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Pharm exam 2 > COPD > Flashcards

COPD Flashcards

1
Q

What is COPD?

A
  • A progressive resp. disease characterized by airflow limitation that is not fully reversible.
  • Abnormal inflamm. response in the airway and lungs to noxious particles or gases.
  • Chronic inflamm. disease with systemic manifestatons
  • chronic bronchitis and or emphysema
  • Preventable in most cases!!!!
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2
Q

Epidemiology

A
  • 3rd leading cause of death

- Major cause of morbidity, mortality, and disability.

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3
Q

Causes/Risk factors

A
  • Cigarette smoke (responsible for 85-90%)
  • Air pollution, occupational dusts & chemicals
  • Genetic predisposition
  • Airway hyperresponsiveness
  • Impaired lung growth
  • Age
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4
Q

Pathophysiology review

A

Inhaled noxious particles or gases–> inflammation–> small airway dx or parenchymal destruction–> airflow limitation

Small airway dx- airway inflammation/airway remodeling
Parenchymal destruction- loss of alveolar attachments/ Decrease of elastic recoil

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5
Q

clinical presentation

A

Dyspnea (persistent, worse with exercise, progressive), chronic cough(intermittent/unproductive), chronic sputum production, physical exam findings (more common in severe dx)

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6
Q

Diagnosis

A
  • Spirometry

- Post-bronchodilatory FEV1/FVC

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7
Q

Considerations for diagnosis:

A

Family hx of COPD
Exposure to risk factors
Age 40 or older with 3 hallmark symptoms of progressive dyspnea, chronic cough, & productive sputum.

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8
Q

Stage I mild classification

A

FEV1 >80%

Chronic cough, sputum production

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9
Q

Stage II Moderate classification

A

50-80% FEV1
SOB on exertion
cough and sputum production

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10
Q

Stage III Severe classification

A

30-50% FEV1

Reduce exercise capacity, great SOB and fatigue, Repeated exacerbations

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11
Q

Stage IV Very Severe

A

FEV1 <30%
Severe airflow limitation
Resp. failure
Cor Pulmonale

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12
Q

Treatment goals

A
  • Reduce symptoms

- Reduce risk

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13
Q

Reducing symptoms

A

Relieve symptoms, improve exercise tolerance, improve health status

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14
Q

Reduce risk

A

Prevent disease progression, prevent and treat exacerbations, reduce mortality

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15
Q

Non-pharmacologic treatment

A

Preventive care (minimize smoke & pollution), smoking cessation, vaccinations, regular physical activity, oxygen, pulm. rehab.

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16
Q

5A’s for smoking cessation

A

Ask, advise, assess, assist, arrange

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17
Q

Beta-2 agonists meds

A

Short-acting: albuterol & levalbuterol

Long acting: formoterol, arformoterol, indacaterol, salmeterol, olodaterol

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18
Q

Anticholinergics meds

A

short acting: ipratropium bromide

long-acting: aclidinium bromide, glycopyrronium bromide, tiotropium, umeclidinium.

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19
Q

Combination beta-agonist/anticholinergic meds

A

Short-acting: albuterol/ipratropium
Long-acting: vilanterol/umeclidinium, formoterol fumarate/glycopyrrolate, indacaterol/glycopyrrolate, olodaterol/tiotropium bromide.

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20
Q

Short-acting Beta 1 agonists (SABA) MOA

A

relax airway smooth muscle (bronchodilator)

Stimulate adenylyl cyclase to increase the formation of cAMP.

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21
Q

Short-acting Beta 1 agonists indication

A

Relief of bronchospasm during exacerbation.

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22
Q

Short-acting Beta 1 agonists adverse effects

A

Tachycardia, tremor, palpitations, dizziness, and headaches.

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23
Q

Increasing frequency of use indicates ________

A

inadequate control!

All patients should have a SABA readily available.

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24
Q

SABA pharmokinetics

A

Oral and parenteral agents discouraged in COPD, higher incidence of systemic adverse effects
Quick onset <5 mins
Duration of action is 4-6 hrs

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25
Q

Long-Acting Beta 2- Agonists (LABA) MOA

A

Relax smooth muscle with longer duration of action (bronchodilator)

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26
Q

LABA indication

A
  • NOT for acute exacerbations ormonotherapy
  • Moderate to severe COPD patients who experience symptoms on a regular and consistent basis
  • Patient with short-acting therapy who are not experiencing adequate relief.
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27
Q

LABA adverse effects

A

Tachycardia, skeletal muscle tremor, hypokalemia

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28
Q

Short-acting anticholinergics MOA

A

Blocks the action of acetylcholine at parasympathetic sites in bronchial smooth muscle causing bronchodilation

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29
Q

Albuterol

A

short-acting beta 2 agonist

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30
Q

Levalbuterol

A

short acting beta 2 agonist

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31
Q

Formoterol

A

Long acting beta 2 agonist

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32
Q

Arformoterol

A

long acting beta 2 agonist

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33
Q

Indacaterol

A

long acting beta 2 agonist

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34
Q

Salmeterol

A

long acting beta 2 agonist

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35
Q

Olodaterol

A

Long acting beta 2 agonist

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36
Q

Ipatropium bromide

A

short acting Anticholinergic

37
Q

Aclidinium bromide

A

long acting anticholinergic

38
Q

Glycopyrronium bromide

A

long acting anticholinergic

39
Q

tiotropium

A

long acting anticholinergic

40
Q

umeclidinium

A

long acting anticholinergic

41
Q

Albuterol/Ipratropium

A

Combination beta-agonist/anticholinergic

42
Q

Vilanterol/umeclidinium

A

Combination beta-agonist/ anticholinergic

43
Q

Formoterol fumarate/glycopyrrolate

A

combination beta agonist/anticholinergic

44
Q

Indacterol/glycopyrrolate

A

combination beta agonist/anticholinergic

45
Q

Olodaterol tiotropium bromide

A

combination beta agonist/anticholinergic

46
Q

Short-acting anticholinergic indication

A

Initial therapy for patients with intermittent symptoms

47
Q

Short acting anticholinergic adverse effects

A

Dry mouth (common), nausea, metallic taste.

48
Q

Short acting anticholinergics

A

Peak of 1.5 to 2 hours
Duration of action 4-6 hours
Usually not as effective for as needed use

49
Q

Ipratropum recommended use

A

2 puffs 4x a day

dose can often be titrated upward often to 24 puffs a day.

50
Q

Long-Acting anticholinergics MOA

A

Competitevely & reversibly inhibit the action of acetylcholine at type 3 muscarinic (m3) receptors in bronchial smooth muscle, causing bronchodilation
Reduction in cyclic guanosine monophosphate (cGMP)

51
Q

Long-Acting anticholinergics indication

A

Moderate to severe COPD with symptoms on a regular basis

52
Q

Long acting anticholinergics adverse effects

A

Dry mouth (common), blurred vision, urinary retention (less common), precipitation of narrow-angle glaucoma symptoms

53
Q

Tiotropium pharmokinetics

A

Tiotropium
Onset within 30 mins, with a peak effect in 3 hours
Duration of action > 24 hours
counsel on appropriate inhaler technique given several different dosage forms

54
Q

Corticosteroids (Inhaled/Oral) MOA

A

Broad anti inflammatory efficacy, mediated in part by inhibition of production of inflamm. cytokines
Reduce bronchial hyperreactivity and reduces the frequency of exacerbations if taken regularly

55
Q

Corticosteroids indication

A

ICSs should NOT be used as monotherapy or first-line therapy
Add on for severe COPD with frequent exacerbations
Oral corticosteroids are generally not indicated for chronic use.

56
Q

Corticosteroid adverse effects

A

Thrush

ensure patients rinse mouth after each use!!!

57
Q

Qvar (Beclomethasone)

A

Inhaled corticosteroids

58
Q

Pulmicort (Budesonide)

A

Inhaled corticosteroids

59
Q

Flovent Arnuity Ellipta (Fluticasone)

A

Inhaled corticosteroids

60
Q

Deltasone (Prednisone)

A

Systemic corticosteroids

61
Q

Medrol (Methylprednisolone)

A

Systemic corticosteroids

62
Q

Symibicort (budesonide/formoterol)

A

combination short-acting beta 2 agonist plus ICS in one inhaler

63
Q

Dulera (mometasone/formoterol)

A

combination short-acting beta 2 agonist plus ICS in one inhaler

64
Q

Advair (fluticasone/salmeterol)

A

combination short acting beta 2 agonist plus ICS

65
Q

Breo Ellipta (fluticasone/vilanterol)

A

combination short acting beta 2 agonist plus ICS

66
Q

Methylxanthines MOA

A

Inhibition of phosphodiesterase, calcium ion influx into smooth muscle, release of mediators from mast cells and leukocytes
Stimulation of endogenous catecholamines

67
Q

Methylxanthines indication

A

Reserve for patients who cannot use inhaled medications or who remain symptomatic despite appropriate use of inhaled bronchodilators

68
Q

Methylxanthines adverse effects

A

GI (dyspepsia, N/V/D)
CV (tachycardia)
CNS (headache, dizziness)

69
Q

Methylxanthines pharmokinetics

A

Therapeutic range of theophylline is 10-20 mcg/ml , more conservative range of 5-15.
Multiple drug to drug interactions
Inhaled bronchodilators preferred

70
Q

PDE-4 Inhibitors MOA

A

Reduce inflammation by inhibiting breakdown of intracellular cAMP.

71
Q

PDE-4 Inhibitors Indication

A

GOLD3 and GOLD4 patients with repeated exacerbations and chronic bronchitis treated with corticosteroids

72
Q

PDE-4 Inhibitors Adverse effects

A

Nausea, reduced appetite, diarrhea, sleep disturbances, headache

73
Q

Daliresp (roflimulast)

A

PDE-4 inhibitor

74
Q

antimicrobial therapy should be used if the patient exhibits at least two of the following signs or symptoms:

A

Increased dyspnea, increased sputum purulence, increased sputum volume.

75
Q

COPD exacerbations need for hospitalization:

A
  • Marked increase in intensity of sx
  • Severe underlying COPD
  • Onset of new physical sx
  • Failure of an exacerbation to respond to initial medical management
  • Presence of serious comorbidities
  • Frequent exacerbations
  • Older age
  • Insufficient home support
76
Q

Elderly special considerations

A

Consider dexterity and ability to use devices

Consider anticholinergic side effects

77
Q

Pediatrics special considerations

A

Consider use of a spacer to improve drug delivery

78
Q

Specialist referral

A
  • Concurrent cardiac dx, suspected asthma, or other pulm. dx
  • Alpha-1 antitrypsin deficiency
  • sx do not respond to optimal therapy or are out of proportion to obstructive dings
  • severe or frequent exacerbations or pna complicating management
  • ICU hospitalization or mechanical ventilation required.
79
Q

COPD quality measures

A
  • Spirometry
  • FEV1/FVC ,70%
  • bronchodilator medication
  • influenza vaccine
  • tobacco used documented
  • current tobacco user
  • tobacco counseling documented
80
Q

COPD clinical pearls

A
  • Smoking cessation!!
  • Bronchodilators!!
  • step-up approach
  • add inhaled corticosteroids in severe patients if repeated exacerbations
  • reverse antibiotics for pts with appropriate symptoms.
81
Q

Inhaler Use- rescue inhaler

A

Used as needed for quick relief of coughing, wheezing, chest tightness, and SOB
Short-acting beta 2 agonist
Short-acting anticholinergic

82
Q

Inhaler use- controller inhaler

A

Used daily to prevent/control resp. symptoms

  • Inhaled corticosteroid
  • Long-acting beta- 2 agonist
  • Long-acting anticholinergic

Counsel pts on the indication of their inhaler and difference between inhalers

83
Q

Inhaler types

A

Dry powder inhalers (DPIs), Ellipta, Metered dose inhalers (MDIs), Respimat

84
Q

Dry powder inhalers

A

contain no propellants
quick and deep breath**
All have dose counters

85
Q

Ellipta

A

Quick and deep breath**

86
Q

Metered dose inhalers (MDIs)

A

Contains hydroflouroalkane (HFA) as a chemical propellant

  • Slow and deep breath**
  • Can be used with a spacer or spacer with mask
87
Q

Respimat

A

Slow and deep breath

88
Q

Spacer

A
  • Remove need for coordination between actuation and inhalation
  • Only used for MDIs
  • Clean once a month; replace every 6-12 months
  • Useful for pediatric or elderly populations
  • Spacer mask available for young pediatrics
89
Q

Inhaler patient education

A
  • Indication/type of inhaler
  • Priming
  • Step-by-step instructions for use
  • Preparing the dose
  • breathing technique for taking the dose
  • refilling
  • cleaning
  • review patient technique
  • rinse mouth for steroid-containing

Pharm exam 2 (6 decks)

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