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CPR Exam 2 > COPD DSA > Flashcards

COPD DSA Flashcards

1
Q

COPD is characterized by __________, with the predominant conditions being _________.

A
  • Airway obstruction that is not fully reversible
  • Chronic bronchitis and emphysema
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2
Q

Chronic bronchitis is described as ____

A

Productive cough for 3 months in each 2 successive years in a patient where other causes of sputum production have been excluded.

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3
Q

What is emphysema?

A

Permanent enlargement of airspaces distal to terminal bronchioles, with destruction of bronchiolar walls without fibrosis. During expiration, airways colapse.

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4
Q

Both emphysema and chronic bronchitis are result in what?

A
    1. Peripheral airway obstruction
    1. Parenchymal destruction
    1. Pulmonary vascular abnormalities that decrease gas exchange and cause hypoxemia, hypercapnia and cor pulmonae.
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5
Q

What should we focus on differentiated from COPD?

A

Other conditions that limit airflow and are not fully reversible: Bronchiectasis, CF and bronchiolitis.

-Asthma

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6
Q

What are risk factors for developing COPD?

A
    1. a1-antitrypsin deficiency => too much elastase => destroys elasin => early onset COPD
    1. Genes involves in detoxifying cigg smoking
  • 3. Developmental risk factors (LBW)
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7
Q

80-90% of the risk of developing COPD is attributable to ___________.

A

Cigarette smoking

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8
Q

How does smoking cessation affect your lungs?

A

1. Decreases FEV1

2. Reduces mortality

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9
Q

Who do we screen for COPD?

A
  • Not done for asymptomatic patient.
  • Screen the following patients for AAT deficiency
      1. Early-onset COPD (younger that 45 YO)
      1. Strong family hx of lung/liver disease.
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10
Q

How many pack/years smoking hx, age, and maximum laryngeal height are the most predictive of COPD?

A
    • >40 pack-year smoking hx
    • ≥45 y/o
    • Maximum laryngeal height ≤4 cm
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11
Q

Cardiac exam of pt with COPD may show what?

A
    • Cor pulmonale
        • ↑ intensity of the pulmonic sound, persistently split S2
        • Parasternal lift due to RVH
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12
Q

How is COPD confirmed and staged?

A
  • Spirometry using the GOLD criteria
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13
Q

All patients who have unexplained dyspnea and cough should be evaluated for what?

A

α1-AT deficiency

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14
Q

Using the GOLD criteria for staging COPD what are the characteristics of stage I through stage IV?

A
    • I (mild) = FEV1 ≥80% of predicted w/ or w/o chronic sx (cough and sputum)
    • II (moderate) =
      • FEV1 is 50 - 80% of predicted w/ or w/o chronic sx (cough and sputum)
  • - III (severe) =
    • FEV1 is 30-50% of predicted w/ or w/o chronic sx (cough and sputum)
    • IV (very severe) =
      • FEV1 is less than 30% of predicted or
      • FEV1 <50% of predicted + chronic respiratory failure
  • *All have FEV1/FVC <70%
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15
Q

What confirms the prescence of a non-reversible airflow obstruction?

A
  • FEV1 less than 80% post-bronchodilator
  • Forced vital capacity ratio (FEV1/FVC) less than 70%
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16
Q

What else can be used to detect the severity of COPD?

A

BODE index.

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17
Q

What does the BODE index entail and what is it used to evaluate?

Higher score means what?

A

Risk for hospitalization, long-term prognosis in COPD patients

    • BMI
    • Airflow Obstruction
    • Dyspnea
    • Exercise capacity (the 6-minute walk distance)

Higher score => greater risk of death.

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18
Q

For patient with GOLD I: mild COPD what is the standard tx?

A

Short-acting bronchodilator when needed.

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19
Q

For patient with GOLD II: moderate COPD what is the standard tx?

A
  • Short acting bronchodilator +
  • Regular treatment with 1 or more long-acting bronchodilators + pulmonary rehab
20
Q

For patient with GOLD III: severe COPD what is the standard tx?

A
  • If repeated excerbation; add ICS (but never take alone).
    • With or without either roflumiast or theophylline
21
Q

For patient with GOLD IV: very severe COPD what is the standard tx?

A
  • Add long-term oxygen therapy if chornic respiratory failure
  • Consider surgery
22
Q

What are the 3 types of bronchodilators are used to treat patients with stable COPD?

A

1. B agonists

2. Anticholinergic agents

3. Methylxanthines (therophylline)

23
Q

What are the difference between short and long-acting B agonists?

A
  • Short-acting B agonists (albuterol and levalbuterol) are rescue meds that act in a few minutes and last 4-6 hours.
  • Long-acting B agonists (salmeterol, formoterol and arformoterol) have a more sustain and predictable imrpovement on lung.
    • Given every 12 hours alone, with other bronchodilators or w inhaled glucocorticoids.
24
Q

Mot comon side effect of B-ago?

A

Increased HR & tremor

25
Q

What anticholinergic drugs are used as bronchodilators?

A
    1. Short-acting inhaled agents (ipatropium)
    1. Long-acting inhaled agents (tiotropium)
26
Q

When are anticholinergics recommened?

A

Combined with short or long-acting B AGO and/or theophylline,

bc they are less potent.

27
Q

Tiotropium should not be given with _______.

A

Short-acting anticholinergic drugs

28
Q

What is the primary SE for anticholinergic agents?

Use with caution in what patients?

A
  • Dry mouth
  • Urinary obstruction and narrow-angle glaucoma
29
Q

What is theophylline and when is it used?

A
  • Nonspecific PDE inhibitor that increases cAMP in smooth muscle of airway and inhibits intracellular Ca2+ release.
  • Trial for 1-2 months by adding to inhaled bronchodilators and glucocorticoids.
30
Q

What is Roflumilast and when is it used?

A
  • Oral PDE-inhibitor used in select patients with severe COPD to reduce risk for exacerbations.
31
Q

Which drug used in tx of COPD is NEVER used alone in COPD?

A

Inhaled glucocorticoids

32
Q

How can we improve the actions of inhaled glucocorticoids and long-acting bronchodilators?

A

TAKE TOGETHER; reduce exacerbations and improve health.

33
Q

Use of inhaled glucocortoids should be monitored in who?

A

-Elderly patients d/t osteopenia, cataracts, hyperglycemia and pneumonia

34
Q

When should oxygen therapy for 15 hours a day be given to a patient with COPD?

A

Stage 4 COPD;

  • Arterial PO2 < 55 mmHg
  • O2 sat less than 88% with or without hypercapnia.
35
Q

What treatment improves quality of life in patients with moderate => severe symptoms that persist depite medical management?

A

Pulmonary rehabilitation

36
Q

What 3 surgical interventions may improve sx’s of COPD in highly selected pt’s?

A
  • Bullectomy
  • Lung volume reduction surgery

- Lung transplantation

37
Q

What are COPD exacerbations?

A
  • Sudden change in patients baseline dyspnea, cough and or sputum production that is beyond day-to-day variations due to infection or air polluation.
38
Q

Exacerbations are classified as: mild, moderate and severe.

How do we treat each?

A
  • Mild to moderate exacerbations: treat at home
    • Mild: short-acting bronchodilators
    • Moderate: short-acting bronchodilators + systemic glucocorticoids and/or ABX.
  • Severe: treat at hospital w oxygen therapy
    *
39
Q

How are severe exacerbations defined as?

A

Loss of alertness or a combo of 2 or more of the following

    1. Dyspnea at rest
    1. RR over 25/min
    1. Pulse rate over 110/min
    1. Use of accessory respiratory muscles
40
Q

What is the goal of hospital therapy for COPD exacerbations?

A
  1. O2 therapy
    * -check by measuring arterial blood gas levels 30-60 min after O2 therapy.
41
Q

Treatment of COPD is stepwise and largely based on what?

A

PFT’s

42
Q

Why is there significant benefit in using ABX in patients with moderate and severe COPD exacerbations?

A

Bacteria are often recovered:

  1. - S. pneumoniae
  2. - M. catarrhalis
  3. - H. influenzae
43
Q

How do we treat bacterial infections seen in COPD exacerbations?

A
  1. Cephalosporin + macrolide
  2. Monotherapy with fluoroquinolone

Sputum gram stain or culture is not necessary.

44
Q

What other patients qualify for O2 therapy?

A
    1. Hematocrit is more than 55%
    1. Arterial pO2 less than 59 mmHg
    1. O2 sat less than 89% if pt has pulmonary HTN, cor pulmonale, edema
45
Q
A

CPR Exam 2 (29 decks)

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