Day 1- COPD and Smoking Cessation Flashcards
Where can GOLD guidelines for COPD be found?
What are your COPD risk factors and what are symptoms?
What is emphysema?
goldcopd.org/gold-reports
Environmental tobacco smoke, air pollutants, occupational dusts and chemicals, genetic disposition( AAT deficiency), Airway hyperresponsiveness, Impaired lung growth. Chronic cough, dyspnea, sputum production, hyper inflation, impaired gas exchange.
imbalance of protineases and antiprotineases( increased protineases), leads to loss of elastic recoil. Neutrophils control inflammation(random to know).
What is GOLD 1 and GOLD 2 standard?
What is GOLD 3 and GOLD 4 standard?
What is small airway disease?
80-100%, GOLD 2 is 50-79%.
Severe, 30-49 % and GOLD 4 is Very severe, <30%.
AKA Chronic Bronchitis, irritants lead to increased mucus production and loss of cilia, cycles of damage and repair.
What are signs on a Physical Examination for COPD?
What is your gold standard diagnosis test?
How is COPD different than asthma?
Cyanosis of Mucosal membranes, Barrel chest, increased RR, shallow breathing, pursed lips during expiration, use of accessory respiratory muscles.
Spirometry. FEV1/ FVC <0.7. If ratio is between 0.6 and 0.8 repeat spirometry on separate visit. Give bronchodialator before.
Onset in mid-life, slowly progressive symptoms, long smoking history, dyspnea during exercise, largely irreversible airflow.
How do you get your GOLD standard % number?
Who is in group A and C with mMRC and CAT scores?
How do you group with exacerbation history?
FEV1 actual/ FEV1 reference.
mMRC: 0-1, CAT <10. B and D are mMRC: > or equal to 2, CAT > than or equal to 10.
C and D are > or equal to 2 exacerbation or ANY hospitalization. A and B are lower than 2 exacerbation and no hospitalization.
What is your SAMA?
What are your LAMA’s?
What are your combo products used for exacerbation? and for maintenance?
Ipatropium(Atrovent).
Tiotropium(Spiriva), Aclidinium(Tudorza), Glycoperrolate( Seebri), Umeclidinium( Incruse).
Combivent, Duoneb. Anoro, Stiolto, Utibron, Bevespi.
Are ICS’s off label in COPD?
What are your 3 corticosteroids systemically used in COPD?
What are your combo steroid products you can use?
Yes.
Prednisone, Prednisolone, Methylprednisolone.
Advair, Symbicort, Breo, Trelegy. Dulera has offlabel use.
What is your PDE-4 inhibitor and when is it indicated?
When can you use macrolides in COPD?
When is pulmonary rehabilitation recommended?
FEV1<50%, Maintenance treatment for COPD. Roflumilast(Dalisrep).
Patients prone to exacerbation who is stable. Azithromycin or Erythromycin. Don’t use for more than 1 year.
Groups B,C,D.
What things to know about oxygen therapy(>15 hours/day)?
When is AAT recommended?
How do you treat Group A?
Specific criteria to initiate it, benefits for mortality, quality of life and exercise tolerance. Severe chronic resting arterial hypoxemia.
AAT with associated emphysema. Most beneficial in never or ex smokers with FEV1 35-60%.
Bronchodilator(short or long acting)(SABA, SAMA, LABA, LAMA)–> Continue, stop, or try alternative depending on outcome.
How do you treat Group B?
How do you treat Group C?
How do you treat Group D?
Initial: LAMA or LABA. If persistent symptoms do LAMA AND LABA(if symptoms not improved use single inhaler).
Initial Treatment: LAMA. Persistent symptoms are LAMA + LABA OR LAMA + ICS.
LAMA + LABA( If asthma COPD overlap use LABA + ICS or if want to start only one do LAMA) Persistent symptoms is LAMA + LABA + ICS or LABA + ICS. Further exacerbations consider roflumilast if FEV1 <50% predicted + Chronic bronchititis, Add macrolide for 1 year if former smoker.
What are your cardinal symptoms for acute exacerbation?
What are your main treatments for mild exacerbations?
What are your main treatments for moderate exacerbation and when is it considered severe?
Worsening dyspnea, Increased sputum volume and increased sputum purulence
Short acting bronchodilators.
SABD + ABX and/or corticosteroids. Requires hospitilization or visits to ED for severe.
What SABD’s do you use in exacerbations?
What corticosteroid do you use in exacerbation?
When is antibiotic use recommended in exacerbations and for how long?
SABA +/- SAMA.
Prednisone 40mg daily for 5 days. Methylpred would be 32.(5 prednisone and 4 methylpred).
3 cardinals cymptoms, or increased sputum purulence + one other or requires mechanical ventilation. Treat for 5-7 days.
What are your most common pathogens in exacerbations and how do you treat them?
What are your more complicated pathogens and treatment?
When do you give oxygen to exacerbation patients?
H.influenzae,S.pneumoniae, M.catarallis, H.parainfluenzae. Treat with Azithromycin, Doxycycline, 2nd or 3rd generation cephalosporins.
Drug resistant pneumococci, B-lactamase producing H.influenzae and M.catarallis, P.aerugonisa. Treat with Augmentin, Respiratory FQ’s, 3rd or 4th generation cephalosporin with antipseudomonal activity.
Considered for hypoxemic patients(hospitalized). Try to achieve 88-92 O2 saturation or Pa02 >60.
What is the BIGGEST thing we can do to help COPD patients?
What are the 5 A’s of smoking cessation?
What are the 5 R’s of smoking cessation?
Smoking Cessation.
Ask, Assess, Advise, Assist, Arrange.
Relevance, Risk, Reward, Roadblocks, Repetition.
What is your non pharm therapy for smoking cessation?
How do you dose Buproprion(Zyban) and what are it’s ADR’s?
How do you dose Varenicline(Chantix) and what are it’s ADR’s?
Cognitive and behavioral therapy–> Review commitment to quit, positive self talk, relaxation through imagery, mental rehearsal and visualization. Water,sugar free chewing gum and hard candies. Quit now smoking line.
Initiate 150 mg 1-2 weeks before quit date. Can be used in combo with NRT. Pregnancy category C. ADR: nausea, insomnia, tremor, headache, agitation, weight loss, dry mouth. CI’d in history of seizure, anorexia, MAOI use in 14 days. Treat for about 3 months.
Initiate 1 week before quit date, Not recommended with NRT’s. Pregnancy category C. Nausea, insomnia, vivid dreams, HA, constipation, CNS depression and serious skin reactions. Precautions in CVD risk, psych issues, renal impairment, seizures. Treat for about 3 months.
How do you dose NRT lozenge and gum?
How do you dose NRT patch(Nicoderm CQ, Nicotrol)?
What is Nicotrol NS and inhalers side effects to know?
Nicorette, Commit. If smoke 1st cig <30 minutes after waking 4 mg. If smoke 1st cig >30 minutes after waking 2 mg for 12 weeks for both. BIG ADR is NAUSEA.
> 10 cigs per day: 21 mg daily for 6 weeks. <10 cigs per day: 14 mg daily for 6 weeks. BIG ADR is SLEEP DISTURBANCE.
NS is Nasal mucosa irritation, Inhaler is oral irritation.
