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Advanced Pharmocology > Week 3 COPD > Flashcards

Week 3 COPD Flashcards

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1
Q

What is chronic obstructive pulmonary disease (COPD)?

A

A heterogeneous lung disease characterized by chronic respiratory symptoms due to airflow limitation resulting from airway disease and/or parenchymal destruction.

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2
Q

What are the two main subtypes of COPD?

A
  • Chronic bronchitis
  • Emphysema
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3
Q

How is chronic bronchitis clinically defined?

A

Productive cough > 3 months per year for at least 2 consecutive years, in the absence of other causes of chronic cough.

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4
Q

What is emphysema pathologically defined as?

A

Destruction and permanent dilation of alveolar sacs.

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5
Q

What is the global prevalence of COPD in individuals over 40?

A

11.7% (expected to rise).

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6
Q

What is the annual death toll from COPD worldwide?

A

3 million.

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7
Q

What is the leading cause of death for COPD in the United States?

A

3rd leading cause of death.

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8
Q

What are some major risk factors for developing COPD?

A
  • Cigarette smoking
  • 2nd-hand smoke
  • Air pollution
  • Occupational exposure to toxins
  • Alpha-1 antitrypsin deficiency
  • Indoor air pollution
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9
Q

What are the main symptoms of COPD?

A
  • Progressive dyspnea
  • Chronic cough
  • Sputum production
  • Chest tightness
  • Weight gain or loss
  • Fatigue
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10
Q

What clinical findings might be present in a patient with advanced COPD?

A
  • Tachypnea
  • Hypoxia
  • Muscle wasting
  • Barrel chest
  • Cyanosis
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11
Q

What are the two historical phenotypes of COPD?

A
  • Blue bloater (chronic bronchitis)
  • Pink puffer (emphysema)
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12
Q

What pulmonary function test results indicate COPD?

A

FEV1/FVC < 70%.

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13
Q

What does a post-bronchodilator test assess in COPD patients?

A

The reversibility of the obstructive condition.

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14
Q

What is the GOLD classification for mild COPD?

A

GOLD I: FEV1 ≥ 80%.

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15
Q

What is the primary goal of management for stable COPD patients?

A
  • Decrease symptoms
  • Decrease exacerbations
  • Improve patient function
  • Improve quality of life
  • Prevent disease progression
  • Decrease mortality
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16
Q

What critical intervention can slow lung function decline in COPD?

A

Smoking cessation.

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17
Q

What vaccinations are recommended for COPD patients?

A
  • Pneumococcal pneumonia
  • Influenza
  • COVID-19
  • Tdap
  • Shingles
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18
Q

What is the importance of pulmonary rehabilitation in COPD management?

A

It aims to improve functional capacity.

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19
Q

What is a key indicator for the need for oxygen therapy in COPD patients?

A

O2 saturation < 88%.

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20
Q

What does the BODE index assess in COPD patients?

A

Body mass index, airflow obstruction, dyspnea, and exercise capacity.

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21
Q

What is the significance of a blood eosinophil count in COPD?

A

Patients with eosinophil count > 300 cells/µL are most likely to benefit from inhaled corticosteroids.

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22
Q

What chest X-ray findings may suggest COPD?

A
  • Barrel-shaped chest
  • Flattened diaphragm
  • Hyperlucency
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23
Q

What are the components of the GOLD ABCD assessment?

A
  • Assessment of symptoms
  • Risk of exacerbation
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24
Q

What is a common characteristic of emphysema on a flow-volume curve?

A

Dynamic airway collapse causing a rapid fall in expiratory flow.

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25
What are the symptoms of an acute exacerbation of COPD?
* Worsening dyspnea * Increased cough * Purulent sputum production * Wheezing * Fever may or may not be present.
26
True or False: The mortality rate for COPD is equal among men and women.
True.
27
Fill in the blank: The annual deaths from COPD in the United States exceed _______.
> 140,000.
28
What is a key indication for therapy in COPD patients?
Rapid clinical decline
29
List some factors that may indicate the need for surgical intervention in COPD.
* Young patients or family history of AAT deficiency * Frequent infections * Hemoptysis * Symptoms disproportionate to objective findings
30
What are the general types of inhaled medications used in COPD management?
* Bronchodilators * Antiinflammatory: inhaled corticosteroids (ICSs)
31
What are the two categories of bronchodilators?
* Short-acting beta-agonists (SABAs) * Long-acting beta-agonists (LABAs) * Short-acting muscarinic antagonists (SAMAs) * Long-acting muscarinic antagonists (LAMAs)
32
True or False: Inhaled corticosteroids (ICS) are used as long-term monotherapy.
False
33
What should be included in combination therapy if there are features of asthma present?
Inhaled corticosteroids (ICS)
34
Fill in the blank: Long-acting agents are preferred for _______.
maintenance therapy
35
What are the considerations when prescribing inhalers for COPD patients?
* Ensure training in inhaler technique * Be aware of drug and device availability * Consider cost * Assess patient preference * Evaluate patient ability to use device
36
What is the typical initial dose for Albuterol via metered-dose inhaler (MDI)?
2 inhalations every 4–6 hours, as needed
37
What does the GOLD criteria recommend for the initial choice of pharmacologic therapy in COPD?
An individualized approach based on a patient's symptoms and exacerbation history
38
What is the preferred therapy for Group B COPD patients according to GOLD recommendations?
LAMA/LABA combination
39
What is the recommendation for patients with persistent dyspnea despite optimal therapy?
Consider opioid therapy with a shared decision-making approach
40
What are the indications for hospital admission in COPD exacerbations?
* Severe underlying COPD * Significant comorbidities * Failure to respond to initial medical management * Insufficient home support * Acute respiratory failure
41
What is the first choice of corticosteroid for managing acute exacerbations?
Prednisone 40 mg daily for a total of 5 days
42
Fill in the blank: The recommended oxygen saturation to maintain in COPD patients is _______.
88%–92%
43
What should be assessed frequently after providing noninvasive ventilation (NIV)?
Arterial blood gas (ABG)
44
What is the management for mild COPD exacerbations?
Short-acting bronchodilators
45
What is a potential consequence of long-term antibiotic use in COPD patients?
Increased bacterial resistance
46
What is recommended if a patient with COPD has eosinophils ≥ 300 cells/µL?
Add ICS to combination therapy
47
What should be the follow-up frequency for spirometry monitoring in COPD patients?
At least annually
48
What surgical intervention is reserved for severe COPD cases not controlled with medical therapy?
Lung transplant
49
What are some palliative treatments that may be helpful to COPD patients?
* Symptom relief of dyspnea * Anxiety and depression * Pain * Fatigue
50
What should be done if a patient with COPD presents with symptoms suggestive of COVID-19?
COVID-19 testing should be performed
51
What additional medications may be considered for COPD management?
* Long-term antibiotics * Methylxanthines * Phosphodiesterase-4 inhibitors * Mucolytics
52
Fill in the blank: The initial management for acute COPD exacerbations should include _______.
Bronchodilator therapy with SABA/SAMA
53
What is an important aspect of discharge planning for COPD patients?
Ensure clinical stability ## Footnote Discharge planning includes double-checking home maintenance therapy, assessing patient understanding of medications, and determining the need for oxygen therapy.
54
What should be scheduled for COPD patients after discharge?
Follow-up within 1–4 weeks ## Footnote Follow-up is crucial to monitor the patient's condition after discharge.
55
What should be performed if a COPD patient presents with symptoms suggestive of infection?
COVID-19 testing ## Footnote Testing is essential to determine if the patient has contracted COVID-19.
56
What is the management approach for mild COVID-19 in COPD patients?
Follow usual protocols for COPD ## Footnote Mild cases are managed similarly to standard COPD exacerbations.
57
What additional pharmacotherapeutic approaches are recommended for moderate-to-severe COVID-19 in COPD patients?
* Remdesivir (within 7 days of symptom onset) * Systemic glucocorticoids (e.g., Dexamethasone 6 mg/day for 10 days) * Intermediate-intensity or therapeutic anticoagulation ## Footnote These approaches are in addition to usual management strategies.
58
What are some methods to manage acute respiratory failure in COPD patients?
* Oxygen supplementation * Prone positioning * Noninvasive ventilation * More frequent monitoring ## Footnote These methods are important for patients experiencing acute respiratory distress.
59
What complications are associated with COPD?
* Respiratory failure * Respiratory infections (pneumonia) * Pulmonary hypertension → cor pulmonale * Long-term complications of steroids → osteoporosis * Weight loss or cachexia * Bullae rupture → secondary spontaneous pneumothorax * Antibiotic-related diarrhea (Clostridium difficile colitis) ## Footnote These complications can significantly impact the health and management of COPD patients.
60
What is Alpha-1 antitrypsin (AAT) deficiency?
A genetic disorder causing defective production of the protease inhibitor alpha-1 antitrypsin ## Footnote This deficiency can lead to lung disease and liver dysfunction.
61
What are common symptoms of asthma?
* Intermittent or persistent wheezing * Cough * Dyspnea ## Footnote Asthma is characterized by reversible airflow obstruction.
62
What is bronchiectasis?
A chronic condition with bronchial dilatation and destruction due to inflammation and infection ## Footnote Symptoms include dyspnea, chronic cough, and purulent sputum.
63
What is bronchiolitis obliterans?
A chronic, obstructive disease of the small airways caused by inflammation and scarring ## Footnote Patients typically present with cough and progressive dyspnea.
64
What is heart failure?
An inability to produce normal cardiac output to meet metabolic needs ## Footnote Symptoms include dyspnea, hypoxia, and peripheral edema.
65
What is cystic fibrosis?
An autosomal recessive disorder leading to dysfunction of chloride channels, causing hyperviscous mucus ## Footnote Patients often have chronic respiratory infections and pancreatic insufficiency.
66
What are common signs and symptoms of pulmonary embolism?
* Pleuritic chest pain * Dyspnea * Tachypnea * Tachycardia ## Footnote Severe cases can lead to hemodynamic instability or cardiopulmonary arrest.
67
What is the primary method for diagnosing pulmonary embolism?
Chest CTA ## Footnote This imaging technique is crucial for identifying pulmonary artery obstructions.

Advanced Pharmocology (42 decks)

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