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pulm 2 > COPD > Flashcards

COPD Flashcards

1
Q

most common sx of dyspnea

A

emphysema

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2
Q

accessory muscle use is more common with which type of COPD

A

emphysema

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3
Q

what part of respiration is prolonged with COPD

A

expiration

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4
Q

4 signs of hyperinflation and which copd is it seen in

A

seen in emphysema d/t air trapping
* flattened diaphragm
* increased AP diameter
* decreased vascular markings
* bullae or blebs

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5
Q

pursued lip breathing is associated with…

A

emphysema

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6
Q

which type is cyanotic and has peripheral edema

A

chronic bronchitis

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7
Q

which type is crackles/rales, rhonci and wheezing associated with

A

chronic bronchitis

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7
Q

which type will have increased Hg, hematocrit/RBC

A

chronic bronchitis

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8
Q

why is there increased Hg?

A

d/t hypoxia stimulating erythropoeisis

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9
Q

V/Q findings in emphysema vs chronic bronchitis

A
  • matched in emphysema d/t hyperventilation
  • severe mismatch in chronic bronchitis; also hypercapnia
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10
Q

what does the presence of bullae on CXR signify?

A

airspace loss

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11
Q

define chronic bronchitis

A

chronic productive cough for at least 3 months a year for 2 consecutive years

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12
Q

3 cardinal sx of chronic bronchitis (from PPP)

A

chronic cough
sputum production
dyspnea (on exertion)

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13
Q

most common type of emphysema (found on CT)

A

centrilobar/proximal acinar

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14
Q

pathophys of emphysema (5 steps)

A
  1. chronic inflammation
  2. less protective enzymes & more damaging ones
  3. alveolar-capillary membrane destruction
  4. loss of recoil & airway collapse; increased compliance
  5. airway obstruction/increased air trapping
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15
Q

weight loss is seen more in which one? why?

A

emphysema d/t inflammation and increased WOB

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16
Q

signs that COPD is d/t AAT deficiency (3)

A
  • panacinar emphysema on CT
  • hepatomegaly
  • cirrhosis
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17
Q

ABG finding (1)

A

respiratory acidosis

18
Q

4 PFT findings indicative of COPD

A
  • low FEV1
  • low or normal FVC
  • low FEV1/FVC ratio
  • increased RV and TLC
19
Q

DLCO finding in emphysema vs chronic bronchitis

A
  • emphysema will be reduced d/t membrane destruction
  • somewhat normal in chronic bronchitis
20
Q

pathophys of chronic bronchitis (4 steps)

A
  1. chronic inflammation
  2. mucous gland hyperplasia & mucus hypersecretion
  3. cilia dmaged
  4. neutrophils & CD8+ T cell infiltration
21
Q

pulmonary HTN, cor pulmonale and multifocal atrial tachy. is associated with…

A

chronic bronchitis

22
Q

3 signs of acute COPD exacerbation (need at least 1 of)

A
  • cough increase
  • sputum increase/changes
  • dyspnnea increases
23
Q

group that would benefit the MOST from pulmonary rehab

A

FEV1 under 50%

24
Q

accuracy of pulse ox decreases when SBP is under what value?

A

80

25
Q

ATS severity criteria

A
  • Mild: FEV 1 70+ %
  • Moderate: FEV1 60-69%
  • Moderately severe: FEV1 50-59%
  • Severe: FEV1 35-49%
  • Very severe: FEV1 < 35%
26
Q

Sympathomimetic activation through β2 receptors in lung→ relax airway smooth muscle

this is the MOA for?

A

beta 2 adrenergic agonists

27
Q

3 other names for albuterol

A

proventil
proair
ventolin

28
Q

name two LABAs

A

formoterol
salmeterol

used 2x a day

29
Q

name two SABAs

A

albuterol
levalbuterol (lasts longer)

30
Q
  • 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
A
  • SAMA
  • SAMA + LAMA
31
Q

what class is Tiotropium (once a day, 24hr)

A

LAMA

32
Q

what class is Ipratropium (atrovent)

A

SAMA

33
Q

between LAMA and LABA which is thought to be a little better

A

LAMA

34
Q

SE of antimuscarinics

A

dry mouth, blurred vision, difficulty swallowing, thirsy, rare urinary sx

35
Q

anti-inflammatory, Antidep., dopamine/NE-reuptake inhibitor
May blunt post-cessation weight gain

what MOA is this for

A

Bupropion (oral steroid)

36
Q

C/I for bupropion

A

seizure disorder

37
Q

3 indications for NIPPV

A

resp. acidosis
severe dyspnea w/ signs of resp. muscle fatigue
persistent hypoxemia despite supplemental oxygen

38
Q

which medication used in frequent exacerbation, decrease airway inflammation & rates of exacerbation but has high SE burden

A

Roflumilast (PPD4 inhibitor)

39
Q

reduces sputum viscosity and elasticity
improves mucociliary clearance & modulates inflammatory response
can reduce frequency of exacerbation

which medication

A

N-acetylcysteine (an expectorant)

40
Q
  • 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)
A

theophylline

41
Q

2 indications for theophylline

A
  • Primary maintenance for those who want PO only or having issues w/ inhaler
  • Additive for ICU pts not responding to beta-2 agonist
42
Q
  • Requires serum monitoring to avoid toxicities (5-15 mcg/ml)
  • Multiple drug interactions (erythromycin, cipro, rifampin)
  • once titrated, serum monitored Q 12 months
A

theophylline

pulm 2 (8 decks)

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