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P&T Cardiopulmonary I > Exam #01 - COPD > Flashcards

Exam #01 - COPD Flashcards

(52 cards)

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1
Q

Define COPD? What are the (2) subdivisions of COPD?

A

a disease state characterized by irreversible airflow obstruction caused by inflammation, excess mucus production, and destruction of alveoli

  1. chronic bronchitis
  2. emphysema
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2
Q

Name (7) risk factors associated with developing COPD?

A
  1. Smoking (including 2nd hand smoke)
  2. pollution
  3. poor nutrition
  4. infection in lungs
  5. lower socioeconomic situation
  6. age
  7. occupational dust & chemicals
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3
Q

Describe the pathophysiology of COPD starting with noxious particles and gas causing inflammation in the bronchioles.

A

Inflammation can lead to small airway disease AND Parenchymal disease. Both diseases lead to airflow limitation

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4
Q

What causes the destruction of alveoli (where they look like deflated balloons) in parenchymal disease?

A

Proteinases

COPD pts have fewer (or completely lack) anti-proteinases that would otherwise block the destruction of alveoli

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5
Q

What characterizes small airway disease (2 things)?

A
  1. airway inflammation

2. airway remodeling

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6
Q

COPD airflow limitation and decreased gas exchange is caused by what (4) factors?

A
  1. Fibrosis of smooth muscle cells in bronchioles
  2. alveolar wall destruction
  3. mucus hypersecretion
  4. hyperinflation of lungs (from trapped air)
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7
Q

How does chronic hypoxia lead to heart failure?

A

chronic hypoxia leads to vasoconstriction in pulmonary arteries. If blood doesn’t leave through the pulmonary artery (deoxygenated blood), blood backs up into the right ventricle and leads to heart failure

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8
Q

Which symptom assessment test for COPD measures disability due to breathlessness and predicts mortality?

A

mMRC (Modified Medical Research Council Questionnaire)

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9
Q

Which symptom assessment test for COPD measures symptomatic impact of the disease on the overall quality of life?

A

CAT (COPD Assessment Test)

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10
Q

List the (4) prognostic indicators of COPD and indicate which one is the most important?

A
  1. BMI
  2. FEV1% (most important!)
  3. Dyspnea
  4. Exercise capacity
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11
Q

True or False - lower BMI’s in smaller patients suggest a worse prognosis for COPD patients?

A

True - b/c of apparent lack of muscle mass

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12
Q

One of the goals of COPD therapy is to prevent the disease progression. What is the most effective way of doing this?

A

smoking cessation (if the patient smokes) or decrease exposure to chemicals, dust, or pollution

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13
Q

What (2) vaccinations must all COPD patients receive regardless of what stage COPD and category patient they are?

A
  1. influenza vaccine (annually)

2. pneumococcal vaccine (every 5 yrs, unless over 65 y/o then once)

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14
Q

In managing COPD with medication, how long should you wait until the full benefits of a drug regimen are realized?

A

3 weeks

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15
Q

What type of inhalers tend to be more effective in patients with COPD?

A

DPI (dry powder inhalers)

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16
Q

True or False - nebulizers are more effective in treating patients with COPD?

A

False - not more effective, just easier for patient to take meds

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17
Q

Explain preferred COPD therapy given to patients in each category (A through D) by listing the first choice medications and any lifestyle modifications.

A

A - SABA prn, smoking cessation, vaccinations

B - SABA prn + long acting bronchodilator, smoking cessation, vaccinations, rehabilitation

C - SABA prn + ONE long acting bronchodilator + ICS, smoking cessation, vaccinations, rehabilitation

D - SABA prn + ONE or TWO*** long acting bronchodilator + ICS, smoking cessation, vaccinations, rehabilitation

***if adding two long-acting bronchodilators, they should be from different drug classes to have the greatest impact on patient

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18
Q

Name the PDE-4 inhibitor and antibiotic used as last line agents to treat COPD patients in category D

A

PDE-4 inhibitor = Roflumilast

ABO = Azithromycin

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19
Q

First choice treatment of COPD patients in category B is a long acting bronchodilator. What is the alternative medications for a category B COPD patient?

A

LABA + LAMA (long acting anti-cholinergic)

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20
Q

If a COPD patient in category C cannot receive inhaled corticosteroids, what is the alternative treatment?

A

LABA + LAMA

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21
Q

What is the MOA of SABA?

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A

relaxation of bronchiole SM

helps empty lungs + decreases hyperinflation

22
Q

Name (3) SABA used to treat COPD patients in EVERY category (generic and brand). Indicate which AE you would monitor patients for when on these medications?

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A
  1. Albuterol
  2. Levalbuterol (Xopenex)
  3. Pirbuterol (Maxair)

Monitor for tachycardia, tremor, hypokalemia

23
Q

Which SABA is available in combination Ipratropium? What is the combination product called?

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A

COMBIVENT (Albuterol + Ipratropium)

24
Q

Name (4) LABA which can be used to treat COPD patients in category B, C, and D (generic and brand)? Indicate which AE you would monitor patients for when on these medications?

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A
  1. Formoterol (Foradil)
  2. Salmeterol (Serevent)
  3. Vilanterol
  4. Indacaterol (Arcapta)

Monitor for tachycardia, tremor, hypokalemia

25
Which LABA is available in combination with budesonide? What is the combination product called?
SYMBICORT (Formoterol + Budesonide)
26
Which LABA is available in combination with Fluticasone (ICS)? What is the combination product called?
ADVAIR DISKUS (Salmeterol + Fluticasone)
27
The LABA Vilanterol is only available in combination with fluticasone furoate. What is name of this combination product?
BreoEllipta
28
Which LABA is metabolized by CYP3A4 and therefore affected by inhibitors and inducers of 3A4? Give 3 examples of 3A4 inhibitors and 3 examples of 3A4 inducers?
Salmeterol Inhibitors: protease inhibitors, erythromycin, azoles Inducers: phenobarbital, rifampin, St. John's Wort
29
Name (1) short-acting anti-cholinergic used to treat COPD patients in category A (brand and generic)? Indicate which AE you would monitor patients for when on these medications?
Ipratropium (Atrovent) Monitor for dry mouth, bitter metallic taste, blurred vision (if sprayed in eyes), constipation
30
Name (2) long-acting anti-cholinergics which can be used to treat COPD patients in category B, C, and D. Indicate which AE you would monitor patients for when on these medications?
1. Tiotropium (Spiriva) 2. Aclidinium (Tudoraza Pressair) Monitor for dry mouth, blurred vision (if sprayed in eyes), constipation, and urinary retention
31
What is the MOA of short-acting anti-cholinergic agents (ipratropium Atrovent)
relaxation of bronchiole SM and decreased nasal secretions
32
What is the MOA of methylxanthines (Theophylline)? What AE would you monitor for in patients taking this medication?
non-selective phosphodiesterase inhibitor and weak bronchodilator Monitor for insomnia, GI upset, and heartburn
33
Name (6) drugs/physiological variables that INCREASE theophylline metabolism in COPD (meaning pt will require HIGHER theophylline dose to be effective)?
1. tobacco 2. Rifampin 3. St. John's Wort 4. Anticonvulsant drugs 5. alcohol 6. high protein meals
34
Name (7) drugs/physiological variables that DECREASE theophylline metabolism in COPD (meaning pt will require LOWER theophylline dose to be effective)?
1. old age 2. hypoxia 3. HF 4. Liver disease 5. macrolide ABO (-mycins) 6. ciprofloxacin 7. cimetidine
35
What is the MOA of PD-4 inhibitors?
Decreases inflammation by specifically inhibiting inflammatory cells involved in pathophysiology of COPD
36
Name (1) PD-4 inhibitor used to treat COPD patients in category C and D (brand and generic)? Indicate which AE you would monitor patients for when on these medications?
Roflumilast (Daliresp) Monitor for reduced appetite, weight loss, abdominal pain, insomnia, anxiety/depression, increase suicidal ideations
37
Roflumilast (Daliresp) will have drug interactions with what other drugs?
any drugs that inhibit or induce 3A4 and 1A2
38
Name (4) ICS which can be used to treat COPD patients in category C and D (generic and brand)? Indicate which AE you would monitor patients for when on these medications?
1. Beclomethasone (QVAR) 2. Budesonide (Pulmicort) 3. Fluticasone furoate 4. Fluticasone propionate (Flovent) Monitor for hoarseness, dry mouth, oral candidiasis, cough, pneumonia
39
What is the general starting dose of ICS for COPD patients?
medium - high dose (not low dose)
40
Which (2) ICS are affected by strong 3A4 inhibitors which will increase systemic effects such as Cushing's syndrome)?
1. Budesonide | 2. Fluticasone
41
Which ICS would be appropriate to treat COPD patients in category C and D who are also on another medication that is a strong 3A4 inhibitor?
Beclomethasone (QVAR)
42
Why is Roflumilast (Daliresp) not considered a 1st line drug to treat COPD?
b/c its dosage form is a tablet and not inhaled
43
True or False - COPD patients usually develop resistance to tachycardia and tremor AE associated with SABA?
True
44
What are the (2) roles for ABO (Azithromycin) in treating COPD?
1. Tx COPD exacerbations (5-10 day short course) | 2. chronic Tx to prevent exacerbations
45
What is the MOA of ABO in Tx of COPD?
decreases RNA synthesis and has antiinflammatory properties
46
What AE need to be monitored in patients taking ABO for COPD?
QT prolongation, hearing decrease, resistant infections
47
True or False - Azithromycin is metabolized by 3A4 and therefore is affected by other drug that inhibit or induce 3A4?
True
48
Which ICS that is only available in combination with vilanterol (combo product called BreoEllipta) has a unique dosing regimen in that it is inhaled only once daily?
Fluticasone furoate
49
True or False - oxygen has been shown to improve survival in patients with severe COPD?
True
50
Name (3) causes of acute exacerbations in COPD patients? Indicate which is the most common)
1. Respiratory tract infections (bacterial or viral) MOST COMMON 2. pollution 3. environmental factors (2nd hand smoke)
51
True or False - 1/3 of acute COPD exacerbations are from unknown causes?
True
52
Explain what symptoms must be present for ABO to be indicated for COPD patients
If patient has increased dyspnea, sputum, and sputum purulence (thickness) OR if patient has a severe exacerbation that requires mechanical ventilation

P&T Cardiopulmonary I (5 decks)

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