2 medications for smoking cessation
1) Varenicline
2) Bupropion
vaccinations for COPD patients
annual influenza
and one off pneumococcal
5 causes of renal loss of H +
- HF
- loop & thiazide diuretics
- cirrhosis
- nephrotic syndrome
- conns syndrome
ECG changes in cor pulmonale (right heart failure)
- P pulmonale
- right axis deviation
- right ventricular hypertrophy/strain
RVH ECG changes
larger R waves on the right sided chest leads (V1-3) and S waves on the left sided chest leads (V4-6)
definition of COPD
non reversible long term deterioration in air flow through the lungs caused by lung tissue damage
list the 5 MRC dyspnoea scale
1 - SoB on strenuous exercise 2 - SoB on walking unphill 3 - SoB walking flat 4 - stop to catch breath when walking 100m on flat 5 - unable to leave house
4 stages of severity of COPD as per FEV1
1) FEV1 > 80%
2) FEV1: 50-79%
3) FEV1: 30-49%
4) FEV1: < 30%
symptoms of hypercapnia
- flapping tremor
- dilated pupils
- bounding pulse
- myoclonus
- confusion
- coma
- drowsiness
CXR signs of hyperinflated lungs
- increased AP diameter
- flattened hemidiaphgram
- increased intercostal spaces
- hyperlucent lungs
4 bacterial organisms in infective exacerbations of COPD
- Haemophilus influenza
- Streptococcus pneumonia
- Moraxella catarrhalis
- Pseduonomas aeruginosa
pathophysiology of COPD
inflammatory response to toxins through tobacco smoking causing loss of elasticity & alveolar recoil & alveolar collapse during expiration
and inflammation and scarring leads to narrowing of small airways
& mucus secretion blocks airways
example of LAMA & side effects
Tiotropium
- dry mouth
- nausea
- headache
example of xanthine & mechanism & side effects
- phosphodiesterase inhibitor
- increases CAMP & increases bronchodilation
side effects
- tachycardia
- arrhythmia
- agitation
example of mucolytic
carbocysteine
decreases sputum viscosity
symptoms of right heart failrue
- peripheral oedema
- raised venous pressure
- systolic parasternal heave
- loud pulmonary 2nd heart sound
how does COPD progress into right ventricular hypertrophy
the hypoxia in COPD causes pulmonary vasoconstriction to divert blood away from poorly ventilated lung and this increases right heart fillling
criteria suggesting asthmatic/steroid responsive features
- previous , secure diagnosis of asthma
- higher blood eosinophil count
- substantial variation in FEV1
- substantial diurnal variation in peak expiratory flow
