COPD Flashcards
If a patient comes in concerned about coughing up blood, what should be the primary diagnosis until proven otherwise?
Cancer
Besides cancer, what are some other more common causes of hemoptysis?
Bronchitis (most common cause)
Bronchiectasis
Pneumonia
What is often the cause of hemoptysis in younger people?
Cystic fibrosis
What are some common causes of hemoptysis in middle aged people?
Mitral stenosis
Bronchial adenomas
Goodpasture’s syndrome
Primary pulmonary HTN
What is a common cause of hemoptysis in people over the age of 50?
Lung carcinoma
What is used to diagnosis COPD?
Spirometry
History
How can otherwise healthy patients with pneumonia be treated?
Macrolides
Doxycycline
How can pneumonia patients who have been ill lately be treated?
Fluoroquinolones
Beta-lactam/beta-lactamase inhibitor + macrolide
What is expected of pulmonary function tests of patients with obstructive lung disease?
High lung volume**
Reduced max flow rate
Reduced FEV1
Reduced FEV1/FVC**
What is expected of pulmonary function tests of patients with restrictive lung disease?
Low lung volume**
Reduced max flow rate
Reduced FEV1
Normal FEV1/FVC**
What are examples of obstructive lung disease?
Asthma
Bronchiectasis
Bronchitis
COPD
What is the primary example of restrictive lung disease?
Pulmonary fibrosis
A COPD patient is having an exacerbation. What should be given?
Short bronchodilator–albuterol or ipratropium
Systemic corticosteroid–prednisone or similar
Transitioned to an inhaled corticosteroid
Supplemental oxygen
A COPD outpatient is having an infectious exacerbation. What antibiotics should be used in addition to the normal COPD drugs?
Oral antibiotics–tetracyclines, amoxicillin, amox/clav, cefaclor, or macrolides
A COPD inpatient is having an infectious exacerbation. What antibiotics should be used in addition to the normal COPD drugs?
Oral/systemic antibiotics–Azithromycin + ceftriaxone, piperacillin/tazobactam, or meropenem
How should group A COPD (few symptoms/low exacerbation risk) patients be treated?
Short bronchodilator PRN–albuterol and/or ipratropium
Education and vaccination
Smoking cessation
How should group B COPD (more symptoms/low exacerbation risk) patients be treated?
Long bronchodilator
Short bronchodilator PRN–albuterol and/or ipratropium
Education, vaccination, pulmonary rehab (maybe?)
Smoking cessation
How should group C COPD (few symptoms/more exacerbation risk) patients be treated?
Long bronchodilator
Short bronchodilator PRN–albuterol and/or ipratropium
Education, vaccination, pulmonary rehab (maybe?)
Smoking cessation
Possibly inhaled corticosteroid, phosphodiesterase-4 inhibitor, or theophylline
How should group D COPD (more symptoms/more exacerbation risk) patients be treated?
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
What is albuterol’s MOA?
Selectively stimulates beta-2 receptors –> relaxes smooth muscle –> bronchodilation
Why is albuterol better for bronchodilation than propranolol, ephedrine, or epinephrine?
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
What is the MOA of FDA approved ipratropium for maintenance of bronchospasms in COPD patients?
Competitively inhibits cholinergic receptors in bronchial smooth muscle –> Inhibition of bronchoconstriction of the large central airways AND inhibition of serous and seromucous secretions
What is the MOA of non-FDA approved beta-2 agonists for reversible obstructive pulmonary diseases?
Stimulates beta-2 receptor –> increases IC cAMP–> smooth muscle relaxation + inhibits release of hypersensitivity mediators from mast cells
What is the MOA of non-FDA approved atropine for bronchodilation?
Competitive antagonist of acetylcholine for muscarinic receptors –> causes smooth muscle dilation
