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mpharm year 3 sem 2 > week 7 > Flashcards

week 7 Flashcards

1
Q

what does COPD stand for ?

A

Chronic Obstructive Pulmonary Disease

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2
Q

COPD is characterised by reduced what?

A

FEV1 and FEV1/VC ratio

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3
Q

consequence of glandular hypertrophy, reduced number of cilia ?(1)

A

increased cough with or without sputum

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4
Q

consequences of cell metaplasia (increases sputum), smooth muscle hypertrophy, fibrosis (2)

A

increased mucous production
increased expiratory flow resistance

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5
Q

consequences of loss of alveolar fine structure (2)

A

loss of lung recoil
reduced gas exchange

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6
Q

name 4 clinical symptoms of COPD

A

cough
sputum
wheeze
dyspnoea (shortness of breath)

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7
Q

BODE index- what does it stand for?

A

BMI
degree of airflow Obstruction (assessed by FEV1)
Dyspnoea scale (modified medical research council)
Exercise capacity assessed by 6min walking distance test

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8
Q

why is early diagnosis for COPD so important?

A

implementation of treatment before irreversible pathological change occurs

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9
Q
  • Overweight and cyanotic (blue)
  • Elevated haemoglobin
  • Peripheral oedema
  • Rhonchi and wheezing

are characteristic of which clinical phenotype of COPD?

A

chronic bronchitis

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10
Q
  • older and thin
  • severe dyspnoea
  • quiet chest
  • x-ray hyperinflation with flattened diaphragms

are characteristic of which clinical phenotype of COPD?

A

emphysema

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11
Q

what gene contributes to genetic susceptibility to COPD?

A

Alpha one anti trypsin (α1-AT)

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12
Q

what does α1-AT do?

A

protease inhibitor
balances activity of elastase and other destructive enzyme proteases
these destroy elastin leading to loss of lung recoil and reduced gas exchange in the lung
common in emphysema

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13
Q

how does pollution affect inflammatory cells action?

A

when neutrophils, macrophages, lymphocytes etc are full of pollution/ smoking particles they cannot deal with pathogens so infections are more likely

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14
Q

why are COPD patients more likely to have infections ?

A

when neutrophils, macrophages, lymphocytes etc are full of pollution/ smoking particles they cannot deal with pathogens so infections are more likely

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15
Q

how does scar tissue affect patient’s breathing ?

A

scar tissue is not very elastic and so causes constriction and narrowing of airways

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16
Q

name 5 treatment goals in COPD

A

improving healthy status
reducing symptoms
preserving lung function decline (slowing rate of decline)
preventing exacerbations
reducing mortality

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17
Q

all COPD stage treatment

A

avoidance of risk factors (smoking, pollution)
flu vaccination

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18
Q

what is stage 0 of COPD? what are some characteristics (4)

A

at risk
chronic cough and sputum
exposure to risk factors
normal spirometry

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19
Q

what is stage 1 of COPD? what are some characteristics?

A

mild COPD
FEV1/FVC<70%
FEV<80% predicted
with or without symptoms

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20
Q

what is stage 2 of COPD? what are 2 characteristics?

A

moderate COPD
FEV1 40-59%

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21
Q

what is stage 3 of COPD? what are 2 characteristics?

A

severe COPD
FEV<40%

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22
Q

mild COPD treatment

A

short acting bronchodilator- only when required

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23
Q

moderate COPD treatment

A

regular treatment with one or more bronchodilators
rehabilitation (lifestyle changes)
inhaled steroids (only carry on if significant improvement) -stop if no response

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24
Q

severe COPD treatment

A

regular treatment with one or more bronchodilators
rehabilitation (lifestyle changes)
inhaled steroids (only carry on if significant improvement) -stop if no response
treatment of complications
long term oxygen therapy
surgical treatments

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25
name 8 different therapy options for COPD
bronchodilators beta 2 antagonists (long, short acting) muscarinic antagonists (long, short acting) inhaled steroids methylxanthines (theophylline) oxygen therapy proteases inhibitors biologics
26
why are protease inhibitors helpful in COPD treatment?
helpful in emphysema patients caused by alpha 1 anti trypsin deficiency
27
define fine particle fraction (FPF)
fraction of particles (<5 microns) that can achieve deposition in the lower respiratory tract
28
define mass median aerodynamic diameter (MMAD)
diameter at which 50% of the particles of an aerosol by mass are larger and 50% are smaller than the median diameter
29
define labelled dose (inhaler)
dose that is metered and stated on device packaging
30
define emitted dose (inhaler)
the mass of drug emitted per actuation that is actually available for inhalation at the mouth
31
define aerosol
colloidal systems consisting of very finely subdivided liquid or solid particles dispersed in and surrounded by a gas
32
name 5 advantages for local treatment of a respiratory disease
- non invasive - painless - delivers high drug concentrations directly to the disease site/sites - rapid clinical responses - bypasses barriers to therapeutic efficacy (like first pass metabolism, GI absorption) - achieve similar or superior clinical effects with much less systemic dose (less side effects)
33
name 3 disadvantages for local treatment of a respiratory disease
- administration techniques differ between and within device categories - less than optimal technique of device can therefore compromise therapeutic effect - more patient training and time is required for effective drug administration
34
name the 5 components for a pressurised meter dosed inhaler
container propellants actuator metering valve formulation
35
what is the container of a pMDI commonly made of - why is this?
aluminium inexpensive and strong enough to withstand pressure of contents inside also good for photo stability
36
what part of the inhaler is where the canister is held?
the actuator
37
what is the typical volume a metering valve will deliver?
25-100 ul
38
name 3 issues related to using ethanol within inhaler preparations
ethanol can change - the formulation density, thus the total mass of formulation atomised during device actuation - atomisation of the formulation and the size of atomised droplets - the evaporation rate of the droplets towards their residual particle sizes
39
why are drug salt forms used in inhalers?
the drug must be practically insoluble in the formulation vehicle- this is why many insoluble salt forms of drugs are used
40
what kind of mill is used to reduce particle size and ensure a narrow particle size distribution for inhaler suspension ?
spiral jet mill- reduces particle size due to high velocity drug particle- particle collisions and particle-wall collisions
41
name 4 particle interactions which can change particle size distribution
mechanical interlocking due to surface asperities capillary forces from the presence of water electrostatic interactions van der Waals forces
42
what can be used to minimise particle interactions?
use of suspending agent stabilisers like PEG
43
name 3 advantages of using a dry powder inhaler
- simpler to use (breath activated, less co-cordination required) - propellant free and environmentally friendly - stability and processing is preferred as they are formulated as one phase, solid particle blends
44
how do dry powder inhalers create an aerosol?
upon inhalation by the patient using device mouthpiece, turbulent flow is created within the reservoir- this causes de-agglomeration of the micronised API from the lactose carrier, creating an aerosol dispersion of the API for inhalation
45
name 4 important considerations of drug properties for dry powder inhalers
powder flow particle size particle shape and surface properties drug-carrier interactions
46
name the 2 common types of nebuliser design
air-jet vibration mesh
47
how does an air jet nebuliser work?
uses compressed air to generate a fine mist
48
name one advantage and one disadvantage of an air jet nebuliser
- offers a range of particle sizes, no medication restrictions - can be loud- patient setting (hopsital- disturbing others)
49
how does a vibrating mesh nebuliser work?
uses ultrasonic vibrations passed through water to generate a fine mist
50
name one advantage and one disadvantage of an vibrating mesh nebuliser
- offers consistant particle size, almost silent - medication restrictions (heat is transferred to medication- if denatured etc cannot be used)
51
patient choice for inspiratory flow of >30 L/min and good actuation
- pMDI - BA-pMDI (breath activated) - DPI - nebuliser
52
patient choice for inspiratory flow of >30 L/min and poor actuation
- pMDI+ spacer - BA- pMDI (breath activated) - DPI - nebuliser
53
patient choice for inspiratory flow of <30 L/min and good actuation
- pMDI - nebuliser
54
patient choice for inspiratory flow of <30 L/min and poor actuation
- pMDI+ spacer - nebuliser
55
name 2 formulation and device characteristics impacting PK/PD following inhalation
lung deposition (amount of distribution) mainly related to FPF pulmonary residence time of drug particle
56
name 2 drug characteristics impacting PK/PD following inhalation
receptor binding efficacy log P, solubility, pKa PK profile (metabolic features, protein binding, vd, Cl
57
name 6 limitations of chronic ICS use
systemic effects - HPA (hypothalamic-pituitary-adrenal) axis effects - growth suppression - corticosteroid induced osteoporosis (decrease osteocalcin) - skin thinning and bruising local effects - oral candidiasis - pharyngitis/ laringitis (husky, hoarse voice)
58
name 8 PK considerations for ICS
- formulation - bioavailiabilty - receptor binding affinity - on-site activation - lung residence time - lipophilicity, lipid conjugation - half life - protein binding - clearance
59
how long should we leave a COPD patient on ICS before review?
6-8 weeks if no improvement/ response then discontinue treatment
60
why should we be cautious with ICS in COPD pateints?
increased risk of pneumonia infections due to immunosuppressant effects of steroid
61
what can eospinohil counts tell us about a patient with COPD?
if these are increased can show possible responsiveness to steroid treatment
62
give 6 reasons why we use respiratory physiotherapy
- improves efficiency of ventilation - mobilises and aids secretion clearance - reduces breathlessness and work of breathing - support weaning from mechanical ventilation - maintain or improve exercise capacity - improve functional activities
63
name 4 methods of breathing control
- belly breathing - pursed lip breathing - square breathing - blow as you go
64
How does a plasma esterase perform acid and base-catalysed hydrolysis of an ester simultaneously?
doesn't let the acid and base touch as they would neutralise each other aspartate acts as base histidine acts as acid
65
what do curly arrows show? full? half?
show the movement of electrons full arrow head shows movement of pairs of electrons while a half arrow head shows movement of just one electron
66
is chronic productive cough more commonly associated with asthma or COPD?
COPD
67
is night time wakening with breathlessness/ wheeze more commonly associated with asthma or COPD?
asthma
68
is more variable symptoms day to day (dinural variation) more commonly associated with asthma or COPD?
asthma
69
which grade of COPD is not troubled except on strenuous exercise ?
grade one
70
which grade of COPD is short of breath when hurrying on the flat or walking up a slight hill?
grade two
71
which grade of COPD is walks slower than most on the flat, stops after about a mile or stops after walking 15 mins at own pace?
grade three
72
which grade of COPD is stops for breath after walking 100 yards pr a few minutes on the level?
grade four
73
which grade of COPD is too breathless to leave the house?
grade five
74
name name 8 aims of COPD management
- reduce symptoms - improve exercise tolerance - improve health related quality of life - prevent exacerbations - provide a package of care that meets the patients needs - provide treatment that minimises the risk of adverse effects - reduce mortality - prevent disease progression
75
name 4 non pharmacological treatments for COPD
- smoking cessation - pulmonary rehabilitation - vaccinations (covid, flu, pneumonia) - physiotherapy
76
treatment for breathlessness/ exercise limitations in COPD
short acting bronchodilator SAMA- Ipratropium OR SABA- salbutamol
77
treatment for exacerbations or persistent breathlessness in COPD with an FEV1 >50%
LABA - salmeterol, formoterol LAMA- tiotropium
78
treatment for exacerbations or persistent breathlessness in COPD with an FEV1 <50%
LABA- salmterol, formoterol AND ICS - budesonide or LAMA- tiotropium
79
treatment for persistent exacerbations or persistent breathlessness in COPD
LAMA- tiotropium AND LABA- salmeterol, formoterol AND ICS- budesonide
80
when are LABAs used in COPD treatment?
only in combination with ICS or LAMA

mpharm year 3 sem 2 (11 decks)

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