COPD

Question 1

COPD def

Answer 1

preventable and treatable
progressive persistent airflow limitation
chronic inflammatory response in airways
caused by noxious particles or gases

Question 2

how many cig smokers get COPD

Answer 2

15-20%

Question 3

Where does COPD rank for death

Answer 3

3rd

Question 4

What are COPD risk factors

Answer 4

smoking
indoor air pollution
occupational dust and chemicals
outdoor air pollution

Question 5

How COPD affects lungs

Answer 5

mucus hypersecretion
ciliary dysfunction
airflow limitation
hyperinflation
gas exchange abnormalities
pulmonary hypertension
systemic effects

Question 6

What are symptoms of COPD

Answer 6

dyspnea
chronic cough
chronic sputum production
exacerbations

Question 7

What is required to diagnosis COPD

Answer 7

spirometry

Question 8

What are the stages of COPD

Answer 8

GOLD 1 - Mild
GOLD 2 - Moderate
GOLD 3 - Severe
GOLD 4 - Very Severe

Question 9

What are symptoms of GOLD 1 for COPD

Answer 9

FEV1 >= 80%

no chronic symptoms

Question 10

What are symptoms of GOLD 2 for COPD

Answer 10

FEV1 between 50 and 80%

DOE

Question 11

What are symptoms of GOLD 3 for COPD

Answer 11

FEV1 Between 30 and 50%

Question 12

What are symptoms of GOLD 4 for COPD

Answer 12

FEV1 < 30%

Question 13

What txt goals COPD

Answer 13

smoke
reduce symptoms
improve exercise tolerance
minimize rate decline
maintain QOL
prevent exacerbations
limit complications

Question 14

What are the COPD management pgm

Answer 14

assess and monitor disease
reduce risk factors
manage stable COPD
manage exacerbations

Question 15

What are nonpharm COPD txts

Answer 15

smoking cessation
pulmonary rehab for GOLD 3 and 4 or B,C,D
O2
Surgery

Question 16

What are pharm txts

Answer 16

Bronchodilators

corticosteroids

Question 17

What are MOA anticholinergic bronchodilators

Answer 17

decrease cyclic GMP and cause bronchial smooth muscle relaxation

Question 18

What are adverse effects anticho bronchodilators

Answer 18

dry mouth
metallic taste
dry eyes
urinary retention
constipation

Question 19

What are the anticho broncho meds

Answer 19

Ipratropium

Tiotropium

Question 20

How use Ipratropium

Answer 20

short acting
2 puffs qid (12 in 24 hrs)
MDI or neb

Question 21

How use tiotropium

Answer 21

long acting

18 mcg inhaled via DPI qd

Question 22

What do cholinergic agents do

Answer 22

Salivation
Lacrimation
Urination
Defecation

Question 23

What are MOA B-2 agonists

Answer 23

stimulate B-2 receptors
increase CAMP
relax bronchial smooth muscle

Question 24

What are adverse effects B-2 agonists

Answer 24

tachycardia
tremor
hypokalemia

Question 25

What are the B-2 meds

Answer 25

Albuterol MDI | Salmeterol MDI

Question 26

How use albuterol MDI

Answer 26

Short acting | 2 puffs q4-6 hr prn

Question 27

How use Salmeterol

Answer 27

long acting | 1 inhalation q12h

Question 28

When use combo short acting bronchodilators

Answer 28

FEV1 < 60% Combivent (ipratropium + albuterol) 2 puffs qid

Question 29

What is MOA methylxantine bronchodilator

Answer 29

block phosphodiesterase Increase CAMP relax bronchi and pulmonary blood vessel smooth muscle

Question 30

What are adverse effects of methylxantine bronchodilator

Answer 30

``` drug interactions restlessness insomnia GERD palpitations diuresis NVD headache ```

Question 31

What is a methylxantine bronchodilator med

Answer 31

Theophylline

Question 32

When should ICS be used

Answer 32

FEV1 < 60%

Question 33

What are adverse effects of ICS

Answer 33

pneumonia candidiasis hoarse voice

Question 34

What should a ICS be used with for COPD

Answer 34

LABA

Question 35

What is a ICS med

Answer 35

Fluticasone | 88-440 mcg bid

Question 36

What is phosphodiesterase 4 inhibitor MOA

Answer 36

inhibit PDE4 involved with CAMP

Question 37

What are adverse effects with phosphodiesterase 4 inhibitor

Answer 37

``` hepatic impairment insomnia weight loss depression suicide D/N ```

Question 38

What is a phosphodiesterase 4 inhibitor med

Answer 38

Daliresp 500 mcg po qday

Question 39

What immunizations should COPD pts get

Answer 39

Influenza | Pneumococcal >65 age or FEV1 < 40%

Question 40

What are patient group A for COPD

Answer 40

GOLD 1 or GOLD 2 | CAT < 10

Question 41

What are patient group B for COPD

Answer 41

GOLD 1 or GOLD 2 | CAT >= 10

Question 42

What are patient group C for COPD

Answer 42

GOLD 3 or GOLD 4 | CAT < 10

Question 43

What are patient group D for COPD

Answer 43

GOLD 3 or GOLD 4 | CAT >= 10

Question 44

How treat Patient group A COPD

Answer 44

SAAC or SABA

Question 45

How treat patient group B COPD

Answer 45

LAAC or LABA

Question 46

How treat patient group C COPD

Answer 46

ICS + LABA or LAAC

Question 47

How treat patient group D COPD

Answer 47

ICS + LABA and/or LAAC

Question 48

What monitoring and follow-up is required for COPD

Answer 48

``` spirometry >= every year Questionaires 2-3 months symptoms each visit smoking each visit meds and inhaler technique exacerbation history comorbidities ```

Question 49

How treat COPD exacerbations

Answer 49

SA bronchodilators Oral corticosteroids (prednisone 40 mg po qd 5 days) antibiotics ( sputum purulence and dyspnea/sputum volume)