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COPD Flashcards

(102 cards)

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1
Q

what is different about the airflow limitation in COPD compared to asthma

A

it is not reversible in COPD

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2
Q

_____ is chronic/recurrent excessive mucus secretion

A

chronic bronchitis

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3
Q

____ is permanent enlargement of air spaces, leading to destruction of the lung’s smallest structures where gas exchange occurs

A

emphysema

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4
Q

avoidable risk factors for COPD

A

tobacco smoke, occupational dusts and chemicals, air pollution

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5
Q

non-modifiable risk factors for COPD

A

genetic predisposition (AAT deficiency), airway hyperresponsiveness, impaired lung growth

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6
Q

what does AAT normally do

A

coats the lungs and protects them from neutrophil elastase

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7
Q

what is neutrophil elastase

A

produced by white blood cells to break down harmful bacteria, potentially damaging to lungs if exposed

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8
Q

what happens with AAT deficiency

A

lungs lack the AAT coating, leaving them open to damage by neutrophil elastase. AAT trapped in the liver, causing liver damage

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9
Q

GOLD Grade 1

A

mild, FEV1 > 80% predicted

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10
Q

GOLD Grade 2

A

moderate, FEV1 50-80% predicted

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11
Q

GOLD Grade 3

A

severe, FEV1 30-50% predicted

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12
Q

GOLD Grade 4

A

very severe, FEV1 <30% predicted

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13
Q

CAT assessment

A

score 10 or more means symptoms not controlled

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14
Q

mMRC dyspnea scale

A

score 2 or more means symptoms not controlled

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15
Q

GOLD E

A

2 or more moderate exacerbations, or 1 or more leading to hospitalization

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16
Q

GOLD A

A

0 or 1 moderate exacerbations (not hospitalization), mMRC 0-1 and CAT <10

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17
Q

GOLD B

A

0 or 1 moderate exacerbations (not hospitalization), mMRC 2+, CAT 10+

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18
Q

PDE4 inhibitor

A

roflumilast

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19
Q

roflumilast place in therapy

A

only recommended after recurrent exacerbations despite triple inhaler therapy

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20
Q

roflumilast side effects

A

nausea, diarrhea, decreased appetite, weight loss, headache, neuropsychiatric effects

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21
Q

theophylline place in therapy

A

considered in acutely ill patient when other long-term treatment bronchodilators are unavailable or unaffordable. therapeutic range is trough of 8-15 mcg/mL. monitor concentrations 1-2x/yr

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22
Q

azithromycin place in therapy

A

chronic therapy reduced exacerbations and improved QOL over one year, but can lead to macrolide resistance among lung flora

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23
Q

mucolytics (NAC) place in therapy

A

commonly started during hospitalizations, reduction of exacerbations in patients with moderate disease over 1 year, breaks up mucoproteins and lowers viscosity so easier to cough up

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24
Q

therapy for group E

A

LABA + LAMA (consider + ICS if blood eos >300)

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25
therapy for group A
a bronchodilator
26
therapy for group B
LABA + LAMA
27
symptoms of COPD exacerbation
increase in sputum volume, increase in sputum purulence, dyspnea
28
outpatient management for COPD mild-moderate exacerbations
SABA, prednisone 40 mg daily for 5 days, azithromycin or doxycycline for 5-7 days, supplemental O2
29
bupropion SR mechanism
enhances noradrenergic and dopamine release
30
varencicline mechanism
partial a4b2 nicotinic receptor agonist, blocks nicotine from receptor binding sites to reduce the reward effects
31
varenicline warnings
black box for neuropsychiatric symptoms removed in 2016. several renal impairment (adjust dose), pregnancy and breastfeeding, adolescents < 18, monitor patients with severe/unstable CV
32
varenicline adverse effects
nausea, sleep disturbance (insomnia, abnormal/vivid dreams), constipation, flatulence, vomiting
33
varenicline dosing
start 1 week prior to quit date. Days 1-3: 0.5 mg once daily with food or water for nausea. Days 4-7: 0.5 mg twice daily (take second dose with evening meal instead of HS if causing insomnia). Day 8-Week 12: 1 mg twice daily
34
varenicline duration
12 weeks, with an additional 12 weeks for successful quitters. (up to 12 months if needed/covered)
35
counseling for varenicline
report changes in mood, thinking, behavior (quitting smoking itself can change mood)
36
when is varenicline useful
when other agents have failed because it has a different MOA. can be used in combination with NRT agents and bupropion.
37
bupropion contraindications
seizures, eating disorders, MAOIs
38
bupropion boxed warning
neuropsychiatric symptoms: suicidal ideation, aggression, depression
39
bupropion precautions
concomitant medications that lower seizure threshold, hepatic impairment, pregnancy and breastfeeding, adolescents <18
40
bupropion side effects
insomnia, dry mouth
41
bupropion dosing
start 1-2 weeks before quit date. 150 mg daily for first 3 days. Then 150 mg BID dosed at least 8 hours apart.
42
bupropion duration of therapy
7-12 weeks, up to 6 months
43
when to consider bupropion
if depression is a comorbidity. may also blunt post-cessation weight gain
44
bupropion counseling
avoid bedtime dosing with insomnia risk (8a/4p)
45
NRT general contraindications
MI past 2 weeks, serious arrhythmias, unstable or worsening angina, pregnancy or breastfeeding, adolescents <18
46
additional contraindications for NRT patch
skin disorders
47
additional contraindications for NRT gum
temporomandibular joint disease
48
additional contraindications for nicotine inhaler
bronchospastic disease
49
additional contraindications for nicotine nasal spray
reactive airway disease or nasal conditions
50
NRT patch side effects
headache, sleep disturbance (insomnia, abnormal dream), skin irritation
51
dosing for NRT patch if >10 cigarettes/day
21 mg/day for 4-6 weeks. 14 mg/day for 2 weeks. 7 mg/day for 2 weeks.
52
dosing for NRT patch if <10 cigarettes/day
14 mg/day for 6 weeks. 7 mg/day for 2 weeks
53
NRT patch duration of therapy
8-10 weeks, has been extended to 6 months
54
NRT patch counseling
change patch daily upon awakening. recommend wearing for 24 hours to start, remove at bedtime if sleep disturbance. apply to clean, dry, hairless, minimal perspiration area. rotate daily
55
NRT gum side effects
mouth/jaw soreness, dyspepsia, hiccups, hypersalivation. if incorrect technique: lightheadedness, nausea, throat and mouth irritation, problematic with dental work
56
instructions for NRT gum
"chew and park" 1 piece of gum with urge to smoke up to 24 pieces/24 hours
57
when to use 2 mg gum dosage
<25 cigarettes/day or 1st cig >30 mins of waking
58
when to use 4 mg gum dosage
>25 cigarettes/day or 1st cig <30 mins of waking
59
gum dosing weeks
weeks 1-6: chew 1 piece q1-2h, at least 9 pieces/day if monotherapy. weeks 7-9: chew 1 piece q2-4h. weeks 10-12: chew 1 piece q4-8h
60
NRT gum duration of therapy
12 weeks, some users extend beyond 3 months
61
NRT gum pros
oral tobacco substitute, can delay weight gain, titrate to manage symptoms while combining with other NRT
62
NRT gum counseling
no food/acidic beverage 15 min pre and post, rotate areas in mouth
63
NRT lozenge side effects
nausea, cough, headache, dyspepsia, hiccups, insomnia
64
when to use 4 mg NRT lozenge
smoke first cigarette <30 min of waking
65
when to use 2 mg NRT lozenge
smoke first cigarette >30 min of waking
66
NRT lozenge dosing weeks
weeks 1-6: one lozenge q1-2h. weeks 7-9: one lozenge q2-4h. weeks 10-12: one lozenge q4-8h. use at least 9 lozenges/day for the first 6 weeks if monotherapy, max 20 lozenges/day
67
NRT lozenge duration of therapy
12 weeks-6 months
68
NRT lozenge pros
oral tobacco substitute, can delay weight gain, titrate to manage symptoms while combining with other NRT
69
NRT lozenge counseling
allow to dissolve slowly (10 min minimum, 20-30 min standard). no food/beverage 15 min pre and post.
70
nicotine inhaler side effects
mouth/throat irritation, dyspepsia, hiccups, cough, rhinitis
71
nicotine inhaler instructions
6-16 cartridges per day, best with continuous active puffing for 20 minutes. inhale into back of throat or puff in short breaths, do not inhale like a cigarette. initial 1 cartridge q1-2h.
72
nicotine inhaler duration of therapy
3-6 months
73
pathologic changes in COPD
decreased ciliary motility, mucus hypersecretion, smooth muscle thickening, chronic inflammation: scarring and fibrosis
74
key cells in COPD versus asthma
COPD: neutrophils, large increase in macrophages, CD8 asthma: eosinophils, mast cells, CD4
75
response to ICS in COPD
variable
76
key differences in COPD vs asthma
COPD: later in life, cough and sputum, no allergic component, airflow limitation cannot be reversed asthma: early in life, cough and wheeze, triad of allergic diseases, airflow limitation is reversible, FEV1 improves after SABA
77
what to prioritize if a patient has asthma and COPD
prioritize asthma treatment, smoking cessation, LAMA, pulmonary rehab, mucolytics
78
COPD symptoms
chronic cough, chronic sputum production, dyspnea progress over time
79
physical exam: COPD
shallow breathing, increased RR, barrel chest due to hyperinflation, pursed lip breathing on exhalation, use of accessory muscles, cachexia, central cyanosis
80
what is required for COPD diagnosis
spirometry: FEV1/FVC <0.7
81
what are some factors that can affect spirometry results
age, height/weight, sex, smoking status, patient effort and coordination, previous pulmonary disease, ethnicity
82
what is a mild COPD exacerbation treated with
SABDs
83
what is a moderate COPD exacerbation treated with
SABDs+ antibiotics and/or oral corticosteroids
84
SAMA MOA
blocks acetylcholine at muscarinic receptors--> decrease smooth muscle contraction
85
ipratropium onset
15-20 mins
86
ipratropium frequency
6 hrs
87
SAMA adverse
dry mouth, metallic taste
88
LAMA advantages over SAMA
better improvement in lung function and symptoms, more convenient dosing (once or twice daily), reduced exacerbations and hospitalization
89
LABA adverse
tachycardia and arrhythmias
90
ICS MOA
anti-inflammatory to decrease mucus, inhibit leukocytes and prostaglandins
91
role of ICS in COPD
no clear benefit for lung function but can reduce exacerbation frequency, never first line and always in combo with LABA due to lack of benefit. can cause pneumonia after long term use
92
what is roflumilast not recommended for
use with theophylline
93
vaccinations for COPD
Flu, COVID, pneumococcal, Tdap, zoster
94
pneumococcal recommendations for COPD
reduces incidence of CAP and exacerbations: one dose of PCV20. Or one dose of PCV15 followed by PPSV23
95
when to consider LABA + LAMA + ICS
if blood eosinophils >300
96
when to consider roflumilast
FEV1<50% and chronic bronchitis
97
when to consider azithromycin
former smokers
98
signs of severe exacerbation
sputum purulence, sputum volume, dyspnea or signs of respiratory failure: mental status changes, RR>30, hypoxemia with supplemental O2
99
on average, how many attempts are necessary for a patient to quit smoking successfully
7
100
how many cigarettes does a usual pack contain
20
101
5 A's for smoking cessation program
ask, advise, assess, assist, arrange
102
stages of change for smoking cessation
precontemplation, contemplation, preparation, maintenance, relapse

Pulmonology (2 decks)

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