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RxPrep > COPD > Flashcards

COPD Flashcards

1
Q

What are the symptoms of COPD?

A
  1. dyspnea
  2. cough
  3. sputum production
  4. wheezing
  5. chronic, progressive symptoms not fully reversible
  6. exacerbations are common
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2
Q

What genetic condition can predispose someone to COPD?

A

alpha-1 antitrypsin deficiency

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3
Q

What is required to assess lung function?

A

spirometry- amount of air a person can breathe out

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4
Q

What confirms a diagnosis of COPD?

A

post-bronchodialator FEV1/FVC <0.7

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5
Q

What are the key differences of COPD?

A
  1. common sputum production
  2. persistent symptoms
  3. progressive disease
  4. treatment with bronchodilators
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6
Q

What post-bronchodilator FEV1 is mild (GOLD 1)?

A

FEV1 ≥80%

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7
Q

What post-bronchodilator FEV1 is moderate (GOLD 2)?

A

FEV1 50-79%

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8
Q

What post-bronchodilator FEV1 is severe (GOLD 3)?

A

FEV1 30-49%

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9
Q

What post-bronchodilator FEV1 is very severe (GOLD 4)?

A

FEV1 <30%

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10
Q

How are COPD symptoms assessed?

A
  1. CAT (0-40)
  2. mMRC (0-4)
    higher numbers are worse symptoms
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11
Q

What is a COPD exacerbation?

A

increase in respiratory symptoms that increase over <14 days

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12
Q

What is a combined assessment of COPD?

A

symptoms assessment (CAT and mMRC) and risk of exacerbations (A,B,E)

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13
Q

What is nonpharm treatment for COPD?

A
  1. smoking cessation
  2. pneumonia and flu vaccines
  3. inhaler technique
  4. long term oxygen treatment
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14
Q

What is first-line treatment for COPD?

A

Bronchodilators:
1. SAMA (short-acting muscarinic antagonist)
2. SABA (short-acting beta 2 agonist)
3. LAMA
4. LABA

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15
Q

When are ICS used in COPD?

A
  1. eosinophil count ≥300
  2. eosinophil count ≥ 100 and not controlled on LAMA+LABA
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16
Q

What is a group A COPD patient?

A
  1. CAT <10
  2. mMRC 0-1
  3. 0-1 moderate exacerbations (oral steroid± antibiotics) not requiring hospitalization
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17
Q

What is a group B COPD patient?

A
  1. CAT ≥10
  2. mMRC ≥2
  3. 0-1 moderate exacerbations (oral steroid± antibiotics) not requiring hospitalization
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18
Q

What is a group E COPD patient?

A
  1. ≥ 2 moderate exacerbations
  2. ≥1 exacerbation leading to hospitalization
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19
Q

What treatment should all patients have in addition to long-acting maintenance medications?

A

SABA and/or SAMA to relieve acute symptoms as needed

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20
Q

What are the preferred treatment for group A patients?

A

SAMA/SABA prn + LAMA/LABA

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21
Q

What are the preferred treatment for group B patients?

A

LAMA+LABA

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22
Q

What are the preferred treatment for group E patients?

A

LAMA+LABA
if eosinophils ≥300 consider LAMA+LABA+ICS

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23
Q

What agent is a SAMA?

A

Ipratropium (Atrovent HFA)

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24
Q

How is Ipratropium (Atrovent HFA) dosed?

A

MDI: 2 inhalations Q 4-6 hours prn

25
Q

What agent is a SAMA+SABA?

A

ipratropium+albuterol (Combivent Respimat)

26
Q

How is ipratropium+albuterol (Combivent Respimat) dosed?

A

MDI: 1 inhalation Q 4-6 hours prn

27
Q

What are warnings with muscarinic antagonists/ anticholinergics (SAMA/LAMA)?

A

Use caution in patients with narrow-angle glaucoma, urinary retention, BPH, or bladder neck obstruction

28
Q

What are SEs with muscarinic antagonists/ anticholinergics (SAMA/LAMA)?

A
  1. DRY MOUTH
  2. upper respiratory tract infection (sinusitis, nasopharyngitis)
  3. cough
  4. bitter taste
29
Q

What should be monitored for patients with COPD?

A
  1. smoking status
  2. COPD questionarres
  3. annual spiromerty
30
Q

What agents are LAMAs?

A
  1. Tiotropium (Spiriva HandiHaler, Spiriva Respimat)-DPI
  2. Aclidinium-DPI
  3. Glycopyrrolate (only in combination)-MDI
  4. Umeclidinium- DPI
  5. Revefenacin-nebulizer
31
Q

What is dosing for Spiriva Handihaler?

A

Tiotropium DPI: inhale contents of 1 capsule via HandiHaler device; do not swallow capsules whole

32
Q

What is dosing for Spiriva Respimat?

A

Tiotropium MDI: 2 inhalation daily

33
Q

What agents are LABAs?

A
  1. Salmeterol- DPI
  2. Formoterol-MDI
  3. Arformoterol- nebulizer
  4. Vilaterol (combination only)-DPI
  5. Olodaterol-MDI
34
Q

How do PDE-4 inhibitors work to treat COPD?

A

increase cAMP levels to reduce lung inflammation; used in combination with a long-acting bronchodilator for very severe COPD

35
Q

What are boxed warnings with beta 2 agonists?

A

increase risk of asthma-related deaths when used alone, should only be used in asthma patients not adequately controlled on ICS

36
Q

What are SEs with beta-2 agonists?

A
  1. nervousness
  2. tremor
  3. tachycardia
  4. palpitations
  5. hyperglycemia
  6. hypokalemia
  7. cough
37
Q

What are warnings with PDE-4 inhibitor, Roflumilast?

A
  1. WEIGHT LOSS
  2. psychiatric events (depression, mood changes), suicidality
38
Q

What are SEs with PDE-4 inhibitor, Roflumilast?

A
  1. DIARRHEA
  2. nausea/decreased appetitie
  3. insomnia
  4. headache
39
Q

What needs to be monitored with Roflumilast?

A

LFTs

40
Q

What drugs interact with Roflumilast?

A

strong CYP3A4 enzyme inducers:
carbamazepine, phenobarbital, phenytoin, rifampin
CYP3A4 and 1A2 inhibitors with increased concentration of Roflumilast:
erythromycin, ketoconazole, fluvoxamine, cimetedine

41
Q

What are the contraindications to LABAs?

A
  1. status asthmaticus
  2. monotherapy in asthma
42
Q

What are the contraindications to using Roflumilast?

A

moderate to severe liver impairment

43
Q

Ipratropium bromide MDI

A

Atrovent HFA

44
Q

Tiotropium MDI

A

Spiriva Respimat

44
Q

Ipratropium bromide + albuterol MDI

A

Combivent Respimat

44
Q

Tiotropium capsule DPI

A

Spiriva HandiHaler

45
Q

Umeclidinium+ vilanterol+ fluticasone DPI

A

Trellagy Ellipta

45
Q

Salmeterol DPI

A

Sverent Diskus

46
Q

Salmeterol + fluticasone

A

Advair Disks, Wixela Inhub

47
Q

Fomoterol+ budesonide MDI

A

Symbicort, Breyna

48
Q

Formoterol + budesonide + glycopyrrolate MDI

A

Breztri Aerosphere

49
Q

Vilanterol + fluticasone DPI

A

Breo Ellipta

50
Q

Roflumilast

A

Daliresp

51
Q

How is the Atrovent HFA primed?

A

spray 2 times away from face, prime again if > 3days from last use

52
Q

How is Atrovent HFA used?

A
  1. make sure canister is fully inserted into the actuator
  2. remove protective dust cap and check for foreign objects
  3. you do not have to shake before using
  4. breath fully out of your mouth and then put lips around inhaler keep inhaler upright
  5. keep you eyes closed so no medications will be sprayed into the eyes
  6. breath slowly and deeply and hold breath for 10 seconds
  7. wait 15 seconds then repeat
  8. rinse mouth piece under water weekly
53
Q

How are Respimat products used?

A

TOP:
1. turn the clear base
2. open the cap and breathe out slowly and fully
3. press the dose release button slowly, deep inhale; do not cover vents
4. wipe mouth piece with wet tissue/cloth weekly

54
Q

How are Respimat products primed?

A
  1. turn clear base in the direction of the arrow on the label until it clicks and flip cap until it snaps fully open
  2. point the inhaler toward the group away from your face and press the dose release button
  3. repeat steps until spray is visible
  4. > 3 days release 1 spray towards the ground
  5. > 21 days repeats priming instructions
55
Q

How is Spiriva HandiHaler used?

A
  1. open the device by pressing the green button and lifting the cap upwards
  2. open the mouthpiece, center chamber should be showing
  3. remove Spiriva capsule from blister package and place into the chamber
  4. firmly close mouth piece until you hear a click
  5. push green button flat once, do not shake
  6. turn head away from the inhaler and breath out
  7. raise HandiHaler to mouth in a horizontal position
  8. inhale deeply and fully until you feel the capsule rattle
  9. you must inhale twice to get the full dose
  10. tip out the used capsule into a trash can without touching it
  11. clean monthly and let airdry for 24 hours
56
Q

How is Pressair devices used?

A
  1. remove protective cap
  2. press button the button will turn green when ready for inhalation
  3. breath quickly and deeply until you hear a click (DO NOT hold down green button while breathing in)
  4. control window will turn to red which indicated the full dose has been received

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