Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharm exam 2 > COPD > Flashcards

COPD Flashcards

1
Q

What is COPD?

A
  • A progressive resp. disease characterized by airflow limitation that is not fully reversible.
  • Abnormal inflamm. response in the airway and lungs to noxious particles or gases.
  • Chronic inflamm. disease with systemic manifestatons
  • chronic bronchitis and or emphysema
  • Preventable in most cases!!!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Epidemiology

A
  • 3rd leading cause of death

- Major cause of morbidity, mortality, and disability.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Causes/Risk factors

A
  • Cigarette smoke (responsible for 85-90%)
  • Air pollution, occupational dusts & chemicals
  • Genetic predisposition
  • Airway hyperresponsiveness
  • Impaired lung growth
  • Age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pathophysiology review

A

Inhaled noxious particles or gases–> inflammation–> small airway dx or parenchymal destruction–> airflow limitation

Small airway dx- airway inflammation/airway remodeling
Parenchymal destruction- loss of alveolar attachments/ Decrease of elastic recoil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

clinical presentation

A

Dyspnea (persistent, worse with exercise, progressive), chronic cough(intermittent/unproductive), chronic sputum production, physical exam findings (more common in severe dx)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Diagnosis

A
  • Spirometry

- Post-bronchodilatory FEV1/FVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Considerations for diagnosis:

A

Family hx of COPD
Exposure to risk factors
Age 40 or older with 3 hallmark symptoms of progressive dyspnea, chronic cough, & productive sputum.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Stage I mild classification

A

FEV1 >80%

Chronic cough, sputum production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Stage II Moderate classification

A

50-80% FEV1
SOB on exertion
cough and sputum production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Stage III Severe classification

A

30-50% FEV1

Reduce exercise capacity, great SOB and fatigue, Repeated exacerbations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Stage IV Very Severe

A

FEV1 <30%
Severe airflow limitation
Resp. failure
Cor Pulmonale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Treatment goals

A
  • Reduce symptoms

- Reduce risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Reducing symptoms

A

Relieve symptoms, improve exercise tolerance, improve health status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Reduce risk

A

Prevent disease progression, prevent and treat exacerbations, reduce mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Non-pharmacologic treatment

A

Preventive care (minimize smoke & pollution), smoking cessation, vaccinations, regular physical activity, oxygen, pulm. rehab.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

5A’s for smoking cessation

A

Ask, advise, assess, assist, arrange

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Beta-2 agonists meds

A

Short-acting: albuterol & levalbuterol

Long acting: formoterol, arformoterol, indacaterol, salmeterol, olodaterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Anticholinergics meds

A

short acting: ipratropium bromide

long-acting: aclidinium bromide, glycopyrronium bromide, tiotropium, umeclidinium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Combination beta-agonist/anticholinergic meds

A

Short-acting: albuterol/ipratropium
Long-acting: vilanterol/umeclidinium, formoterol fumarate/glycopyrrolate, indacaterol/glycopyrrolate, olodaterol/tiotropium bromide.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Short-acting Beta 1 agonists (SABA) MOA

A

relax airway smooth muscle (bronchodilator)

Stimulate adenylyl cyclase to increase the formation of cAMP.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Short-acting Beta 1 agonists indication

A

Relief of bronchospasm during exacerbation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Short-acting Beta 1 agonists adverse effects

A

Tachycardia, tremor, palpitations, dizziness, and headaches.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Increasing frequency of use indicates ________

A

inadequate control!

All patients should have a SABA readily available.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

SABA pharmokinetics

A

Oral and parenteral agents discouraged in COPD, higher incidence of systemic adverse effects
Quick onset <5 mins
Duration of action is 4-6 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Long-Acting Beta 2- Agonists (LABA) MOA
Relax smooth muscle with longer duration of action (bronchodilator)
26
LABA indication
- NOT for acute exacerbations ormonotherapy - Moderate to severe COPD patients who experience symptoms on a regular and consistent basis - Patient with short-acting therapy who are not experiencing adequate relief.
27
LABA adverse effects
Tachycardia, skeletal muscle tremor, hypokalemia
28
Short-acting anticholinergics MOA
Blocks the action of acetylcholine at parasympathetic sites in bronchial smooth muscle causing bronchodilation
29
Albuterol
short-acting beta 2 agonist
30
Levalbuterol
short acting beta 2 agonist
31
Formoterol
Long acting beta 2 agonist
32
Arformoterol
long acting beta 2 agonist
33
Indacaterol
long acting beta 2 agonist
34
Salmeterol
long acting beta 2 agonist
35
Olodaterol
Long acting beta 2 agonist
36
Ipatropium bromide
short acting Anticholinergic
37
Aclidinium bromide
long acting anticholinergic
38
Glycopyrronium bromide
long acting anticholinergic
39
tiotropium
long acting anticholinergic
40
umeclidinium
long acting anticholinergic
41
Albuterol/Ipratropium
Combination beta-agonist/anticholinergic
42
Vilanterol/umeclidinium
Combination beta-agonist/ anticholinergic
43
Formoterol fumarate/glycopyrrolate
combination beta agonist/anticholinergic
44
Indacterol/glycopyrrolate
combination beta agonist/anticholinergic
45
Olodaterol tiotropium bromide
combination beta agonist/anticholinergic
46
Short-acting anticholinergic indication
Initial therapy for patients with intermittent symptoms
47
Short acting anticholinergic adverse effects
Dry mouth (common), nausea, metallic taste.
48
Short acting anticholinergics
Peak of 1.5 to 2 hours Duration of action 4-6 hours Usually not as effective for as needed use
49
Ipratropum recommended use
2 puffs 4x a day | dose can often be titrated upward often to 24 puffs a day.
50
Long-Acting anticholinergics MOA
Competitevely & reversibly inhibit the action of acetylcholine at type 3 muscarinic (m3) receptors in bronchial smooth muscle, causing bronchodilation Reduction in cyclic guanosine monophosphate (cGMP)
51
Long-Acting anticholinergics indication
Moderate to severe COPD with symptoms on a regular basis
52
Long acting anticholinergics adverse effects
Dry mouth (common), blurred vision, urinary retention (less common), precipitation of narrow-angle glaucoma symptoms
53
Tiotropium pharmokinetics
Tiotropium Onset within 30 mins, with a peak effect in 3 hours Duration of action > 24 hours counsel on appropriate inhaler technique given several different dosage forms
54
Corticosteroids (Inhaled/Oral) MOA
Broad anti inflammatory efficacy, mediated in part by inhibition of production of inflamm. cytokines Reduce bronchial hyperreactivity and reduces the frequency of exacerbations if taken regularly
55
Corticosteroids indication
ICSs should NOT be used as monotherapy or first-line therapy Add on for severe COPD with frequent exacerbations Oral corticosteroids are generally not indicated for chronic use.
56
Corticosteroid adverse effects
Thrush | ensure patients rinse mouth after each use!!!
57
Qvar (Beclomethasone)
Inhaled corticosteroids
58
Pulmicort (Budesonide)
Inhaled corticosteroids
59
Flovent Arnuity Ellipta (Fluticasone)
Inhaled corticosteroids
60
Deltasone (Prednisone)
Systemic corticosteroids
61
Medrol (Methylprednisolone)
Systemic corticosteroids
62
Symibicort (budesonide/formoterol)
combination short-acting beta 2 agonist plus ICS in one inhaler
63
Dulera (mometasone/formoterol)
combination short-acting beta 2 agonist plus ICS in one inhaler
64
Advair (fluticasone/salmeterol)
combination short acting beta 2 agonist plus ICS
65
Breo Ellipta (fluticasone/vilanterol)
combination short acting beta 2 agonist plus ICS
66
Methylxanthines MOA
Inhibition of phosphodiesterase, calcium ion influx into smooth muscle, release of mediators from mast cells and leukocytes Stimulation of endogenous catecholamines
67
Methylxanthines indication
Reserve for patients who cannot use inhaled medications or who remain symptomatic despite appropriate use of inhaled bronchodilators
68
Methylxanthines adverse effects
GI (dyspepsia, N/V/D) CV (tachycardia) CNS (headache, dizziness)
69
Methylxanthines pharmokinetics
Therapeutic range of theophylline is 10-20 mcg/ml , more conservative range of 5-15. Multiple drug to drug interactions Inhaled bronchodilators preferred
70
PDE-4 Inhibitors MOA
Reduce inflammation by inhibiting breakdown of intracellular cAMP.
71
PDE-4 Inhibitors Indication
GOLD3 and GOLD4 patients with repeated exacerbations and chronic bronchitis treated with corticosteroids
72
PDE-4 Inhibitors Adverse effects
Nausea, reduced appetite, diarrhea, sleep disturbances, headache
73
Daliresp (roflimulast)
PDE-4 inhibitor
74
antimicrobial therapy should be used if the patient exhibits at least two of the following signs or symptoms:
Increased dyspnea, increased sputum purulence, increased sputum volume.
75
COPD exacerbations need for hospitalization:
- Marked increase in intensity of sx - Severe underlying COPD - Onset of new physical sx - Failure of an exacerbation to respond to initial medical management - Presence of serious comorbidities - Frequent exacerbations - Older age - Insufficient home support
76
Elderly special considerations
Consider dexterity and ability to use devices | Consider anticholinergic side effects
77
Pediatrics special considerations
Consider use of a spacer to improve drug delivery
78
Specialist referral
- Concurrent cardiac dx, suspected asthma, or other pulm. dx - Alpha-1 antitrypsin deficiency - sx do not respond to optimal therapy or are out of proportion to obstructive dings - severe or frequent exacerbations or pna complicating management - ICU hospitalization or mechanical ventilation required.
79
COPD quality measures
- Spirometry - FEV1/FVC ,70% - bronchodilator medication - influenza vaccine - tobacco used documented - current tobacco user - tobacco counseling documented
80
COPD clinical pearls
- Smoking cessation!! - Bronchodilators!! - step-up approach - add inhaled corticosteroids in severe patients if repeated exacerbations - reverse antibiotics for pts with appropriate symptoms.
81
Inhaler Use- rescue inhaler
Used as needed for quick relief of coughing, wheezing, chest tightness, and SOB Short-acting beta 2 agonist Short-acting anticholinergic
82
Inhaler use- controller inhaler
Used daily to prevent/control resp. symptoms - Inhaled corticosteroid - Long-acting beta- 2 agonist - Long-acting anticholinergic Counsel pts on the indication of their inhaler and difference between inhalers
83
Inhaler types
Dry powder inhalers (DPIs), Ellipta, Metered dose inhalers (MDIs), Respimat
84
Dry powder inhalers
contain no propellants quick and deep breath** All have dose counters
85
Ellipta
Quick and deep breath**
86
Metered dose inhalers (MDIs)
Contains hydroflouroalkane (HFA) as a chemical propellant - Slow and deep breath** - Can be used with a spacer or spacer with mask
87
Respimat
Slow and deep breath
88
Spacer
- Remove need for coordination between actuation and inhalation - Only used for MDIs - Clean once a month; replace every 6-12 months - Useful for pediatric or elderly populations - Spacer mask available for young pediatrics
89
Inhaler patient education
- Indication/type of inhaler - Priming - Step-by-step instructions for use - Preparing the dose - breathing technique for taking the dose - refilling - cleaning - review patient technique - rinse mouth for steroid-containing

Pharm exam 2 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions