NR 601 Midterm review 2024 already passed

NR 601 Midterm review 2024 already passed FEV1 Greater than or equal to 80% predicted Gold 1: Mild COPD 50% less than or equal to FEV1 Less than 80% predicted Gold 2: Moderate COPD 30% less than or equal to FEV1 Less than 50% predicted Gold 3: Severe COPD FEV1 Less than 30% predicted Gold 4: Very severe COPD What gold guidelines suggest following meds for COPD Long acting bronchodilators (LABA) A long acting muscarinic antagonist (LAMA) or both Inhaled corticosteroids (ICS) Although not for monotherapy (with ICS plus a LABA For step up therapy An oral PDE4 Inhibitor as an add-on therapy for patients with COPD plus chronic bronchitis, if previously recommended medicines are in effective or in adequate Gold guidelines suggest using these medications according to the following grading scheme of clinical severity Grade A: any short or long acting bronchodilator Grade B: A long-acting bronchodilator(LAMA or LABA) or both, if continued difficulty breathing with only one drug Grade C: A long acting muscarinic antagonist (LAMA) Or if continued exacerbations occur, A switch to LAMA+LABA or LABA+ICS Grade D: individualized management, possibly using a PDE4 Inhibitor, Roflumilast (Daliresp) and azithromycin (Zithromax); antibiotics are warranted in the presence of a prolonged illness, especially with purulent sputum Management of COPD exacerbations Treatment modalities Include short acting beta two agonist's with or without anti-cholinergics, long acting bronchodilators, systemic corticosteroids, antibiotics, non-invasive mechanical ventilation, and or invasive mechanical ventilation Classification of asthma severity Intermittent, MildPersistent, Moderate persistent, severe persistent Intermittent asthma severity Symptoms less then two days per week Nighttime symptoms less than twice per month Asymptomatic and normal peak expiratory flow between exacerbations PEF or forced expiratory volume in one second (FEV1) Less than 80% predicted, PFT variability greater than 20% Mild persistent asthma Symptoms occur >2x/wk, but not daily May occur Several times at night per month PEF or FEV1 Greater than 80% predicted, PFT variability 20% to 30% Moderate persistent asthma Step 3: low dose ICS + LABA (Salmeterol) Daily symptoms but not continual, nighttime symptoms more than once a week, but not nightly Exacerbations affect activity and sleep PEF or FEV1 less than 60% to 80% predicted, PFT Variability less than 30% Severe persistent asthma Continuous daily symptoms Frequent nighttime symptoms Physical activity is limited by asthma Frequent exacerbations PEF or FEV1 Less than 60% predicted, variability greater than 30% Diagnostics for asthma Spirometry or pulmonary function testing, particularly forced expiratory volume in one second (FEV1), FEV6, forced final capacity (FVC), and FEV1/FVC ratio before and after bronchodilator challenge, showing an improvement of 12% and 200 ML, indicates reversible airway obstruction Intermittent asthma step one treatment SABA PRN less than twice per week Persistent asthma mild persistent step 2 Treatment SABA PRN, not to exceed 3 to 4 times per day Preferred daily medications low-dose ICS Alternative daily medications Leukotriene receptor agonist, Cromolyn, Nedocromil, or theophylline Moderate persistent asthma step three SABA PRN, not to exceed 3 to 4 times per day Preferred daily medications: Low dose ICS Plus LABA Or Medium dose ICS Alternative daily medications: low-dose ICS Plus either leukotriene receptor agonist, theophylline, zileuton Severe persistent asthma step four treatment SABA PRN, not to exceed 3 to 4 times per day consider short course of oral systemic corticosteroids Preferred daily medications Medium-dose ICS plus LABA Alternative daily medications Medium-dose ICS plus either Leukotriene receptor agonist, theophylline, or Zileuton Asthma step five Treatment SABA inhale treatments at 20 minute intervals times three if needed consider short course of oral systemic corticosteroids Prefer daily medications High-dose ICS plus LABA Alternative daily medications Consider omalizumab for patients who have allergies Asthma step six treatment SABA, inhale treatments and 20 minute intervals times three if needed Prefer daily medications High-dose ICS plus LABA plus oral corticosteroid Alternative meds Consider omalizumab probation to have allergies Long-term therapy may include systemic corticosteroids