Term
What is the difference between Emphysema and Chronic Bronchitis?
What role do they play in COPD? |
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Definition
Emphysema is alveolar destruction (Pink Puffer)
Chronic Bronchitis is sputum production for 3 months of the yr for at least 2 years (Blue Bloater)
People with COPD often have both Emp. and CB |
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Term
COPD or Asthma
1) Onset in midlife
2) Usually nonsmokers
3) Dyspnea during exercise
4) Family Hx
5) Airflow limitiation irreversible
6) Slowly progressive |
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Definition
1) Onset in midlife-COPD
2) Usually nonsmokers-Asthma
3) Dyspnea during exercise-COPD
4) Family Hx-Asthma
5) Airflow limitiation irreversible-COPD
6) Slowly progressive-COPD |
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Term
| Why do COPD patients develop right heart failure? |
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Definition
| Decreased Flow doesnt match perfusion and the right ventricle has to work harder to match perfusion (Q). This causes right ventricle hypertrophy and pulmonary edema |
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Term
| What are some key indicators fo COPD? |
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Definition
↓ FEV, ↓ FCV, chronic cough, sputum production, Barrel chest, Rt HF, chronic airway obstruction, air way destruction (Bullae) ABG PaO2<60
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Term
COPD Classification and Tx
FEV> 50 and <80, SOB with exertion + cough sputum production
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Definition
Moderate Stage II
Smoking Cessation, Influenza Vaccination, SABA prn + LABA |
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Term
COPD Classification & Tx
53 yo Male with FEV <30 pred, 4 exacerbations in the last 2 years |
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Definition
Very Severe IV
Smoking cessation, Inlfuenza Vaccine, H1N1 vaccine, Pneumococcal, SABA+ LABA+ ICS |
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Term
| What came out of the UPLIFT trial? |
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Definition
| Support for the use of Tiotropium as the 1st LABA for COPD patients |
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Term
| What is the vaccination regimen for people with COPD? |
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Definition
All patients: Influenza
> 65 or <65 with FEV<40% Pneumo
Patients <65 H1N1 |
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Term
| Regular use of ICS puts COPD patients at risk for____ |
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Definition
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Term
| What was the outcome of the TORCH study? |
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Definition
| Support for the use of combined ICS/LABA |
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Term
| Which drugs are not recommended in patients with COPD? |
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Definition
| alpha 1 antitrypsin therpay, chronic abx, mucolytics, antioxidants, antitussives, narcotics, vasodilators, leukotriene modifiers, cromones, antiTNF atb |
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Term
| What is the dosing regimen for Albuterol for COPD exacerbations and self-care? |
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Definition
Exacerbation: 4-6 puffs Q 20 mins up to 4 hrs. Then Q4H PRN
Selfcare: 3-4 puffs PRN |
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Term
| What is the dosing regimen for LABA in patients with COPD for maintenance therapy? |
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Definition
Salmeterol, Formoterol and Arformeterol Q12H
No black box warning not for use for acute exacerbations |
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Term
| What is the dosing regimen for anticholinergics in patients with COPD for maintenance therapy and acute exacerbations? |
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Definition
Exacerbation: Ipratropium + SABA (neb 0.5 mg Q20 min for 3 doses then PRN, MDI 8 puffs Q20 min PRN up to 3 hrs)
Maint: individually or with SABA (Ipratrop. MDI 2 inh QID) Tiotrop DPI 1 capsule daily |
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Term
| What place does theophylline have in therapy for COPD? |
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Definition
It's more effective in COPD than asthma, it improves diaphragm contractility and acts as a respiratory stimulant.
Caution in patients with HF b/c its also a cardiac stimulant |
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Term
| What factors increase and decrease theophylline metabolism? |
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Definition
Inc: Smoking, Anticonvulsants, Alcholol
Dec: Older age, arterial hypoxemia, Resp Acidosis, CHF, Viral infections |
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Term
| What other therapy is recomended for patients receiveing ICS? |
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Definition
| Vit D, Calcium and Bisphosphonate |
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Term
| When should abx be used for COPD? |
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Definition
| If the patient is mechanically ventilated, evidence of infection |
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Term
Which abx should be used?
a) Mild exacerbation
b) Hx of recent hospitalization
c) E. Coli, Klebsiella Pneumoniae |
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Definition
a) SMZ/TMP, TCN, Beta Lactam
b) High dose Levofloxacin
c) Amoxicillin Clavulanate |
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Term
Classification and Tx
Patient with asthma symptoms every day, FEV 75%. |
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Definition
Stage 4
SABA-rescue, + Med dose ICS+LABA
alt (Med dose ICS+ theoph/zileuton/LTRA |
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Term
Classification and Tx
Patient with asthma symptoms throughout the day, FEV 55. |
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Definition
Stage 5
SABA+ High dose ICS+LABA+oral CS
and consider omalizumab |
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Term
| What are the possible side effects of SABA? |
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Definition
| CVD, diabetes, seize disorders, glaucoma, hypokalemia |
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Term
What are the target serum theophylline concentrations?
What are important counseling points? |
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Definition
Acute exacerbations (12-15)
Chronic (5-12)
Stop smoking, take on empty stomach, avoid dietary stimulants |
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Term
| Doses of CS at what concentration cause adrenal suppression? |
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Definition
| >7.5mg/day for more than 2-3 weeks |
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Term
What are the glucocorticoid equivalents?
a) Cortisone
b) Hydrocortisone
c)Prednisone
d) Prednisolone
e) Methylprednisolone
f) Dexamethasone |
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Definition
a) Cortisone-25mg
b) Hydrocortisone-20mg
c) Prednisone-5mg
d)Prednisolone-5mg
e) Methylprednisolone-4 mg
f) Dexamethasone- 0.75mg |
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Term
| How long does it take to see the effects of cromolyn? |
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Definition
up to 4 weeks
No side effects or interactions |
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Term
T/F
(during asthma exacerbation)
a) 40mg of prednisone is advantagous to 60mg
b) IV is better than oral steroids
c)No need to taper CS if <10days
d) Split dosing CS is more effective
e) shouldnt start ICS if already on oral |
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Definition
a) FALSE no advantage to higher doses
b) FALSE no advantage to route
c) TRUE
d) TRUE
e) FALSE may start ICS anytime during systemic regimen |
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Term
| PR has been taking prednisone 20mg daily for 3 months, and is now adrenally suppressed. What should be done? |
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Definition
| He should slowly be tapered off the CS over several weeks |
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Term
| What other tx should be given in patients taking a high or medium dosed ICS? |
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Definition
| Vit D, Calcium and maybe bisphosphonate |
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Term
What precaution should be considered when giving montelukast?
What is its advantage? |
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Definition
It contains phenylalanine and is contraindicated in patients with PKU
It can be given to children (>1yr) |
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Term
What drugs does zileuton interact with?
What are its side effects? |
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Definition
Theophylline (Inc its concentration)
Warfarin (Inc its concentration)
Hepatotxic |
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Term
Stage and Tx
FH reports to the ED, with an acute asthma exacerbation. She can only speak in short phrases and is using accessory muscles to breathe. Her RR is 25BPM and HR is 110BPM. She is wheezing loud on expiration.
How long will her symptoms persist after tx? |
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Definition
Moderate exacerbation
Tx with O2+ SABA + high dose of oral CS monitor therapy
Symptoms will persist for 1-2 days |
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Term
| YM is rushed into the ER suffering from an actue asthma exacerbation. His O2 is 45mmHg, RR 45, and is bradycardic. How should he be treated? |
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Definition
Resipiratory Arrest
O2 to achieve 90%, high dose SABA+ipratropium, IV CS, place on mechanical ventilation and intubate. Admit to ICU |
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Term
| Following an acute exacerbation, what are the discharge instructions? |
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Definition
| Finish oral CS, continue SABA and ICS |
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