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NAPLEX 25 > Chapter 42: COPD > Flashcards

Chapter 42: COPD Flashcards

(73 cards)

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1
Q

What is chronic obstructive pulmonary disease (COPD)?

A

A respiratory condition that causes obstructed airflow from the lungs.

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2
Q

What are the most common causes of COPD?

A

Tobacco smoke and other air pollutants (e.g., smoke from fires, coal burning, marijuana, occupational hazards).

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3
Q

What is the result of long-term exposure to gases or particles causing COPD?

A

Chronic inflammation in the lungs, leading to emphysema and/or bronchitis.

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4
Q

Define emphysema.

A

Destruction of the small passages in the lungs, called alveoli.

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5
Q

Define bronchitis.

A

Inflammation and narrowing of the bronchial tubes that results in mucus production.

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6
Q

What genetic condition increases the risk of developing COPD?

A

Alpha-1 antitrypsin (AAT) deficiency.

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7
Q

What symptoms should prompt suspicion of COPD?

A

Chronic, progressive symptoms such as dyspnea (shortness of breath), cough, sputum production, and wheezing.

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8
Q

What risk factors are associated with COPD?

A

Exposure to tobacco smoke.

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9
Q

How does airflow limitation in asthma differ from that in COPD?

A

In asthma, airflow limitation is reversible with medication; in COPD, it is not fully reversible and progresses over time.

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10
Q

What is the primary purpose of spirometry?

A

To assess lung function and make a diagnosis of COPD

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11
Q

A post-bronchodilator FEV1/FVC ratio of _______ confirms a diagnosis of COPD.

A

< 0.70

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12
Q

What is the typical age of onset for COPD?

A

Usually > 40 years

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13
Q

Is a smoking history common in COPD patients?

A

Usually > 20 years

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14
Q

What is the first-line treatment for COPD?

A

Bronchodilators

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15
Q

What is the first-line treatment for asthma?

A

Inhaled corticosteroids

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16
Q

What are the four components of a COPD assessment?

A
  • Degree of airflow limitation
  • Symptom assessment
  • Risk of exacerbations
  • Presence of comorbidities
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17
Q

What does the post-bronchodilator FEV1 assess?

A

The severity of airflow limitation

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18
Q

How does the GOLD grading system classify COPD severity?

A

In patients with FEV1/FVC < 0.7:
* GOLD 1: Mild (FEV1 ≥ 80% predicted)
* GOLD 2: Moderate (FEV1 50-79% predicted)
* GOLD 3: Severe (FEV1 30-49% predicted)
* GOLD 4: Very severe (FEV1 < 30% predicted)

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19
Q

What does mMRC dyspnea scale assess?

A

Breathlessness

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20
Q

What is assessed by COPD Assessment Test (CAT)?

A

This test assesses various symptoms of COPD, with higher scores indicating more severe symptoms.

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21
Q

What defines a COPD exacerbation?

A

An increase in respiratory symptoms that worsen over < 14 days

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22
Q

What components drive the combined assessment of COPD?

A
  • Symptom assessment
  • Risk of exacerbations
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23
Q

How are patients assigned in the combined assessment of COPD?

A

Patients are assigned to a group (A, B, or E) based on symptoms and exacerbation history

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24
Q

Which patients fall under Group E COPD?

A
  • > =1 exacerbation leading to hospitalization per year
  • > = 2 moderate exacerbation (treated with steroids or antibiotics) per year
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25
Which patients fall under Group A COPD?
0 or 1 moderate exacerbation without hospitalization AND CAT < 10 AND mMRC 0-1
26
Which patients fall under Group B COPD?
0 or 1 moderate exacerbation without hospitalization AND CAT >= 10 or mMRC >=2
27
What is an essential management strategy proven to slow the progression of COPD?
Smoking cessation
28
What should patients with COPD receive according to ACIP recommendations?
All age-appropriate vaccines, including an annual influenza vaccine and pneumococcal vaccinations
29
How to improve outcomes in COPD patients?
* Routinely assess inhaler technique and adherence
30
What is the primary goal of medications used to treat COPD?
Decrease symptoms and/or prevent complications such as exacerbations and hospitalizations.
31
What factors should a patient's treatment regimen for COPD be based on?
CAT and/or mMRC score and risk of exacerbations.
32
What types of bronchodilators can be used for patients with intermittent symptoms?
Short-acting beta-2 agonist (SABA) or short-acting muscarinic antagonist (SAMA).
33
What treatments may be appropriate for patients with more persistent symptoms?
Long-acting beta-2 agonist (LABA) and/or long-acting muscarinic antagonist (LAMA).
34
In which patients are inhaled corticosteroids (ICS) recommended?
Select patients with a history of exacerbations and an eosinophil count ≥ 300 cells/uL.
35
Why is ICS not recommended for patients with lower eosinophil counts?
There is no demonstrated benefit for < 100 cells
36
What combination treatment is often required for COPD patients?
LABA + LAMA +/- ICS.
37
What is preferred to improve adherence in combination treatment?
A single inhaler containing 2 - 3 medications.
38
What should all patients receiving long-acting bronchodilators also be prescribed?
A SABA and/or SAMA for acute symptoms.
39
What is the treatment recommendation for patients with only occasional dyspnea?
Short-acting bronchodilators (i.e., SAMA or SABA) may be used.
40
What is the initial recommended therapy for Group A patients?
A bronchodilator * SAMA PRN * SABA PRN * LABA or LAMA
41
What is the initial recommended therapy for Group B patients?
LAMA + LABA
42
What is the initial recommended therapy for Group E patients?
* LAMA + LABA +/- ICS
43
What are the steps of esclation of therapy if the primary problem is dyspnea?
1. LAMA or LABA 2. LAMA + LABA 3. Switch inhaler 4. Look for other causes of SOB
44
What are the steps of esclation of therapy if the primary problem is exacerbation?
45
What is the acute treatment used for COPD exacerbation?
SABA+/- SAMA, oxygen, systemic steroids
46
What do muscarinic antagonists do in the treatment of COPD?
They cause bronchodilation by blocking the constricting action of acetylcholine at M3 muscarinic receptors in bronchial smooth muscle
47
List SAMAs available for COPD!
1. Ipratropium bromide (Atrovent HFA) 2. Ipratropium + Albuterol (Combivent respimat)
48
Ipratropium bromide brand name
Atrovent HFA
49
What are the medications in Combivent respimat?
Ipratropium + Albuterol
50
What is the dosing for Ipratropium bromide (Atrovent HFA) in MDI form?
2 inhalations Q4-6H PRN
51
What is the dosing for Combivent respimat in MDI form?
1 inhalations Q4-6H PRN
52
List LAMA available for COPD
1. Tiotropium (Spiriva handihaler (DPI) and Spiriva respimat (MDI)) 2. Aclidinium (Tudorza pressair (DPI)) 3. Glycopyrrolate + formoterol + budesonide (Breztri Aerosphere) 4. Umeclidinium + Vilanterol + Fluticasone (Trelegy Ellipta)
53
Tiotropium brand name
1. Spiriva HandiHaler (DPI) 2. Spiriva Respimat (MDI)
54
Aclidinium brand name
Tudorza Pressair
55
What combination medication is Breztri Aerosphere?
LAMA + LABA + ICS * Glycopyrrolate * Formoterol * Budesonide
56
What combination medication is Trelegy Ellipta?
LAMA + LABA + ICS * Umeclidinium * Vilanterol * Fluticasone
57
What are common side effects of SAMA & LAMA?
Dry mouth, upper respiratory tract infections, cough, bitter taste
58
What monitoring is required for patients using SAMA or LAMA?
S/sx at each visit, smoking status, COPD questionnaires, annual spirometry
59
What is the dosing for Tiotropium (Spiriva HandiHaler)?
Inhale contents of 1 capsule via HandiHaler device daily (requires 2 puffs)
60
What is a key note regarding the HandiHaler device?
Do not swallow the capsules by mouth
61
What should patients do to prevent oral candidiasis when using inhalers with ICS?
Rinse mouth with water and spit
62
What is the effect of beta-2 agonists on bronchial smooth muscle?
Causes relaxation
63
For which condition can LABAs be used as monotherapy?
COPD
64
List Single drug LABA!
1. Salmeterol (Serevent Diskus) 2. Formoterol 3. Olodaterol 3. Vilanterol (only in combo)
65
List Dual therapy LABA + LAMA
1. Formoterol + Glycopyrrolate (Bevespi Aerosphere) 2. Ododaterol + Tiotropium (Stiolto Respimat) 3. Vilanterol + Umeclidinium (Anoro Ellipta)
66
What is Bevespi Aerosphere composed of?
Formoterol + Glycopyrrolate
67
What are the active ingredients in Stiolto Respimat?
Olodaterol + Tiotropium
68
What combination is found in Anoro Ellipta?
Vilanterol + Umeclidinium
69
What are the side effects associated with LABA?
* Nervousness * Tremor * Tachycardia * Hyperglycemia * Hypokalemia
70
What is the MOA of Roflumilast?
It's a PDE-4 iinhibitor that blocks the breakdown of cAMP, thereby increasing it's duration of action.
71
What is the role of cAMP in COPD?
Opens up the airways by causing smooth muscle relaxation in the bronchi.
72
What is the CI associated with Roflumilast?
Moderate to severe liver impairment
73
What is the most conserning side effect of Roflumilast?
Weight loss

NAPLEX 25 (33 decks)

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