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568 > Unit 3-COPD > Flashcards

Unit 3-COPD Flashcards

1
Q

Essentials of dx for COPD

A

hx cig smoking

chronic cough, dyspnea, sputum production

rhonchi, decreased intensity of breath sounds and prolonged expiration

airflow limitation of PFT that is not fully reversible and progressive

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2
Q

COPD prevention

A

elimination of tobacco

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3
Q

COPD

A

presence of airflow obstruction d/t chronic bronchitis of emphysema. May be accompanied by hyper reactivity and may be partially reversible

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4
Q

Late-stage COPD complications

A

pulm HTN
Cor pulmonale
chronic respiratory failure

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5
Q

mMRC dyspnea scale

A

Grade 0: only breathless w/ strenous exercise

grade 2: walk slower than people same age, stop for breath when walking on own pace

grade 4: too breathless to leave the house or breathless when dressing/undressing

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6
Q

s/sx COPD

A

excessive cough, sputum and chronic/progressive dyspnea

periodic exacerbation of sx beyond normal day to day variation including: dyspnea, increase frequency and severity of cough, increased sputum, change in sputum

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7
Q

goal of assessment for COPD

A

determine airflow limitation, impact of disease on pt health and risk of future events >help guide therapy

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8
Q

T or F: dyspnea at rest indicates mild disease

A

FALSE

it indicates severe disease

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9
Q

what are the 2 patterns that emerge with progression?

A
  1. pink puffers emphysema predominant

2. blue bloaters chronic bronchitis predominant

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10
Q

What is chronic bronchitis?

A

excessive secretions of bronchial mucus with daily cough for 3 months for at least 2 consecutive years

BLUE BLOATERS- overweight d/t activity intolerance, elevated hgb, periheral edema d/t RHF, rhonchi and wheezing, chronic and productive cough, PaCo2 elevated

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11
Q

Dx tests of COPD

A
  • increase total lung capactiy
  • increase residual vlm
  • decrease FEV1 and FVC>air trapping
  • FEV1<40%: hypoxemia or hypercapnia
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12
Q

What is reuired to make diagnosis of COPD

A

spirometry

The presence of post-bronchodilator FEV1/FVC <70 confirms presence of persistent airflow limitation

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13
Q

dx tools for COPD

A

ABG=hypercapnia>chrnic resp acidosis> chronic resp failure

Sputum=test for colonization in bronchitis

CXR=insensitive for dx show hyperinflation w/ flattening of diaphragm

CT:more sensitive and specifi for dx

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14
Q

Empysema

A

abnormal permanent enlargement of air spaces to distal to terminal bronchiole w/ destruction of walls without obvious fibrosis

Abnormal PERMANENT enlargement and destruction of alveoli and terminal bronchiole

PINK PUFFER- older, thin, severe dyspnea, quiet chest, hyperinflated lungs and flattened diaphragm on x-ray, cough is rare, PaCo2 is normal

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15
Q

Mild COPD treated with?

A

SABA

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16
Q

Moderate COPD treated with

A

SABD’s plus abx and PO steroids

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17
Q

Blood ______ may predict exacerbation rates in pt tx w/ LABA without ICS

A

eosinophils

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18
Q

When to refer COPD

A

COPD before 40

exacerbation 2 or more despite tx

severe or rapidly progressive sx disproportionate to severity of aiflow obstruction

need for long term O2

onset of comorbid illness

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19
Q

Prevention in COPD

A

Smoking cessation

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20
Q

T or F: inhaler technique should be checked at each pt visit to continue to use correctly

A

TRUE

21
Q

What two vaccines helps with COPD

A

Influenza

Pneumococcal

22
Q

_________ improves s/sx, quality of life, and ADLS

A

pulmonary rehab

23
Q

What agents are preferred over short acting agains in t with only occasional dyspnea

a. corticosteroids
b. LABA and LAMA
c. inhaled steroids
d. none of the above

A

B. LABA and LAMA

24
Q

Which is preferred in COPD?

a. inhaled bronchodilators
b. PO bronchodilators
c. Inhaled steroids
d. PO steroids

A

A. inhaled bronchodilators

25
Q

______ is NOT recommended unless other long-term tx bronchodilators are unavailable or unaffordable

A

Theophylline.

Phosphodiesterase inhibitor

26
Q

T or F: long-term monotherapy with ICS is recommended

A

FALSE

It is NOT recommended, but may be considered given with LABA for pt with hx of exacerbation despite tx with long-acting dilators

27
Q

T or F: long-term PO corticosteroids are recommended

A

FALSE

28
Q

What medication class may be considered if LABA/ICS and LABA/LAMA/ICS still have severe airflow obsturction

A

PDE4- Phosphodiesterase inhibitor

29
Q

May medication may be considered with former smoker w/ exacerbations despite appropriate therapy?

a. PO steroids
b. Macrolides (azithro)
c. PDE4
d. Inhaled steroids

A

B.

Macrolides such as azithromycin can be considered

30
Q

T or F: Statin therapy and antixodant mucolytics are both recommended for exacerbations

A

FALSE

STATINS= NOT RECOMMENDED

ANTIXODANT MUCOLYTICS ARE RECOMMENDED in select pt

31
Q

T or F: starting pharmacoligcal tx in newly dx COPD pt is recommended

A

FALSE

There is lack of evidence supporting it

32
Q

GROUP A, 0-1 moderate exacerbations, mmMRC 0-1, CAT <10

A

All should be offered BRONCHODILATOR tx based on effect on breathlessness (short or long acting)

should be continued if benefit is documented

33
Q

GROUP B, 0-1 moderate exacerbation, mmMRC >=2, CAT >=10

A

Initial therapy should consist of long acting bronchodilator (LABA or LAMA)

Laba superior to short-acting dilators taken PRN

SEVER breathlessness: consider initial therapy w/ 2 bronchodilators

pt likely to have comorbidities that add to sx and impact prognosis

34
Q

GROUP C, >=2 moderate exacerbation or >=1 leading to hospital admit, mmMRC 0-1 CAT <10

A

initial therapy should be single long acting bronchodilator (LAMA)

35
Q

GROUP D, >=2 moderate exacerbations or >=1 hospital admit, mmMRC >=2, CAT >=10

A

Therapy with LAMA
CAT >=20 (severe breathlessness w/ exercise limits) LAMA/LABA or

ICS+LABA if eos>= 300

36
Q

Medications for smoking cessations include:

a. bupropion
b. varenicline
c. cysteine
d. all of the above

A

D. all of the above

37
Q

First line for COPD

a. LABA and SABA
b. LABA and ICS
c. SABA and ipratropium bromide
d. SAVA and SABA

A

C. SABA and ipratropium bromide

38
Q

T or F: SABA are less expensive and better pt satisfaction

A

TRUE

39
Q

SABA and anticholinergics improve bronchodilation but do not improve _____

a. nighttime awakenings
b. exercise fatigue
c. dyspnea
d. oxygen demand

A

D. Dyspnea

40
Q

T or F: LABA and ipratropium achieve or beat bronchodilation

A

TRUE

41
Q

Corticosteroids:

a. reduce exacerbations
b. impact mortality rate
c. improve functional status
d. Improve lung function
e. all of the above
f. A, C, D

A 
F. 
reduce exacerbation
no impact mortality rate
improve lung functional status
reduce decline in lung status
42
Q

Trial corticosteroids for 3-4 weeks, if improvement in FEV! by ___% or greater, continue inhaled agent

a. 15%
b. 45%
c. 20%
d. 50%

A

C. 20%

43
Q

Theophylline

A

4th line tx for pt with inhaled anticholinergics, beta 2, and corticosteroids

improved hgb during sleep and sleep disorders.
Improves dyspnea rates, exercise performance, and pulm function

44
Q

T or F: Theophylline causes brochodilation, and has anti-inflammatory properties

A

TRUE

DOES have narrow therapeutic range

45
Q

T or F: You have to monitor ranges when given theophylline

A

TRUE

very narrow range

46
Q

Abx improve outcomes in COPD with what pt?

a. acute exacerbation
b. acute bronchitis
c. prevent acute exacerbation in chronic bronchitis
d. all of the above

A

D all of the above

Those that benefit the most are those with increased sputum purulence accompanied by dyspnea or increase in quantity of sputum

47
Q

ABX that can be used?

A 
Doxy
Bactrim
Cephalosporins
MACROLIDES
Fluoroquinolones
Augmentin

DURATION 3-7 days

give if high risk: >65, FEV1 <50%, 3 or more exacerbations/year, abx past 3 mo, comorbid conditiosn

48
Q 
Goal of pulmonary rehab
a. improves exercise capacity
b. decrease hospitalizations
c. enhance quality of life
d all of the above
A

D. all of the above

49
Q

Teach pt

A

avoid cough suppressants and sedatives

adequate hydration
handheld flutter valve
postural drainage and chest percussion in thsoe w/ excessive secretions

568 (8 decks)

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