Copd

Front 1

COPD

Back 1

-airflow obstruction from chronic bronchitis and/or emphysema
-due to chronic inflamm of terminal airways and distal airspaces
-look at stages slide!

Front 2

chronic bronchitis

Back 2

-excessive mucous production and cough
-hyperplasia of mucus glands,smooth muscle, hypertrophy, inflamm
-repeated infxs

Front 3

Emphysema

Back 3

-destruction of the acinar walls--> diminshed gas exchange
-dyspnea at rest is predominant symptom

Front 4

key indicators for COPD

Back 4

-dyspnea that is: progressive, worse w/exercise, persistent, described as "heaviness"
-chronic cough
-chronic sputum production
-hx of exposure to risk factors: tobacco smoke, dust and chemicals
-dx: spirometry testing FEV1 <80%, FEV1/FVC <70%

Front 5

goals of therapy for COPD

Back 5

-smoking cessation: Nicotine replacement, Bupropion, Chantix
-improvement in obstructive status (modest)
-tx and prevent acute exacerbations
-improve quality of life
-reduce mortality, hospitalizations

Front 6

Monitoring Efficacy with COPD-

Back 6

-Clinical- dec in dyspnea, improved exercise tolerance, less tachypnea
-FEV1 & FEV1/FVC ratio
-ABG in acute exacerbations

Front 7

tx of COPD

Back 7

-bronchodilators are central to pharmacotherpay for COPD
-B2 agonists or antocholinergics

Front 8

sympathomimetics (B2 agonists)

Back 8

-1st line
-short acting
-long acting = preferred choice
-B2 agonists inhaled inc cAMP an cause relaxation of smooth muscle --> bronchodilation
AE: tremor, sinus tachycardia

Front 9

Anticholinergics, inhaled

Back 9

-MOA: blocks effect of ach at M receptors --> bronchodilation
-improves PFTs
-Ipatropium bromide (atrovent) (inhaled MDI, or neb)- peaks 1.5 hrs and last for up 2 8 hrs
-Tiotropium (spireva) (dry power inhalation)- longer duration of action
-Oxitropium
AE: dry mouth and metallic taste

Front 10

B2 agonist + anticholinergic agent

Back 10

-Combivent (MDI) and Duoneb (neb)
(albuterol and ipitropium)
-use when 2 bronchodilators are needed
-additive effects

Front 11

Theophylline and aminophylline (IV)

Back 11

-2nd line for COPD due to AE
-valuable in exacervations
-risks: low TI, requires loading dose, arrhythmias, seizures, DI

Front 12

Corticosteroids (inhaled and systemic)

Back 12

-for chronic stable COPD (inhaled)
-role: regular tx w/inhaled steroids for symptomatic pts with FEV1< 50% predicted and repeated exacerbations (>3 in last 1yr)
-added to long acting bronchodilators: Advair, Symbicort
-Po/IV steroid for ACUTE exacerbations
-long term oral not reccommended

Front 13

exacerbations of COPD

Back 13

-often related to infx or air pollution
-symptoms: inc dyspnea, inc sputum, purulent sputum (green, yellowish)
-tx: O2 therapy controlled, bronchodilators, po or IV steroids, abx (outpt or inpt)

Front 14

acute bacterial exacerbations

Back 14

-common cause of hospitalization and mortality
-H. flue*, M. cat, S.pneumoa and H. parainfluenza

Front 15

immunotherapy

Back 15

-influenza vaccine yearly
-pneumococcal vaccine (> 65 years may beed every 5 yrs)

Front 16

lomg term O2

Back 16

-stable COPD pts with resting PaO2 of < 55mmHg or PaO2 < 60 mm Hg with evidence of right heart failure or polycythemia impaired neuropsych function
-reduces mortality
-fewer hospitalizations
-improved quality of life
-usually delivered by mask or NC

Front 17

non-pham measures for COPD

Back 17

-exercise
-nutrition
-O2 therapy
-surgical options