Shared Flashcard Set

Details

P&T
COPD/Asthma
34
Health Care
Professional
02/06/2011

Additional Health Care Flashcards

 


 

Cards

Term

What is the difference between Emphysema and Chronic Bronchitis?

What role do they play in COPD?

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

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

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

Term
Why do COPD patients develop right heart failure?
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
Term
What are some key indicators fo COPD?
Definition

↓ FEV, ↓ FCV, chronic cough, sputum production, Barrel chest, Rt HF, chronic airway obstruction, air way destruction (Bullae) ABG PaO2<60

 

 

Term

COPD Classification and Tx

 

 FEV> 50 and <80, SOB with exertion + cough sputum production

 

Definition

Moderate Stage II

 

Smoking Cessation, Influenza Vaccination, SABA prn + LABA

Term

COPD Classification & Tx

 

53 yo Male with FEV <30 pred, 4 exacerbations in the last 2 years

Definition

Very Severe IV

 

Smoking cessation, Inlfuenza Vaccine, H1N1 vaccine, Pneumococcal, SABA+ LABA+ ICS

Term
What came out of the UPLIFT trial?
Definition
Support for the use of Tiotropium as the 1st LABA for COPD patients
Term
What is the vaccination regimen for people with COPD?
Definition

All patients: Influenza

> 65 or <65 with FEV<40% Pneumo

Patients <65 H1N1

Term
Regular use of ICS puts COPD patients at risk for____
Definition
Pneumonia
Term
What was the outcome of the TORCH study?
Definition
Support for the use of combined ICS/LABA
Term
Which drugs are not recommended in patients with COPD?
Definition
alpha 1 antitrypsin therpay, chronic abx, mucolytics, antioxidants, antitussives, narcotics, vasodilators, leukotriene modifiers, cromones, antiTNF atb
Term
What is the dosing regimen for Albuterol for COPD exacerbations and self-care?
Definition

Exacerbation: 4-6 puffs Q 20 mins up to 4 hrs. Then Q4H PRN

 

Selfcare: 3-4 puffs PRN

Term
What is the dosing regimen for LABA in patients with COPD for maintenance therapy?
Definition

Salmeterol, Formoterol and Arformeterol Q12H

 

No black box warning not for use for acute exacerbations

Term
What is the dosing regimen for anticholinergics in patients with COPD for maintenance therapy and acute exacerbations?
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

Term
What place does theophylline have in therapy for COPD?
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

Term
What factors increase and decrease theophylline metabolism?
Definition

Inc: Smoking, Anticonvulsants, Alcholol

Dec: Older age, arterial hypoxemia, Resp Acidosis, CHF, Viral infections

Term
What other therapy is recomended for patients receiveing ICS?
Definition
Vit D, Calcium and Bisphosphonate
Term
When should abx be used for COPD?
Definition
If the patient is mechanically ventilated, evidence of infection
Term

Which abx should be used?

 

a) Mild exacerbation

b) Hx of recent hospitalization

c) E. Coli, Klebsiella Pneumoniae

Definition

a) SMZ/TMP, TCN, Beta Lactam

b) High dose Levofloxacin

c) Amoxicillin Clavulanate

Term

Classification and Tx

Patient with asthma symptoms every day, FEV 75%.

Definition

Stage 4

 

SABA-rescue, + Med dose ICS+LABA

alt (Med dose ICS+ theoph/zileuton/LTRA

Term

Classification and Tx

Patient with asthma symptoms throughout the day, FEV 55.

Definition

Stage 5

 

SABA+ High dose ICS+LABA+oral CS

and  consider omalizumab

Term
What are the possible side effects of SABA?
Definition
CVD, diabetes, seize disorders, glaucoma, hypokalemia
Term

What are the target serum theophylline concentrations?

What are important counseling points?

Definition

Acute exacerbations (12-15)

Chronic (5-12)

Stop smoking, take on empty stomach, avoid dietary stimulants

Term
Doses of CS at what concentration cause adrenal suppression?
Definition
>7.5mg/day for more than 2-3 weeks
Term

What are the glucocorticoid equivalents?

a) Cortisone

b) Hydrocortisone

c)Prednisone

d) Prednisolone

e) Methylprednisolone

f) Dexamethasone

Definition

a) Cortisone-25mg

b) Hydrocortisone-20mg

c) Prednisone-5mg

d)Prednisolone-5mg

e) Methylprednisolone-4 mg

f) Dexamethasone- 0.75mg

Term
How long does it take to see the effects of cromolyn?
Definition

up to 4 weeks

No side effects or interactions

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

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

Term
PR has been taking prednisone 20mg daily for 3 months, and is now adrenally suppressed. What should be done?
Definition
He should slowly be tapered off the CS over several weeks
Term
What other tx should be given in patients taking a high or medium dosed ICS?
Definition
Vit D, Calcium and maybe bisphosphonate
Term

What precaution should be considered when giving montelukast?

What is its advantage?

Definition

It contains phenylalanine and is contraindicated in patients with PKU

It can be given to children (>1yr)

Term

What drugs does zileuton interact with?

What are its side effects?

Definition

Theophylline (Inc its concentration)

Warfarin (Inc its concentration)

Hepatotxic

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?

Definition

Moderate exacerbation

Tx with O2+ SABA + high dose of oral CS monitor therapy

Symptoms will persist for 1-2 days

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?
Definition

Resipiratory Arrest

O2 to achieve 90%, high dose SABA+ipratropium, IV CS, place on mechanical ventilation and intubate. Admit to ICU

Term
Following an acute exacerbation, what are the discharge instructions?
Definition
Finish oral CS, continue SABA and ICS
Supporting users have an ad free experience!