COPD Flashcards
COPD def
preventable and treatable
progressive persistent airflow limitation
chronic inflammatory response in airways
caused by noxious particles or gases
how many cig smokers get COPD
15-20%
Where does COPD rank for death
3rd
What are COPD risk factors
smoking
indoor air pollution
occupational dust and chemicals
outdoor air pollution
How COPD affects lungs
mucus hypersecretion ciliary dysfunction airflow limitation hyperinflation gas exchange abnormalities pulmonary hypertension systemic effects
What are symptoms of COPD
dyspnea
chronic cough
chronic sputum production
exacerbations
What is required to diagnosis COPD
spirometry
What are the stages of COPD
GOLD 1 - Mild
GOLD 2 - Moderate
GOLD 3 - Severe
GOLD 4 - Very Severe
What are symptoms of GOLD 1 for COPD
FEV1 >= 80%
no chronic symptoms
What are symptoms of GOLD 2 for COPD
FEV1 between 50 and 80%
DOE
What are symptoms of GOLD 3 for COPD
FEV1 Between 30 and 50%
What are symptoms of GOLD 4 for COPD
FEV1 < 30%
What txt goals COPD
smoke reduce symptoms improve exercise tolerance minimize rate decline maintain QOL prevent exacerbations limit complications
What are the COPD management pgm
assess and monitor disease
reduce risk factors
manage stable COPD
manage exacerbations
What are nonpharm COPD txts
smoking cessation
pulmonary rehab for GOLD 3 and 4 or B,C,D
O2
Surgery
What are pharm txts
Bronchodilators
corticosteroids
What are MOA anticholinergic bronchodilators
decrease cyclic GMP and cause bronchial smooth muscle relaxation
What are adverse effects anticho bronchodilators
dry mouth metallic taste dry eyes urinary retention constipation
What are the anticho broncho meds
Ipratropium
Tiotropium
How use Ipratropium
short acting
2 puffs qid (12 in 24 hrs)
MDI or neb
How use tiotropium
long acting
18 mcg inhaled via DPI qd
What do cholinergic agents do
Salivation
Lacrimation
Urination
Defecation
What are MOA B-2 agonists
stimulate B-2 receptors
increase CAMP
relax bronchial smooth muscle
What are adverse effects B-2 agonists
tachycardia
tremor
hypokalemia
What are the B-2 meds
Albuterol MDI
Salmeterol MDI
How use albuterol MDI
Short acting
2 puffs q4-6 hr prn
How use Salmeterol
long acting
1 inhalation q12h
When use combo short acting bronchodilators
FEV1 < 60%
Combivent (ipratropium + albuterol)
2 puffs qid
What is MOA methylxantine bronchodilator
block phosphodiesterase
Increase CAMP
relax bronchi and pulmonary blood vessel smooth muscle
What are adverse effects of methylxantine bronchodilator
drug interactions restlessness insomnia GERD palpitations diuresis NVD headache
What is a methylxantine bronchodilator med
Theophylline
When should ICS be used
FEV1 < 60%
What are adverse effects of ICS
pneumonia
candidiasis
hoarse voice
What should a ICS be used with for COPD
LABA
What is a ICS med
Fluticasone
88-440 mcg bid
What is phosphodiesterase 4 inhibitor MOA
inhibit PDE4 involved with CAMP
What are adverse effects with phosphodiesterase 4 inhibitor
hepatic impairment insomnia weight loss depression suicide D/N
What is a phosphodiesterase 4 inhibitor med
Daliresp 500 mcg po qday
What immunizations should COPD pts get
Influenza
Pneumococcal >65 age or FEV1 < 40%
What are patient group A for COPD
GOLD 1 or GOLD 2
CAT < 10
What are patient group B for COPD
GOLD 1 or GOLD 2
CAT >= 10
What are patient group C for COPD
GOLD 3 or GOLD 4
CAT < 10
What are patient group D for COPD
GOLD 3 or GOLD 4
CAT >= 10
How treat Patient group A COPD
SAAC
or
SABA
How treat patient group B COPD
LAAC
or
LABA
How treat patient group C COPD
ICS + LABA
or
LAAC
How treat patient group D COPD
ICS + LABA
and/or
LAAC
What monitoring and follow-up is required for COPD
spirometry >= every year Questionaires 2-3 months symptoms each visit smoking each visit meds and inhaler technique exacerbation history comorbidities
How treat COPD exacerbations
SA bronchodilators
Oral corticosteroids (prednisone 40 mg po qd 5 days)
antibiotics ( sputum purulence and dyspnea/sputum volume)
