16. Systemic pharmacotherapy Flashcards
What are the systemic corticosteroids used in combination with long-acting bronchodilators?
Fluticasone, budesonide, ciclesonide, beclometasone.
What is the effect of systemic corticosteroids?
Anti-inflammatory effect, improve lung function (FEV1), oxygenation, and shorten recovery time and hospitalization duration.
What are the indications for systemic corticosteroids?
COPD or asthma +/- acute exacerbations.
What are the side effects of systemic corticosteroids?
Oropharyngeal candidiasis, acne, erythema, skin thinning.
What are the antibiotics indicated in COPD patients who are most likely to have a bacterial infection causing the exacerbation?
- Macrolides (azithromycin, clarithromycin),
- ketolide (telithromycin),
- cephalosporin (cefuroxime).
What is the duration of antibiotic treatment for COPD patients with bacterial infection causing exacerbation?
5-7 days.
What is the mechanism of action of beta-2 agonists?
Beta-2 receptors in bronchial tree -> Gs coupled mechanism -> SM relaxation -> bronchodilation.
What are the short-acting beta-2 agonists?
Salbutamol, fenoterol, terbutaline.
What are the long-acting beta-2 agonists?
Salmeterol, formoterol.
What are some examples of long-acting beta-2 agonists?
Salmeterol, formoterol.
What is the mechanism of action of muscarinic antagonists in the treatment of COPD?
Competitive inhibition of M3 receptors (Gq coupled) to prevent bronchoconstriction mediated by vagal discharge.
What is an exacerbation of COPD?
An acute worsening of respiratory symptoms that results in additional therapy.
What are some common causes of COPD exacerbations?
Respiratory tract infections such as influenza, strep, and COVID.
What is the goal of treatment for COPD exacerbations?
To minimize the negative impact of the current exacerbation and prevent subsequent events.
What is the recommended initial bronchodilator therapy for an acute COPD exacerbation?
Short-acting inhaled beta-2 agonists (SABA), with or without short-acting anticholinergics.
