• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/47

Click to flip

47 Cards in this Set

  • Front
  • Back
Where does COPD rank in causes of death in the US?
4th
Types of Causes of Airflow Obstruction?
Luminal Causes
Mural Causes
Extramural Causes
Types of Luminal Causes?
Mucus Plug
Tumor
Foreign Body
Types of Mural Causes
Bronchial Wall Edema
Infl Cell Infiltration
Mucus Gland Hypertrophy
Acute Bronchoconstriction
Smooth Muscle Hypertrophy
Airway Wall Remodeling (fibrosis)
Types of Extramural Causes?
Loss of Alveolar Attachments
Decreased Lung Elastic Recoil

(think emphysema)
Decline in FEV1

Normal vs COPD vs Accelerate COPD
Normal: 25-30mL per year after 25
COPD: 45-60mL/yr
Accelerated (20% of smokers): 150-200mL/yr
COPD vs Asthma
reversibility?
COPD: partially w/ cessation and bronchodilator

Asthma: near normal w/ bronchodilators
COPD vs Asthma

when do they cough?
COPD: early AM

Asthma: Nocturnal, post exercise
COPD vs Asthma

elevated IgE?
COPD: rare

Astham: common
Sx's that accompany an AE?
Inc Cough
Inc Sputum
Fever
Dyspnea
Wheezing
Dec FEV1
Frequency of AE's in COPD pts?
1 or 2 per year

often precipitated by infection
How to reduce frequency of AE's?
Maximize FEV1
Long-term bronchodilator use
Vaccinations
Why are AE's so important?
Major determinant of QOL
Consume 70% of $$ spent on COPD
Accelerate loss of fxn and FEV1
Predictor of mortality
COPD findings on Physical Exam?
Hyperresonance on percussion
Dec breath sounds
Wheezing or prolonged exp phase
Thin w/ muscle wasting
Barrel chest
Pursed lip breathing
Peripheral Edema
CXR findings in COPD pts?
Often normal till late

Flat Diaphragms
Hyperexpanded lung fields
Inc Radiolucency
Bullae
Long, Narrow Heart
Spirometry Findings required for COPD Dx?
FEV1 < 80% predicted
FEV1: FVC <70% predicted
What constitutes a positive bronchodilator response?
12% AND 0.2 L increase in either FEV1 or FVC

COPD pts often have this
ABG's typicall worsen in COPD pts w/????
Exercise
Sleep
AE's
Components of BODE Index for COPD Staging?
BMI
Airway Obstruction (FEV1)
Dyspnea (scaled)
Exercise Capacity (6 minute walk in meters)
Types of Rx for COPD
Smoking Cessation
Pharmacotherapy
O2 Therapy
Pulmonary Rehab
Transplant
Which Rx will improve FEV1?
only Inhaled Bronchodilators
Types of Pharmacologic interventions for smoking?
Antidepressants (bupropion)
Nicotine Replacement Therapy
Nicotine Receptor Agonist (chantix)
How to prescribe bupropion for smoking?
Start it 1-2 weeks before quit date
Continue for 7-12 weeks
Two types of bronchodilators?
Short Acting
Long Acting
Examples of Short Acting Bronchodilators?
Anticholinergic (ipratropium bromide)
Beta Agonist (albuterol)
Types of Long Acting Bronchodilators?
Anticholinergic (tiotropium)
Beta Agonist (salmterol)
Which type of bronchodilator is best for COPD?
Anticholinergics!
Benefits of Anticholinergics in COPD?
Inc FEV1
Reduced AE's
Minimal SE's (don't cross BBB, minimal GI distress)
When should you prescribe a Beta Agonist?
If initial anticholinergic therapy is suboptimal
SE's of beta agonist?
Tachycardia
Arrhythmias
Jitters
How often do you have to use the long acting inhalers?
Anticholinergic: once a day
Beta Agonist: twice a day

Ok to use w/ short acting inhalers
Who gets Inhaled corticosteroids?
Pts w/ wheezing and/or frequent AE's

Along w/ long acting bronchodilators
Benefits of Inhaled Corticosteroids?
Dec AE's
Inc QOL

controversial
Why are Corticosteroids not beneficial?
Don't change decline of FEV1
Don't change mortality rate

SE: bone loss, catarracts, pneumonia
Other possible drug used for COPD?
Theophylline
Pro's for Theophylline?
Oral Agent
Long Acting
Bronchodilator + Antiinflammatory
Improves FEV1 and gas exchange
Improves Resp Muscle Fxn
Con's for Theophylline?
Narrow therapeutic window
Who wins, pros or cons?
Cons
When are systemic corticosteroids used for COPD?
During AE's for 1-2 weeks

Not good long term b/c of SE's
Flow of Rx for AE's?
Empiric Antibiotics
Oral Corticosteroids
Nebulized Bronchodilators
O2 Therapy
Hospitalization
Mechanical Ventilation
Does supplemental O2 increase survival COPD pts?
YES YES YES

dec Pulm HTN
dec risk of arrhythmias
Who gets long term O2 therapy?
PaO2 <55mmHg
or
SaO2 <88%
Benefits of long term O2 therapy?
Inc survival of hypoxemic pts
Inc cognitive fxn
Inc Exercise performance
Inc sleep quality
inc Activities of Daily Living
Benefits of Pulmonary Rehab?
Reduced Dyspnea
Inc Exercise capacity
Inc QOL
Dec AE's
Dec Hospitalizations and mortality
What does Pulm Rehab not do?
Doesn't Improve PFT's or ABG's
Who is eligible for a lung transplant?
Not smoking for 6 months
Advanced disease (FEV1<25%)
Age < 65 and able to rehab
No Severe Comorbidities
Benefits of Transplant?
Inc FEV1
Inc QOL
Extends Life