smoking cessation/quit date, proper inhaler technique, pulmonary rehabilitation, vaccines, oxygen therapy
What should we address at every appointment? (5)
symptomatic people with hx of frequent/ severe exacerbations
Trelegy Ellipta has been proven to lower mortality in which patients?
smoking cessation, pulmonary rehab, long-term O2, noninvasive positive pressure ventilation, lung volume reduction surgery
Which non-pharmacological treatments have been proven to lower
mortality? (5)
COVID-19, flu, pneumococcal, tdap, zoster
Which vaccines do we recommend for COPD patients?(5)
PCV20; PCV15; PPSV23
The CDC recommends one dose of _______; or one dose of _______
followed by one dose of ________.
false
Integrative care and Telehealth have demonstrated benefits in reducing exacerbations. T/F?
>1; SABAs
_______ canisters a month of ______ suggest inadequate control of COPD.
b
Which are the MOST effective for relief of acute bronchospasms?
a) LABAs
b) SABAs
c) SAMAs
d) LABA+ LAMA
e) LAMA
LABAs & LAMAs
__________ can be used alone in COPD.
a
Which can cause QTc prolongation?
a) LABAs
b) SABAs
c) SAMAs
d) LABA+ LAMA
e) LAMA
improves lung function; decreases dyspnea/exacerbations
What are the benefits of Antimuscarinics? (2)
LAMAs; LABAs
_______ have a greater effect on exacerbation & hospital reductions than _______.
blood eosinophil count
How can we predict the magnitude of the effect when using ICS?
history of hospitalizations, >=2 moderate exacerbations per year, blood eosinophil >=300, history of asthma
When do we STRONGLY FAVOR the use of an ICS to a patient's therapy? (4)
repeated pneumonia events, blood eosinophils < 100, history of mycobacterial infection
When are we AGAINST the use of an ICS? (3)
severe/very severe COPD (Gold 3 &4) + history of exacerbation
Roflumilast is indicated for which patients? (2)
after hospitalization
When is the most beneficial time to give a patient Roflumilast?
warfarin, digoxin
What medications interact with Theophylline? (2)
dose-related
Theophylline has a ________ toxicity.
b,c
Which patient Groups should receive a LABA + LAMA for initial treatment?
a) Group A
b) Group B
c) Group E
a
Which groups receive a bronchodilator?
a) Group A
b) Group B
c) Group E
b,c
Which group receives smoking cessation + pulmonary rehab?
a) Group A
b) Group B
c) Group E
60-90 days
When do we recheck patient's oxygen levels?
pneumonia, pulmonary embolism, HF
What are the most common causes of COPD exacerbations? (3)
bronchodilators, corticosteroids, antibiotics
The most common medications used in COPD exacerbations? (3)
group E; blood eos >=300
When can we consider starting a patient on LABA + LAMA + ICS? (2)
different MOA, increases bronchodilation, improves FEV1/symptoms
What are the benefits of using a LABA + LAMA? (3)
budesonide, albuterol, ipratropium + albuterol, formoterol
Which medications are available in nebulizers? (4)
b
Trelegy Ellipta is a ______ inhaler.
a) soft-mist
b) DPI
c) MDI
d) twist
occasional dyspnea
Short-acting agents are preferred in patients with _________
an ICS
In patients with COPD + features with asthma, their treatment should
ALWAYS contain what?
PaO2 <=55-60mmHg; cor pulmonale or secondary polycythemia
Long-term O2 therapy improves mortality in which patients? (2)
hospitalized for exacerbation during/within <=4 weeks of discharge
Pulmonary rehabilitation improves mortality in which patients?
stable COPD w marked hypercapnia
Noninvasive positive pressure ventilation improves mortality in which patients?
upper lope emphysema + low exercise capacity
Lung volume reduction surgery improves mortality in which patients?
Longterm O2 therapy
__________ is NOT recommended in stable COPD.
tremors, tachycardia, hypokalemia, hyperglycemia
AE's of SABAs? (4)
increase side effects; hyper-responsiveness
Regularly scheduled use of SABAs can _________ & cause __________.
bitter, metallic taste, upper RT infection, constipation, blurred vision (sprayed in eyes)
AE's of Antimuscarinics (4)
increases risk of exacerbation
What happens in a patient w COPD + Blood eos >=300 that suddenly
discontinues their ICS?