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COPD meds Flashcards

1
Q

COPD is characterized by airflow obstruction due to:

A

Chronic bronchitis

Ephysema

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2
Q

What is chronic bronchitis?

A

Chronic or recurrent excess mucus secretion into the bronchial tree

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3
Q

Characterize the chronic bronchitis cough

A

Most days >3 months/year for at least 2 consecutive years

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4
Q

How is emphysema defined?

A

Defined by anatomic pathology

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5
Q

What is emphysema characterized by?

A

Permanent enlarged air spaces and destruction of alveolar walls

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6
Q

What is the key component of the chronic bronchitis hx?

A

Impressive hx of productive cough

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7
Q

How are chronic bronchitis pts described?

A

Blue bloaters

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8
Q

Why are chronic bronchitis pts described as blue bloaters?

A

CO2 retention

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9
Q

Two main PE findings in chronic bronchitis:

A

Percussion is resonant

Breath sounds are distant to auscultation

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10
Q

What is the key hx of emphysema

A

Minimal cough

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11
Q

How do you describe pts with emphysema and why?

A

Pink puffers

Tachypnea

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12
Q

What does pursed lip breathing compensate for in emphysema pts?

A

Compensate for loss of elastic recoil

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13
Q

Why do emphysema pts sit forward with hands on knees?

A

Minimizes energy of breathing

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14
Q

What are two key PE findings in pts w/ emphysema?

A

Accessory muscle use

Hyperresonant percussion

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15
Q

What is a major RF for chronic bronchitis and emphysema?

A

Cigarette smoking

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16
Q

Is inflammation in COPD the same or different than inflammation of asthma?

A

Different

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17
Q

How is COPD characterized?

A

By exacerbations

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18
Q

What is the definition of exacerbation of COPD?

A

Worsening of pts sx that is beyond normal day-to-day variations
Leads to change in medication

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19
Q

How many exacerbations do pts have yearly?

A

1-2

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20
Q

What % of exacerbations can be handled out patient?

21
Q

What are sx of severe exacerbations? Where should they be managed?

A

Accessory muscle use
Cyanosis
Peripheral edema
Hospital

22
Q

What are sx of life-threatening exacerbations? Where should they be managed?

A

Mental status changes
Worsening respiratory status
Hemodynamic instability
ICU

23
Q

What are the COPD medication classes?

A 
Cholinergic antagonists
Sympathomimetics
Combination anticholinergics/b2 agonists
Inhaled corticosteroids
Long-term oxygen
Antibiotics
24
Q

What are cholinergic antagonists also known as?

A

Anti-muscarinic agents

Anticholinergics

25
What are sympathomimetrics also known as?
Beta 2 agonists
26
Is the long term O2 high or low dose?
Low dose
27
When do you use abx for COPD?
Exacerbations, not as prophylaxis
28
What line of therapy are inhaled cholinergic antagonists (ICA) and for what severity of COPD?
1st line in stable COPD
29
What are the available ICA agents?
Ipratropium Tiotropium Atropine
30
Do ICAs have more or less side effects that sympathomimetics?
Less
31
What line of tx are sympathomimetics?
2nd line
32
When are sympathomimetics the drug of choice?
Acute exacerbations
33
What do you do if response to ipratropium is unsatisfactory?
Begin trial of sympathomimetics
34
Do inhaled corticosteroids (ICS) modify lung function decline or improve mortality?
No
35
When are ICS recommended?
Pts w/ severe or very severe COPD w/ frequent exacerbations
36
What are some AEs of ICS?
Oropharyngeal candidiasis | Hoarse voice
37
Should you use ICS long term?
No, due to AEs
38
What has continuous O2 therapy been shown to do?
Decrease mortality Improve quality of life Reduce times in hospital
39
How do you administer O2?
Via nasal canula @ 2-3 L/min
40
What is the goal of long term O2?
Raise PaO2 to > 60 mm Hg
41
Why do you not raise PaO2 too high?
Don't want to depress respiratory drive
42
What is a risk of inhibiting respiratory drive?
Death
43
What do you have to avoid on long term O2?
Flames (smoking)
44
When are abx only effective for COPD?
Infection
45
How long do you use the abx for COPD infections?
7-10 days
46
What is the MC abx used w/ COPD infection?
Azithromycin 3rd generation macrolide for 3-5 days
47
Summary of COPD pharmacotherapy
See slide 61
48
Stepwise COPD drug therapy
1) Short acting bronchodilator for acute sx relief 2) Long acting bronchodilator 3) Combination anticholinergic + beta agonist bronchodilator 4) consider theophylline 5) Combination inhaled corticosterouds + LABA
49
What is the difference between inflammatory cell infiltration w/ asthma and inflammation w/ COPD?
Asthma = eosinophils and mast cells | COPD: caused by neutrophils, macrophages, T lymphocytes

Pharm (32 decks)

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