Pulmonary Exam #1 2012

Pneumonic - I always forget how cAMP works. cAMP-ing makes me relaxed.

COPD stands for Chronic Obstructive Pulmonary Disease, which is a progressive lung disease that causes difficulty in breathing. Spirometry is a diagnostic test used to measure lung function. It assesses the amount of air a person can inhale and exhale, as well as the speed at which they can do so. Since COPD is a specific condition with distinct symptoms, it is important to confirm the diagnosis through spirometry to differentiate it from other respiratory disorders. Therefore, the statement "A diagnosis of COPD must be confirmed by spirometry" is true.

Buproprion, also known as Wellbutrin or Zyban, is an antidepressant medication that has been found to be effective in helping people quit smoking. It works by reducing nicotine cravings and withdrawal symptoms. Nicotine Replacement Therapy (NRT) is another method commonly used to help individuals quit smoking, which involves using products like nicotine gum, patches, or lozenges to provide a controlled amount of nicotine. Combining buproprion with NRT has been shown to increase the chances of successfully quitting smoking, making the statement "Buproprion can be used with NRT" true.

Ipratropium and tiotropium are both anticholinergic medications used to treat COPD. However, they differ in their duration of action. Ipratropium is considered a short-acting anticholinergic, meaning it provides relief for a shorter period of time. On the other hand, tiotropium is a long-acting anticholinergic, providing sustained relief over a longer duration. Therefore, the statement that "Ipratropium is short-acting anticholinergic while tiotropium is a long-acting anticholinergic" is true.

A standard pack of cigarettes typically contains 20 cigarettes. This is a common knowledge question as it is widely known that cigarette packs usually contain 20 cigarettes.

Protease, anti protease imbalance destroys elastic

Exposure to secondhand smoke is indeed considered a risk factor for COPD. Secondhand smoke contains harmful chemicals that can damage the lungs and lead to the development of COPD. Breathing in this smoke can cause inflammation and irritation in the airways, leading to chronic bronchitis and emphysema. Therefore, it is important to avoid secondhand smoke to reduce the risk of developing COPD.

When using the Nicotine nasal spray, the patient should not inhale when it is sprayed into the nostril because the purpose of the nasal spray is to deliver nicotine directly to the nasal membranes, not to the lungs. Inhaling the spray would bypass the intended route of administration and may lead to improper absorption of the nicotine. Therefore, it is important for the patient to follow the instructions and avoid inhaling the spray.

Airway hypersensitivity is not a key pathogenesis process in COPD. COPD is primarily caused by inflammation, protease-anti-protease imbalance, and oxidative stress. Inflammation refers to the chronic inflammation of the airways, leading to damage and narrowing of the airways. Protease-anti-protease imbalance refers to the imbalance between proteases (enzymes that break down proteins) and their inhibitors, leading to tissue destruction. Oxidative stress is the imbalance between the production of reactive oxygen species and the body's ability to detoxify them, causing damage to lung tissue. However, airway hypersensitivity, which is characterized by an exaggerated response of the airways to certain stimuli, is not considered a key process in COPD.

A CAT score is used to assess the severity of symptoms in patients with COPD. A score of 10 is the threshold that differentiates between severe and not as severe COPD. This means that if a patient has a CAT score of 10 or higher, their COPD is considered severe, while a score below 10 indicates a less severe form of the disease.

It "hides" the potassium in your cells (I think I heard this during her lecture)

emphysema- breakdown of airway surface (think smokers cough)
chronic bronchitis - mucusy cough

Both of these condiitions fall under COPD

COPD is always worsened by excercise (more symptoms), asthama CAN be induce by excercise but not ALL people experience (cross ref w/ Dixit notes)

A practitioner should consider COPD and performing spirometry at the age of 40 years. This is because COPD, a chronic lung disease, typically develops slowly over time and is more common in individuals who smoke or have a history of smoking. By the age of 40, individuals who smoke or have other risk factors may already be experiencing symptoms or have reduced lung function, making it important to consider COPD and conduct spirometry testing to assess lung function.

When sputum is green-colored, then ONLY concurrent presence increased volume OR dyspnea are requirements to give antibiotics.

I have this in my notes from Dr. Smith's lecture, but wasn't positive about "evening" vs. bedtime. I think "evening" was the correct choice

That was the old guidelines, the new ones look at:
Symptoms (based on symptom scores)
Airflow limitation (based on FEV1)
Frequency of exacerbations

Corticosteroids are less effective in treating COPD compared to asthma. This is because the underlying mechanisms of these two conditions are different. In asthma, inflammation plays a major role, and corticosteroids are effective in reducing inflammation and controlling symptoms. However, in COPD, inflammation is not the primary cause of symptoms. Instead, it is mainly caused by damage to the airways and lungs due to smoking or long-term exposure to irritants. Corticosteroids may still be used in COPD to manage exacerbations or in combination with other medications, but their overall effectiveness is lower compared to asthma.

The hallmark spirometry indicator of COPD is FEV1/FVC

Important because Theophylline has a narrow therapeutic range.

Dr. Smith's notes, under "Medication Adjustments" following the charts describing severity/persistence of asthma

Tiotropium is a muscarinic receptor antagonist commonly used in the treatment of chronic obstructive pulmonary disease (COPD). Among the muscarinic receptors (M1, M2, M3, and M4), the M3 receptor is the most antagonized by Tiotropium. By blocking M3 receptors, Tiotropium helps to relax the smooth muscles in the airways, leading to bronchodilation and improved airflow in patients with COPD.

Right heart pumps blood to the lungs. COPD = more work for the right lung, leading to its failure

Corticosteroids have minimal drug interactions because they are minimally absorbed systemically. This means that they do not interact with many other medications, except for some interactions that are mediated through the enzyme CYP3A4. Therefore, the statement "True" is correct.

Note - PDE inhibitors would be thought to act as a broncodialator (due to its impact on cyclic molecules; cAMP cGMP), but its action is more like an anti-inflammatory

1 lozenge every 1-2 hours using at least 9/day for the first 6 weeks
then every 2-4 hours x 3 weeks
then every 4-8 hours x 3 weeks

max = 20 lozenges/day

Varenicline (Chantix) is a medication used to help people quit smoking. It works by reducing the craving for nicotine and blocking the pleasurable effects of smoking. While smoking is known to delay weight gain, varenicline itself does not have this effect. Therefore, it is the correct answer to the question.

Varenicline should not be taken on an empty stomach.

Formoterol = Full
Salmeterol = Sometimes

In ASTHMA they should not be used as monotherapy.
In COPD, they can be used as monotherapy.

Inhibiting phosphodiesterases actually causes the increase of cAMP which both cause bronchodialation

(from Dixit) inhibition of deacytalation of DNA causes the (Smithburger) inhibition of release of inflammatory mediators

I made up the part about leukocytes

Cigarettes in a day (10=21mg)
21 mg; 4-6weeks
14 mg 4-6 weeks
7 mg 2 weeks

Note- can cause vivid dreams

Wheezing cough is not a diagnostic symptom of COPD. While wheezing can be a symptom of COPD, it is not specific to this condition and can occur in other respiratory conditions as well. Other symptoms such as history of smoking, dyspnea (shortness of breath), chronic cough, and chronic sputum production are more commonly associated with COPD and can aid in its diagnosis.

1 piece every 1-2 hours x 6 weeks
then every 2-4 hours x 3 weeks
then every 4-8 hours x 3 weeks
max = 24 pieces/day

Bupropion is a medication commonly used to help people quit smoking. It works by reducing cravings and withdrawal symptoms. While insomnia and dry mouth are known side effects of Bupropion, vivid dreams are not typically associated with this medication. Therefore, vivid dreams are NOT a side effect of Bupropion.

Match the following cells with their role in asthma:
Mast Cells - release histamine and leukotrienes
Eosinophils - contain inflammatory enzymes
Basophils - Granulocyte that releases mediators
Lymphocytes - distinct mediators; contribute to remodeling
Macrophages - release mediators
Neutrophils - unknown
(Dr. Smith’s section)