COPD Flashcards

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1
Q

What is the non-pharm management of COPD that should be offered to all patients?

A

Pulmonary rehab

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2
Q

What methods can be used to encourage smoking cessation?

A

Nicotine replacement therapy- increases chances of quitting. Dose relates to amount they smoke.

Varenicline- nicotinic receptor partial agonist. Reduces cravings and withdrawal. Start taking 2 weeks before quitting. Ass with depressed mood and suicide

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3
Q

What is the management of mild- moderate COPD?

A

SABAs and short acting anti muscarinic antagonist (ipatroprium) PRN

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4
Q

How does ipratropium work?

A

Blocks mACh receptors in SM –> inhibits bronchoconstriction and mucous production.

Short term relief

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5
Q

What preparation of ipratroprium are available?

A

MDI or neb

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6
Q

How long does ipratropium’s effects last?

A

3-6 hours

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7
Q

What are the adverse effects of ipratropium?

A
Dry mouth
Constipation
Urinary retention 
Mydriasis
Angle-closure
Glaucoma
Blurred vision
Cough
Headache
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8
Q

What is the management of moderate-severe COPD with FEV1 >50% predicted?

A

Long acting anti-muscarinic or LABA

LABA with steroid inhaler can be used in those remaining symptomatic

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9
Q

What is the management of moderate-severe COPD with FEV1 less than 50% predicted?

A

Either long acting anti-muscarinic or LABA with steroid combo inhaler

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10
Q

What is the management of patients with COPD who remain breathless?

A

Triple therapy- LABA and steroid combo inhaler plus long acting anti-muscarinic bronchodilator

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11
Q

What are examples of LAMAs used in COPD?

A

Tiotropium most common. Not useful in acute exacerbations

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12
Q

What are the SEs of LAMAs?

A

Similar to ipratropium

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13
Q

What should not be prescribed with tiotropium?

A

Ipatropium

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14
Q

What mucolytics are prescribed for COPD?

A

Carbocisteine

Reduces sputum viscosity. Trial for 4 weeks to check response

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15
Q

What PDE4 inhibitors are prescribed in COPD?

A

Roflumilast. Adjunct to bronchodilators. Used in severe disease with frequent exacerbations

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16
Q

What vaccinations should patients with COPD have?

A

Flu- annual

Pneumococcus (5-10 years)

17
Q

What is LTOT?

A

Long term oxygen therapy.

At least 15 hours a day

18
Q

Who is eligible for LTOT?

A

PaO2 less than 7.3kPa when breathing air and clinically stable

PaO2 7.3-8kPa in the presence of secondary polycythaemia, nocturnal hyperaemia, peripheral oedema or evidence of pulmonary HTN.

Severe chronic asthma with PaO2 less than 7.3 kPa or persistent disabling breathlessness

19
Q

What must all patients on LTOT have?

A

Oxygen card

20
Q

How is suitability for LTOT determined?

A

2 ABGs 4 weeks apart in a patient with no recent exacerbations

21
Q

How do you mx COPD acute exacerbations?

A

Nebulised bronchodilators- normally 24-48 hours

Corticosteroids0 short course 30mg pred 7-14 days. IV if very severe

Abx- if signs infection. Typically doxy or clari

22
Q

How do you mx severe COPD acute exacerbations?

A

AMinophylline (theophylline) if response to nebulised bronchodilators very poor

Consider NIV/BiPAP if severe T2 respiratory failure