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CMN 568 > Module 3- COPD/TB > Flashcards

Module 3- COPD/TB Flashcards

1
Q

COPD

A

Common, treatable, preventable
clinical syndrome of chronic respiratory symptoms, structural pulmonary abnormalities, impaired lung function arising from multiple causes that result in airflow limitation that is not fully reversible

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2
Q

Causes of COPD

A

Smoking and biomass fuel cooking
hereditary factors- alpha I antiprotease

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3
Q

Symptoms and Sign of COPD

A

normally 5th or 6th decade of life
excessive cough, sputum productive and shortness of breath
if dx early absence of smoking will reduce decline in lung function
Dyspnea is mild on exertion at the start but in severe disease dyspnea occur at rest
Pink puffers vs blue bloaters

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4
Q

Exacerbations of COPD

A

commonly precipitated by infection or environmental factors

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5
Q

Prevention of COPD

A

preventable through elimination of longterm exposure to tobacco, products of combustion of biomass fuels, and other inhaled toxins

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6
Q

High Risk indicators of COPD

A

FEV1 less than 50% of predicted
two or more exacerbations within pervious year
one or more hospitalizations for COPD exacerbations in the pervious year

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7
Q

Smoking cession

A

single most important intervention

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8
Q

Oxygen Therpay

A

for resting hypoxemia- PaC02 < 56mm hg
include longer survival, reduced hospitalizations and better quality of life

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9
Q

inhaled bronchodilators

A

do not alter decline in lung function
SAMA 1st line due to longer duration of action
SABA offer more rapid onset but more side effects
does not improve dyspnea
LAMA- 1st line in mild disease- more severe LAMA/LABA initated

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10
Q

Corticosteroids

A

ICS- not first line but can be added to LABA
if stable for 2 years remove ICS
No oral steroid unless acute exacerbation present

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11
Q

Theophylline

A

4th line defense- improves dyspnea, exercise and pulmonary function, benefits are from bronchodilation, anti-inflammatory properties and extra-pulmonary effects
toxicity concerns
Last resort

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12
Q

Antibiotics of COPD

A

Treat acute exacerbation, to treat acute bronchitis and prevent acute exacerbation of chronic bronchitis
Increased sputum will benefit from abx

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13
Q

Abx choices for COPD

A

Treat pseudomonas aeruginosa
doxy, trimethoprim, cephalosporin, macrolide, fluoroquinolone, augmentin
3-5 days

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14
Q

Pulmonary rehabilitation

A

graded aerobic physical exercise programs

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15
Q

phosphodiesterase 4 inhibitor

A

Rofumilast- reduce exacerbation frequently

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16
Q

Procedures for COPD

A

lung transplant
lung volume reduction surgery
bullectomy

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17
Q

When to refer for COPD

A

COPD before age 40, frequent excerbautions, severe or rapid disease, need for long-term o2, disproportionate symptoms, onset of comorbid illness

18
Q

When to admit for COPD

A

severe symptoms, acute hypoxemia/hypercapnia/peripheral edema/change in mental status

19
Q

Pulmonary tuberculosis

A

causes by M. tuberculosis
Transmitted by inhaled airborne droplet nuclei containing viable organisms

20
Q

Risk Factors of TB

A

disadvantage populations
malnourished, homeless, overcrowded and substandard housing, HIV

21
Q

Primary TB

A

clinically and radiographically silent, most people with intact T cell medicated responses limit multiplication and spread but doesn’t eradicated disease but lies dormant

22
Q

Latent TB infection

A

do not have an active disease and cannot transmit the organism to others, but reactivation of disease may occur if immune defense are impaired

23
Q

Active TB

A

5-15% of individuals with latent TB who are not give preventive therapy,

24
Q

Drug resistant TB

A

resistant to one of the first line drugs, either isoniazid or rifampin

25
Q

Multidrug resistant TB

A

resistant to both isoniazid and rifampin and possibly other agents

26
Q

Extensively drug resistant TB

A

resistant to isoniazid, rifampin, fluoroquinolone and either aminoglucoside or capreomycin or both

27
Q

Signs and Symptoms of TB

A

slowly progressive constitutional symptoms- malaise, anorexia, weight loss, fever, and night sweats. Chronic cough most common- dry at first but becomes productive of purulent sputum,

28
Q

Lab Findings of TB

A

Cx- from 3 consecutive morning sputum, acid fast staining of sputum smear,
Nucleic acid amplification- detects & identifies resistance markers- allows for early isolation/treatment

29
Q

Imaging for TB

A

pulmonary TB can not be distinguish btw primary and latent

30
Q

Test for latent TB

A

Tuberculin skin test- transverse width in mm of induration measured in 48-72 hours
Interferon gamma release assays- no more sensitive that skin test

31
Q

Treatment of Latent TB- 1 medication

A

Isoniazid- 9 month oral regimen preferable to 6 months, daily dose of 300mg or 2xWkly dose of 15mg/kg
supplement of B6 for high risk patient for neuropathy

32
Q

Treatment for Latent TB 2 Medicaitons

A

Isoniazid/Rifampin- 3 month regimen daily (300/600)
Isoniazid/Rifampin- 3 month once weekly (15mg/kg & 15-30 mg/kg)

33
Q

Tx for latent TB if intolerable to Isoniazid

A

Rifampin- 4 months daily at 400mg

34
Q

Tx of HIV positive pt

A

Refer to HIV spec, need to be treated for 12 months

35
Q

COPD Treatment

A

Bronchodilator- LABA/LAMA- LAMA- LAMA/LABA or ICS/LABA

36
Q

Dyspnea with COPD

A

LABA or LAMA
then- LABA and LAMA or LABA and ICS then
LABA + LAMA + ICS
Consider switching inhaler device or investigate other causes

37
Q

exacerbation w/COPD

A

LABA or LAMA then
LABA +LAMA or LABA + ICS then
LABA + LAMA + ICS then
Roflumilast or Zithromax- former smokers

38
Q

SABA (short acting beta2 agonists

A

Fenoterol, Levalbuterol, Salbutamol, Terbutaline

39
Q

LABA (Long acting Beta2 agonists)

A

Arformoterol, Formoterol, Indacaterol, olodaterol, salmeterol

40
Q

SAMA (short acting anticholinergics)

A

Ipratropium bromide, oxitropium bromide

41
Q

LAMA (long acting anticholinergics)

A

Aclidinium Bromide, Glycopyrronium bromide, Tiotropium, Umeclidnium, glycopyrrolate, revefenacin

42
Q

Combination SABA and SAMA

A

Fentoterol/ipratropium
salbutamol/ipratropium

CMN 568 (6 decks)

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