Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Kirsty - Y3S2 > CPT2: COPD > Flashcards

CPT2: COPD Flashcards

1
Q

What is COPD?

A

Airflow limitation due to airway and / or alveolar abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the pathophysiology of COPD?

A

2 Main processes involved: Chronic bronchitis and emphysema:

Chronic bronchitis

Normally particles/dust/toxins in the airway become tapped in sputum which is sweeped away by cilia. However in COPD due to extensive exposure and inhalation of toxins these cilia become impaired and damaged. This leads to soutm and particles not being cleared as effectively therefore clogginf the airways and making it difficult to breathe, as well as, a perfect enviroment for infection.

There is also an increase in inflammatory cells which cause bronchoconstriction of the airways, narrowing them and making it more difficult to breathe. This can also lead to gas trapping.

Emphysema

Extensive toxin inhalation can also directly affect the alveoli. It causes damage and thinning of the alveloar walls eventually leading to them dissolving all together. This leads to enlargement of distal gas exchange spaces. Gas exchange is therefore less effective and gas trapping can also occur. The patient can have hypoxemia (low O2 in blood) or hypercapnia (high CO2 in blood)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What symptoms to patients with COPD present with?

A
  • Breathlessness which has had a gradual onset
  • Cough
  • Sputum production
  • Wheeze
  • Frequent winter bronchitis/ chest infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does it mean by COPD is a hetrogenous condition/ multifactorial

A

Associated with significant, co-existing medical conditions e.g. CVS, osteoporosis, anxiety, depression. These all negatively impact the mortality and morbidity in patients with COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is COPD caused by?

Epidemiology?

Treatment goals?

A
  • Long term exposure to toxins
    • Tobacco smoke most common
  • Common Condition
    • 4th leading cause of death
    • morbidity high
  • Preventable
  • Treatable
    • Symptom Management
    • Reduce Risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does assessment involve?

What is used?

A

2 important factors:

  • Symptoms
  • Risk of exacerbation

These must be combined for the purpose of improving management of COPD.

Gold Criteria used to assess COPD and places patients in 4 categoties based on those 3 important factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What assessment tools are used?

A
  • mMRC
  • FEV1/FVC and FEV1
  • CAT assessment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe mMRC

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the use of CAT

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the use of FEV1/FVC

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which is more severe?

A

Neither - both severe in own way and require different treatments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Goals of treatment for COPD?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are low cost treatment options which can be extremely beneifical nad effective?

A

Vaccinations

Pulmonary rehabilitation

Smoking cessation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe vaccinations

A
  • •Pneumococcal vaccination and an annual influenza vaccine should be offered to all patients with COPD
  • Helps reduced respiratory infections therefore exacetbations
  • Cheap, easy, effective
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the use of pulmonary rehabilitation

A

•All COPD patients appear to benefit from rehabilitation and maintenance of physical activity, improving their exercise tolerance and experiencing decreased dyspnoea and fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the use of smoking cessation

A

•Smoking cessation is the key intervention for all COPD patients who continue to smoke

17
Q

What are the main pharmacological treatment options for COPD?

A

Bronchodilators

CCS

18
Q

What are bronchodilators broken up into?

What is each short/long acting used for?

Give some example of drugs used

A

Two main classes of bronchodilators:

  • B2-agonsits
    • SABA/LABA
  • Anti-musclaranics
    • SAMA/LAMA

Short acting are used for relief/rescue when there is an acute exacerbation of symptoms. Examples include Salbutamol (SABA) or terbutaline (SABA)

Long acting preperations are used to prevent symptoms of breathlessness. Examples include Formoterol (LABA), Vilanterol (LABA), tiotropium (LABA), Glycopyttonium (LAMA), Indacaterol (LABA). LA preperations are more effective and convient for maintance and can also reduce risk of exacerbations

19
Q

What is the mechanism of action of SABA or LABAs

A

Stimulate B2 receptors on airway smooth muscle. This has 2 effects on the airway:

  1. Bronchodilation
  2. Increases cAMP which antagonises bronchoconstriction

This therefore opens up the airway an aims to stop the closing of the airway relieving breathlessness

20
Q

Mechanism of action of LAMA/SAMA

A

Bind to M3 receptors and block them therefore ACH mediated bronchoconstriction and mucus secretion is inhibited. This helps to produce wider airways and prevent mucus secretion clogging the airways

21
Q

MAin effects of bronchodilators

A
  • Overall alters airway smooth muslce tone and widens the airways improving expiratory flow
  • Reduces air trapping and imroves lung emptying therefore improves symptoms and exercise capacity
  • Improves skeletal muscle function and mucocilary clearance
22
Q

What is an exacerbation?

A

An exacerbatio is an event in the natural course of the disease characterised by a changed in a patients baseline symptoms - dysponea, cough and/or sputum that is beyond the normal day-to-day variation and is acute in onset and may cause a change in normal medication in a patient with underlying COPD

23
Q

What are the conseuquences of an exacerbation

A

Increased inflammation:

  • Increased bronchonstriction
  • increased odema
  • increased mucus
  • airflow limited
  • hyperinflation
  • Systemic inflammation
24
Q

What do ICS do?

Benefits?

A

They reduce inflammation

  • Reduced exacerbatin
  • Improved breathlessness
  • Improve QOL
  • Reduce hospital admissions
  • Preserve lung function
  • Potentially reduce mortality

When used in combo with a LABA dramatically decrease exacerbation risk. Also reduce hospital admissions, improve QOL and reduce rate of decline

25
Q

Risks of ICS

A
  • •Cataracts
  • •Adrenal suppression
  • •Osteoporosis and fractures
  • •Pneumonia
  • •Diabetes
26
Q

Pharmacological treatment based on GOLD catergories

A

BRONCHODILATORS - BREATHLESSNESS

ICS - EXACERBATIONS

27
Q

Which GOLD group do each patient belong too and what treatment would be benefical?

CASE 1:

77 year old, FEV1 61% predicted. Coughs up green sputum most days. 3 exacerbations in the last year (no hospital admissions). Can walk an almost unlimited distance on the flat (SOB on hills)

CASE 2:

79 year old, FEV1 58% predicted. SOB on walking 100 yards. Oxygen saturations 87% on air so started on home long term oxygen therapy. No exacerbations or hospital admissions in the past year.

A

CASE 1: D - frequent exacerbator (ICS needed - LAMA/LABA/ICS)

CASE 2: B - breathlessness (LABA/LAMA)

28
Q

What are medications used in exacerbations?

A
  • Oxygen if hypoxemia
  • Non-invasive positve pressure ventilation
    • Offered if in hospital due to exacerbation and have type II respiratory failure
    • Removes CO2 and replaces with O2
  • SABA +/- SAMA
    • For bronchodilation
    • May be nebulised depending on how breathlessness and whether can use inhaler properly
    • Switch back to inhaled as soon as possible
    • SAMA normal inhaler withheld to avoid unnecessary side effects if on neb
  • Oral/systemic CCS - Prednisolone
    • Improves lung function
    • Improves oxygenation
    • Shortens recovery time
    • 30mg for 5 days
  • Antibiotics
    • If indicated by infection markers, raised temp, x-ray consolidation, clincical history and sputum production (change in Volume, viscosity or colour)
    • Aimed at causative organisms
    • Usually for 5-7 days and wither by IV or oral
29
Q

What are the 2 main classes of inhalers and what is good/bad about them?

A
30
Q

Inhaler technique

Determinants of poor inhaler techniquw

A

•Assessed regularly

•

•Determinants of poor inhaler technique

  • Older age
  • Use of multiple devices
  • Lack of previous education on inhaler technique

-

•Quality education regarding proper inhaler technique is important

31
Q

What can be used to help decide on inhaler choice?

A

In check inhaler device - patient breathes in and indicates devices suitable according to patients inspiratory flow

32
Q

Examples of dual therpay (LAMA/LABA)

A
  • Ultibro (DPI)
    • Remove cap and capsule needs put in
    • Many steps
    • Audable sound - lets know if breathed in correct
    • See powder gone - see if used
  • Incruse (ellipta) (DPI)
    • slide cap till clicks
    • dose counter
  • Respimat
    • Releases powder in soft/fine mist format
    • Good if poor inspiratory flow
    • Needed loaded with a carteidge each month
33
Q

Tripple therapy

A
  • Trimbow (MDI)
  • Triellgy (DPI)
34
Q

Other therapies used?

A
  • Theophylline (methylanthalines)
    • Oral bronchodilator
    • Narrow TW
    • Often associated with adverse effects in elderly
  • Roflumilast (phosphodiesterase-4 inhibitor)
    • Improve lung function
    • Oral tab
    • Not approved for use
  • Mucolytic (acetlcysteine)
    • ORal tablets daily
    • Breaks down sputum and makes thinner
  • Macrolides
    • Prophylaxis AB
    • Reduce exacerbations
    • Hearing impariment
    • AB resistance

Kirsty - Y3S2 (40 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions