the liver enzymes which affect when used with other medications like digoxins.

Question 8

When to use ICS in COPD?

Answer 8

History of Asthma
Eosinophils more than 300
History of Allergy

Question 9

When use theophylline ?

Answer 9

when patient refuse inhaled therapy

contraindication of inhaled therapy

Question 10

Before prescribe it , you must rule out risk of arrhythmia or hypotension
Which medication is this ?

Answer 10

Theophylline which has low theraputic index and need to be monitored by blood serum level.

Question 11

indication of chronic use of O2 ( Long-term more than 15 hours a day ) ?

Answer 11

Two different cases :
1-PaO2 < 55 mmHg
2-PaO2 = 55-60 ,but with right heart failure or erythrocytosis

Question 12

For Patients with viscous sputum and COPD

What do we need to use?

Answer 12

a-N-acetyl cysteine
b-carbocysteine
c-Erdosteine especially for Exacerbation.

Question 13

Three things consider to prescribe Antibiotics in COPD:

Answer 13

1-the volume of secretion in respiratory tract increase
2-change in color of secretion ( green or yellow)
3-degree of infection

Question 14

What are the Antibiotics used in COPD:

Answer 14

1-Macrolides= Azithromycin and Clarithromycin
2-Second and Third generation of Cephalosporins = cefaclor and cefuroxime
3-Doxycycline

Question 15

What are the Antibiotics should be avoided in COPD:

Answer 15

1-Trimethoprim–sulfamethoxazole =because of increasing
pneumococcal resistance
2-Amoxicillin and first-generation cephalosporins are not
recommended =because of β-lactamase susceptibility.
3-Erythromycin is not recommended because of insufficient
activity against H. influenzae

Question 16

In complicated exacerbations consider Pseudomonas aeruginosa, so use:

Answer 16

1-Fluoroquinolone (levofloxacin 750 mg/day).
2-If IV therapy is required, a β-lactamase-resistant penicillin with
antipseudomonal activity (ticarcillin mainly or piperacillin )or a
third- or fourth-generation cephalosporin with
antipseudomonal activity should be used.

Question 17

What is the treatment for COPD Exacerbation?

Answer 17

1-Oxygen: titrate to improve the patient’s hypoxemia with a target saturation of 88-92%.

2-Initial: SABA, with or without SAMA, as the initial bronchodilators 3-Systemic corticosteroids for 5-7 (A dose of 40 mg prednisone once per day for 5 days) then shift LABA or LAMA when stable
3-Antibiotics, for 5-7 days when indicated, will shorten recovery time,
4-Methylxanthines are not recommended due to increased side effect
5-Consider SC heparin or LMWH to prevent against thromboembolic disease 6-Fluid and electrolyte balance
7-Nebulized magnesium sulphate ( bronchodilator)
8-Non-invasive mechanical ventilation and may consider intubation invasive mechanical ventilation if severe cases