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Pharm Exam 3 - summer > COPD > Flashcards

COPD Flashcards

1
Q 
COPD Review
It includes: 
•chronic bronchitis with obstruction of ?
•Emphysema with \_\_\_\_\_\_\_\_\_\_ of air sacs
•Destruction of lung \_\_\_\_\_\_\_\_
A
  • small airways
  • enlargement
  • parenchyma
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2
Q

COPD: Emphysema /Bronchitis
➢COPD contrasts with asthma in that the obstruction is either not _________ or incompletely reversible by _________
➢Cell death and destruction of the ________ is due to impaired lung parenchyma, degraded matrix, and toxic actions of _________ cells (specifically macrophages and neutrophils)
➢Results in enlargement of _______, fibrosis, and increased _______ production

A
  • reversible, bronchodilators
  • alveoli, inflammatory
  • air spaces, mucus
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3
Q

COPD: Emphysema/Bronchitis (Cont)

➢Inflammation process In COPD- _________ have limited effect.
➢____________ help in reducing frequency of exacerbations and
➢__________ have modest role in air outflow with patient suffering from chronic breathlessness “worsened by exertion”

A
  • steroids
  • inhaled corticosteroids
  • bronchodilators
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4
Q

COPD and Hyperresponsive Airways

➢COPD does not have many of the markers of _______ that are found in asthma
●Serum ____ levels
●Skin test reactivity to allergens
●Eosinophilia

A
  • atophy

* IgE

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5
Q 
Review:Pathophysiology (COPD) ----> Risk Factors
●\_\_\_\_\_\_\_\_\_\_\_
●Passive smoking ?
●Ambient air pollution ?
●Hyperresponsive airways ?
●\_\_\_\_\_\_\_\_\_ Infection?
●Occupational factors ?
●\_\_\_\_\_\_\_\_\_\_ deficiency
          *Only known genetic abnormality that leads to COPD
          *Accounts for less than
A
  • cigarette smoking
  • respiratory
  • alpha 1- antitrypsin deficiency
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6
Q 
Review:Pathophysiology
➢Anatomic Changes
*Enlargement of \_\_\_\_\_\_\_\_\_ glands
*\_\_\_\_\_\_\_\_\_\_\_ inflammatory process
*Emphysema
*Bronchoconstriction
*Pulmonary \_\_\_\_\_\_\_
A
  • bronchial mucus
  • mononuclear
  • fibrosis
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7
Q

FEV1/FVC ratio in COPD?

A
  • decrease
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8
Q

COPD: ***Pink Puffer = ________
➢(PaO2 ____, ______ PaCO2)
➢Thin, anxious, purse lips
➢Accessory muscles, dyspnea
➢___ secretions, markedly diminished breath sounds
➢With resp infx right -sided heart compromise
➢CXR- ________ low diaphragm

A
  • emphysema
  • PaO2 >60, normal PaCO2
  • scant
  • hyperinflation
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9
Q 
COPD: **** Blue Bloater = ?
➢(PaO2\_\_\_\_, PaCO2 \_\_\_\_)
➢Overweight, cyanosis dusky appearance
➢Cough, \_\_\_\_\_\_ secretions
➢Diminished breath sounds
➢\_\_\_\_\_\_\_\_\_ / cor pulmonae
➢CXR- increased \_\_\_\_\_\_\_\_ markings
A
  • chronic bronchitis
  • PaO2 less than 60, PaCO2 greater than 45
  • copious
  • R sided heart failure
  • broncho-vascular
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10
Q 
The Anesthesia Plan: Signs of increased risk on History/Physical
● \_\_\_\_\_\_\_\_
●Chronic \_\_\_\_\_
●Dyspnea
●Absent breath sounds or \_\_\_\_\_\_\_
●Prolonged \_\_\_\_\_\_\_\_
A
  • exercise intolerance
  • cough
  • wheezing
  • exhalation
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11
Q 
The Anesthesia Plan (con't)
➢Pre-operative Optimization
●Smoking \_\_\_\_\_\_\_\_
● ? (think meds)
●Eliminate Infection
A
  • cessation

* bronchodilation

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12
Q

Resp. Prep Maneuvers Dilate the Airway/Treatment Bronchospasm

  • Sympathomimetics: increased cAMP causes _________
  • Steroids -> ________
  • PDE inhibitors - inhibits breakdown of ______
  • Cromolyn - ______ stabilization
A
  • bronchodilation
  • decrease mucosal edema
  • cAMP
  • mast cell
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13
Q

Preop treatment interventions:
Benefit to stop smoking ______ preop however no smoking after midnight (to decrease ______).
*_______ for evidence of respiratory infection
*Oxygen for ______ and/or evidence of increased pulmonary vascular resistance
*__________ to address reversible component, if present
*Hydration

A
  • 8 weeks
  • carboxyhemoglobin
  • antibiotics
  • hypoexmia
  • bronchodilators
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14
Q

Preop treatment interventions con’t: Treatment is aimed at using
●Step 1-________ bronchodilators
●Step 2- regular inhaled ________
●Step 3- _______ bronchodilators
●Step 4- __________/Methylanthines/leukotriene inhibitor
●Step 5- regular ____ corticosteroid
●Other- ?

A
  • short-acting
  • corticosteroids
  • long-acting
  • phosphodiesterase inhibitors
  • oral
  • cromolyn
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15
Q

Smoking Cessation:
Smoking decreases _______ motility and increases _______ production
➢Produces airway _______ and development of obstructive disease
➢It is one of main and most prevalent risk factors associated with post-operative morbidity
➢2-6 fold risk of developing post-operative ________

A
  • ciliary, sputum
  • reactivity
  • pneumonia
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16
Q

Smoking Cessation (con’t):
➢Best benefit to surgery is smoking cessation for _______ pre-operatively
➢____ abstinence may decrease carboxyhemoblogin level to normal but may increase risk of post-operative _________ complications

A
  • 2 months
  • 24 hr
  • pulmonary
17
Q

Smoking Cessation Time Course (Chart):

  • 12-24hr: decreased ______ and nicotine levels
  • 48-72hr: COHg normalized, _____ function improves
  • 1-2wk: decreased _____ production
A
  • carboxyhbg
  • ciliary
  • sputum
18
Q

Smoking Cessation Time Course (con’t)

  • 4-6wk: ____ improved
  • 6-8wk: ______ function and metabolism normalizes
  • 8-12wk: decreased overall ______ morbidity & mortality
A
  • PFTs
  • Immune
  • postoperative
19
Q

What should the preop evaluation include for this patient?
➢Counsel pt regarding: post op complications
●Atelectasis
●________, Hypoxemia
●Retention of _______
●Bronchospasm
➢Explain need for post op ________

A
  • hypercapnia
  • secretions
  • ventilation
20
Q

What is the goal for the anesthetic management of patients COPD:
➢Patients with obstructive disease are at risk for both intraoperative post-operative ________ complications
➢GOAL: Minimize the risk of postop respiratory failure.
➢__________ will blunt airway reflexes and reflex bronchoconstriction but consider the CV effects

A
  • pulmonary

* volatile agents

21
Q

What is the goal for the anesthetic management of patients COPD:
➢Regional anesthesia may offer benefits for surgery of the extremities and lower abdomen (not above ____?).
➢Judicious use of ________ – prevent and/or treat postop pain but avoid respiratory depression.

A
  • T6

* opioids

22
Q

The Anesthesia Plan
➢Induction
●Regional
•Good choice extremity surgery, +/- lower abdominal; consider that patient can not tolerate additional IV ________
•levels _____ should be avoided as they need their accessory muscles

A
  • sedation

* >T6

23
Q

The Anesthesia Plan (con’t): General Anesthesia
•No specific agent ‘ideal”-consider co-morbidities
•Volatile agents produce _________ and are rapidly eliminated
•Consider prolonged respiratory effects, use short acting ______
•titrate opioids carefully –resp depression
•consider less tolerance for respiratory depressant effects of all drugs
•Adjunctive IV administration of opioids and ________ prior to airway instrumentation will decrease reactivity

A
  • bronchodilation
  • NMB
  • lidocaine
24
Q

The Anesthesia Plan: Maintenance
●__________ = bronchodilation
●ETT ________ natural airway humidification : need to use humidifier and ______

A
  • inhaled agents
  • bypasses
  • low flows
25
Q

The Anesthesia Plan: Emergence
●Post-operative ________ status is the priority issue
●Adequate pain control (pain free breathing and improved coughing)
●Consider prolonged _________– adjust vent using ABG guidance

A
  • respiratory

* mechanical ventilation

26
Q

What are the potential advantages/disadvantages of using N2O:
➢Advantages:
●decrease dose of _______ and (quick on, quick off).

A

*volatile anesthetic

27
Q

What are the potential advantages/disadvantages of using N2O:
➢Disadvantages:
●potential to diffuse into airspaces quicker than nitrogen can exit, potentially leading to bullae rupture and ______________
●Also nitrous is usually given in concentrations between 50 and 70% - this limits the concentration of _______ that can be administered.

A
  • tension pneumothorax

* oxygen

28
Q

Ratios:

  • stage 1 - FEV1 ______ predicted
  • stage 2 - FEV1 ______ predicted
  • stage 3 - FEV1 ______ predicted
A
  • > 50%
  • 35-49%
  • less than 35%
29
Q

Extubation: Effects of surgery and anesthesia on VC and FRC
●VC decreases 40% after upper _______ and can take up to 14 days to return to normal
●FRC decreases 10% to 15% in ______, healthy spontaneously breathing subjects
●_________ decreases FRC another 5% to 10%
●FRC requires 3 to 7 days to recover after upper abdominal procedures

A
  • abdominal surgery
  • supine
  • general anesthesia
30
Q

Extubation (con’t): Effects of surgery and anesthesia on VC and FRC
➢Patients with pre-operative FEV1/FVC ratio less than _____ or with a pre-op PAC02 greater than ______ will likely need post-op mechanical ventilation
➢Post-op mechanical ventilation should be to maintain
●Pa02 _____
●Pa02 to maintain ph 7.35-7.45

A
  • 0.5, 50

* 60-100

31
Q

Extubation:
➢Post-op ________ is not a complication
●an expected result of anesthesia and surgery in patients with moderate to severe COPD
●Patients should be counseled about possible prolonged post-op ventilation with possible need for ___________

A
  • ventilation

* tracheostomy

32
Q

Extubation (con’t)
●Encourage lung expansion maneuvers decrease the risk of _______ by increasing lung volumes
•Deep breathing, Chest PT, _________

A
  • atelectasis

* incentive spirometry

33
Q

Post -Anesthetic Management
➢Post-op Pulmonary problems are primarily _________
●________ lung volumes
●Consider _______ on movement of diaphragm
●Abnormal resp pattern with shallow breathing with rapid respirations
●Consider ________ site-this is an important risk factor for development of of Post-operative pulmonary complications

A
  • restrictive
  • decreased
  • abdominal impingement
  • surgical
34
Q

Post -Anesthetic Management
➢Patient with COPD benefit from the following anesthetic considerations pre-operatively in order to prevent post-operative pulmonary complications
*Receive ________ therapy, Chest PT, Deep breathing maneuvers
*Forced oral fluids ____ per day, Smoking cessation __ months pre-op

A
  • bronchodilator
  • > 3L
  • 2
35
Q

COPD Review:

➢Definition - Current Standards
●“a disease state characterized by the presence of airflow obstruction due to _________ or ________ ; the airflow obstruction is generally progressive, may be accompanied by airway __________, and may be partially reversible.”

A
  • chronic bronchitis
  • emphysema
  • hyperactivity
36
Q

The Anesthesia Plan: Maintenance con’t - Ventilation

  • _________ adjusted to keep airway pressure less than ____ cm/h20
  • slow rate of 8-10 breaths per minute
  • allows for optimal exhalation and _________
  • be aware of pulmonary barotrauma
A
  • tidal volumes
  • 40
  • venous return
37
Q

The Anesthesia Plan: Maintenance con’t - Ventilation

  • consider baseline PaCO2: a rapid correction to “normal values” may result in resp _________
  • spontaneous ventilation may result in ___________
A
  • alkalosis

* hypercapnia

Pharm Exam 3 - summer (6 decks)

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