Pathology Therapeutics (General)

Question 1

Pts w/CHF are drowning in their own fluid, what will help fix this?

Answer 1

Delivering pressure

Question 2

How can you improve high RR, accessory muscle use, and WOB?

Answer 2

Start increasing/add FiO2 they were on before and wean down.

Question 3

In normal Pts, increasing RR can help blow off PaCO2 (ventilation).
- Does the same apply for pts with COPD?

Answer 3

No, in COPD pts increasing the RR consumes O2 faster and working harder with less pay off.

Question 4

COPD: GOLD A risk classification

1. Gold + Airflow limitations
2. FEV
3. Exacberations/year
4. mMRC
5. CAT

Answer 4

Low risk ; less symptoms

1. Gold 1 or Gold 2
   mild to mod airflow limitations
2. FEV1 > 80%
3. 0-1 exacerbations/year
4. mMRC grade 0-1
5. CAT < 10

Question 5

COPD: GOLD risk classification Ç
1. Gold + Airflow limitations
2. FEV
3. Exacberations/year
4. mMRC
5. CAT

Answer 5

High Risk; less symptoms

1. Gold 3 or 4
   severe -> very severe airflow limitation
2. FEV1 30-49%
3. > = 2 exacerbations/year
4. mMRC grade 0-1
5. CAT score < 10

Question 6

GOLD risk classification B

1. Gold + Airflow limitations
2. FEV
3. Exacberations/year
4. mMRC
5. CAT

Answer 6

Low risk ; more symptoms

1. Gold 1 or Gold 2
   mild to mod airflow limitations
2. FEV1 >= 80%/50 -79%
3. 0-1 exacerbations/year
4. mMRC grade > 2
5. CAT > 10

Question 7

GOLD risk classification D

1. Gold + Airflow limitations
2. FEV
3. Exacberations/year
4. mMRC
5. CAT

Answer 7

High Risk - More symptoms

1. Gold 3 or Gold 4
   Severe or very severe Airflow limitations
2. FEV1 (30-49%)
3. > 2 exacerbations/year
4. mMRC grade > 2
5. CAT > 10

Question 8

COPD: Group D treatment

Answer 8

1. LAMA
2. LAMA/LABA
3. Add ICS to either of these (LABA/ICS or triple therapy)
   or if:

• eosinophil count is >300 or
• eosinophil >100w/recent hospitalizations

Question 9

Mild exacerbation treatment (Tx)

Answer 9

Only with Short acting bronchodilator agent (SABA)

Question 10

Moderate exacerbation Tx

Answer 10

SABA plus oral antibiotics or organ care system (OCS)

Question 11

Severe exacerbation Tx

Answer 11

Hospitalization with or without resp. failure may need NIV (very beneficial), intubation/ventilation

Question 12

COPD: Group A Treatment

Answer 12

short acting bronchodilator

E.g

• Ventolin (salbutamol)
• atrovent (ipatropium)

Question 13

COPD: Group B treatment

Answer 13

LAMA or LABA

ex) serevent (salmeterol) or Spiriva (tiotropium)

Question 14

COPD: Group C treatment

Answer 14

LAMA - better effect at reducing exacerbations

ex) spiriva (tiotropium)

Question 15

COPD: Group D treatment

Answer 15

LAMA or LAMA/LABA

Add ICS to either of these (LABA/ICS or triple) if eosinophil count is >300 or >100 with recent hospitalization

Question 16

When to add PDE4 inhibitor

Answer 16

when eosinophil levels are <100 and triple therapy is not effective

Question 17

COPD: What pharmalogical plan is recommended for a increased eosinophil count of 300/ml + 1 exacerbation a year?

Answer 17

LABA + ICS assuming

• Blood eosinphil count of 300 + 1 exacerbation a year.

Question 18

How would you determine if a pattern of pathology was obstructive?

Answer 18

Spirometry test (FEV1/FVC)

Question 19

How is the CAT score determined and what does it determine?

Answer 19

8 questions on a scale w/(0-40)
- it confirms clients health status

Question 20

What does mMRC determine and how is it determined?

Answer 20

mmRC is a dyspnea scale.

Grades:

0. Only breathless w/strenuous exercise
1. SOB when hurrying on level ground or walking up a slight hill
2. On level ground, slower than ppl same age bc SOB (needs to move to own pace)
3. Stop for breath after 100 yards or a few mins on level ground
4. Too breathless to leave house or when dressing.