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ICC1 > COPD part 1 (009) > Flashcards

COPD part 1 (009) Flashcards

1
Q

what are the risk factors of COPD ?

A 
smoking 
factory fumes 
pollution 
alpha 1 antitrypsin deficiency 
impaired lung development 
severe infections in childhood ( measles)
long standing bronchial asthma
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2
Q

when to suspect alpha 1 anti trypsin deficiency ?

A

young patient who is a non smoker and no exposure to any of the COPD risk factors

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3
Q

is inspiration an active or passive process ?

A

active whilst expiration is passive

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4
Q

what is the pathophysiology involved with COPD?

A 
air trapping (poor ventilation )
ventilation/perfusion mismatch 
chronic hypoxia (cor pulmonale)
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5
Q

what is the main cause of low oxygen saturation in emphysema patients ?

A

v/q mismatch

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6
Q

what is the main cause of low oxygen saturation in Chronic bronchitis?

A

poor ventilation / air trapping

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7
Q

which disease is commonly associated with pink puffers ?

A

emphysema

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8
Q

which disease is commonly associated with blue bloaters?

A

chronic bronchitis

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9
Q

consequence of v/q mismatch vs. air trapping ?

A

v/q mismatch – hypoxia

air trapping – hypercapnia

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10
Q

what are the spirometry requirements for making a diagnosis of COPD ?

A
  • decreased FEV and FVC
  • expiration take a longer time
  • increased residual volume (RV) of air after expiration
  • increased total lung volume (TLV)
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11
Q

what is the cut off value for the FVC/FEV1 ratio to diagnose COPD ?

A

less than 70% post bronchodilator

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12
Q

what other pulmonary function tests can be used to diagnose COPD ?

A

1-platysmography
2- diffusion capacity of CO
3- exercise testing

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13
Q

what are the types of exercise testing used for pulmonary function test ?

A

6 minute walk test

cardiopulmonary exercise testing

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14
Q

what kind radiological imaging methods can be used ?

A

chest x-ray

CT scan

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15
Q

what are the radiological findings of COPD on a chest X-Ray?

A

ribbon shaped hearts
flat diaphragm
hyper translucency
hyperinflation

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16
Q

what laboratory tests would you ask for ?

A 
ABG 
CBC 
Sputum culture and sensitivity 
alpha 1 antitrypsin blood levels 
blood eosinophil count
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17
Q

what are the complications of COPD ?

A 
respiratory failure 
heart failure 
pneumothorax 
bronchieactsis 
depression 
recurrent exacerbations
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18
Q

what is cor pulmonale ?

A

Cor pulmonale is a condition that causes the right side of the heart to fail. Long-term high blood pressure in the arteries of the lung and right ventricle

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19
Q

what are the three main management options ?

A

general measures
drugs
surgical

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20
Q

what are examples of general measures ?

A 
cessation of smoking 
vaccination against influenza and pneumonia 
exercise 
nutrition 
Rehabilitation
21
Q

what are the surgical options ?

A

lung volume reduction

lung transplantation

22
Q

what are the types of bronchodilators ?

A

b2 agonists
anticholinergics
methylxanthines

23
Q

what are examples of each of :
b2 agonists
anticholinergics
methyxanthines

A 
1. b2 agonists - SABA salbutamol ( short acting 
LABA formeterol ( long acting)
indaceterol ( ultra long lasting)
  1. anticholinergics- short acting ipratopium bromide
    long acting - tiotropium
  2. short acting aminophylline
    ultra-long acting - theophylline
24
Q

mechanism of b2 agonist ?

A

activation of g proteins - cAMP- inhibition of calcium release leads to bronchodilation

25
Q

what are the side effects of b2 agonists ?

A

palpitations
hypokalemia
tremors
anxiety

26
Q

what is the method of administration with anticholinergics ?

A

given by inhalation ONLY

27
Q

which is more effective LAMA or LABA in the reduction of exacerbation rates inn COPD ?

A

LAMA

28
Q

what is the mechanism of anticholinergics ?

A

block acetylcholine

29
Q

what are the side effects of anticholinergics ?

A

dry mouth , bitter metallic taste

poor systemic absorption

30
Q

what is the method of administration of methylxanthine ?

A

oral or intravenous and not by inhalation
aminophylline - rescue
theophylline - maintenance

small bronchodilator effect modest symptomatic improvement

31
Q

what is the mechanism of action with methylxanthine ?

A

inhibition of phosphodiesterase

32
Q

what are the side effects of methylxanthine ?

A

cardiac
cns stimulation
GIT

33
Q

what anti inflammatory drugs can be used ?

A

inhaled corticosteroids
systemic corticosteroids
phophodiesterase-4-inhibitors
macrolide

34
Q

how can the treatment benefit of `ICS be predicted ?

A

by blood eosinophil count (>300 cell shows greates benefit whilst <100 is less likley

35
Q

what are the side effects of ICS ?

A

oral candidiasis, hoarsness of voice

risk of pneumonia

36
Q

what type of anti-inflammatory drug is more likely to be used with acute exacerbations ?

A 
systemic corticosteroids (e.g prednisolone) 
not recommended for longer durations
37
Q

what are the side effects of predinsolone (systemic corticosteroids)?

A

immunosuppression
muscle weakness gastritis/peptic ulcer
osteoporosis

38
Q

what are the indications to giving phosphodiesterase inhibitors ?

A

in COPD patiients who hhave a FEV1 of less than 50% and frequent exacerrbations despite ICS LABA LAMA

39
Q

an example of a phosphodiesterase 4 inhibitor ?

A

roflumilast

40
Q

what is the contraindication of using phosphodiesterase inhibitors?

A

methylxanthine ( which is also contraindicated in asthma patients )

41
Q

what antibiotics can be used for COPD patients ?

A

macrolide (azithromycin) 250mg once a day for a year

42
Q

what are the expected findings in an ABG ?

A

hypoxemia
hypercapnia
type 2 resp failure

43
Q

what is expected to bee seen on a CBC of a patient with COPD ?

A

secondary polycythemia
in order to increase O2 capacity

44
Q

what is the inherritedd form of emphysema called ?

A

alpha 1 antitrypsin blood level

45
Q

what are the essential criteria needed to establish a diagnosis of COPD ?

A

persistent dyspnea/cough
history of smoke exposure
low FEV1/FVC
large volume on x-ray

46
Q

what is the significance of performing blood eosinophil count in a patient with COPD ?

A

if they have a count higher than 300 they are more likely to respond and benefit from ICS
and have a higher risk of exacerbation

47
Q

should methylxanthine be used in an acute exacerbation ooff COPD?

A

not recommended

48
Q

patient is arrythmic and in CCOPD exacerbation ?

A

avoid beta. 2 agonists as they already cause arrythmias

ICC1 (50 decks)

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