COPD Flashcards
What is the dosing regimen for varenicline? What side effects should patients be warned about?
12 weeks of treatment in total
Day 1-3 0.5 mg once daily
Day 4-7 0.5 mg twice daily
Day 8 onwards = 1mg BD
Warn patients regarding side effects including nausea, sleep disturbance and vivid/colourful dreams
What is the mechanism of action of varenicline?
It is a partial agonist and partial antagonist of the nicotine receptor in the brain. The agonistic effect helps to release dopamine and reduce cravings, whilst the antagonistic effect inhibits dopamine release in response to smoking, aiming to decouple smoking from the reward.
What is cytisine? How would a course be prescribed?
Naturally occurring chemical derived from Cytisus laburnum (plant from the Balkans). It is a nicotine analogue and can reduce cravings. Prescribed as a 25 day course, starting at 6 tablets daily and reducing gradually to 2 tablets daily.
Side effects are most commonly GI in nature
What are the 4 GOLD stages in COPD?
Stage 1: Mild = FEV1 >=80
Stage 2: Moderate FEV1 >=50 <80
Stage 3: Severe FEV1 >=30, <50
Stage 4: Very Severe FEV1 <30
What are the GOLD groups in COPD and how are they defined?
Group A (Alright): 0-1 exac, no hospital. MRC 0-1, CAT <10
Group B (Breathless) 0-1 exac, no hospital MRC >=2, CAT >=10
Group E (Exacerbators) >=2 exac per year or 1 requiring hospital
What are the indications for roflumilast in COPD?
Symptoms of chronic bronchitis and FEV1 <50%
It is a selective PDE-4 inhibitor that can be used as an adjunct to bronchodilators
What is the inheritance pattern of PCD? How may it present?
Autosomal recessive
May have clinical features of bronchiectasis with recurrent infections
Hearing loss and otitis media. Sinus infections
Subfertility
What are the potential risks of repeated oral steroid use on pregnancy (for foetus)?
Risk of pre-term birth, low birth rate and certain congenital abnormalities such as cleft palate.
What is the inheritance pattern of alpha-1-antitripsin deficiency?
Autosomal co-dominant
One defective allele results in milder disease than 2 defective alleles
What are the main benefits to a patient of commencing a LAMA?
Improvement in breathlessness
Reduction in exacerbation frequency
Improvement in FEV1 (although does not affect the rate of decline)
What are the minimum recommended Peak Flow monitoring requirements recommended when investigating occupational asthma?
Need to record for at least 3 WEEKS of normal work exposure with minimum 4 READINGS PER DAY
Alternatively 8 days of work and 3 days off with readings every 2 hours
What is the closest to Gold standard test in identifying the causative agent in occupational asthma?
SIC - Specific inhalational challenge
