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Flashcards in COPD meds Deck (49):
1

COPD is characterized by airflow obstruction due to:

Chronic bronchitis
Ephysema

2

What is chronic bronchitis?

Chronic or recurrent excess mucus secretion into the bronchial tree

3

Characterize the chronic bronchitis cough

Most days >3 months/year for at least 2 consecutive years

4

How is emphysema defined?

Defined by anatomic pathology

5

What is emphysema characterized by?

Permanent enlarged air spaces and destruction of alveolar walls

6

What is the key component of the chronic bronchitis hx?

Impressive hx of productive cough

7

How are chronic bronchitis pts described?

Blue bloaters

8

Why are chronic bronchitis pts described as blue bloaters?

CO2 retention

9

Two main PE findings in chronic bronchitis:

Percussion is resonant
Breath sounds are distant to auscultation

10

What is the key hx of emphysema

Minimal cough

11

How do you describe pts with emphysema and why?

Pink puffers
Tachypnea

12

What does pursed lip breathing compensate for in emphysema pts?

Compensate for loss of elastic recoil

13

Why do emphysema pts sit forward with hands on knees?

Minimizes energy of breathing

14

What are two key PE findings in pts w/ emphysema?

Accessory muscle use
Hyperresonant percussion

15

What is a major RF for chronic bronchitis and emphysema?

Cigarette smoking

16

Is inflammation in COPD the same or different than inflammation of asthma?

Different

17

How is COPD characterized?

By exacerbations

18

What is the definition of exacerbation of COPD?

Worsening of pts sx that is beyond normal day-to-day variations
Leads to change in medication

19

How many exacerbations do pts have yearly?

1-2

20

What % of exacerbations can be handled out patient?

80%

21

What are sx of severe exacerbations? Where should they be managed?

Accessory muscle use
Cyanosis
Peripheral edema
Hospital

22

What are sx of life-threatening exacerbations? Where should they be managed?

Mental status changes
Worsening respiratory status
Hemodynamic instability
ICU

23

What are the COPD medication classes?

Cholinergic antagonists
Sympathomimetics
Combination anticholinergics/b2 agonists
Inhaled corticosteroids
Long-term oxygen
Antibiotics

24

What are cholinergic antagonists also known as?

Anti-muscarinic agents
Anticholinergics

25

What are sympathomimetrics also known as?

Beta 2 agonists

26

Is the long term O2 high or low dose?

Low dose

27

When do you use abx for COPD?

Exacerbations, not as prophylaxis

28

What line of therapy are inhaled cholinergic antagonists (ICA) and for what severity of COPD?

1st line in stable COPD

29

What are the available ICA agents?

Ipratropium
Tiotropium
Atropine

30

Do ICAs have more or less side effects that sympathomimetics?

Less

31

What line of tx are sympathomimetics?

2nd line

32

When are sympathomimetics the drug of choice?

Acute exacerbations

33

What do you do if response to ipratropium is unsatisfactory?

Begin trial of sympathomimetics

34

Do inhaled corticosteroids (ICS) modify lung function decline or improve mortality?

No

35

When are ICS recommended?

Pts w/ severe or very severe COPD w/ frequent exacerbations

36

What are some AEs of ICS?

Oropharyngeal candidiasis
Hoarse voice

37

Should you use ICS long term?

No, due to AEs

38

What has continuous O2 therapy been shown to do?

Decrease mortality
Improve quality of life
Reduce times in hospital

39

How do you administer O2?

Via nasal canula @ 2-3 L/min

40

What is the goal of long term O2?

Raise PaO2 to > 60 mm Hg

41

Why do you not raise PaO2 too high?

Don't want to depress respiratory drive

42

What is a risk of inhibiting respiratory drive?

Death

43

What do you have to avoid on long term O2?

Flames (smoking)

44

When are abx only effective for COPD?

Infection

45

How long do you use the abx for COPD infections?

7-10 days

46

What is the MC abx used w/ COPD infection?

Azithromycin
3rd generation macrolide
for 3-5 days

47

Summary of COPD pharmacotherapy

See slide 61

48

Stepwise COPD drug therapy

1) Short acting bronchodilator for acute sx relief
2) Long acting bronchodilator
3) Combination anticholinergic + beta agonist bronchodilator
4) consider theophylline
5) Combination inhaled corticosterouds + LABA

49

What is the difference between inflammatory cell infiltration w/ asthma and inflammation w/ COPD?

Asthma = eosinophils and mast cells
COPD: caused by neutrophils, macrophages, T lymphocytes