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pha 550 > COPD > Flashcards

COPD Flashcards

1
Q

Effects of inflammation of small airways

A

predominance of neutrophils, macrophages, cytotoxic T lymphocytes

progressive narrowing

fibrosis

destruction of lung parenchyma

destruction of alveolar walls

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2
Q

Results of inflammation

A

airway closure on expiration

air trapping and hyperinflation – DOE and exercise limitation

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3
Q

COPD: reversible

A

mucus and inflammatory cells and mediators in secretions

bronchial smooth muscle contraction in airways

dynamic hyperinflation during exercise

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4
Q

COPD: irreversible

A

fibrosis and narrowing of airways

reduced elastic recoil and loss of alveolar surface area

destruction of alveolar support with reduced patency of small airways

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5
Q

COPD: symptoms

A

chronic progressive dyspnea
cough
sputum production
wheezing and chest tightness

fatigue, weight loss, anorexia, syncope, rib fractures, ankle swelling, depression, anxiety

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6
Q

COPD: goals

A

prevent disease progression
relieve symptoms

improve exercise tolerance
improve overall health status
prevent and treat exacerbations 
prevent and treat complications
reduce morbidity and mortality
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7
Q

Classification of airflow limitation (post bronchodilator FEV1)

A

gold 1: mild: 80+%
gold 2: moderate: 50-79%
gold 3: severe: 30-49%
gold 4: very severe: <30%

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8
Q

COPD exacerbation

A

acute worsening of respiratory symptoms that result in additional therapy

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9
Q

Mild Exacerbation

A

treated with SABDs only

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10
Q

Moderate Exacerbation

A

treated with SABDs + antibiotics +/- oral corticosteroids

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11
Q

Severe Exacerbation

A

requires hospitalization or ER

may also be associated with acute respiratory failure

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12
Q

Blood Eosinophil Count

A

may predict exacerbation rates (in patients treated with LABA without ICS)

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13
Q

Bronchodilator: Beta Agonist: short acting

A

ex: albuterol

rapid onset (5 min)
duration: 2-6 hr

not as effective as in asthma

small improvement in FEV1

may improve respiratory symptoms and exercise tolerance

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14
Q

Bronchodilator: Beta Agonist: long acting

A

superior outcomes in lung function

reduced exacerbation frequency

improved quality of life

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15
Q

Bronchodilator: Beta Agonist: ADEs

A

sinus tachycardia, rhythm disturbances

skeletal muscle tremors (subside as tolerance develops)

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16
Q

Bronchodilator: Antimuscarinic (Anticholinergic)

A

ex: ipratropium (short), tiotropium (long)

competitively inhibit cholinergic receptors in bronchial smooth muscle –> bronchodilation

long acting: equal or greater efficacy than LABA

improve lung function
improve quality of life
reduce frequency of exacerbation/hospitalizations
lower morbidity and mortality risk

ADE:
dry mouth
nausea
metallic taste

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17
Q

LAMA + LABA combination therapies

A

StioltoRespimat - tiotropium bromide/olodaterol

Anoro Ellipta - umeclidinium bromide/vilanterol

Bevespi Aerosphere - glycopyrrolate and formoterol

Utibron Neohaler - glycopyrrolate/indacaterol)

18
Q

LAMA + LABA combination therapies

A

StioltoRespimat - tiotropium bromide/olodaterol

Anoro Ellipta - umeclidinium bromide/vilanterol

Bevespi Aerosphere - glycopyrrolate and formoterol

Utibron Neohaler - glycopyrrolate/indacaterol)

19
Q

Corticosteroids

A

antiinflammation

  • reduce capillary permeability –> dec mucus
  • inhibit release of proteolytic enzymes
  • inhibit prostaglandins

potentially slows disease progression

ICS for

  • severe COPD
  • high risk of exacerbations
20
Q

Corticosteroids: ADEs

A 
osteoporosis
muscular atrophy
thinning of skin
cataracts
adrenal suppression
21
Q

LABA + ICS

A

improvements in

  • FEV1
  • health status
  • frequency of exacerbations

salmeterol + fluticasone
budesonide + formoterol
mometasone + formoterol

22
Q

LABA + ICS

A

improvements in

  • FEV1
  • health status
  • frequency of exacerbations

salmeterol + fluticasone
budesonide + formoterol
mometasone + formoterol

23
Q

LABA + LAMA + ICS

A

trelegy ellipta (dry powder)

24
Q

Phosphodiesterase 4 Inhibitor: Roflumilast

A

active N oxide metabolite

  • selective PDE4 inhibition
  • antiinflammation (suppression of cytokine release)
  • dec remodeling and mucociliary malfunction
25
Q

PDE 4

A

degrades cAMP

26
Q

PDE 4 Inhibitor: ADEs

A 
HA
dizziness
insomnia
diarrhea
weight loss
nausea
appetite decreased
back pain
27
Q

PDE 4 Inhibitor: contraindication

A

mod-sev hepatic impairment

28
Q

PDE 4 Inhibitor: drug interactions

A

cimetidine, ciprofloxacin: inc serum concentration of roflumilast

roflumilast enhances effect of immunosuppressants (except: beclomethasone, budesonide)

similar mechanism to theophylline - dont use together

29
Q

Alpha Antitrypsin Replacement Therapy

A

inherited AAT deficiency associated emphysema

replace with pooled human AAT

potential reduction in lung tissue loss/destruction

30
Q

Five Step Strategy for Smoking Cessation

A 
ask
advise
assess
assist
arrange
31
Q

Smoking Cessation Pharmacotherapies

A 
Bupropion SR (insomnia, dry mouth)
Nicotine gum (sore mouth, dyspepsia)
Nicotine inhaler (sore mouth, throat)
Nicotine nasal spray (nasal irritation)
Nicotine patches (skin reaction, insomnia)
Varenicline (nausea, sleep disturbances)
32
Q

COPD: prevention and maintenance therapy

A

inhaler technique
influenza, pneumococcal vaccination
pulmonary rehabilitation
long term oxygen (severe resting chronic hypoxemia)

33
Q

COPD: Staging Acute Exacerbations

A
  1. mild: one cardinal symptom + URTI/fever/inc wheezing/inc cough/inc respiratory or HR
  2. moderate: 2 cardinal symptoms
  3. severe: 3 cardinal symptoms
34
Q

Cardinal Symptoms

A

worsening dyspnea
inc sputum volume
inc sputum purulence

35
Q

COPD: therapy for acute exacerbations

A 
antibiotics 
corticosteroids (oral or IV)
bronchodilators 
controlled oxygen therapy 
noninvasive mechanical ventilation (for acute respiratory failure)
36
Q

Noninvasive Mechanical Ventilation: contraindications

A

altered mental status
severe acidosis
respiratory arrest
cardiovascular instability

37
Q 
Which antibiotics: 
uncomplicated
<4 exacerbations/year
no comorbid illness
FEV1 >50%
A

macrolide
2nd/3rd gen cephalosporin
doxycycline

38
Q 
Which antibiotics: 
complicated 
65+ years old
>4exacerbations/year
FEV1 <50% but >35%
A

amoxicillin/clavulanate

fluoroquinolone w/ enhanced pneumococcal activity (levofloxacin, gemifloxacin, moxifloxacin)

39
Q

Which antibiotics:
complicated exacerbations with risk of P. aeruginosa
chronic bronchial sepsis
need for chronic corticosteroid therapy
resident of nursing home with <4 exacerbations per year
FEV1 <35% of predicted

A

Fluoroquinolone with enhanced pneumococcal and P. aeruginosa activity (levofloxacin)

IV therapy if required: β-lactamase resistant penicillin with antipseudomonal activity 3rd- or 4th-generation cephalosporin with antipseudomonal activity

40
Q

Indications for supplemental oxygen

A

arterial hypoxemia

  • PaO2 < 55
  • SaO2 <88%

OR

PaO2>55 but <60 with R heart failure or erythrocytosis

pha 550 (26 decks)

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