Therapeutics I Exam VII (COPD) Flashcards
COPD Treatment per GOLD
1
Q
Define COPD.
A
Common, preventable, and treatable disease characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. There are two types including chronic bronchitis and emphysema.
2
Q
What is the one of the biggest differences between asthma and COPD?
A
Asthma has a greater level of reversibility than COPD.
3
Q
Define chronic bronchitis.
A
This is one type of COPD. It is a persistent cough with sputum production for most days for 3 months in 2 or more consecutive years.
4
Q
Define emphysema.
A
This is one type of COPD. It includes abnormal permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls without obvious fibrosis.
5
Q
Those with COPD chronic bronchitis will likely have more of a ____________ paired with inflammation and mucus while those with COPD emphysema have much more significant ____________ issues.
A
Cough
Breathing
6
Q
Those with emphysema are ________ retainers due to their lack of proper gas exchange from damage to alveoli.
A
Carbon dioxide
7
Q
COPD is the ________ leading cause of death in the US.
A
6th
8
Q
What are the main 5 symptoms associated with COPD?
A
- Constant coughing (also called smoker’s cough and seen more so with chronic bronchitis)
- SOB
- Dyspnea (inability to breath easily)
- Excess mucus production coughed up as sputum
- Wheezing
9
Q
Why might someone develop a constant cough or smoker’s cough after quitting smoking?
A
Cigarette smoke paralyzes the cilia in the back of the throat. When smoking is stopped, those cilia become active again and tickle the throat causing a cough.
10
Q
How do the symptoms of COPD compare to the symptoms of asthma?
A
The symptoms for COPD are much more constant and persistent dyspnea is seen with COPD. Asthma and COPD both present with symptoms of wheezing, SOB, and cough.
11
Q
Per the guidelines, when should someone be tested for COPD?
A
40 years and older with symptoms and risk factors for COPD.
12
Q
What are the 5 risk factors associated with COPD?
A
- environmental (tobacco smoke, occupational exposure, smoke from cooking)
- asthma (if not treated appropriately)
- lung growth and development (low birth weight)
- lung infections
- alpha antitrypsin deficiency
- unknown
13
Q
What is the biggest risk factor for COPD?
A
Tobacco smoke
14
Q
How does an alpha antitrypsin deficiency contribute to COPD?
A
Alpha antitrypsin is made in the liver and travels to the lungs to protect from proteases that lead to oxidative stress and damage. With this deficiency, the lungs are not as protected.
15
Q
T or F: Airflow limitation is fully reversible with COPD.
A
False. Airflow limitation will not be fully reversed even with treatment for COPD. However, with asthma, airflow limitation can typically be reversed.
16
Q
What FEV1/FVC ratio via spirometry indicates a COPD diagnosis?
A
<70% FEV1/FVC
17
Q
What 3 things seen with spirometry testing should be decreased in someone with COPD?
A
FEV1, FVC, and FEV1/FVC ratio
18
Q
How is airflow limitation categorized in COPD?
A
GOLD 1-4 classifications
19
Q
What is the FEV1 associated with GOLD 1 and mild airflow limitation in COPD?
A
FEV1 80% or greater than predicted
20
Q
What is the FEV1 associated with GOLD 2 and moderate airflow limitation in COPD?
A
FEV1 between 50 to 79%
21
Q
What is the FEV1 associated with GOLD 3 and severe airflow limitation in COPD?
A
FEV1 30 to 49%
22
Q
What is the FEV1 associated with GOLD 4 and very severe airflow limitation in COPD?
A
FEV1 < 30%
23
Q
What is the Modified British Medical Research Council Breathlessness Scale (mMRC)?
A
This is a symptom scale that can be used to evaluate the symptoms of breathlessness/dyspnea for COPD patients.
24
Q
On the dyspnea scale per the mMRC, what dyspnea symptoms are classified as Grade 0?
A
Breathlessness only occurs with strenuous exercise
25
On the dyspnea scale per the mMRC, what dyspnea symptoms are classified as Grade 1?
Breathlessness occurs when hurrying or walking up a slight hill.
26
On the dyspnea scale per the mMRC, what dyspnea symptoms are classified as Grade 2?
Patient walks slower than peer due to breathlessness and often have to stop to catch breathe when walking at a normal pace.
27
On the dyspnea scale per the mMRC, what dyspnea symptoms are classified as Grade 3?
Stopping to breath after walking about every 100 meter or every few minutes.
28
On the dyspnea scale per the mMRC, what dyspnea symptoms are classified as Grade 4?
Too breathless to leave the house or gets breathless when dressing or undressing.
29
What is the COPD Assessment Test (CAT)?
This is the other COPD symptom evaluator but this one, unlike mMRC, looks at more than just breathlessness/ dyspnea. A score of less than 10 indicates less symptoms but greater than 10 indicates more symptoms.
30
With the COPD Assessment Test (CAT), a score of less than __________ indicates less symptoms while a score of 10 or greater indicates more symptoms.
10
31
How is specific treatment for a person with COPD decided?
Once spirometry and airflow assessment is completed, a person is evaluated for exacerbations, hospitalizations, and symptom presentation. They are placed into A, B, or E category and treatment is initiated based on that category.
32
If a person has had any sort of hospitalization due to their COPD within the last year, they are automatically placed into what COPD treatment category?
Category E
33
If a person diagnosed with COPD has only had 0-1 exacerbations and has an mMRC between 0-1 and a CAT less than 10, what treatment category would they be placed in?
Category A
34
If a person with COPD has only has 0-1 exacerbations within the last year but has a mMRC 2 or more and a CAT score 10 or greater, what treatment category would they be placed in?
Category B
35
If a person has had 2 or more exacerbations due to their COPD within the last year but only has a mMRC score of 1 and a CAT score of 9, what COPD treatment category should they be placed in?
Likely category E
36
If a patient has an FEV1 of 3L post-bronchodilator (goal is 4.2L), what GOLD grade does the patient have?
GOLD looks at airflow limitation. Divide 3/4.2= 71%. This places the patient within GOLD 2 or moderate airflow limitation.
37
A patient has an FEV1 of 3L post-bronchodilator (goal is 4.2L),was found to be GOLD 2, moderate airflow limitation. In the last 5 months, the patient has been hospitalized once for COPD and has an mMRC of 1. Which risk/category are they in?
Category E
38
What guidelines are typically used for COPD?
Global Initiative for Chronic Obstructive Lung Disease 2025 Guidelines (GOLD)
39
What are the goals of therapy per the GOLD guidelines for COPD?
1. Reduce symptoms by reliving them, improving exercise tolerance, and improving health status
2. Reduce risk by preventing disease progression, preventing, treating, and increasing time between exacerbations, and reducing mortality.
40
What is the main thing that can be done for COPD to prevent disease progession?
Stop smoking
41
T or F: Per the GOLD guidelines, pulmonary rehabilitation is only indicated for risk levels B and E but this type of physical therapy is beneficial to all risk levels of COPD, including category A.
True
42
What are the 4 factors involved in pulmonary rehabilitation?
Smoking cessation, disease state education, exercise training (increase exercise without symptoms), and nutrition counselling
43
T or F: There is no link between increased time spend in pulmonary rehabilitation to increased effectiveness of the program.
False. The longer COPD patients are in the program allows the program to be more effective for them and their COPD.
44
In terms of the initial assessment with COPD, what things should be assessed?
1. Find FEV1 with spirometry and determine GOLD 1-4
2. Use CAT or mMRC to determine symptoms
3. How many exacerbations and/or hospital stays for COPD. Steps 2 and 3 determine category A, B, or E
4. Smoking status
5. Blood eosinophil count
6. Alpha1 antitrypsin levels
7. Treating comorbidites
45
Those with COPD that have a higher _________ count will respond better to inhaled cortiocsteroids.
Eosinophil
46
In terms of initial management of COPD, what are things that should be done to prevent worsening of COPD?
- smoking cessation
- vaccinations!!!!
- active lifestyle
- exercise
- manage comorbidites
- self-management education (risk factors, inhaler technique, breathlessness, and written action plans)
47
What 4 things are included within self-management education for the management for COPD?
- How to manage risk factors
- How to use inhaler
- How to tell if you are experiencing breathlessness
- Using the written action plan for COPD exacerbations
48
Per the guidelines, spirometry testing should be conducted ___________ for those with COPD. However, this typically is not the case as insurance will not cover it and the patients likely do not need it.
Annually
49
What 6 vaccines are typically recommended in those with COPD?
- COVID
- FLU
- PCV20 for pneumococcal
- RSV if 60+ and/or chronic heart/lung disease
- Shingrix if 50+
- Tdap for pertussis
50
For those categorized into risk group A for COPD, what is the pharmacological treatment?
A bronchodilator. It can be a SABA or SAMA if the person has occasional symptoms or a LABA or LAMA if the person has more than occasional COPD symptoms.
51
For those categorized into risk group B for COPD, what is the pharmacological treatment?
LABA and LAMA (single-inhaler preferred)
52
For those categorized into risk group E for COPD, what is the pharmacological treatment?
LABA and LAMA (single-inhaler preferred)
53
For those categorized into risk group E for COPD and has a blood eosinophil count 300 or greater, what is the pharmacological treatment?
LABA and LAMA (single-inhaler preferred) and an ICS
54
What is the only time in which triple therapy is initiated for COPD?
Triple therapy is only used in COPD patients categorized as Group E and has blood eosinophil counts greater than 300.
55
In terms of de-escalation of COPD therapy, which pharmacological agent is typically removed first?
The ICS
56
Lets say a COPD patient on treatment presents to the clinic for a follow-up and they are having severe dyspnea. What could be done for this patient?
First you could add either a LABA or a LAMA. If that does not work, you can add a LABA and a LAMA (single-inhaler preferred).
57
Lets say a COPD patient on treatment presents to the clinic for a follow-up and they are having exacerbations. What could be done for this patient?
First you could add either a LABA or a LAMA. If the eosinophil count is less than 300, do both LABA and LAMA (single-inhaler preferred), but if eosinophil count is greater than 300, start on LABA+LAMA+ICS.
58
What is unique about the use of LABAs in COPD and the use of LABAs in asthma?
LABAs can be used by themselves in COPD but have to be used together with an ICS for asthma to prevent the asthma-related deaths from LABAs alone.
59
Lets say someone presents with dyspnea on follow-up for COPD. They are already on a LABA and a LAMA after be categorized into risk category B. What alterations can be made to the therapies or medications?
You could switch the active ingredient for a different LAMA or LABA, switch device type (HFA vs diskus), and possibly add ensifentrine.
60
Lets say someone is experiencing COPD exacerbations on follow-up. They are already on a LABA, LAMA, and ICS as they were in risk category E and has a blood eosinophil count greater than 300. What medication could we put this patient on if they are still experiencing the exacerbations?
- Dupilumab (chronic bronchitis)
61
When would roflumilast be used in COPD treatment?
If on follow-up the patient is on a LAMA, LABA, and ICS but is still have exacerbations and has a FEV1 less than 50% and has chronic bronchitis type COPD.
62
When would azithromycin be used in COPD treatment?
It is typically used in those with COPD on follow-up who still have exacerbations after being on a LAMA, LABA, and ICS, then azithromycin could be added for its anti-inflammatory effects for previous smokers.
63
When would Dupilumab be used in COPD treatment?
If COPD patients on follow-up who are still experiencing exacerbation even on a LABA, LAMA, and ICS and still have a blood eosinophil count greater than 300 and have chronic bronchitis type COPD.
64
ICSs are mainly used in COPD for the management of ______________________.
Exacerbations
65
If the current treatment, whatever it may be, for a COPD patient is working well, we should recommend the _______ shot every year and other vaccines, assess __________ cessation, maintain ___________ activity including exercise and pulmonary rehabilitation.
Flu
Smoking
Physical
66
T or F: Triple therapy in COPD (LABA, LAMA, ICS) in a single-inhaler reduces mortality better than dual LAMA and LABA single-inhaler use.
True.
67
What 6 things are shown to reduce mortality in patients with COPD?
- LABA, LAMA, and ICS
- smoking cessation
- pulmonary rehab
- long-term oxygen therapy
- non-invasie positive pressure ventilation
- lung volume reduction surgery
68
What needs to be considered before recommending a dry powder inhaler (DPI)?
This type of inhaler requires forceful and deep inhalation to get the drug into the lungs. Those who can't take deep and froceful breaths should not be given DPI inhalers.
69
What needs to be considered before recommending a metered dose inhaler (MDI)?
The ability of the patient to coordination the spacer and the inhale while pressing the top of the inhaler. Additionally, dexterity is needed with the fingers to eject the medication.
70
What medications can be used PRN or scheduled dosing in all risk category groups (A,B, E) for COPD?
PRN SABAs (albuterol and levalbuterol) and SAMAs (ipratropium). They can also be combined in an inhaler called Combivent which contains both albuterol and ipratropium bromide.
71
What two medications are contained in the inhaler Combivent?
Ipratropium bromide (SAMA) + albuterol (SABA)
72
What are the 4 typically used LAMAs or LAACs in COPD?
- aclidinium (Tudorza Pressair)
- revefenacin (Yupelri nebulizer)
- umeclidinium (Incruse Ellipta)
- tiotropium (spiriva HandiHaler or Respimat)
73
What is the brand name for the LAMA, aclidinum?
Tudorza Pressair
74
What is the brand name for the LAAC (used like a LAMA), revefenacin?
Yupelri Nebulizer
75
What are the 2 brand names for the LAMA, tiotropium?
Spiriva Handihaler and Spiriva Respimat
76
What is the brand name for the LAMA, umeclidinium?
Incruse Ellipta
77
What is the dosing in COPD for aclidinium (Tudorza Pressair)?
1 inhalation BID (400mcg/inhale)
78
What is the dosing for COPD for revefenacin (Yupelri Nebulizer)?
175 mcg once daily (comes in little packets)
79
Revefenacin (Yupelri Nebulizer) is not recommended for use in those with any level of __________ impairment.
Hepatic
80
What is the dosing in COPD for umeclidinium (Incruse Ellipta)?
1 inhalation per day (62.5 mcg/inhale)
81
Umeclidinium (Incruse Ellipta) has not been studied, and therefore should not be used, in those with ____________ impairments.
Hepatic
82
Out of the 4 LAMAs/LAACs used in COPD, which one has the greatest systemic absorption?
Revefenacin (Yupelri Nebulizer)
83
What is the dosing for Tiotropium (Spiriva Handihaler) in COPD?
2 puffs daily from 18 mcg capsule in Handihaler device
84
What is the dosing for Tiotropium (spiriva Respimat) in COPD?
2 inhalations once daily (2.5 mcg/inhale)
85
T or F: Even though spiriva handihaler dose of tiotropium is 18mcg and in the spiriva Respimat is 2.5 mcg per inhale, both inhaler types deliver a similar amount of drug to the lungs.
True
86
What is the brand name for the LABA by itself, salmeterol?
Serevent Diskus
87
What is the brand name for the LABA itself, Formoterol?
Perforomist Nebulizer
88
What is the brand name for the LABA itself, Olodaterol?
Striverdi Respimat
89
What is the brand name for the LABA itself, Arformoterol?
Brovana Nebulizer
90
The formoterol nebulizer (Perforomist Nebulizer) has not been studied in those with ________ and _________ impairments and should therefore not be used in those populations.
Renal and/or hepatic
91
Olodaterol (Striverdi Repismat) has not be studied in those with severe _________ impairment and should therefore be avoided in this population.
Hepatic
92
What is the dosing for salmeterol (Serevent Diskus) in COPD?
50 mcg BID
93
What is the dosing for olodaterol (Striverdi Respimat) in COPD?
2 inhalations once per day (2.5 mcg/ inhale)
94
What is the dosing for arformoterol (Brovana) in COPD?
15 mcg BID (nebulized)
95
What is the dosing for formoterol (Perforomist) in COPD?
20 mcg BID (nebulized)
96
The inhaled corticosteroids, fluticasone and budesonide both are substrates for what CYP enzyme?
CYP3A4
97
Inhaled corticosteroid use in COPD is associated with an increased risk of _____________.
Pneumonia
98
T or F: Unlike asthma, where ICS dosing is low, medium, or high, in COPD, ICS dosing is a moving target and is not clear cut in COPD.
True
99
What are 3 instances where ICS should not be used with COPD?
Repeated pneumonia events, blood eosinophil count less than 100 (ICS just won't work well), and history of mycobacterial infections.
100
If a person has asthma, but only has risk category A for COPD, do we still put them on an ICS?
Yes! This person would need to be on an ICS for sure solely for the asthma (ICS-formoterol) but then other medications based on the level of asthma severity.
101
Most COPD patients only on a LABA and an ICS likely have a previous asthma diagnosis. How is COPD managed in these patients if they are not having an exacerbations and are responding to treatment?
If they have low symptoms, continue current treatment. If they have a lot of symptoms, can consider the addition of a LAMA with the LABA and ICS.
102
Most COPD patients only on a LABA and an ICS likely have a previous asthma diagnosis. How is COPD managed in these patients if they are experiencing exacerbations?
It depends on their blood eosinophil count. If it is less than 100, consider changing to a LABA and LAMA. If the eosinophil count is greater than 100, consider adding a LAMA to the LABA and ICS.
103
What is the brand name for the drug Roflumilast?
Daliresp
104
What is the MOA of Roflumilast (Daliresp)?
It is a phopshodiesterase-4 inhibitor used in those with continued exacerbations with FEV1 less than 50% and with chronic bronchitis who are already on triple therapy including a LAMA, LABA, and ICS.
105
What are the 3 contraindications for use for Roflumilast (Daliresp)?
Pregnant, breastfeeding, and child pugh score B or C
106
What is the dosing for Roflumilast (Daliresp)?
250 mcg once daily for 4 weeks followed by 500 mcg daily
107
T or F: Roflumilast (Daliresp) is a bronchodilator used for COPD.
False. It is used for COPD but it is not a bronchodilator, it is more of a maintenance medication.
108
Why is the dosing for Roflumilast (Daliresp), the way that it is?
The patient spends the first 4 weeks on the medication at tolerance dosing to help the body adjust to the side effects. After 4 weeks, the dose in brought from 250 mcg to therapeutic level of 500mcg per day.
109
Roflumilast (Daliresp) is a CYP _________ substrate and can be affected but what inducers and inhibitors of that same enzyme?
CYP3A4
CYP3A4 inducers include rifampin, phenytoin, carbamazepine, st johns wort)
CYP3A4 inhibitors include protease inhibitors, amiodarone, _____-
110
What are the 6 adverse effects associated with Roflumilast (Daliresp)?
Nausea, decreased appetite, headache, insomnia, depression, and weight loss
111
What is the brand name for the drug Ensifentrine?
Ohtuvayre
112
What is the MOA of the medication Ensifentrine (Ohtuvayre)?
It is a phosphodiesterase 3/4 inhibitor
113
What is the dosing for Ensifentrine (Ohtuvayre)?
3 mg BID (nebulizer)
114
T or F: Ensifentrine (Ohtuvayre) is not a bronchodilator.
True.
115
Where is Ensifentrine (Ohtuvayre) typically seen in the treatment of COPD?
There is limited utility of this medication at the moment but it can be used in those with COPD who on follow-up present with dyspnea.
116
What are the 4 main adverse effects associated with Ensifentrine (Ohtuvayre)?
Back pain, hypertension, paradoxical bronchospasms, and neuropsychiatric effects
117
Ensifentrine (Ohtuvayre) has not be studied in severe ___________ impairment and should therefore not be used in this population.
Renal
118
Why is azithromycin used in COPD treatment?
It can be used in those with persistent exacerbations but need to weight the risk of the symptoms and possible antibiotic resistance.
119
What is the dosing for azithromycin is COPD?
250mg once per day for 1 year
or
250-500mg 3x per week for 1 year
120
What are the 3 big side effects of azithromycin use in those with COPD exacerbations?
Antibiotic resistance, reversible hearing loss, and possible QTc prolongation
121
Azithromycin has been studied in COPD for its role in decreasing ____________.
Exacerbations
122
What 3 characteristics should be present in a patient before considering the possibly of an alpha-antitrypsin deficiency?
COPD before 45 years old, strong family history, and caucasian
123
What is the only medication that can be used for those with alpha-antitrypsin deficient COPD?
Alpha1-proteinase inhibitor (Zemaira)
124
What is the indication for use of Alpha1-proteinase inhibitor (Zemaira)?
Only used in those with alpha-antitrypsin deficiency and they also have documented emphysema.
125
What is the dosing for Alpha1-proteinase inhibitor (Zemaira)?
60 mg/kg IV every week
126
What are the 4 adverse effects associated with Alpha1-proteinase inhibitor (Zemaira)?
Infection, increase in LFTs, nausea, and hypersensitivity reactions.
127
What are the two values that indicate/define arterial hypoxemia?
- PaO2 55 mmHg or less
- SaO2 less than 88%
128
When is at-home supplemental oxygen given to patients with COPD?
If they have a PaO2 less than 55 mmHg or an O2 saturation of less than 88%
129
Why do we not just give all patients with COPD at-home supplemental oxygen?
Remember, COPD patients are CO2 retainers. By giving more oxygen, their body is producing more CO2 that is can't get rid of as well. This changes the acid base balance of the blood and can be very bad.
130
When counseling on at-home supplemental oxygen, besides what is common sense, what else should be discussed with the patient?
Use a water-based moisturizer for the nasal canula. Do not change oxygen flow rate without talking to the doctor.
131
Which RX smoking cessation product has the fastest onset of action?
Nicotine Nasal Spray (Nicotrol NS)
132
What is the dosing for smoking cessation for nicotine nasal spray?
8-40 doses per day with 1-2 doses per hour (max 5/hour and 40/day) (0.5mg/ spray).
133
What are the 2 adverse effects associated with nicotine nasal spray?
Nasal irritation and transient changes in taste and smell
134
What are the contraindications for use of nicotine nasal spray (same as OTC)?
Diabetes, uncontrolled HTN, on medications for asthma, depression, or prescription NRT, breastfeeding or pregnant, recent MI, active PUD, younger than 18, sodium restricted diet, arrhythmias, and severe reactive airway diseases, and nasal problems.
135
Each spray of nicotine nasal spray delivers _________ mg of nicotine.
0.5mg
136
With nicotine nasal spray, the absorption needs to be ___________. Do not inhale or sniff the medication.
Passive
137
How is nicotine nasal spray primed?
Pump spray 6-8 times and re-prime if not used in over a 24 hour period.
138
When should nicotine replacement therapy be started in general?
Start the replacement on the quit date.
139
What is the brand name for nicotine nasal spray?
Nicotrol NS
140
What is the brand name for Bupropion SR?
Zyban
141
What is the black box warning associated with bupropion SR (Zyban)?
Pediatric use and suicidial ideations
142
What are the 4 contraindications for use for bupropion SR (Zyban)?
- history of seizures
- history of eating disorders
- use of MAOis
- abrupt discontinuation of alcohol, BZs, Barbs, or anti-epileptic drugs
143
What two RX oral medications can be used to aid in smoking cessation?
Bupropion SR (Zyban) and Varenicline (Chantix)
144
What is the dosing for Bupropion SR (Zyban) for smoking cessation?
150 mg in the morning for 3 days then twice daily.
Start 1-2 weeks before quitting
145
For a CrCl between 15-60 mL/min, what is the maximum amount of bupropion SR that can be given?
150 mg /day maximum
146
For a CrCl below 15 mL/min, what is the maximum amount of bupropion SR that can be given?
Avoid in this population completly.
147
Bupropion dosing should be adjusted for those with _______-________ ________ impairment and completely avoided in those with _______ _________ impairment.
Mild-moderate hepatic
severe hepatic
148
What are the two main drug/enzyme interactions with bupropion SR (Zyban)?
Any drug that lowers the seizure threshold and any drug that is metabolized through CYP2D6 as this medication inhibits that enzyme.
149
What are the two adverse effects that will most likely occur in the majority of patients taking bupropion SR (Zyban)?
Dry mouth and insomnia
150
What is the brand name for Varenicline?
Chantix
151
What is the MOA for varenicline?
Partial nicotine agonist
152
What is the dosing for varenicline (Chantix) for smoking cessation?
Start 1 week before quit date:
0.5 mg once daily for 3 days
0.5 mg twice daily for 4 days
1 mg twice daily starting on quit date
153
In those with CrCl less than 30 mL/min, what is the maximum amount of varenicline that can be given?
Maximum is 1mg daily or 0.5mg BID
154
In those on hemodialysis, what is the maximum amount of varenicline that can be given?
0.5mg daily
155
What are the 3 adverse effects associated with varenicline (Chantix)?
Nausea, insomnia, and vivid dreams. Also watch out for neuropsychotic events as this used to be a contraindication for the medication.
156
What are the many precautions for use when considering the use of varenicline (Chantix) for smoking cessation?
Alcohol use (med can decrease alcohol tolerance), cardiovascular disease, nausea, pregnant, breastfeeding, seizure history, and skin reactions
157
How are seizures monitored on varenicline?
For those with and without seizure history, it is monitored for the 1 month at least in all people.
158
Why were neuropsychiatric issues a contraindication for the use of varenicline is the past?
Nicotine withdrawals symptoms can increase depression, changes in behavior, agitation, and suicidial thoughts. This medication limits withdrawal symptoms but these still need to be monitored.
159
When counseling on varenicline (Chantix), what should be discussed?
Start medication 1-4 weeks before quitting and monitor for mood changes and may experience difficulty driving. Take the medication with food to help with nausea.
160
What is a predictable symptom of varenicline (Chantix)?
Nausea
161
Patients need to watch for changes in _________ while on varenicline (Chantix), as this used to be a black box warning for the medication.
Mood
162
If a patient presents with a COPD exacerbation, what other 3 things could it also be?
Heart failure, pneumonia, or PE
163
What are the 3 severities of COPD exacberations?
Mild, Moderate, and Severe
164
If terms of COPD exacerbations, what 4 things may be given?
-Supplemental O2 to target 88-92%
- Increase SABA and/or SAMA inhaling
- oral prednisone for 5-7 days
- antibiotics if bacterial infection present
165
What 3 things need to be done on presentation for a COPD exacerbation?
- determine symptom severity (mild, moderate, or severe)
- order blood gases (important in COPD as they are CO2 retainers)
- chest radiograph
166
What are the 3 cardinal symptoms that indicate that need for antibiotics in a COPD exacerbation?
- Increased dyspnea
- increased sputum volume
- increased sputum purulence (color or consistency)
167
When are antibiotics needed in COPD exacerbations?
- all 3 cardinal symptoms present
- 2 cardinal symptoms with one being increased sputum purulence
- COPD exacberations that requires mechanical ventilation
168
A patient should follow up with their provider after a COPD exacerbation by at least _______ weeks and _______ weeks after the exacerbation.
4 weeks
16 weeks
169
How do vitamin D play in role in reducing the frequency of COPD exacerbations?
It is possible that vitamin D deficiencies contribute to COPD exacerbations.`
170
In COPD, the dosing for Breo Ellipta (Fluticasone and Vilanterol) is _______ per day.
1 puff per day
171
In COPD the dosing for other ICS/LABAs except Breo Ellipta (Fluticasone and Vilanterol), are dosed ________ per day.
Twice per day
172
What is the brand name for the LABA-LAMA, Formoterol and Aclidinium that is only indicated for COPD?
Duaklir Pressair
173
What is the brand name for the LABA-LAMA, Glycopyrrolate and formoterol?
Bevespi Atmosphere
174
How often are the LABA-LAMA combinations, Stiolto Respimat (Olodaterol and tiotropium) and Anoro Respimat (Umeclidinium and vilanterol) dosed in COPD?
1 puff daily
175
How often are the LABA-LAMA combinations, Bevespi Atmosphere (Glycopyrrolate and formoterol) and Duaklir Pressair (Formoterol and Aclidinium) dosed in COPD?
Twice daily
176
What is the brand name for the LAMA+LABA+ICS combination with Glycopyrrolate (LAMA), formoterol, and budensonide?
Breztri Aerosphere
177
What is the dosing in COPD for Breztri Aerosphere (glycopyrrolate, formoterol, and budesonide)?
2 inhalation twice daily
178
What is the dosing for Trelegy ellipta (formoterol, vilanterol, and unmeclidium) for COPD?
1 puff daily
179
What is the symbicort (budesonide and formoterol) dosing for COPD?
2 puffs twice daily
180
What is the dosing for fluticasone (Flovent) diskus in COPD?
250-500 mcg twice daily
181
What is the dosing for fluticasone and salmeterol (Advair Diskus) in COPD?
1 puff BID
182
What is the dosing for fluticasone and vilanterol (Breo ellipta) in COPD?
1 puff daily
183
What is the dosing for tiotropium Respimat in COPD?
2 puffs daily (2.5mcg per puff)
184
What is the dosing for tiotropium (spiriva) HandiHaler in COPD?
2 puffs daily (18 mcg)
185
Which class of medication is not recommended as monotherapy in COPD management?
A. LAMA
B. LABA
C. ICS
D. SABA
C. ICS
186
According to guidelines, what role does azithromycin play in COPD treatment?
A. First-line maintenance therapy
B. Used to treat acute bronchospasms
C. May reduce exacerbation frequency in former smokers
D. Replaces ICS in eosinophilic patients
C. May reduce exacerbations frequency in former smokers
187
Which condition is a contraindication to roflumilast?
A. Cardiac arrhythmias
B. Renal impairment
C. Child-pugh class B or C
D. Asthma
C. Child-pugh class B or C
188
Which of the following works by increasing sodium concentration in the airways allowing water to enter the airway and thing the mucosal layer?
A. Dornase alfa
B. Hypertonic saline
C. N-acetylcysteine
D. None of the above
E. All of the above
Hypertonic saline
189
A patient is taking Orkambi. She is also prescribed ketoconazole. What is the correct management?
A. Co-administration is not recommended
B. Reduce the frequency of dosing to 2 times weekly
C. Take 1 tab QD for a week then continue with normal dosing
D. Patients already on Orkambi do not require dose adjustments when starting ketoconazole.
D. Patients already on Orkambi do not require dose adjustments when starting ketoconazole.
190
Creon is dosed based upon __________ units.
A. Lipase
B. Amylase
C. Protease
A. Lipase
