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FINALS RESP > copd > Flashcards

copd Flashcards

1
Q

features COPD

A

cough // SOB // wheeze // smoking // severe = right HF

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2
Q

bronchitis and emphysema COPD

A

bronchitis = -Smooth muscle spasm and hypertrophy // emphysema = alveolar destruction –> decreased air exchange

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3
Q

CXR COPD

A

hyperinflated // bullae (mimic pneumothorax)

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4
Q

why is FBC required for COPD

A

secondary polycythaemia

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5
Q

diagnosis COPD

A

spirometry - FEV1/FVC <0.7 // FEV1 reduced, FVC normal

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6
Q

stage 1 COPD spirometry

A

FEV1 >80% + symptomatic

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7
Q

stage 2 COPD spirometry

A

FEV 50-79%

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8
Q

stage 3 COPD spirometry

A

FEV1 40-49 % (severe)

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9
Q

stage 4 COPD spirometry

A

FEV1 <30% (V severe)

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10
Q

general mx COPD

A

smoking cessation // influenza vaccine // one off pneumococcal vaccine // pulm rehab

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11
Q

COPD 1st line mx

A

1 = SABA OR SAMA

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12
Q

COPD progressive mx no features asthma

A

1 = SABA or SAMA // 2 = SABA + LABA + LAMA // 3 = theophylline

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13
Q

what featured indicate asthma COPD overlap

A

history atopy // high eosinophils // variation in FEV1 (esp diurnal)

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14
Q

COPD progressive mx with features asthma

A

1 = SAMA OR SAMA // 2 = add LABA + ICS // 3 = SABA + LAMA + LABA + ICS (no LAMA) // 4 = add theophylline

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15
Q

important note with LAMA + SAMA

A

cannot be taken together, if adding LAMA discontinue SAMA

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16
Q

interaction theophylline with abx

A

reduce macrolide (eyrthromycin, clarithromycin) + fluroquinilones (ciprofloxacin)

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17
Q

abx prophylaxis in COPD

A

azithromycin

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18
Q

monitoring with azithromycin

A

ECG (azithromycin prolongs QT interval)

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19
Q

features cor pulmonale COPD

A

peripheral oedema, raised JVP, parasternal heave

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20
Q

mx cor pulmonale COPD

A

diuretics + long term O2

21
Q

methods to improve surviva COPD

A

stop smoking // long term O2 // long volume surgery

22
Q

who should be assessed for long term O2 COPD

A

FEV1 <30% // cyanosis // polycythaemia // peripheral oedema // raised JVP // O2 <92%

23
Q

how is long term O2 COPD assessment done + what results indicate need for it

A

2 ABG 3 weeks apart // pO2 <7.3 // OR pO2 between 7.3-7.8 + one of: polycythaemia, peripheral oedema, pulm HTN

24
Q

who is not suitable for long term O2 COPD

A

smokers!!

25
Q

indications non-invasive ventilation COPD

A

resp acidosis pH 7.24-7.35

26
Q

other indications NIV (not COPD)

A

type II resp failure from deformity // cardiogenic pulm oedema // weaning tracheal intubation

27
Q

medications to help in smoking cessation

A

nicotine patch // varenicline // bupropion (monotherapy only)

28
Q

when can repeat prescirption for smoking cessation be offered

A

after 6 months

29
Q

use nicotine therapy smoking cessation

A

patches (+ gum, inhaler etc if needed)

30
Q

mechanism Varenicline

A

nicotinic receptor agonist

31
Q

SE Varenicline

A

nausea, headache, insomnia // caution with depression

32
Q

mechanism Bupropion

A

NA + dopamine reuptake inhibitor // nicotine antagonist

33
Q

SE + contraindication Bupropion

A

SE = seizures // contraindicated in epilsey, pregnancy, breast feeding, eating disorder

34
Q

smoking cessation in pregnancy + breast feeding

A

CBT –> NRT // others contraindicated

35
Q

what is Alpha-1 antitrypsin deficiency

A

inherited disorder causing COPD in young non-smokers

36
Q

inheritance + genetics Alpha-1 antitrypsin deficiency

A

chromosome 14 // autosomal recessive or co-dominant

37
Q

alleles Alpha-1 antitrypsin deficiency

A

M = normal, S = slow, Z = v slow

38
Q

homozygous PiSS levels

A

50% normal Alpha-1 antitrypsin levels

39
Q

homozygous piZZ levels

A

10% normal Alpha-1 antitrypsin

40
Q

features Alpha-1 antitrypsin deficiency

A

normally PiZZ // emphysema in LOWER lobes // liver cirrhosis, hepatocellular carcinoma

41
Q

invx Alpha-1 antitrypsin deficiency

A

A1AT // spirometry - obstructive picture

42
Q

medical + lifetyle mx Alpha-1 antitrypsin deficiency

A

no smoking // supportive + physio // IV Alpha-1 antitrypsin //

43
Q

surgical mx Alpha-1 antitrypsin deficiency

A

lung volume reduction surgery OR transplant

44
Q

cause AECOPD

A

H influe!! // strep pneumo, moraxella // virus

45
Q

mx community/ at home AECOPD

A

increase LABA + LAMA // 30mg pred 5 days

46
Q

when are abx indicated COPD + what is given

A

purulent sputum or pneumonia –> amox / doxy / clarithro

47
Q

admission AECOPD

A

severe SOB // confusion or reduced LOC // cyanosis // O2 sats <90% // cant look after themselves at home // comorbid

48
Q

mx severe/ hospitalised AECOPD

A

neb LABA + LAMA // IV hydrocortisone // IV theophylline // NIV

FINALS RESP (12 decks)

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