Hosam Mohamed-
smoking cessation/quit date, proper inhaler technique, pulmonary rehabilitation, vaccines, oxygen therapy
What should we address at every appointment? (5)
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symptomatic people with hx of frequent/ severe exacerbations
Trelegy Ellipta has been proven to lower mortality in which patients?
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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)
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COVID-19, flu, pneumococcal, tdap, zoster
Which vaccines do we recommend for COPD patients?(5)
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PCV20; PCV15; PPSV23
The CDC recommends one dose of _______; or one dose of _______
followed by one dose of ________.
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false
Integrative care and Telehealth have demonstrated benefits in reducing exacerbations. T/F?
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>1; SABAs
_______ canisters a month of ______ suggest inadequate control of COPD.
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b
Which are the MOST effective for relief of acute bronchospasms?
a) LABAs
b) SABAs
c) SAMAs
d) LABA+ LAMA
e) LAMA
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LABAs & LAMAs
__________ can be used alone in COPD.
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a
Which can cause QTc prolongation?
a) LABAs
b) SABAs
c) SAMAs
d) LABA+ LAMA
e) LAMA
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improves lung function; decreases dyspnea/exacerbations
What are the benefits of Antimuscarinics? (2)
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LAMAs; LABAs
_______ have a greater effect on exacerbation & hospital reductions than _______.
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blood eosinophil count
How can we predict the magnitude of the effect when using ICS?
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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)
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repeated pneumonia events, blood eosinophils < 100, history of mycobacterial infection
When are we AGAINST the use of an ICS? (3)
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severe/very severe COPD (Gold 3 &4) + history of exacerbation
Roflumilast is indicated for which patients? (2)
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after hospitalization
When is the most beneficial time to give a patient Roflumilast?
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warfarin, digoxin
What medications interact with Theophylline? (2)
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dose-related
Theophylline has a ________ toxicity.
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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
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60-90 days
When do we recheck patient's oxygen levels?
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pneumonia, pulmonary embolism, HF
What are the most common causes of COPD exacerbations? (3)
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bronchodilators, corticosteroids, antibiotics
The most common medications used in COPD exacerbations? (3)
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group E; blood eos >=300
When can we consider starting a patient on LABA + LAMA + ICS? (2)
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different MOA, increases bronchodilation, improves FEV1/symptoms
What are the benefits of using a LABA + LAMA? (3)
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budesonide, albuterol, ipratropium + albuterol, formoterol
Which medications are available in nebulizers? (4)
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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?
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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)
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increase side effects; hyper-responsiveness
Regularly scheduled use of SABAs can _________ & cause __________.
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bitter, metallic taste, upper RT infection, constipation, blurred vision (sprayed in eyes)
AE's of Antimuscarinics (4)
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increases risk of exacerbation
What happens in a patient w COPD + Blood eos >=300 that suddenly
discontinues their ICS?
