54 - COPD Flashcards
_____ is a big modifiable risk factor
smoking
FEV1 < ___% of the predicted value is necessary to establish the diagnosis along with a decreased FEV1/FVC
80
non-pharms
- stop smoking
- avoid exposure to pollution/chemicals, encourage physical activity
- action plan
- Aerobika device may improve lung function
Increased mortality with ____ monotherapy
ICS
Role of ICS in COPD?
only as part of ICS/LABA combo since ICS monotherapy increases mortality
Stable COPD and prevention of acute exacerbations:
______ are the mainstay of therapy (PRN of scheduled)
bronchodilators
Stable COPD and prevention of acute exacerbations:
Recommend ___ use of a SABA as increased doses can cause tachycardia, tremor and potential hypokalemia
PRN
Stable COPD and prevention of acute exacerbations:
Do oral beta agonists have any role in COPD
no
Stable COPD and prevention of acute exacerbations:
What is a 1st line option?
LAMA (tiotropium)
*ipratropium can increase CV events
Stable COPD and prevention of acute exacerbations:
Can also use LABAs, give 2 examples
- salmeterol
- formoterol
Stable COPD and prevention of acute exacerbations:
There are 2 ultra long acting LABAs, what are they?
*only used for COPD, not asthma
- indacaterol
- olodaterol
Stable COPD and prevention of acute exacerbations:
ICS/LABA may have increased risk of _____ compared to LABA monotherapy
pneumonia
Stable COPD and prevention of acute exacerbations:
Who would you consider triple therapy in? (ICS/LABA with LAMA)
in those with mod-severe COPD and > 2 exacerbations/year or > 1 requiring hospitalization
Stable COPD and prevention of acute exacerbations:
ICS therapy can increase risk of contracting or reactivating _______
tuberculosis
What vaccines do COPD patients need?
flu and pneumococcal
Stable COPD and prevention of acute exacerbations:
Give an example of PDE4 inhibitor
roflumilast
Stable COPD and prevention of acute exacerbations:
How does Roflumilast work? (PDE4 inhibitor)
suppresses release of inflammatory mediators (PO med)
Stable COPD and prevention of acute exacerbations:
s/e of Roflumilast? (PDE4 inhibitor)
- nausea, diarrhea and weight loss
- neuropsych effects
Stable COPD and prevention of acute exacerbations:
Can use theophylline for severe symptoms. What is the therapeutic range?
55-85 mcmol/L
Stable COPD and prevention of acute exacerbations:
Can use theophylline for severe symptoms. Levels may increase if what?
patient stops smoking or is taking clarithromycin (CYP 3A4 inhibitor)
Stable COPD and prevention of acute exacerbations:
People with low Vitamin ___ may supplement to maybe decrease exacerbations
D
Stable COPD and prevention of acute exacerbations:
Can use ____ therapy if severe
oxygen
Stable COPD and prevention of acute exacerbations:
Can try ______ antibiotic therapy if need prevention and risks don’t outweigh benefits
*consider patients risks for QTc prolongation, ototoxicity and AB resistance
macrolide
Stable COPD and prevention of acute exacerbations:
Current ______ will not benefit from antibiotic therapy
smokers
Treatment of Acute Exacerbations of COPD:
Should increase dose/frequency of existing bronchodilator?
yes
Treatment of Acute Exacerbations of COPD:
Treat dyspnea with what?
SABA and ipratropium (SAMA)
Treatment of Acute Exacerbations of COPD:
Can use what else for exacerbations?
- corticosteroids
- antibiotics
Treatment of Acute Exacerbations of COPD:
When should corticosteroids be given to reduce risk of further exacerbations?
within 30 days of an acute exacerbation
Treatment of Acute Exacerbations of COPD:
For COPD without risk factors, what are the first line antibiotics?
- amox
- doxy
- sulfa trim or macrolide
Treatment of Acute Exacerbations of COPD:
For COPD with risk factors, what do you use?
- amox/clav
- cephalosporin 2nd gen
- FQ
