copd consi & ira

8/6/2019 COPD Consi & Ira

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What is Chronic obstructive pulmonary

( COPD) disease?

COPD is a progressive disease that limitsthe function of the lungs by Loss of lung

function.

The airway in lungs are blocked andbreathing takes more effort.


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Currently in USA, more then 36.1 million

people are suffering with COPD

119,000 deaths from COPD per year

COPD is 4th leading cause of death inthe U.S.

In short it is a lung problem steamingform smoking to exposure to other toxins

including environmental that damages

respiratory system.


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COPD

Severity

Symptoms

Stage I

Mild

Mild airflow limitation andsometimes, but not always

chronic cough and sputum

production present

Stage IIModerate

Worsening airflow limitation withshortness of breath typically

developing during exertion.

This is the stage at which patients

typically seek medical attention

Stage III

Severe

Further worsening of airflow limitation

greater shortness of breath, reduced

exercise capacity, and repeated

exacerbations which have an impacton patients quality of life.

Stage IV

Very Severe

Severe airflow limitation

At this stage, quality of life is very

appreciably impaired and

exacerbations may be

lifethreatening.


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Smoking

Occupational Exposure

Air Pollution Genetic

Auto Immune Diseases

Risk Factors Asthma

Repeated Lung infection

Diet High in Cured Meat


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Labor breathing

Lack of energy

Irritability Frustration

Headache

drowsiness

Chronic cough with sputum production

Chest tightness


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Tachypnea

Wheezing sound and crackles heard whileauscultation.

Exhalation is longer then inhalation

Enlargement of chest ( Ant-Post) ( BarrelChest)

Active use of neck muscles

Breathing through pursed lips

Cyanosis

Peripheral edema


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Oxidative stress produce by free radicals

in inhaled air

Cytokine release response due to irritantparticles

Narrow airway limiting the effectiveness

of the lungs Dynamic hyperinflation

Loss of surface area ( reduction in gasexchange)


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Rehabilitation

Regular exercise, good nutrition, Flu and

Pneumonia vaccines Smoking cessation and elimination Of

environmental irritant

Oxygen Therapy Nicotine Patch


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Bronchodilator

Anticholinergic

x Ipratopiumx Tiotropium

Beta-2 Agonist

x Albuterol

x Levabuterol

x Salmeterol

x Formoterol

x Faromoterol


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Corticosteroidx Fluticason

x Budesonidex Prednison

Expactrontx Guaifenesin

Theophyline

x Aminophyline


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Antibioticsx Cefuroxime (2nd Generation Ceph. )

x Azithromycinex Clarithromycine


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Surgeryx Bullectomy

x Lung volume Reduction Surgeryx Lung Transplant


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No specific manifestation related to

COPD are reported


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1st : Oral pathogens may be inhaled

2nd: Action of bacterial enzymes on oral

epithelial cells may promote colonizationby respiratory pathogens

3rd: Bacterial enzymes may reduce the

protection against colonization providedby mucosal secretions

4th: Cytokine may contribute to

colonization of the respiratory epithelium


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Bronchodilator

Anticholinergic

x Ipratopiumx Drugs with anticholinergic properties (eg, dronabinol)

may increase toxicity; albuterol may increase effects


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Beta-2 Agonistx Albuterol

x Beta-adrenergic blockers antagonize effects; inhaled ipratropiummay increase duration of bronchodilatation by albuterol;cardiovascular effects may increase with MAOIs, inhaledanesthetics, TCAs, and sympathomimetic agents

x Salmeterolx Concomitant use of beta-blockers may decrease bronchodilating

and vasodilating effects of beta agonists; concurrent administrationwith methyldopa may increase pressor response; coadministrationwith oxytocic drugs may result in severe hypotension; ECG changesand hypokalemia resulting from diuretics may worsen whencoadministered with salmeterol

x Formoterolx Concomitant use of beta-blockers may decrease bronchodilating

and vasodilating effects of beta-agonists such as salmeterol;concurrent administration with methyldopa may increase pressorresponse; coadministration with oxytocic drugs may result in severehypotension; ECG changes and hypokalemia resulting fromdiuretics may worsen when coadministered with salmeterol


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Corticosteroidx Fluticasonx None reported

x Budesonidex None reported

x Prednisonx Coadministration with estrogens may decrease

prednisone clearance; concurrent use with digoxinmay cause digitalis toxicity secondary tohypokalemia; phenobarbital, phenytoin, and rifampinmay increase metabolism of glucocorticoids(consider increasing maintenance dose); monitor forhypokalemia with coadministration of diuretics


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Theophylinex Aminophyline

xAminoglutethimide, barbiturates, carbamazepine,ketoconazole, loop diuretics, charcoal, hydantoins,phenobarbital, phenytoin, rifampin, isoniazid, andsympathomimetics may decrease effects oftheophylline; theophylline effects may increase withallopurinol, beta-blockers, ciprofloxacin,

corticosteroids, disulfiram, quinolones, thyroidhormones, ephedrine, carbamazepine, cimetidine,erythromycin, macrolides, propranolol, and interferon


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Antibioticsx Cefuroxime (2nd Generation Ceph. )

x Disulfiramlike reactions may occur when alcohol is consumed within 72 h aftertaking cefuroxime; may increase hypoprothrombinemic effects ofanticoagulants; may increase nephrotoxicity in patient receiving potent

diuretics such as loop diuretics; coadministration with aminoglycosidesincrease nephrotoxic potential

x Azithromycinex May increase toxicity of theophylline, warfarin, and digoxin; effects are

reduced with coadministration of aluminum and/or magnesium antacids;nephrotoxicity and neurotoxicity may occur when coadministered withcyclosporine

x Clarithromycinex Toxicity increases with coadministration of fluconazole, astemizole, and

pimozide; clarithromycin effects decrease and GI adverse effects mayincrease with coadministration of rifabutin or rifampin; may increase toxicityof anticoagulants, cyclosporine, tacrolimus, digoxin, omeprazole,carbamazepine, ergot alkaloids, triazolam, and HMG CoA-reductaseinhibitors; cardiac arrhythmias may occur with coadministration of cisapride;plasma levels of certain benzodiazepines may increase, prolonging CNSdepression; arrhythmias and increase in QTc intervals occur withdisopyramide; coadministration with omeprazole may increase plasma levelsof both agents


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Nicotine Patch

May decrease diuretic effects of

furosemide and decrease cardiacoutput; may decrease absorption ofglutethimide; may increase circulatingcortisol and catecholamines; not for use

in patients who continue to smoke, usesnuff, chew tobacco, or use othernicotine products because it mayincrease toxicity of nicotine


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Contra indications with COPD

Narcotic Analgesics

Diazepam, Lorazepam Nitrous Oxide

Epinephrine

Avoid Aspirin, Indocine, NSAID, Penicillin,Narcotics, Antihistamines, anticholinergics


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Review history for concurrent heart disease

Avoid treatment if upper respiratory tract

infection is present Treat in upright position

Avoid rubber dam in severe cases

Use pulse oximetry (if pulse ox


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