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Pharmacotherapeutics > COPD (exam 2) > Flashcards

COPD (exam 2) Flashcards

1
Q

COPD

A

Heterogeneous lung condition
Results from airway/alveolar abnormalities

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2
Q

Airway abnormalities

A

bronchitis
bronchiolotis

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3
Q

Alveolar abnormalities

A

emphysema

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4
Q

Is COPD reversible?

A

Not fully

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5
Q

Most common risk factor for COPD

A

Cigarette smoking

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6
Q

Additional COPD risk factors

A

Noxious particles
Alpha-1 antitrypsin deficiency
Older age/female
Asthma

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7
Q

Role of alpha-1 antitrypsin

A

protects cells from destruction by ELASTASE

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8
Q

ELASTASE breaks down _____

A

elastin

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9
Q

Low AAT levels causes

A

increased elastase activity –> lung damage –> COPD

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10
Q

COPD pathophysiology

A

inhalation of noxious particles –> activation of inflammatory cells and mediators

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11
Q

Inflammatory cells activated in COPD

A

Neutrophils
Macrophages
CD8+ T cells

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12
Q

COPD impacts the

A

small + large airways
pulmonary vasculature
lung parenchyma

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13
Q

Inflammatory fluid present means

A

increased goblet cells + mucus glands = increased mucus
impaired ciliary motility
thickening of SM

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14
Q

Results of COPD inflammation

A

Scarring + fibrosis
FEV1 decline
Impaired gas exchange
Air trapping

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15
Q

Mediators involved in COPD

A

LTB-4
IL-8
TNF-a

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16
Q

COPD has a ____ response to glucocorticoids

A

variable
(not rlly used in COPD)

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17
Q

Presentation of COPD

A

cough, sputum production
barrel chest
hypoxemia
hypercapnia

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18
Q

Diagnosis of COPD

A

dyspnea that is progressive + persistent
recurrent wheeze
chronic cough
recurrent lower RTIs
history of smoking

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19
Q

Post-bronchodilator FEV1/FVC is ____ of predicted which indicates COPD

A

< 70%

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20
Q

Severity of COPD is classified based on

A

Airflow obstruction (FEV1)
Patient symptoms (CAT, mMRC)
Exacerbation risk

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21
Q

Gold 1

A

Mild
> 80% predicted

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22
Q

Gold 2

A

Moderate
50-80% predicted

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23
Q

Gold 3

A

Severe
30-50% predicted

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24
Q

Gold 4

A

Very Severe
< 30% predicted

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25
Q

COPD assessment tools

A

COPD Assessment Test (CAT)
COPD Control Questionnaire (CCQ)
Chronic Respiratory Questionnaire (CRQ)
St. George’s Respiratory (SGRQ)

26
Q

Tool for assessment of breathlessness ONLY

A

Modified British Medical Research Council Questionnaire (mMRC)

27
Q

COPD Assessment Test (CAT)

A

Score 0-40
>10 indicates increased symptoms

28
Q

Modified British Medical Research Council Questionnaire (mMRC)

A

Score 0-4
Score >2 indicates increased breathlessness

29
Q

LAMAs are _____ effective than LABAs but ____ is better

A

more

LABA+LAMA

30
Q

LAMA+LABA better than either agent alone at

A

reducing symptoms
improving FEV1
reducing exacerbations

31
Q

Mainstay of COPD therapy

A

LABAs & LAMAs

32
Q

Short Acting Beta2 Agonists (SABAs)

A

Albuterol
Levalbuterol

33
Q

Long Acting Beta2 Agonists (LABAs)

A

Salmeterol
Formoterol
Indacaterol
Olodaterol
Aformoterol

34
Q

Short Acting Muscarinic Antagonists (SAMAs)

A

Ipratropium Bromide

35
Q

Long Acting Muscarinic Antagonists (LAMAs)

A

Tiotropium
Aclidinium bromide
Umeclidinium
Glycopyrrolate
Revefenacin

36
Q

Combination LABA/LAMA

A

Anoro Ellipta
Stiolto Respimat
Bevespi Aerosphere
Duaklir Pressair

37
Q

Combination SABA/SAMA

A

Combivent
Duoneb

38
Q

There is an increased risk of ____ in ICS’ at high doses

39
Q

Combination ICS/LABA

A

Advair
Symbicort
Dulera
Breo Ellipta

40
Q

Triple Combination Inhaler

A

Trelegy Ellipta
Breztri Aerosphere

41
Q

PDE4 Inhibitor

A

Roflumilast (Daliresp)

42
Q

Roflumilast (Daliresp) MOA

A

reduces inflammation vis cAMP inhibition

43
Q

Roflumilast (Daliresp) Indications

A

COPD exacerbations

44
Q

PDE3&4 Inhibitor

A

Ensifentrine (Ohtuvayre)

45
Q

Ensifentrine (Ohtuvayre) MOA

A

inhibits PDE3&4 –> decreased activation of immune & inflammatory cells

46
Q

Ensifentrine (Ohtuvayre) Indication

A

Add on therapy to LABA+LAMA for dyspnea

47
Q

Ensifentrine (Ohtuvayre) side effects

A

Neuropsychiatric events

48
Q

Macrolide Antibiotic

A

Azithromycin

49
Q

Azithromycin side effects

A

Hearing impairment
Bacterial resistance
Diarrhea

50
Q

Azithromycin indication

A

Exacerbation in former smokers

51
Q

IL-4 Receptor Antagonist

A

Dupilumab (Dupixent)

52
Q

Dupilumab (Dupixent) MOA

A

decreases IL-4 –> decreased inflammatory mediators

53
Q

Dupilumab (Dupixent) indication

A

add on to LABA+LAMA+ICS for exacerbation in patients w/ eos >300

54
Q

AI-Proteinase Inhibitors

A

Prolastin-C
Aralast NP
Zemaira
Glassia

55
Q

AI-Proteinase Inhibitors are only indication for patients with ____

A

alpha1-antitrypsin deficiency

56
Q

Other COPD treatments not really recommended

A

NAC & carbocysteine
Guaifenesin
Antitussives

57
Q

Initial therapy for group E

A

LABA+LAMA
consider triple therapy

58
Q

Initial therapy for group B

59
Q

Initial therapy for group A

A

Bronchodilator
SABA or SAMA or LABA or LAMA

60
Q

Patients experiencing both dyspnea and exacerbations should use the ____ pathway.

A

exacerbation

61
Q

Nonpharmacological treatment for group A

A

Smoking cessation
Physical activity
Vaccines

62
Q

Nonpharmacological treatment for groups B and E

A

Smoking cessation
Pulmonary rehabilitation
Physical activity
Vaccines

Pharmacotherapeutics (16 decks)

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