COPD Flashcards
most common sx of dyspnea
emphysema
accessory muscle use is more common with which type of COPD
emphysema
what part of respiration is prolonged with COPD
expiration
4 signs of hyperinflation and which copd is it seen in
seen in emphysema d/t air trapping
* flattened diaphragm
* increased AP diameter
* decreased vascular markings
* bullae or blebs
pursued lip breathing is associated with…
emphysema
which type is cyanotic and has peripheral edema
chronic bronchitis
which type is crackles/rales, rhonci and wheezing associated with
chronic bronchitis
which type will have increased Hg, hematocrit/RBC
chronic bronchitis
why is there increased Hg?
d/t hypoxia stimulating erythropoeisis
V/Q findings in emphysema vs chronic bronchitis
- matched in emphysema d/t hyperventilation
- severe mismatch in chronic bronchitis; also hypercapnia
what does the presence of bullae on CXR signify?
airspace loss
define chronic bronchitis
chronic productive cough for at least 3 months a year for 2 consecutive years
3 cardinal sx of chronic bronchitis (from PPP)
chronic cough
sputum production
dyspnea (on exertion)
most common type of emphysema (found on CT)
centrilobar/proximal acinar
pathophys of emphysema (5 steps)
- chronic inflammation
- less protective enzymes & more damaging ones
- alveolar-capillary membrane destruction
- loss of recoil & airway collapse; increased compliance
- airway obstruction/increased air trapping
weight loss is seen more in which one? why?
emphysema d/t inflammation and increased WOB
signs that COPD is d/t AAT deficiency (3)
- panacinar emphysema on CT
- hepatomegaly
- cirrhosis
ABG finding (1)
respiratory acidosis
4 PFT findings indicative of COPD
- low FEV1
- low or normal FVC
- low FEV1/FVC ratio
- increased RV and TLC
DLCO finding in emphysema vs chronic bronchitis
- emphysema will be reduced d/t membrane destruction
- somewhat normal in chronic bronchitis
pathophys of chronic bronchitis (4 steps)
- chronic inflammation
- mucous gland hyperplasia & mucus hypersecretion
- cilia dmaged
- neutrophils & CD8+ T cell infiltration
pulmonary HTN, cor pulmonale and multifocal atrial tachy. is associated with…
chronic bronchitis
3 signs of acute COPD exacerbation (need at least 1 of)
- cough increase
- sputum increase/changes
- dyspnnea increases
group that would benefit the MOST from pulmonary rehab
FEV1 under 50%
accuracy of pulse ox decreases when SBP is under what value?
80
ATS severity criteria
- Mild: FEV 1 70+ %
- Moderate: FEV1 60-69%
- Moderately severe: FEV1 50-59%
- Severe: FEV1 35-49%
- Very severe: FEV1 < 35%
Sympathomimetic activation through β2 receptors in lung→ relax airway smooth muscle
this is the MOA for?
beta 2 adrenergic agonists
3 other names for albuterol
proventil
proair
ventolin
name two LABAs
formoterol
salmeterol
used 2x a day
name two SABAs
albuterol
levalbuterol (lasts longer)
- exhibits broncholytic action by reducing cholinergic influence on bronchial musculature. Blocks muscarinic ACh receptors w/o specificity→ cGMP degradation
- Inhibit parasympathetic tone at smooth muscle cells
- SAMA
- SAMA + LAMA
what class is Tiotropium (once a day, 24hr)
LAMA
what class is Ipratropium (atrovent)
SAMA
between LAMA and LABA which is thought to be a little better
LAMA
SE of antimuscarinics
dry mouth, blurred vision, difficulty swallowing, thirsy, rare urinary sx
anti-inflammatory, Antidep., dopamine/NE-reuptake inhibitor
May blunt post-cessation weight gain
what MOA is this for
Bupropion (oral steroid)
C/I for bupropion
seizure disorder
3 indications for NIPPV
resp. acidosis
severe dyspnea w/ signs of resp. muscle fatigue
persistent hypoxemia despite supplemental oxygen
which medication used in frequent exacerbation, decrease airway inflammation & rates of exacerbation but has high SE burden
Roflumilast (PPD4 inhibitor)
reduces sputum viscosity and elasticity
improves mucociliary clearance & modulates inflammatory response
can reduce frequency of exacerbation
which medication
N-acetylcysteine (an expectorant)
- competitive nonselective PPD inhibitor→ raised intracellular cAMP, activates PKA, inhibits TNF-alpha & inhibits leukotriene synthesis
- less inflammation & innate immunity
- Increases force of diaphragmatic muscle contraction
- Suppresses COL1 mRNA (codes for collagen)
theophylline
2 indications for theophylline
- Primary maintenance for those who want PO only or having issues w/ inhaler
- Additive for ICU pts not responding to beta-2 agonist
- Requires serum monitoring to avoid toxicities (5-15 mcg/ml)
- Multiple drug interactions (erythromycin, cipro, rifampin)
- once titrated, serum monitored Q 12 months
theophylline
