COPD

Question 1

Risk Factors for COPD

Answer 1

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

Question 2

Emphysema Clinical Presentation

Answer 2

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

Question 3

Bronchitis Clinical Presentation

Answer 3

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

Question 4

4 Steps to Assess COPD

Answer 4

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

Question 5

3 Most Common Symptoms of COPD

Answer 5

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

Question 6

COPD Assessment Test (CAT)

Answer 6

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

Question 7

In patients with… you can use COPD spirometric Grading

Answer 7

FEV1/FVC less than 0.70

Question 8

GOLD 1 =

Answer 8

Mild

FEV1 >/= 80% predicted

Question 9

GOLD 2 =

Answer 9

Moderate

50%-80% FEV1 predicted

Question 10

GOLD 3 =

Answer 10

Severe

30%-50% of FEV1 predicted

Question 11

GOLD 4 =

Answer 11

Very severe

Less than 30% predicted FEV1

Question 12

Category A =

Answer 12

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

Question 13

Category B =

Answer 13

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

Question 14

Category D =

Answer 14

mMRC >/= 2
CAT >/= 10
+

Question 15

Category C =

Answer 15

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

Question 16

Non-Pharmacologic Recommendations for COPD

Answer 16

Smoking Cessation
Pulmonary Rehab
Immunizations

Question 17

What Immunizations?

Answer 17

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)

Question 18

Short Acting Beta 2 Agonists

Answer 18

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

Question 19

Long Acting Beta 2 Agonists

Answer 19

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

Question 20

Beta 2 Agonists MOA

Answer 20

Bronchodilation, smooth muscle relaxation

Question 21

Beta 2 Agonists ADRs

Answer 21

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

Question 22

Beta 2 Agonists Precautions

Answer 22

CV disease
DM
Seizure Disorder

Question 23

Beta 2 Agonists DDI

Answer 23

MAOI
TCAs
K wasting

Question 24

Beta 2 Agonists Counseling

Answer 24

Inhaler technique

Carry SABA inhaler with you at all times

Question 25

Short Acting Anticholinergics

Answer 25

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

Question 26

Long Acting Anticholinergics

Answer 26

Tiotropium (spiriva)

Question 27

Anticholinergic MOA

Answer 27

Leads to bronchodilation and decreased mucus production | - SLOW ONSET

Question 28

Short Acting MAX dose

Answer 28

24 puffs/day

Question 29

Short Acting ADR

Answer 29

dry mouth and constipation

Question 30

Long Acting ADR

Answer 30

dry mouth

Question 31

Anticholinergic DDI

Answer 31

other anticholinergics

Question 32

Anticholinergic Counseling

Answer 32

``` Inhaler technique (priming SAMA and handihaler instructions) Always carry SAMA inhaler with you ```

Question 33

Inhaled Corticosteroids

Answer 33

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

Question 34

Inhaled Corticosteroids should NOT

Answer 34

be used as monotherapy

Question 35

Corticosteroid MOA

Answer 35

Anti-inflammatory

Question 36

Inhaled Corticosteroid ADRs

Answer 36

candidiasis, cough/wheezing, dysphonia, bronchospasmm | Systemic: insomnia and hypoglycemia

Question 37

Oral Corticosteroid Risk

Answer 37

``` Osteoporosis DM Cataracts HTN Mood changes ```

Question 38

Corticosteroids Precautions

Answer 38

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

Question 39

Corticosteroids DDI

Answer 39

 DM agents  NSAIDs  K+ wasting  Vaccines

Question 40

Corticosteroids Counseling

Answer 40

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

Question 41

PDE5 Inhibitor Drug

Answer 41

Roflumilast

Question 42

Roflumilast MOA

Answer 42

Reduce inflammation

Question 43

Roflumilast ADR

Answer 43

Diarrhea Weight loss Back pain Flu-like symptoms

Question 44

***Roflumilast Precations

Answer 44

Mental health (risk of suicidal ideations and depressive symptoms)

Question 45

Roflumilast DDI

Answer 45

CYP3A4 and theophylline

Question 46

Roflumilast Monitoring

Answer 46

Weight and mood!!!

Question 47

Ambulatory Oxygen consider for those:

Answer 47

With exercise oxygen desaturation | Patients that show improvement in exercise capacity or dyspnea with oxygen

Question 48

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

Answer 48

Add SABA PRN

Question 49

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

Answer 49

SABA PRN Add LABA Add Pulmonary rehabilitation

Question 50

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

Answer 50

SABA PRN LABA AddICS if repeated exacerbations OR PDE4 inhibitor

Question 51

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

Answer 51

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