COPD/NRT Flashcards
what are the main risk factors for COPD
- exposure to irritants (ie smoking, indoor/outdoor pollution)
- lung growth during gestation (smoking, abx use, preterm, low birth weight, RTI, childhood asthma)
- genetic susceptibilities (alpha 1 antitrypsin gene)
what is the basic pathophysiology of COPD
chronic irritant exposure leads to inflammation, oxidative stress, and apoptotic and autophagic cell death
Bronchitis: bronchial inflammation & edema leads to increased mucous secretion from goblet cells (which increase in size and number) that cannot be cleared due to impaired ciliary function
emphysema: chronic inflammation leads to proteases, which break down elastin leading to loss of elastic recoil, causing air trapping & hyperinflation of the lungs (barrel chest)
what are the underlying mechanisms of chronic bronchitis
hypersecretion of mucous & chronic productive cough (>3months/year)
what are the underlying mechanisms of emphysema
permanent enlargement of gas-exchange airways & destruction of alveolar walls
what are the common etiologies of AECOPD
URTI (viral or bacterial), non-optimized prescribed pharm, poor adherence/administration technique
at is 1st & 2nd line treatment for mild COPD
SABA prn –> LAMA (or LABA)
what is first, second, and third line treatment for moderate/severe COPD w/ LOW risk for AECOPD
LAMA or LABA –> LAMA/LABA –> LAMA/LABA/ICS
what is first, second, and third line treatment for moderate/severe COPD w/ HIGH risk for AECOPD
LAMA/LABA or ICS/LABA –> LAMA/LABA/ICS –> oral therapies`
what is the diagnostic criteria for COPD
FEV1/FVC <.7
how is severity of COPD determined
FEV1 > 80 = mild
FEV1 50-80 = mod
FEV1 30-50 = severe
FEV1 <30 = very severe
what are the 5 grades of dyspnea (mMRC scale)
0- none except for strenuous exercise
1- SOB when hurrying on level or walking uphill
2 - walks slower than expected for age on level due to SOB or has to stop for breath when walking at own pace
3 - stops for breath q100m/every few minutes
4- cannot leave house, SOB from dressing/undressing
what does the CAT score assess?
self assessment tool for COPD severity
0-10 milk
11-20 mod
21-30 severe
31-40 very severe
what are the two main classes of drugs used for COPD
bronchodilators & antimuscarinic drugs
what are the two bronchodilators used in COPD
SABA - short acting (Salbutamol/ventolin, terbutaline/brincanyl)
LABA - long acting (Salmeterol, Formoterol)
what are the two antimuscarinic agents used in COPD
SAMA - short acting (Ipratoprium bromide)
LAMA - long acting (triotropium bromide/spiriva)
what is a consideration when using triple therapy with LAMA/LABA/ICS?
increased likelyhood of pneumonia
what would favor addition of ICS to long acting bronchodilator
hx hospitalization for AECOPD, >2 moderate exacerbations/year, blood eosinophils >300, hx asthma
what are the three oral therapies used for severe COPD with high risk of exacerbations
roflumilast, N-acetylcysteine, azithromycin
what is an AECOPD characterized by (3 cardinal symptoms)
increased dyspnea, cough, or sputum purulence
when should abx be used in AECOPD
if all three of cardinal symptoms are present or two are present and one is increased purulence
what abx are used 1st and 2nd line in low risk patients
1st: Amox, doxy, tetra, TMP/SMX
2nd: clarithro, azithro, cefuroxime, cefprozil
what are 1st and 2nd line abx for complicated exacerbations
1st: amox-clav
2nd: levo, moxifloxacin
if suspected p. aeruginosa = Cipro
what is the target o2 for COPD
88-92
what makes somebody mild vs moderate AECOPD
mild / severe
FEV1 >50% / FEV1<50%
<=3/year / 4+/year
no CV disease/ CVD(CAD, CHF)
/ use O2
/ recent chronic use of steroids/abx
what are the 4 a’s
ask, advise, assist, arrange
what is the most effective NRT
patch
which NRT is contraindicated in asthma
inhaler
what are the two prescription anti-smoking drugs
buproprion (atypical antidepressant) and varenicline (nicotinin partial receptor agonist)
what is the black box warning for buproprion
neuropsychiatric effects - caution in those with mood changes/suicidal ideation
what are the main AEs of varenicline
sedation, increased risk of CV events
