Yes book (COPD)

Question 1

What is COPD?

Answer 1

COPD is a slowly progressive disease of airflow obstruction. Involving both airways, pulmonary parenchyma, or both.
Emphysema/Bronchitis

Question 2

What is the pathophysiology of emphysema?

Answer 2

Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli

Decreased alveolar surface area increases in “dead space,” impaired oxygen diffusion

Hypoxemia results

Increased pulmonary artery pressure may cause right-sided heart failure (cor pulmonale)

Question 3

What is the pathophysiology of chronic bronchitis?

Answer 3

Cough and sputum production for at least 3 months in each of 2 consecutive years

Ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, and mucous may plug airways

Alveoli become damaged, fibrosed, and alveolar macrophage function diminishes

The patient is more susceptible to respiratory infections

Question 4

Complications of COPD include?

Answer 4

Respiratory insufficiency and failure

Pneumonia

Chronic atelectasis

Pneumothorax

Cor pulmonale

Question 5

Major risk factor for COPD:

Answer 5

Smoking, primary care = prevention, smoking cessation.

Question 6

Therapeutic management for COPD:

Answer 6

Drug Therapy, Respiratory hygiene, oxygen therapy

Question 7

How do bronchodilators work?

Answer 7

They relax smooth muscle in the airway and improve the ventilation of the lungs - can be used as monotherapy.

Question 8

What do short acting beta adrenergic agonists do?

Answer 8

Increase exercise tolerance, used in mild COPD or intermittent symptoms.

Question 9

What are the SABAs?

Answer 9

Albuterol
Atrovent
Levalbuterol HFA
Metaproterenol Sulfate

Question 10

What are the side effects of SABAs?

Answer 10

Hypersensitivity, tremor (Most common), tachycardia, palpatiations, headache, anxiety, blurred vision, GI symptoms, muscle cramps.

Question 11

What are the side effects of LABAs?

Answer 11

Dizziness, headaches, tremor, palipations, tachycardia, rash.

Question 12

Why are LABAs used?

Answer 12

Used in addition to a short-acting bronchodilator as symptoms persist or moderate stages of COPD develop. It can be used as monotherapy.

Question 13

What are the LABAs?

Answer 13

Salmeterol

Formoterol

Question 14

How are anticholinergics used to treat COPD?

Answer 14

Used for dyspnea management, improves lung function and quality of life, and decreases the number of COPD exacerbations and hospitalizations.

Question 15

What are the anticholinergics used to treat COPD?

Answer 15

Ipratropium
Tiotropium
Xanthines

Question 16

What does the nurse need to remember about Ipratropium?

Answer 16

May be used as a nasal spray to treat rhinorrhea.
Used 4x a day with MDI
Common adverse effects - Cough, nervousness, nausea, GI upset, headache, dizziness, dryness of mouth and respiratory secretions, may cause increased wheezing in some patients.

Question 17

What does the nurse need to remember about tiptropium?

Answer 17

Long acting, dosed once a day
Superior to ipratropium as an anticholinergic agent
Adverse effects: Dry mouth is primary. Also headache, dizziness, abdominal pain, constipation, diarrhea, flulike symptoms, chest pain.

Question 18

Why are Xanthines used

Answer 18

Considered a second-line agent added in severe disease inadequately controlled by first-line drugs.

Question 19

What are the Xanthines?

Answer 19

Theophylline (SIO-Bid, Theo-Dur) - oral form, used for long term treatment.
Aminophylline (IV form, 85% theophylline)

Question 20

What is important for the nurse to remember about Xanthines?

Answer 20

The exact mechanism of action is unknown. In addition to bronchodilation, thought to increase ability of cilia to clear mucus from the airways, strengthen contractions of the diaphragm, and decrease inflammation.
Monitor drug levels - toxic levels in excess of 20 mcg/ml
Drug toxicity symptoms - anorexia, nausea, vomiting, stomach cramps, diarrhea, confusion, headache, increased urination, insomnia, tachycardia, seizures

Question 21

What are the anti-inflammatory agents (Corticosteriods) used in the treatment of COPD?

Answer 21

Prednisone 
Methylpredinosone 
Hydrocortisone 
Beclomethasone 
Triamcinolone 
Budesonide 
Dexamethasone

Question 22

What are the side effects of corticosteroid use in patients with COPD?

Answer 22

Especially with high doses and long term use - hyperglycemia, fluid retention, dyspepsia, GI bleeding, impaired healing, muscle wasting, osteoporosis, susceptibility to infection, mood swings.

Question 23

What are the expectorants used in COPD?

Answer 23

Guaifensin

Question 24

How do expectorants work in COPD

Answer 24

Aids in expectoration by reducing adhesiveness and surface tension of secretions.