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CRRAB II PBL > COPD > Flashcards

COPD Flashcards

1
Q

If a patient comes in concerned about coughing up blood, what should be the primary diagnosis until proven otherwise?

A

Cancer

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2
Q

Besides cancer, what are some other more common causes of hemoptysis?

A

Bronchitis (most common cause)
Bronchiectasis
Pneumonia

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3
Q

What is often the cause of hemoptysis in younger people?

A

Cystic fibrosis

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4
Q

What are some common causes of hemoptysis in middle aged people?

A

Mitral stenosis
Bronchial adenomas
Goodpasture’s syndrome
Primary pulmonary HTN

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5
Q

What is a common cause of hemoptysis in people over the age of 50?

A

Lung carcinoma

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6
Q

What is used to diagnosis COPD?

A

Spirometry

History

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7
Q

How can otherwise healthy patients with pneumonia be treated?

A

Macrolides

Doxycycline

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8
Q

How can pneumonia patients who have been ill lately be treated?

A

Fluoroquinolones

Beta-lactam/beta-lactamase inhibitor + macrolide

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9
Q

What is expected of pulmonary function tests of patients with obstructive lung disease?

A

High lung volume**
Reduced max flow rate
Reduced FEV1
Reduced FEV1/FVC**

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10
Q

What is expected of pulmonary function tests of patients with restrictive lung disease?

A

Low lung volume**
Reduced max flow rate
Reduced FEV1
Normal FEV1/FVC**

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11
Q

What are examples of obstructive lung disease?

A

Asthma
Bronchiectasis
Bronchitis
COPD

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12
Q

What is the primary example of restrictive lung disease?

A

Pulmonary fibrosis

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13
Q

A COPD patient is having an exacerbation. What should be given?

A

Short bronchodilator–albuterol or ipratropium
Systemic corticosteroid–prednisone or similar
Transitioned to an inhaled corticosteroid
Supplemental oxygen

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14
Q

A COPD outpatient is having an infectious exacerbation. What antibiotics should be used in addition to the normal COPD drugs?

A

Oral antibiotics–tetracyclines, amoxicillin, amox/clav, cefaclor, or macrolides

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15
Q

A COPD inpatient is having an infectious exacerbation. What antibiotics should be used in addition to the normal COPD drugs?

A

Oral/systemic antibiotics–Azithromycin + ceftriaxone, piperacillin/tazobactam, or meropenem

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16
Q

How should group A COPD (few symptoms/low exacerbation risk) patients be treated?

A

Short bronchodilator PRN–albuterol and/or ipratropium
Education and vaccination
Smoking cessation

17
Q

How should group B COPD (more symptoms/low exacerbation risk) patients be treated?

A

Long bronchodilator
Short bronchodilator PRN–albuterol and/or ipratropium
Education, vaccination, pulmonary rehab (maybe?)
Smoking cessation

18
Q

How should group C COPD (few symptoms/more exacerbation risk) patients be treated?

A

Long bronchodilator
Short bronchodilator PRN–albuterol and/or ipratropium
Education, vaccination, pulmonary rehab (maybe?)
Smoking cessation

Possibly inhaled corticosteroid, phosphodiesterase-4 inhibitor, or theophylline

19
Q

How should group D COPD (more symptoms/more exacerbation risk) patients be treated?

A

Long bronchodilator
Short bronchodilator PRN–albuterol and/or ipratropium
Education, vaccination, pulmonary rehab (maybe?)
Smoking cessation

Possibly inhaled corticosteroid, phosphodiesterase-4 inhibitor, theophylline, supplemental oxygen, or surgical interventions

20
Q

What is albuterol’s MOA?

A

Selectively stimulates beta-2 receptors –> relaxes smooth muscle –> bronchodilation

21
Q

Why is albuterol better for bronchodilation than propranolol, ephedrine, or epinephrine?

A

Propranolol is non-selective beta antagonist –> decreases HR and may be bronchoconstrictive

Ephedrine non-selective beta agonist –> bronchodilation + increased HR

Epinephrine non-selective adrenergic agonist –> vasoconstriction + increased HR + bronchodilation

22
Q

What is the MOA of FDA approved ipratropium for maintenance of bronchospasms in COPD patients?

A

Competitively inhibits cholinergic receptors in bronchial smooth muscle –> Inhibition of bronchoconstriction of the large central airways AND inhibition of serous and seromucous secretions

23
Q

What is the MOA of non-FDA approved beta-2 agonists for reversible obstructive pulmonary diseases?

A

Stimulates beta-2 receptor –> increases IC cAMP–> smooth muscle relaxation + inhibits release of hypersensitivity mediators from mast cells

24
Q

What is the MOA of non-FDA approved atropine for bronchodilation?

A

Competitive antagonist of acetylcholine for muscarinic receptors –> causes smooth muscle dilation

25
Q

What are four advantages to inhaled drugs over systemic drugs?

A

Reduced systemic side effects
Faster onset
Less loss of drug d/t metabolism
Greater bronchodilation

CRRAB II PBL (2 decks)

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