COPD

Question 1

How does COPD differ from asthma

Answer 1

COPD
1. Neutrophillic
2. LTB4, IL8, and TNFa
3. Squamous metaplasia of epithelium
4. Parenchymal destruction
5. GC have variable effect

Asthma
1. Eosinophilic
2. LTD4, IL4, IL5, others
3. Fragile epithelium
4. Thickening of basement membrane
5. GC inhibit inflammation

Question 2

What are the symptoms of COPD?

Answer 2

1. Chronic cough
2. Sputum production
3. Dyspnea
4. A1at deficiency

Question 3

What are the physical examination of COPD?

Answer 3

1. Cyanosis
2. Barrel chest
3. Shallow breathing
4. Pursed lips
5. Use accessory respiratory muscles

Question 4

What are diagnosis tests for COPD?

Answer 4

1. Spirometry
2. X ray
3. Arterial blood bas

Question 5

What are the risk factors for COPD?

Answer 5

Tobacco smoke

Question 6

What is GOLD 1?

Answer 6

FEV1/FVC < 70%
FEV1 ≥80%
With or without symptoms

Question 7

What is GOLD 2?

Answer 7

FEV1/FVC < 70%
FEV1: 50-79%

Question 8

What is GOLD 3?

Answer 8

FEV1/FVC: <70
FEV1: 30-49

Question 9

What is GOLD 4?

Answer 9

FEV1/FVC <70%
FEV1: <30%

Question 10

What are the nonpharm therapy of COPD?

Answer 10

1. End of life plans
2. Palliative care (morphine and lorazepam)
3. Smoking cessation
4. Light excersise

Question 11

What are immunizations ok for COPD?

Answer 11

1. Annual flu vaccine
2. Pneumococcal polysaccharide
3. Shingrex
4. COVID

Question 12

What is Group A?

Answer 12

SABDs PRN

Question 13

What is group B?

Answer 13

LABDs with group A regimen

Question 14

What is group e?

Answer 14

ICS-LABDs added to group B

Question 15

What are the bronchodilators for COPD?

Answer 15

1. Beta agonist
2. Anticholingergics
3. Methlxanthines

Question 16

What route of med is preferred for COPD meds?

Answer 16

Inhalation

Question 17

What is the max dose of ipratropium?

Answer 17

12 puffs/day

Question 18

How does levalbuterol different from albuterol?

Answer 18

More expensive

Question 19

What are the ultra-laba?

Answer 19

Indacaterol, olodaterol, vilanterol

Question 20

Which LABA has a greater effect?

Answer 20

Indacterol

Question 21

What are long acting bronchodilators for?

Answer 21

patients high risk for exacerbations

Question 22

What are LAMA examples?

Answer 22

1. Tiotropium
2. Aclidinium
3. Umeclindinium

Question 23

What are ADRS of LAMA?

Answer 23

Tachycardia, blurred vision, narrow angle glaucoma, constipation, urinary retention, dry mouth

Question 24

What is the difference between tiotropium and aclidinium?

Answer 24

Aclidinium: faster onset

Question 25

What are the dosage forms of tiotropium?

Answer 25

DPI, SMI

Question 26

What LAMAs are available only as DPIs?

Answer 26

Aclidium and umeclidinium

Question 27

What are the LABA-LAMAs?

Answer 27

1. Umeclidium-vilanterol (DPI) 2. Umeclindinium-vilanterol-fluticasone (DPI) 3. Tiotropium-olodaterol (SMI)

Question 28

What is a major concern of theophylline?

Answer 28

1. Closely monitored 2. Arrhythmias and seizures

Question 29

What are the limits of CS?

Answer 29

Short term: acute exacerbations Long term: osteoporosis, atrophy, thinning of skin, cataract, adrenal suppression

Question 30

When should you use CS?

Answer 30

Very sever COPD but increases risk for pneumonia

Question 31

What are some ICS+bronchodilators?

Answer 31

Salmeterol + Fluticasone, Budesonide + Formoterol, Mometasone + Formoterol

Question 32

What are PDEis?

Answer 32

Roflumilast

Question 33

What are the ADRs of PDEis?

Answer 33

Weight loss, neuropsychitric

Question 34

When would you use PDEis?

Answer 34

Severe COPD at risk for acute exacerbations

Question 35

What are the CIs of PDEis?

Answer 35

CYP3A4 and 1A2 inducers

Question 36

When should you consider antibiotics fo COPD?

Answer 36

1. Increased dyspnea 2. Increased sputum volume 3. Increased sputum purulence If patient has 2 or more