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Therapeutics > COPD > Flashcards

COPD Flashcards

1
Q

Define Emphysema

A

Abornal enlargment of the airspace distal (Below) to the terminal of bronchioles, accompanied by destrcution of their walls and without obvious fibrisis

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2
Q

Define chronic bronchitis

A

Chrinoc cough for at least 3 months for 2 consecutive years

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3
Q

How do we diagnose COPD?

A

Spirometry

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4
Q

How how is the incidence of cigarette smoking and COPD?

A

80% of deaths

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5
Q

What are other causes of COPD?

A

Infections with chronic illnesses (HIV)
Socio-economic status
Genetic factors (1-antitrypsin deficiency)

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6
Q

What is the genetic factors that contribute to COPD hereditary

A

1-antitrypsin deficiency

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7
Q

What leads to a large occurence of emphysema?

A

Smoking

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8
Q

What other particles other then smoking can lead to increased risk factors of COPD?

A

Occupational dusts
Outdoor air pollution
Indoor air pollution

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9
Q

What infections can lead to increased incidence to COPD

A

HIV, Tuberculosis

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10
Q

What percentage of patients via genetic hereditary conditions lead to COPD?

A

5%

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11
Q

With a 1-antitrypsin deficiency what FEV1 absolute reduction can be seen?

A

7-10%

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12
Q

Is age a factor in COPD?

A

Possibly, obviously as someone who is older has longer exposure

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13
Q

Is asthma a risk factor of COPD?

A

Not necessarily it is more of a correlation

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14
Q

What is the pathophysiology of COPD?

A

Oxidative stress that leads to an neutrophil elastase reaction that leads to inflammation

Protease antiprotease

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15
Q

What is a hallmark of COPD?

A

Expiratory Flow limitation due to an increase of mucosal inflammation and airway remodelling

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16
Q

What is lung hyperinflation?

A

Obstruction of the small airways resulting in air trapping causing lung hyperinflation

Develops early and causes dypsnea

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17
Q

What happens to gas exchange in COPD?

A

Gas transfer for O2 and CO2 worsens as disease progresses

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18
Q

What is mucous hypersecretion?

A

leads to chronic productive cough, but not necessarily associated with airflow limitation

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19
Q

What occurs during exacerbations?

A

Increase hyperinflation and agas trapping with decreased expiratory flow

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20
Q

What are the three cardinal symptoms of COPD?

A

Shortness of breath
Chronic Cough
Phlegm

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21
Q

What are some other symptoms present in COPD?

A

Frequent lung infection
Reduced ability to go about daily activities
Barrel-shaped chest
Fatique
Unexplained weight loss

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22
Q

What occurs at end stage symptoms of COPD?

A

Adopt positions that relieve dyspnea
Cyanosis
Enlarged liver from right heart failure

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23
Q

How to patients initially present who have COPD?

A

Sedentary lifestyle with general fatigue
Patient has complaints of dyspnea and chronic cough
Patient who presents with episodes of cough sputum wheezing and fatigue and dyspnea

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24
Q

What is the general onset of COPD?

A

<40 years of age

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25
Q

What is the smoking history of someone who has COPD?

A

usually >10 packs-years

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26
Q

What is the sputum production in someone with COPD?

A

Often

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27
Q

Do allergens usually lead to COPD?

A

No/Infrequent

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28
Q

What are the clinical symptoms of COPD in terms of progression?

A

Persistent and progressive

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29
Q

What type of airway inflammation is COPD usually associated with?

A

Neutrophilic

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30
Q

How is COPD diagnoses?

A

We focus on Shortness of breath
Chronic Cough
Phlegm

Other secondary symptoms such as lung infections and barrel shaped chest

(Other co-mborbidities present)

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31
Q

What is spirometry measurement required for COPD diagnosis?

A

Spirometry post-bronchodilator FEV1/FVC ration <0.7 confirms diagnosis

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32
Q

How do we stage COPD?

A

FEV1 value

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33
Q

What are the risk factors for those who may have COPD (Screening)

A

Smoker, Persistent cough, RTI, SOB, evening wheeze

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34
Q

What is the pulmonary function testing?

A

Used to determine degree of reversibility

FEV <80%, FEV1/FVC ratio <0.7

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35
Q

What are the assessment of risk factors that we can measure

A

Quantification of tobacco consumption

Environmental exposures

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36
Q

What is the formula for determining pack years?

A

(# cigarettes smoker per day/20)*# years of smoking

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37
Q

What is the MRC dyspnea scale or CAT test?

A

used for the assessment of severity of breathlessness

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38
Q

What is the CAT test?

A

8 item and simple patient completed questionnaire for the purposes of monitoring COPD progression

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39
Q

Who do we usually suspect COPD in (population)?

A

Age >40 years
Smokers or ex smokers
Progressive dyspnea, worse with exercise

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40
Q

What is the definition of spirometry realted to COPD?

A

FEV1/FEVc ratio less then 70% after a bronchidilator

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41
Q

What is considered mild stage COPD? (FEV1)

A

> 80% of predicted

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42
Q

What is considered moderate stage COPD? (FEV1)

A

50-79

43
Q

What is considered severe stage COPD? (FEV1)

A

30-49%

44
Q

What is considered very severe stage COPD? (FEV1)

A

<30%

45
Q

Do we treat based off the symptoms of the spirometry results (FEV1) with COPD?

A

Symptoms, we want them to feel better

46
Q

When we compare asthma what is the criteria?

A

FEV1/FVC ratio 75-80% with 12% improvement post bronchodilator

47
Q

When we evaluate COPD what is the criteria?

A

FEV1/FVC <70% is diagnostic, FEV1 used to stage/determine severity

48
Q

Why should we provide smoking cessation resources for COPD?

A

Reduces to risk of developing COPD and the only intervention has been shown to slow its progression

49
Q

What type of difference do we see in indivudals who stop smoking at an earlier stage.

A

As we age we seea decrease in FEV1, hence quitting early slows the deterioration of COPD

50
Q

What type of drug classes should those with COPD avoid? Why?

A

Narcotics/sedatives due to the respiratory depression (Only exacerbate the issue more.

51
Q

What vaccines are especially for individuals with COPD?

A

Influenza vaccine, pneumococcal vaccine, and Covid-19 vaccine

52
Q

When is long term oxygen therapy introduced with people living with COPD>

A

When someone has severe hypoxemia and they have a goal of PaO2 of greater then 60mmHg

53
Q

What drug class has a larger role in COPD treatment?

A

Muscarinic antagonists (SAMA/LAMA)

54
Q

What drug class plays less of a role in COPD treatment?

A

ICS

55
Q

What are our short acting bronchodilators for usage in COPD patients?

A

Salbutamol and Terbutaline

56
Q

What are our SAMA for usage in COPD patients?

A

Ipratropium

57
Q

What is the combination therapy of SABA + SAMA use for therapy in COPD?

A

Salbutamol and Ipratropium

58
Q

What type of usage is SABA therapy used in COPD patient?

A

PRN and higher doses are obviously used for more bronchodilaton

May increase beyond recommended dose in severe disease states

59
Q

When is the SABA + SAMA used in COPD treatment?

A

usually during asthma exacerbation or initial COPD treatment

60
Q

What is a possible S/E from our SAMA/LAMA therapy

A

Dry mouth
constipation
Headache
Possible cardiovascular

Rinse mouth to avoid the dry mouth S/E

61
Q

What are our long acting bronchodilators? SABA (4)

A

Salmeterol
Formeterol
Indacaterol
Olodaterol

62
Q

What are our long acting muscarinic antagonists? LAMA

A

Tiotropium
Aclindinium
Glycopyrronium
Umeclidinium

63
Q

What are the differences between LAMA and LABA therapy

A

LAMA is generally more tolerated

Main difference in S/E is drymouth/constipation in LAMA

LAMA (Tiotropium) may be superior in decreasing exacerbations

64
Q

Which drug should not be used as monotherapy in COPD

A

ICS

65
Q

What type of cellular increased count will patients generally respond to better with respect to ICS

A

Eosinophil count

66
Q

Why would we recommend prophylactic azithromycin for a patient?

A

Aids in inflammation

67
Q

What is N-acetylcysteine

A

Potentially used in COPD for the resolution or reduction of exacerbations in those who had greater then 2 events in the previous 2 year period

68
Q

What is Roflumilast?

A

This is a PDE4 inhibitor that improves FEV1 and decreases exacerbations

69
Q

What is Theophylline?

A

Bronchodilator, but has a range of side effects

70
Q

What is considered a mild exacerbation?

A

Worsening or new respiratory symptoms without a change in prescribed medications

71
Q

What is a moderate exacerbation?

A

Prescribed an antibiotic and oral corticosteroid

72
Q

What is considered a severe exacerbation?

A

Requires hospital admission or ED visit

73
Q

What is considered to a a low-risk of exacerbations

A

If they had 1 or less moderate exacerbation in the last year and did not require an ED visit or hospitalization

74
Q

What is considered a high-risk of exacerbations

A

If they had at least 2 moderate or 1 severe exacerbation in the last year requiring hospital admission

75
Q

What is the therapy used for mild COPD?

A

LAMA or LABA

76
Q

What is the therapy used for low AECOPD Risk?

A

LAMA/LABA then LAMA/LABA/ICS

77
Q

What is the therapy used for high AECOPD Risk?

A

LAMA/LABA/ICS** Where the ICS may be added if the patient also has asthma or

LAMA/LABA/ICS + Prophylactic macrole/PDE4- inhibitor, mucolytic agents

78
Q

What are considered our last ditch therapies for COPD?

A

Lung volume reduction surgery

Lung Transplant

79
Q

When would we consider stepping down COPD therapy?

A

When side effects are exceeding the benefit

80
Q

What encompasses AECOPD?

A

Reduced health related quality of life
Increased mortality
Accelerated decline in lung function
increase health resource utilization and cost

81
Q

What is the treatment for an acute exacerbation?

A

Bronchodilator
Systemic steroid
Consider antibiotic

82
Q

What percentage of AECOPD are thought to be infectious in nature?

A

50%

83
Q

What is considered the symptoms of simple COPD?

A

Cough, sputum, dyspnea,

84
Q

What is considered as antibiotic 1st line treatment for simple COPD?

A

amoxicilin doxy, cotrimoxazole

85
Q

What is considered complicated COPD?

A

FEV1 <50%

86
Q

What abx are used to treat complicated COPD AECOPD?

A

amox/clav
Cefuroxime axetil
Levofloxacin

87
Q

If someone has a FEV1 >80% predicted what is their stage in accordance to the Canadian Thoracic Society?

A

Mild

88
Q

If someone has a FEV1 50-79% predicted what is their stage in accordance to the Canadian Thoracic Society?

A

Moderate

89
Q

If someone has a FEV1 30-49% predicted what is their stage in accordance to the Canadian Thoracic Society?

A

Severe

90
Q

If someone has a FEV1 <30% predicted what is their stage in accordance to the Canadian Thoracic Society?

A

Very Severe

91
Q

Post bronchodilator if FEV1/FVC is less then _____ is diagnostic while _____ use to stage/determine severity

A

70%, FEV1

92
Q

What is Titropium?

A

LAMA

93
Q

What is Aclindinium?

A

LAMA

94
Q

What is Glycopyrronium>?

A

LAMA

95
Q

What is Umeclidinium?

A

LAMA

96
Q

When would we consider stepping down therapy for COPD?

A

If treatment benefits not realized or side effects exceed benefits

97
Q

What are the four consequences of AECOPD?

A

Reduce health related quality
Increased mortality
Accelerated decline in lung function
Increased health resource utilization and costs

98
Q

What are the Simple COPD without risk factors antibiotic treatment?

A
99
Q

What are the COmplicated COPD with risk factors treatment?

A
100
Q

What is considered moderate therapy for COPD? What is FEV?

A
101
Q

What is considered Severe therapy for COPD? What is FEV?

A
102
Q

What is considered therapy for Mod/Sev COPD with Low AECOPD risk? ? What is FEV?

A

Picture

103
Q

What is ipratropium>

A

SAMA

104
Q
A

Therapeutics (10 decks)

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