Respiratory Disorders Flashcards
For COPD, what is the assessment tool called and what is it examining?
GOLD ABCD assessment tool to figure out what treatment option is best based on likely exacerbation probability and sypmtoms
CD
AB
left side of assessment is >= 2 moderate exacerbations, or >=1 exacerbation leading to hospitalization
along bottom takes in consideration sypmtoms: mMRC 0-1 or CAT <10, mMRC >=2 or CAT >= 10
For COPD, what does the assessment say about each group and what are the treatment options?
CD
AB
Group A: mMRC 0-1 or CAT <10 with <=1 exacerbations not leading to hospitalization
*treatment: Bronchodilator
Group B: mMRC >=2 or CAT >=10 with <=1 exacerbations not leading to hospitalization
*LABA or LAMA
Group C: mMRC 0-1 or CAT <10 with >=2 moderate exacerbations or >= 1 exacerbations leading to hospitalization
*LAMA
Group D: mMRC >=2 or CAT >=10 with 0-1 moderate exacerbations not leading to hospitalizations (or for those highly symptomatic CAT >20)
*LAMA or LAMA plus LABA or ICS + LABA For those with EOS >300
**IF first exacerbation default to lower treatment
T/F: non-selective BB should be avoided in COPD and ASTHMA? what are the cardoselective BBs?
T: What are the selective BB: metoprolol, atenolol, Zebeta (bisoprolol), Bystolic (nebivolol)
What are the two SABA?
Albuterol
levalbuterol
what is the only SAMA?
Ipratropium
What are the ICS used in COPD?
Flovent/Arnuity/Armonair, fluticasone
Asmanex, mometasone
Pulmicort, budesonide
Qvar, beclometasone
What are the LAMAs?? and what are the frequencies?
Spiriva, tiotropium QD
Tudorza, aclidinium BID
Lonhala, glycopyrrolate (NEB) BID
Incruse, umeclidinium QD
Yupelri, revefenacin (NEB)
what are the LABAs?
Perforomist, formoterol (NEB) BID
Arcapta, indacaterol QD
Striverdi, olodaterol QD
Serevent, salmeterol BID
What are the 3 NEBs used in COPD?
LAMA: Lonhala, glycopyrronate BID
LAMA: Yupelri, revefenacin QD
LABA: Perforomist, formoterol BID
what are the triple therapy inhalers for COPD?
Trelegy: vilanterol, fluticasone, umeclidinium QD, DPI
Breztri: formoterol, budesonide, glycopyrrolate BID, MDI
When would you consider ICS for COPD?
When EOS >300 or EOS >100 with >=2 moderate exacerbations or >=1 mod exacer leading to hosp
Why is it risky to use ICS in COPD?
ICS inc risk for pneumonia. try to de-escalate if possible, however, since COPD progressive, deescalation is improbable.
Describe mMRC dyspnea scale 0-4
0: breathless with strenuous exercise
1: SOB when hurrying on level ground or walking up slight incline
2: walks slower than ppl of same age on level ground due to breathlessness or must stop for breath when walking at own pace on level grnd
3: Stop for breath for breath after walking 100 meters or after a few minutes on level ground
4: Too breathless to leave house or breathless when dressing/undressing
Which assessment is more convenient for COPD: mMRC or CAT? Which is more sensitive?
mMRC, CAT more sensitive
What are the three types of inhalers?
Metered dose (MDI): req coordinated activation, hand strength, slow and deep inhalation
Dry Powder (DPI): less coordination needed but req adequate peak inspiratory vol and effort
Soft Mist (SMI): gentler mist may deliver more medication but still requires coordinated activation, hand strength, and slow & deep inhalation
