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NAPLEX Content > COPD > Flashcards

COPD Flashcards

1
Q

What causes COPD?

A

Inhalation of cigarette smoke and other noxious particles or gas, which triggers an abnormal inflammatory response in the lung

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2
Q

Result of chronic inflammatory response?

A

Emphysema (lung tissue destruction)

Small airway narrowing and fibrosis (alter normal repair and defense mech)

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3
Q

When should a clinical diagnose be considered in any pt?

A

Dyspnea (SOB, which is chronic and progressive)

Chronic cough or sputum production

Hx of exposure to risk factors of COPD, esp, cigarette smoke

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4
Q

What’s req for COPD diagnosis?

A

Spirometry (ways to measure breathing)

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5
Q

What confirms the presence of persistent airflow limitation and thus COPD?

A

Presence of a post-bronchodilator FEV1/FVC < 0.70

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6
Q

What’s the only mgt strategy proven to slow progression of COPD?

A

Smoking cessation

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7
Q

List other imp mgt strategies of COPD

A

Vaccinations

Pulmonary rehabilitation programs

Drug therapies (often using inhalers)

Some req long-term oxygen therapy

Lung transplantation (rarely done)

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8
Q

List risk factors of COPD

A

Smoking or smoke exposure

Alpha-1 antitrypsin deficiency

Occupational dusts and chemicals (chemical agents and fumes)

Indoor and outdoor air pollution

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9
Q

Howz COPD assessed?

A

Sx

Degree of airflow limitation (using spirometry)

Risk of exacerbations

Comorbidities

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10
Q

How do u classify severity of airflow limitation in COPD (in pts with FEV1/FVC < 0.70)?

A

GOLD 1 - Mild - FEV1 >= 80% predicted

GOLD 2 - Moderate - 50% =< FEV1 < 80% predicted

GOLD 3 - Severe - 30% =< FEV1 < 50% predicted

GOLD 4 - Very Severe - FEV1 < 30% predicted

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11
Q

What factors make up the GOLD 1 classification of severity of airflow limitation in COPD (based on Post-Bronchodilator FEV1; in pts with FEV1/FVC < 0.70)?

A

Severity = Mild

Airflow = FEV1 >= 80% predicted

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12
Q

What factors make up the GOLD 2 classification of severity of airflow limitation in COPD (based on Post-Bronchodilator FEV1; in pts with FEV1/FVC < 0.70)?

A

Severity = Moderate

Airflow = 50% =< FEV1 < 80% predicted

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13
Q

What factors make up the GOLD 3 classification of severity of airflow limitation in COPD (based on Post-Bronchodilator FEV1; in pts with FEV1/FVC < 0.70)?

A

Severity = Severe

Airflow = 30% =< FEV1 < 50% predicted

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14
Q

What factors make up the GOLD 4 classification of severity of airflow limitation in COPD (based on Post-Bronchodilator FEV1; in pts with FEV1/FVC < 0.70)?

A

Severity = Very Severe

Airflow = FEV1 < 30% predicted

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15
Q

List comorbidities that may influence mortality and hospitalizations and should be looked for routinely and treated appropriately.

A

Cardiovascular dx

Osteoporosis

Depression and anxiety

Skeletal muscle dysfunction

Metabolic syndrome

Lung cancer

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16
Q

How do u choose risk of COPD?

A

When assessing risk, chose the highest risk according to GOLD grade or exacerbation hx

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17
Q

List xteristics of patient A wrt:

Xtics
Spirometric classification
Exacerbation per year
mMRC
CAT
A

Xtics - low risk & sx

Spirometric classification - GOLD 1-2

Exacerbations per year - =< 1 per yr

mMRC - 0-1

CAT - < 10

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18
Q

List xteristics of patient B wrt:

Xtics
Spirometric classification
Exacerbation per year
mMRC
CAT
A

Xtics - low risk & MORE sx

Spirometric classification - GOLD 1-2

Exacerbations per year - =< 1 per yr

mMRC - >= 2

CAT - >=10

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19
Q

List xteristics of patient C wrt:

Xtics
Spirometric classification
Exacerbation per year
mMRC
CAT
A

Xtics - HIGH risk & Less sx

Spirometric classification - GOLD 3-4

Exacerbations per year - >= 2 per yr

mMRC - 0-1

CAT - <10

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20
Q

List xteristics of patient D wrt:

Xtics
Spirometric classification
Exacerbation per year
mMRC
CAT
A

Xtics - HIGH risk & more sx

Spirometric classification - GOLD 3-4

Exacerbations per year - >= 2 per yr

mMRC - >= 2

CAT - >= 10

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21
Q

What’s the pharmacologic therapy for stable COPD pt grp A?

Recommended first choice
Alternative choice
Other possible tx

A

Patient group A

Recommended first choice - SA anticholinergic PRN or SA beta-
agonist PRN

Alternative choice - LA anticholinergic or LA beta-agonist or SA beta-
agonist and SA anticholinergic

Other possible tx - Theophylline

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22
Q

What’s the pharmacologic therapy for stable COPD pt grp B?

Recommended first choice
Alternative choice
Other possible tx

A

Patient group B

Recommended first choice - LA anticholinergic or
LA beta2-agonist

Alternative choice - LA beta 2-agonist and LA anticholinergic

Other possible tx - SA beta-agonist and/or SA anticholinergic
Theophylline

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23
Q

What’s the pharmacologic therapy for stable COPD pt grp C?

Recommended first choice
Alternative choice
Other possible tx

A

Patient group C

Recommended first choice - LA anticholinergic or
ICS (inhaled corticosteroid) + LA beta2-
agonist

Alternative choice - LA beta2-agonist and LA anticholinergic or
LA anticholinergic and PDE-4 inhibitor or
LA beta2-agonist and PDE-4 inhibitor

Other possible tx - SA beta2-agonist and/or SA anticholinergic
Theophylline

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24
Q

What’s the pharmacologic therapy for stable COPD pt grp D?

Recommended first choice
Alternative choice
Other possible tx

A

Patient group D

Recommended first choice - LA anticholinergic and/or
ICS (inhaled corticosteroid) + LA beta2-
agonist

Alternative choice - ICS + LA beta2-agonist and LA anticholinergic or
LA anticholinergic and LA beta2-agonist or
ICS + LA beta2-agonist and PDE-4 inhibitor
LA anticholinergic and PDE-4 inhibitor

Other possible tx - Carbocysteine
SA beta2-agonist and/or SA anticholinergic
Theophylline

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25
Q

Uses of meds in COPD?

A

Used to decrease sx and/or complications (no medication had been shown to modify the long-term decline in lung fxn)

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26
Q

What’s Carbocysteine?

A

Mucolytic that has shown a small benefit in pts with viscous sputum

27
Q

What’s more effective and more convenient if used on a regular basis for COPD?

A

Long acting inhaled bronchodilators

28
Q

What can be done to improve efficacy and decrease the risk of SE in COPD?

A

Combining bronchodilators of different pharmacologic classes

29
Q

Is long term monotherapy with oral or inhaled corticosteroids recommended in COPD?

30
Q

List agent for PDE-4 inhibitor in COPD

A

Roflumilast (Daliresp)

31
Q

MOA of PDE-4 inhibitor (Roflumilast - Daliresp) in COPD?

A

Reduce inflammation by inhibiting the breakdown of intracellular cyclic AMP

32
Q

How should PDE-4 inhibitor (Roflumilast - Daliresp) be used in COPD?

A

Should always be used in combo with at least one long-acting bronchodilator

33
Q

Is tx with theophylline recommended in COPD?

A

No! Unless other long-term tx bronchodilators are unavailable or unaffordable

34
Q

Which vaccines must a pt with COPD get?

A

Influenza (each fall)

Pneumococcal (PPSV23, Pneumovax) x 1, repeat at 65yrs or older, and if received vaccine more than 5 yrs ago

35
Q

MOA of anticholinergics?

A

Block action of acetylcholine (and reduce cyclic guanosine monophosphate (cGMP) at parasympathetic sites in bronchial smooth muscle causing bronchodilation

36
Q

List short acting anticholinergics

A

Ipratropium bromide (Atrovent HFA)

37
Q

What’s the brand name of Ipratropium bromide (short-acting anticholinergic used in COPD)?

A

Atrovent HFA

38
Q

What’s the brand name of the combo Ipratropium bromide (short-acting anticholinergic used in COPD) + Albuterol?

A

Combivent Respimat

DuoNeb

39
Q

List long acting anticholinergics

A

Aclidinium (Tudorza Pressair)

Tiotropium (Spriva HandiHaler)

40
Q

What’s the brand name of Tiotropium (long-acting anticholinergic used in COPD)?

A

Spiriva HandiHaler

41
Q

SE of anticholinergics?

A

Dry mouth (more common with Tiotropium)

Upper respiratory tract infection

Nasopharyngitis

Sinusitis

Cough

Bitter taste

42
Q

T/F? Avoid spraying ICS into the eyes?

43
Q

What’s the caution with Tiotropium (Spiriva HandiHaler) use?

A

Don’t swallow capsules of Tiotropium

44
Q

MOA of beta2-agonist (COPD)?

A

Bind to beta2 receptors causing relaxation bronchial smooth muscle, resulting in bronchial smooth muscle, resulting in bronchodilation

45
Q

List long-acting beta2-agonist agents

A

Salmeterol (Serevent Diskus)

Formoterol (Foradil Aerolizer)

Arformoterol (Brovana)

Indacaterol (Arcapta Neohaler)

Vilanterol/Fluticasone (Breo Elipta)

46
Q

List long-acting beta2-agonist agents that comes in combination for COPD

A

Salmeterol + Fluticasone (Advair Diskus)

Formoterol + Budesonide (Symbicort)

47
Q

What’s the brand name of salmeterol (LA-beta2-agonist) + Fluticasone?

A

Advair Diskus

48
Q

Whats the brand name of combo of Formoterol (LA beta2-agonist) + Budesonide?

49
Q

SE of LABAs?

A

Tachycardia

Tremor

Shakiness

Lightheadedness

Cough

Palpitations

Hypokalemia

Hyperglycemia

50
Q

How are bronchodilators used in COPD?

A

On a PRN or scheduled basis to reduce sx

51
Q

What’s the concern about combo therapy with ICS?

A

Increase risk of pneumonia (however, the combo showed a decrease in Exacerbations and improvement in lung fxn when compared to individual components)

52
Q

Which LABAs tablet should absolutely not be swallowed?

A

Indacaterol (Arcapta Neohaler)

53
Q

What should be done after using any/all steroid-containing inhalers?

A

Rinse mouth with water after use and spit

54
Q

MOA of Phosphodiesterase 4 inhibitor (PDE-4 inh)?

A

Increases cAMP levels, leading to a reduction in lung inflammation

55
Q

List agents under PDE-4 inh

A

Roflumilast (Daliresp)

56
Q

Theophylline and inhaled corticosteroids?

A

See asthma

57
Q

What meds can’t be used with Roflumilast (Daliresp)?

A

Strong enzyme inducers

CBZ

Phenobarbital

Phenytoin

Rifampin

58
Q

List meds that increase the levels of Roflumilast (Daliresp)?

A

Erythromycin

Ketoconazole

Fluvoxamine

Cimetidine

59
Q

Why should u keep ur eyes closed when spraying Atrovent (ipratropium)?

A

Mistakenly spraying Atrovent into eye can lead to the ff:

Blurry vision and other vision abnormalities

Eye pain or discomfort

Dilated pupils or narrow-angle glaucoma

60
Q

Directions for using Combivent Respimat (Ipratropium + Albuterol)?

A

TURN

OPEN

PRESS

61
Q

Which COPD meds come as dry powder inhaler?

A

Arcapta Neohaler (Indacaterol)

Tudorza Pressair (Aclidinium)

62
Q

How soon do u discard Breo Ellipta (Vilanterol/Fluticasone) after opening?

63
Q

What’s COPD?

A

Preventable and somewhat treatable dx xterized by persistent airflow limitation that’s usually progressive and ass with an enhanced chronic inflammatory response in the airways to noxious particles and gases

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