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Patho/Pharm 2 > COPD/NRT > Flashcards

COPD/NRT Flashcards

1
Q

what are the main risk factors for COPD

A
  1. exposure to irritants (ie smoking, indoor/outdoor pollution)
  2. lung growth during gestation (smoking, abx use, preterm, low birth weight, RTI, childhood asthma)
  3. genetic susceptibilities (alpha 1 antitrypsin gene)
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2
Q

what is the basic pathophysiology of COPD

A

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)

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3
Q

what are the underlying mechanisms of chronic bronchitis

A

hypersecretion of mucous & chronic productive cough (>3months/year)

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4
Q

what are the underlying mechanisms of emphysema

A

permanent enlargement of gas-exchange airways & destruction of alveolar walls

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5
Q

what are the common etiologies of AECOPD

A

URTI (viral or bacterial), non-optimized prescribed pharm, poor adherence/administration technique

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6
Q

at is 1st & 2nd line treatment for mild COPD

A

SABA prn –> LAMA (or LABA)

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7
Q

what is first, second, and third line treatment for moderate/severe COPD w/ LOW risk for AECOPD

A

LAMA or LABA –> LAMA/LABA –> LAMA/LABA/ICS

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8
Q

what is first, second, and third line treatment for moderate/severe COPD w/ HIGH risk for AECOPD

A

LAMA/LABA or ICS/LABA –> LAMA/LABA/ICS –> oral therapies`

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9
Q

what is the diagnostic criteria for COPD

A

FEV1/FVC <.7

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10
Q

how is severity of COPD determined

A

FEV1 > 80 = mild
FEV1 50-80 = mod
FEV1 30-50 = severe
FEV1 <30 = very severe

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11
Q

what are the 5 grades of dyspnea (mMRC scale)

A

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

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12
Q

what does the CAT score assess?

A

self assessment tool for COPD severity
0-10 milk
11-20 mod
21-30 severe
31-40 very severe

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13
Q

what are the two main classes of drugs used for COPD

A

bronchodilators & antimuscarinic drugs

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14
Q

what are the two bronchodilators used in COPD

A

SABA - short acting (Salbutamol/ventolin, terbutaline/brincanyl)

LABA - long acting (Salmeterol, Formoterol)

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15
Q

what are the two antimuscarinic agents used in COPD

A

SAMA - short acting (Ipratoprium bromide)

LAMA - long acting (triotropium bromide/spiriva)

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16
Q

what is a consideration when using triple therapy with LAMA/LABA/ICS?

A

increased likelyhood of pneumonia

17
Q

what would favor addition of ICS to long acting bronchodilator

A

hx hospitalization for AECOPD, >2 moderate exacerbations/year, blood eosinophils >300, hx asthma

18
Q

what are the three oral therapies used for severe COPD with high risk of exacerbations

A

roflumilast, N-acetylcysteine, azithromycin

19
Q

what is an AECOPD characterized by (3 cardinal symptoms)

A

increased dyspnea, cough, or sputum purulence

20
Q

when should abx be used in AECOPD

A

if all three of cardinal symptoms are present or two are present and one is increased purulence

21
Q

what abx are used 1st and 2nd line in low risk patients

A

1st: Amox, doxy, tetra, TMP/SMX
2nd: clarithro, azithro, cefuroxime, cefprozil

22
Q

what are 1st and 2nd line abx for complicated exacerbations

A

1st: amox-clav
2nd: levo, moxifloxacin

if suspected p. aeruginosa = Cipro

23
Q

what is the target o2 for COPD

A

88-92

24
Q

what makes somebody mild vs moderate AECOPD

A

mild / severe
FEV1 >50% / FEV1<50%
<=3/year / 4+/year
no CV disease/ CVD(CAD, CHF)
/ use O2
/ recent chronic use of steroids/abx

25
Q

what are the 4 a’s

A

ask, advise, assist, arrange

26
Q

what is the most effective NRT

A

patch

27
Q

which NRT is contraindicated in asthma

A

inhaler

28
Q

what are the two prescription anti-smoking drugs

A

buproprion (atypical antidepressant) and varenicline (nicotinin partial receptor agonist)

29
Q

what is the black box warning for buproprion

A

neuropsychiatric effects - caution in those with mood changes/suicidal ideation

30
Q

what are the main AEs of varenicline

A

sedation, increased risk of CV events

Patho/Pharm 2 (7 decks)

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