COPD

Question 1

What are the GOLD 1 FEV1% predicted classes?

Answer 1

Gold I FEV1%= >80% mild
Gold II FEV1%= 50-80%, moderate
Gold III FEV1%=30-50%, severe
Gold IV FEv1%= <30%, extremely severe

Question 2

What are the steps in evaluating COPD patients?

Answer 2

Step 1 obtain spirometry FEV1/FVC= <70%, the use FEV1% categories to place patient in I,II,II, or IV
Step 2: assess airflow limitations, mMRC or CAT score
step 3: evaluate exacerbations, more than 1 hospital admission or more than 2=categories C or D
0-1 with no hospital admissions= categories A or B

Question 3

What is the order of vaccine administration in patients >65 y/o?

Answer 3

vaccine naive >65y/o: give PVC 13, wait a year then given PPSV23
if patient got PPSV23 already give PCV13 a year later

Question 4

What vaccine do you give if patient got PPSV23 before age 65.

Answer 4

wait and give PCV 13, wait another year, then give PCV13

Question 5

Name 3 smoking cessation tx drugs(6)?

Answer 5

1. Bupropion
2. Nicotine gum
3. Nicotine inhaler
4. Nicotine spray
5. nicotine patches
6. Varenicline

Question 6

What are of ADE Varenicline 2?

Answer 6

• nausea

- insomnia

Question 7

What are ADE of nicotine patches 2?

Answer 7

• skin irritation

- insomnia

Question 8

What is ADE nasal spray 1

Answer 8

-nasal irritation

Question 9

What are ADE of Bupropion2?

Answer 9

• dry mouth

- insomnia

Question 10

What are ADE of nicotine gum 2?

Answer 10

• indigestion/dyspepsia

- sore mouth

Question 11

What are ADE of nicotine inhaler 1?

Answer 11

-sore throat and mouth

Question 12

When should you use ICS for COPD?

Answer 12

• concomitant asthma with COPD
• blood eosinophils >300
• > 2 exacerbation per year

Question 13

What are ADE of beta agonists?

Answer 13

• tachycardia

- tremors

Question 14

Name 1 SAMA:

Answer 14

• ipratropium

- more prolonged effect than albuterol

Question 15

What are ADE of anti muscarinic?

Answer 15

-dry mouth, metallic taste, cough

Question 16

Name two LABA + LAMA medications

Answer 16

-Stiolto Respimat (tiotropium bromide and olodaterol
Anoro Ellipta (umelclidinium bromide +vilanterol)

Question 17

What do corticosteroids do?

Answer 17

• reduce capillary permeability to reduce mucous production

- inhibit prostaglandins synthesis

Question 18

Name 1 drug for ICS+ LABA

Answer 18

-salmeterol and fluticasone

Question 19

Name 1 drug for triple therapy LABA+LAMA+ICS

Answer 19

• Trelegy Ellipta

- dry powder delivery inhaler 1x/day

Question 20

What is MOA of Roflumilast/Dalisrep?

Answer 20

• blocks PDE-4

- stops break down of cAMP= bronchodilation

Question 21

What are the effects of Roflumilast /Dalisrep?

Answer 21

• prevent bronchial remodeling

- prevents mucociliary malfunction

Question 22

When should you use Roflumilast?

Answer 22

• chronic bronchitis

- FEV1<40%

Question 23

What are ADE of Roflumilast (5)?

Answer 23

• dizziness
• insomnia
• diarrhea
• weight loss
• back pain

Question 24

What are contraindications for Roflumilast (2)?

Answer 24

• ciprofloxacin: increases serum concentration of Roflumilast
• liver disease

Question 25

How do you treat emphysema?

Answer 25

-AAT (alpha anti-trypsin infusion therapy)

Question 26

What risk is placed on patient taking AAT?

Answer 26

mad cow disease

Question 27

Common bacterial causes of uncomplicated exacerbations | FEV1>50%

Answer 27

- S. pneumonia - M. cattarhalis - H. flu - H. paraflu

Question 28

What is the tx for uncomplicated bacterial exacerbations

Answer 28

- macrolide - doxycycline - 2nd gen cephalosporin

Question 29

Common causes of bacterial complicated exacerbations, FEV1 <50% byt greater than 30%?

Answer 29

- Bacterial resistance - S. pneumonia - M. cattarhalis - H. flu - H. paraflu

Question 30

What is tx for bacterial complicated exacerbations?

Answer 30

augmentin -fluoroquinolones levofloxacin, moxifloxacin NOT CIPROFLOXACIN

Question 31

What is common cause of COPD exacerbations in nursing homes patients?

Answer 31

P. areuginosa

Question 32

How do you treat P. aeruginosa?

Answer 32

- levofloxacin | - 3 or 4th gen cephalosporin

Question 33

When do you need to prescribe oxygen to COPD patient?

Answer 33

1. when SaO2% <88%, PaO2 <55mmg | 2. re assess in 60-90 days, keep SaO2 above or equal to 90%

Question 34

T/F You don't a prescription for O2

Answer 34

False, you do need prescription to give O2