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AmCare Exam 3 > COPD > Flashcards

COPD Flashcards

1
Q

Risk Factors for COPD

A 
Age and gender (female)
Chemical exposure (smoke, etc)
Genetic (alpha-1-antitrypsin def)
Socioeconomic status
Chronic lung diagnostics (asthma or chronic bronchitis
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2
Q

Emphysema Clinical Presentation

A

o Severe dyspnea (SOB)
o Cough AFTER dyspnea
o Sputum- scanty and mucoid

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3
Q

Bronchitis Clinical Presentation

A

o Less severe dyspnea
o Cough BEFORE dyspnea
o Sputum- copious and purulent

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4
Q

4 Steps to Assess COPD

A

o Symptom severity → spirometry → exacerbation → comorbidities (smoking, HF, etc)

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5
Q

3 Most Common Symptoms of COPD

A

Dyspnea (progressive and persistent or exertional breathlessness)
Chronic cough
Chronic sputum productions

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6
Q

COPD Assessment Test (CAT)

A

o Less than 10 = low
o 10-20 = moderate
o 20-30 = high
o >30 = very high

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7
Q

In patients with… you can use COPD spirometric Grading

A

FEV1/FVC less than 0.70

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8
Q

GOLD 1 =

A

Mild

FEV1 >/= 80% predicted

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9
Q

GOLD 2 =

A

Moderate

50%-80% FEV1 predicted

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10
Q

GOLD 3 =

A

Severe

30%-50% of FEV1 predicted

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11
Q

GOLD 4 =

A

Very severe

Less than 30% predicted FEV1

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12
Q

Category A =

A 
mMRC 0-1
CAT less than 10
\+
GOLD 1 or 2
Exacerbation 0-1
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13
Q

Category B =

A 
mMRC >/=2
CAT >/= 10
\+
GOLD 1 or 2
Exacerbation 0-1
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14
Q

Category D =

A

mMRC >/= 2
CAT >/= 10
+

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15
Q

Category C =

A 
mMRC >/=2
CAT >/= 10
\+
GOLD 3 or 4
Exacerbation 2+
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16
Q

Non-Pharmacologic Recommendations for COPD

A

Smoking Cessation
Pulmonary Rehab
Immunizations

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17
Q

What Immunizations?

A 
Influenza
Pneumonia (Per ACIP COPD is a qualifying condition to receive PPSV23 prior to age 65; ACIP recommends PCV14 at 65 years then PPSV23 1 year later and 5 years after the first dose of PPSV23)
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18
Q

Short Acting Beta 2 Agonists

A

Albuterol
Combivent (albuterol + ipratropium)
Duoneb (albuterol + ipratropim nebs)

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19
Q

Long Acting Beta 2 Agonists

A 
Salmetrol
Formoterol
Advair (salmeterol + fluticasone)
Symbicort (budesinide + formoterol)
Dulera (mometasone + formoterol)
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20
Q

Beta 2 Agonists MOA

A

Bronchodilation, smooth muscle relaxation

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21
Q

Beta 2 Agonists ADRs

A

tachycardia
skeletal muscle tremor
anxiety (short only)
nervousness (short only)

22
Q

Beta 2 Agonists Precautions

A

CV disease
DM
Seizure Disorder

23
Q

Beta 2 Agonists DDI

A

MAOI
TCAs
K wasting

24
Q

Beta 2 Agonists Counseling

A

Inhaler technique

Carry SABA inhaler with you at all times

25
Q

Short Acting Anticholinergics

A

Ipratropium
Combivent (albuterol + ipratropium oral)
Duoneb (albuterol + ipratropium nebs)

26
Q

Long Acting Anticholinergics

A

Tiotropium (spiriva)

27
Q

Anticholinergic MOA

A

Leads to bronchodilation and decreased mucus production

- SLOW ONSET

28
Q

Short Acting MAX dose

A

24 puffs/day

29
Q

Short Acting ADR

A

dry mouth and constipation

30
Q

Long Acting ADR

A

dry mouth

31
Q

Anticholinergic DDI

A

other anticholinergics

32
Q

Anticholinergic Counseling

A 
Inhaler technique (priming SAMA and handihaler instructions)
Always carry SAMA inhaler with you
33
Q

Inhaled Corticosteroids

A

Symbicort (budesonide + formoterol)
Advair (fluticasone + salmeterol)
Breo ellipta (fluticasone + vilanterol)

34
Q

Inhaled Corticosteroids should NOT

A

be used as monotherapy

35
Q

Corticosteroid MOA

A

Anti-inflammatory

36
Q

Inhaled Corticosteroid ADRs

A

candidiasis, cough/wheezing, dysphonia, bronchospasmm

Systemic: insomnia and hypoglycemia

37
Q

Oral Corticosteroid Risk

A 
Osteoporosis
DM
Cataracts
HTN
Mood changes
38
Q

Corticosteroids Precautions

A

HF, HTN, psychosis, h/o seizures, glaucoma, osteoporosis

39
Q

Corticosteroids DDI

A

 DM agents
 NSAIDs
 K+ wasting
 Vaccines

40
Q

Corticosteroids Counseling

A

 Inhaler technique
 Rinsing mouth after each use of inhaled steroids to prevent thrush
 AVOID CHRONIC USE OF SYSTEMIC (ORAL) STEROIDS IF ABLE

41
Q

PDE5 Inhibitor Drug

A

Roflumilast

42
Q

Roflumilast MOA

A

Reduce inflammation

43
Q

Roflumilast ADR

A

Diarrhea
Weight loss
Back pain
Flu-like symptoms

44
Q

***Roflumilast Precations

A

Mental health (risk of suicidal ideations and depressive symptoms)

45
Q

Roflumilast DDI

A

CYP3A4 and theophylline

46
Q

Roflumilast Monitoring

A

Weight and mood!!!

47
Q

Ambulatory Oxygen consider for those:

A

With exercise oxygen desaturation

Patients that show improvement in exercise capacity or dyspnea with oxygen

48
Q

Grade 1 Mild
FEV1/FVC less than 70%
Post BA FEV1 >/= 80%
Treatment?

A

Add SABA PRN

49
Q

Grade 2 moderate
FEV1/FVC less than 70%
Post BA FEV1 50-80%
Treatment?

A

SABA PRN
Add LABA
Add Pulmonary rehabilitation

50
Q

Grade 3 Severe
FEV1/FVC less than 70%
Post BA FEV1 30-50%
Treatment?

A

SABA PRN
LABA
AddICS if repeated exacerbations OR PDE4 inhibitor

51
Q

Grade 4 Very Severe
FEV1/FVC less than 70%
Post BA FEV1 less than 30%
Treatment?

A

SABA PRN
LABA
ICS if repeated exacerbations OR PDE4 inhibitor
Add long-term oxygen and consider surgical treament

AmCare Exam 3 (7 decks)

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