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pulmonary 684 > 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?

A

No

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?

A

True

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?

A

Symbicort

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?

A

6 weeks

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

pulmonary 684 (14 decks)

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